Positive margins are common in head and neck squamous cell carcinoma, yet intraoperative re-resection is often imprecise because margin locations are typically communicated verbally from pathology. We present an all-in-one augmented reality (AR) system that relocalizes positive margins from a resected specimen to the resection bed and visualizes them in situ using HoloLens 2 depth sensing and fully automated markerless surface registration. In a silicone phantom study with six medical trainees, markerless registration achieved target registration errors comparable to a marker-based baseline (median 1.8 mm vs. 1.7 mm; maximum < 4 mm). In a margin relocalization task, AR guidance reduced error from verbal guidance (median 14.2 mm) to a few millimeters (median 3.2 mm), with all AR localizations within 5 mm error. These results support the feasibility of markerless AR margin guidance for more precise intraoperative re-excision.

翻译：切缘阳性在头颈部鳞状细胞癌中常见，而术中二次切除常因病理科口头传达切缘位置导致精度不足。我们提出一种一体化增强现实系统，通过HoloLens 2深度传感与全自动无标记物表面配准，将切除标本上的阳性切缘重新定位至手术创面，并原位可视化显示。在六名医学培训生参与的硅胶模型实验中，无标记物配准实现了与标记物基准相当的目标配准误差（中位1.8毫米对比1.7毫米；最大误差<4毫米）。在切缘重新定位任务中，增强现实引导将误差从口头引导的14.2毫米中位数降至数毫米（中位3.2毫米），且所有增强现实定位误差均在5毫米以内。该结果支持无标记物增强现实切缘引导在提高术中二次切除精度方面的可行性。