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：在头颈部鳞状细胞癌中，切缘阳性现象常见，但术中二次切除常因定位不精确——病理科通常口头告知切缘位置——而效果不佳。我们提出一种一体化增强现实系统，该系统能将切除标本上的阳性切缘重新定位至手术创面，并借助HoloLens 2深度感知及全自动无标记物表面配准技术，在手术原位实现可视化呈现。在六名医学受训者参与的硅胶模型实验中，无标记物配准的目标配准误差与基于标记物的基线方法相当（中位数1.8毫米对比1.7毫米；最大值<4毫米）。在切缘重定位任务中，增强现实引导将口头引导的误差（中位数14.2毫米）降低至仅数毫米（中位数3.2毫米），且所有增强现实定位误差均控制在5毫米以内。这些结果证明，无标记物增强现实切缘引导技术可实现更精准的术中二次切除。