Mixed Reality Guidance of a Surgical Scalpel Using Magic Leap: Evaluation on a 3D-Printed Liver Phantom

Augmented and mixed reality (MR) systems have the potential to improve surgical precision by overlaying digital guidance directly onto the operative field. This paper presents a novel MR guidance system using the Magic Leap head-mounted display to assist surgeons in executing precise scalpel movements during liver surgery. The system projects holographic cues onto a patient-specific 3D-printed liver phantom, guiding resection along a predetermined path. We describe the system design, including preoperative modeling, registration of virtual content to the phantom, and real-time visualization through the Magic Leap device. In a controlled phantom study, surgical trainees performed resection tasks with and without MR guidance. Quantitative results demonstrated that MR guidance improved cutting accuracy (mean deviation from planned path was reduced from 5.0 mm without AR to 2.0 mm with AR guidance) and efficiency (mean task time decreased from 55 s to 32 s). These improvements of approximately 60% in accuracy and 40% in speed underscore the potential benefit of MR in surgical navigation. Participants reported that the Magic Leap visualization enhanced depth perception and confidence in locating tumor boundaries. This work provides a comprehensive evaluation of an MR-assisted surgical guidance approach, highlighting its feasibility on a realistic organ phantom. We discuss the technical challenges (registration accuracy, line-of-sight, user ergonomics) and outline future steps toward clinical translation. The results suggest that Magic Leap-based MR guidance can significantly augment a surgeon's performance in delicate resection tasks, paving the way for safer and more precise liver surgery.