Toward a Surgical Clip-Based Registration Approach for Aligning Pathology Data to Tumor Bed Using Mixed Reality.

During tumor resections, surgeons must integrate visual cues from the operative field with feedback from pathology to evaluate resection margins. This process requires constructing a complex mental spatial map of the tumor bed and the ability to integrate pathological analysis back for additional resections. Unfortunately, this can lead to incomplete resections and result in positive margins. Such outcomes often necessitate additional surgeries, increasing patient risk, anxiety, and overall healthcare burden. To address this challenge, we are investigating a mixed reality (MR) system that transforms pathology-confirmed positive margins directly to locations within the surgical field. A critical requirement of this system is accurate alignment of pathology data with the intraoperative presentation of the tumor bed. We present and evaluate a registration workflow that employs surgical clips placed on both resection specimens and corresponding tumor bed sites as corresponding fiducial markers. Data acquisition was performed using the Microsoft HoloLens