Accuracy of augmented reality-guided needle placement for pulsed radiofrequency treatment of pudendal neuralgia: a pilot study on a phantom model.

Background: Pudendal neuralgia (PN) is a chronic neuropathy that causes pain, numbness, and dysfunction in the pelvic region. The current state-of-the-art treatment is pulsed radiofrequency (PRF) in which a needle is supposed to be placed close to the pudendal nerve for neuromodulation. Given the effective range of PRF of 5 mm, the accuracy of needle placement is important. This study aimed to investigate the potential of augmented reality guidance for improving the accuracy of needle placement in pulsed radiofrequency treatment for pudendal neuralgia. Methods: In this pilot study, eight subjects performed needle placements onto an in-house developed phantom model of the pelvis using AR guidance. AR guidance is provided using an in-house developed application on the HoloLens 2. The accuracy of needle placement was calculated based on the virtual 3D models of the needle and targeted phantom nerve, derived from CBCT scans. Results: The median Euclidean distance between the tip of the needle and the target is found to be 4.37 (IQR 5.16) mm, the median lateral distance is 3.25 (IQR 4.62) mm and the median depth distance is 1.94 (IQR 7.07) mm. Conclusion: In this study, the first method is described in which the accuracy of patient-specific needle placement using AR guidance is determined. This method could potentially improve the accuracy of PRF needle placement for pudendal neuralgia, resulting in improved treatment outcomes.

Photonics-powered augmented reality skin electronics for proactive healthcare: multifaceted opportunities.

Rapid technological advancements have created opportunities for new solutions in various industries, including healthcare. One exciting new direction in this field of innovation is the combination of skin-based technologies and augmented reality (AR). These dermatological devices allow for the continuous and non-invasive measurement of vital signs and biomarkers, enabling the real-time diagnosis of anomalies, which have applications in telemedicine, oncology, dermatology, and early diagnostics. Despite its many potential benefits, there is a substantial information vacuum regarding using flexible photonics in conjunction with augmented reality for medical purposes. This review explores the current state of dermal augmented reality and flexible optics in skin-conforming sensing platforms by examining the obstacles faced thus far, including technical hurdles, demanding clinical validation standards, and problems with user acceptance. Our main areas of interest are skills, chiroptical properties, and health platform applications, such as optogenetic pixels, spectroscopic imagers, and optical biosensors. My skin-enhanced spherical dichroism and powerful spherically polarized light enable thorough physical inspection with these augmented reality devices: diabetic tracking, skin cancer diagnosis, and cardiovascular illness: preventative medicine, namely blood pressure screening. We demonstrate how to accomplish early prevention using case studies and emergency detection. Finally, it addresses real-world obstacles that hinder fully realizing these materials' extraordinary potential in advancing proactive and preventative personalized medicine, including technical constraints, clinical validation gaps, and barriers to widespread adoption.

Keyhole-aware laparoscopic augmented reality.

Augmented Reality (AR) from preoperative data is a promising approach to improve intraoperative tumour localisation in Laparoscopic Liver Resection (LLR). Existing systems register the preoperative tumour model with the laparoscopic images and render it by direct camera projection, as if the organ were transparent. However, a simple geometric reasoning shows that this may induce serious surgeon misguidance. This is because the tools enter in a different keyhole than the laparoscope. As AR is particularly important for deep tumours, this problem potentially hinders the whole interest of AR guidance. A remedy to this issue is to project the tumour from its internal position to the liver surface towards the tool keyhole, and only then to the camera. This raises the problem of estimating the tool keyhole position in laparoscope coordinates. We propose a keyhole-aware pipeline which resolves the problem by using the observed tool to probe the keyhole position and by showing a keyhole-aware visualisation of the tumour. We assess the benefits of our pipeline quantitatively on a geometric in silico model and on a liver phantom model, as well as qualitatively on three patient data.

Reflections on augmented reality codes for teaching fundamental defensive techniques to boxing beginners.

AR technology allows users to interact with virtual objects in real-world settings. Immersive AR experiences can enhance creativity and possibilities. Learners can explore real-life situations in a safe, controlled environment, understand abstract concepts and solve problems. This study investigates whether AR-codes affect boxing beginners' performance in some fundamental defensive techniques. An experimental and control group were created to implement a quasi-experimental design. By using the ASSURE instructional design model, AR technology was incorporated into the educational program and delivered in flipped classroom method to the experimental group. Comparatively, the control group is taught a program using a teacher's command style. A post-measurement of defensive boxing skills was conducted for both groups. Participants were 60 boxing beginners aged 12 to 14 who had enrolled in Port Fouad Sports Club's 2023/2024 training season in Port Said, Egypt. Randomly, participants were divided into control and experimental groups. They were homogenized and equivalent in terms of age, height, weight, IQ, physical fitness, and skill level. According to the study results, the experimental group performed better in post-measurements than the control group. The AR Codes technology had a large effect size on the learning of boxing defensive skills under study. Consequently, it is necessary to use AR Codes technology as an educational resource to enhance the learning process, integrate it with active learning strategies, and use it to teach defensive boxing skills and apply them to offensive and counterattack skills, thereby improving the learning process.

AI and augmented reality for 3D Indian dance pose reconstruction cultural revival.

This paper delves into the specialized domain of human action recognition, focusing on the Identification of Indian classical dance poses, specifically Bharatanatyam. Within the dance context, a "Karana" embodies a synchronized and harmonious movement encompassing body, hands, and feet, as defined by the Natyashastra. The essence of Karana lies in the amalgamation of nritta hasta (hand movements), sthaana (body postures), and chaari (leg movements). Although numerous, Natyashastra codifies 108 karanas, showcased in the intricate stone carvings adorning the Nataraj temples of Chidambaram, where Lord Shiva's association with these movements is depicted. Automating pose identification in Bharatanatyam poses challenges due to the vast array of variations, encompassing hand and body postures, mudras (hand gestures), facial expressions, and head gestures. To simplify this intricate task, this research employs image processing and automation techniques. The proposed methodology comprises four stages: acquisition and pre-processing of images involving skeletonization and Data Augmentation techniques, feature extraction from images, classification of dance poses using a deep learning network-based convolution neural network model (InceptionResNetV2), and visualization of 3D models through mesh creation from point clouds. The use of advanced technologies, such as the MediaPipe library for body key point detection and deep learning networks, streamlines the identification process. Data augmentation, a pivotal step, expands small datasets, enhancing the model's accuracy. The convolution neural network model showcased its effectiveness in accurately recognizing intricate dance movements, paving the way for streamlined analysis and interpretation. This innovative approach not only simplifies the identification of Bharatanatyam poses but also sets a precedent for enhancing accessibility and efficiency for practitioners and researchers in the Indian classical dance.

Influence of augmented reality technique on the accuracy of autotransplanted teeth in surgically created sockets.

BACKGROUND: The objective of the present study was to evaluate the reliability of an augmented reality drilling approach and a freehand drilling technique for the autotransplantation of single-rooted teeth. MATERIALS AND METHODS: Forty samples were assigned to the following surgical techniques for drilling guidance of the artificial sockets: A. augmented reality technique (AR) (n = 20) and B. conventional free-hand technique (FT) (n = 20). Then, two models with 10 teeth each were submitted to a preoperative cone-beam computed tomography (CBCT) scan and a digital impression by a 3D intraoral scan. Afterwards, the autotrasplanted teeth were planned in a 3D dental implant planning software and transferred to the augmented reality device. Then, a postoperative CBCT scan was performed. Data sets from postoperative CBCT scans were aligned to the planning in the 3D implant planning software to analize the coronal, apical and angular deviations. Student's t-test and Mann-Whitney non-parametric statistical analysis were used to analyze the results. RESULTS: No statistically significant differences were shown at coronal (p = 0.123) and angular (p = 0.340) level; however, apical deviations between AR and FT study groups (p = 0.008) were statistically significant different. CONCLUSION: The augmented reality appliance provides higher accuracy in the positioning of single-root autotransplanted teeth compared to the conventional free-hand technique.

[Experts consensus on transbronchial diagnosis, localization and treatment of peripheral pulmonary nodules guided by the augmented reality optical lung navigation].

Lung cancer is the second most common malignancy with the highest mortality rate worldwide. In recent years, the rapid development of various bronchoscopic navigation techniques has provided conditions for the minimally invasive diagnosis and treatment of peripheral pulmonary nodules through the airway.Augmented reality optical lung navigation is a new technology that combined virtual bronchoscopy navigation (VBN) with augmented reality (AR) and optical navigation technology, which could assist bronchoscopist and has been widely applied in clinics. The clinical evidence certified that the navigation, has the advantages of safety and efficacy in guiding transbronchial diagnosis, localization, and treatment of pulmonary nodules. In order to standardize the clinical operation of augmented reality optical lung navigation technology and guide its application in clinical practice, Interventional Group, Society of Respiratory Diseases, Chinese Medical Association/Interventional Pulmonology Group of the Zhejiang Medical Association organized multidisciplinary experts to take the lead in formulating the Consensus of experts on transbronchial diagnosis, localization and treatment of peripheral pulmonary nodules guided by the augmented reality optical lung navigation after multiple rounds of discussion, and provided recommendation opinions and clinical guidance for the indications and contraindications, equipment and devices, perioperative treatment, operating process and complication management of peripheral pulmonary nodules applicable to augmented reality optical lung diagnosis navigation technology.

Using Mixed Reality Simulation to Improve Junior Medical Trainees' Preparedness to Manage High-Acuity Trauma.

High-acuity trauma necessitates experienced and rapid intervention to prevent patient harm. However, upskilling junior trainees through hands-on management of real trauma cases is rarely feasible without compromising patient safety. This quality education report sought to investigate whether a simulation course operated via mixed reality (MR) headset devices (Microsoft HoloLens) could enhance the clinical knowledge recall and preparedness to practice of junior trainees with no prior experience managing trauma.The Plan-Do-Study-Act quality improvement method was used to refine six emergency trauma vignettes compatible with an MR teaching platform. Each vignette was curated by a multidisciplinary team of orthopaedic surgeons, clinical fellows and experts in simulation-based medical education. As a baseline assessment, a 2-hour emergency trauma course was delivered using traditional didactic methods to a cohort of pre-registration medical students with no clinical exposure to high-acuity trauma (n=16). Next, we delivered the MR simulation to an equivalent cohort (n=32). Clinical knowledge scores derived from written test papers were recorded for each group during and 2 weeks after each course. Each attendee's end-of-rotation clinical supervisor appraisal grade was recorded, as determined by a consultant surgeon who supervised participants during a 2-week placement on a major trauma ward. Balancing measures included participant feedback and validated cognitive load questionnaires (National Aeronautics and Space Administration-Task Load Index).Overall, attendees of the MR simulation course achieved and sustained higher clinical knowledge scores and were more likely to receive a positive consultant supervisor appraisal. This project serves as a proof of concept that MR wearable technologies can be used to improve clinical knowledge recall and enhance the preparedness to practice of novice learners with otherwise limited clinical exposure to high-acuity trauma.

Comparison between accuracy of augmented reality computed tomography-based and portable augmented reality-based navigation systems for cup insertion in total hip arthroplasty.

Augmented reality (AR) has been used for navigation during total hip arthroplasty (THA). AR computed tomography (CT)-based navigation systems and AR-based portable navigation systems that use smartphones can also be used. This study compared the accuracy of cup insertion during THA using AR-CT-based and portable AR-based navigation systems. Patients with symptomatic hip disease who underwent primary THA in the supine position using both AR CT-based and portable AR-based navigation systems simultaneously between October 2021 and July 2023 were included. The primary outcome of this study was the absolute difference between cup angles in the intraoperative navigation record and those measured on postoperative CT. The secondary outcome was to determine the factors affecting the absolute value of the navigation error in radiographic inclination (RI) and radiographic anteversion (RA) of the cup, including sex, age, body mass index, left or right side, approach, and preoperative pelvic tilt. This study included 94 consecutive patients. There were 11 men and 83 women, with a mean age of 68 years. The mean absolute errors of RI were 2.7° ± 2.0° in the AR CT-based and 3.3° ± 2.4° in the portable AR-based navigation system. The mean absolute errors of RA were 2.5° ± 2.1° in the AR CT-based navigation system and 2.3° ± 2.2° in the portable AR-based navigation system. No significant differences were observed in RI or RA of the cup between the two navigation systems (RI: p = 0.706; RA: p = 0.329). No significant factors affected the absolute value of the navigation errors in RI and RA. In conclusion, there were no differences in the accuracy of cup insertion between the AR CT-based and portable AR-based navigation systems.

Extended reality in cranial and spinal neurosurgery - a bibliometric analysis.

PURPOSE: This bibliometric analysis of the top 100 cited articles on extended reality (XR) in neurosurgery aimed to reveal trends in this research field. Gender differences in authorship and global distribution of the most-cited articles were also addressed. METHODS: A Web of Science electronic database search was conducted. The top 100 most-cited articles related to the scope of this review were retrieved and analyzed for trends in publications, journal characteristics, authorship, global distribution, study design, and focus areas. After a brief description of the top 100 publications, a comparative analysis between spinal and cranial publications was performed. RESULTS: From 2005, there was a significant increase in spinal neurosurgery publications with a focus on pedicle screw placement. Most articles were original research studies, with an emphasis on augmented reality (AR). In cranial neurosurgery, there was no notable increase in publications. There was an increase in studies assessing both AR and virtual reality (VR) research, with a notable emphasis on VR compared to AR. Education, surgical skills assessment, and surgical planning were more common themes in cranial studies compared to spinal studies. Female authorship was notably low in both groups, with no significant increase over time. The USA and Canada contributed most of the publications in the research field. CONCLUSIONS: Research regarding the use of XR in neurosurgery increased significantly from 2005. Cranial research focused on VR and resident education while spinal research focused on AR and neuronavigation. Female authorship was underrepresented. North America provides most of the high-impact research in this area.

[The impact of augmented reality glasses on human visual efficiency and digital eye fatigue].

Objective: To investigate the differences in reading efficiency and visual fatigue between the use of augmented reality (AR) glasses and laptops. Methods: A prospective self-controlled study was conducted. Healthy students from Capital Medical University who frequently engaged in long-term near work and used laptops and other digital display devices were recruited as subjects at Beijing Tongren Hospital, Capital Medical University between November 1 and November 15, 2023. LogMAR visual acuity, visual functions (accommodation, convergence, and fusion), and visual fatigue scores (Likert visual fatigue scale) of the participants were assessed. The order of using the laptop and AR glasses for each participant was determined by a coin toss. Reading efficiency (reading speed and error rate multiplied by the detection rate of incorrect numbers) with different devices for 10 minutes at the same time on different dates and visual fatigue scores after watching a 20-minute video were measured. Statistical analyses were performed using paired t-tests and Wilcoxon signed-rank tests. Results: A total of 20 eligible subjects were included, comprising 7 males and 13 females, with a mean age of (25.45±2.27) years. There was no significant change in binocular visual acuity before and after using AR glasses and laptops (both P>0.05). The reading speed and reading efficiency of using AR glasses [(34.03±9.25) and (29.19±7.62) digits/min, respectively] were significantly lower than those of using laptops [(39.43±10.36) and (35.67±9.87) digits/min, respectively] (t=4.36, P<0.001), while the difference in error detection rate was not statistically significant (t=1.29, P=0.213). There was no statistically significant difference in visual fatigue scores before watching videos with the two devices (Z=-0.71, P=0.480). However, the visual fatigue score after watching videos with AR glasses [(20.55±5.04) points] was significantly higher than that with laptops [16.50 (13.00, 19.75) points] (Z=-2.85, P=0.004). The visual fatigue scores after watching videos with both devices were significantly higher than before (P<0.05), with a more significant increase observed with AR glasses [(6.05±3.50) points] (Z=-3.41, P<0.001). Conclusion: Compared with using laptops, the reading speed and efficiency were lower, and the visual fatigue was more pronounced with the use of AR glasses at the current technical level. Further optimization and improvement of AR glasses are warranted.

Therapists and patients perceptions of a mixed reality system designed to improve trunk control and upper extremity function.

A prototype system aimed at improving arm function and trunk control after stroke has been developed that combines mixed-reality (MR) feedback with a mobile seat system (Holoreach). The purpose of this study was to assess the usability of Holoreach in a rehabilitation setting from both the patient and therapist perspective. Ten therapists (eight physiotherapists and two occupational therapists) used the device in their regular therapy programs for fifteen stroke patients with trunk control issues. Each patient received four individual therapy sessions with the device performed under the supervision of the therapist. Therapists and patients kept therapy diaries and used customized questionnaires. At the end of the study two focus groups were conducted to further assess usability. Generally, the prototype system is suitable for training trunk and arm control. The therapists expressed overall positive views on the impact of Holoreach. They characterized it as new, motivating, fresh, joyful, interesting, and exciting. All therapists and 80% of the patients agreed with the statement that training with Holoreach is beneficial for rehabilitation. Nonetheless, improvements are required in the hardware and software, and design. The prototype system contributes at various levels to the rapidly evolving advances in neurorehabilitation, particularly regarding the practical aspect of exercise delivery.

Applying augmented reality in teaching of surgical residents-telementoring, a "stress-free" way to surgical autonomy?

BACKGROUND: Achieving surgical autonomy can be considered the ultimate goal of surgical training. Innovative head-mounted augmented reality (AR) devices enable visualization of the operating field and teaching from remote. Therefore, utilization of AR glasses may be a novel approach to achieve autonomy. The aim of this pilot study is to analyze the feasibility of AR application in surgical training and to assess its impact on intraoperative stress. METHODS: A head-mounted RealWear Navigator® 500 glasses and the TeamViewer software were used. Initial "dry lab" testing of AR glasses was performed in combination with the Symbionix LAP Mentor™. Subsequently, residents performed various stage-adapted surgical procedures semi-autonomously (SA) (on-demand consultation of senior surgeon, who is in theatre but not scrubbed) versus permanent remote supervision (senior surgeon not present) via augmented reality (AR) glasses, worn by the resident in theatre. Stress was measured by intraoperative heart rate (Polar® pulse belt) and State-Trait Anxiety Inventory (STAI) questionnaire. RESULTS: After "dry lab" testing, N = 5 senior residents performed equally N = 25 procedures SA and with AR glasses. For both, open and laparoscopic procedure AR remote assistance showed satisfactory applicability. Utilization of AR significantly reduced intraoperative peak pulse rate from 131 to 119 bpm (p = 0.004), as compared with the semi-autonomous group. Likewise, subjectively perceived stress according to STAI was significantly lower in the AR group (p = 0.011). CONCLUSION: AR can be applied in surgical training and may help to reduce stress in theatre. In the future, AR has a huge potential to become a stepping stone to surgical autonomy.

i-MYO: A multi-grasp prosthetic hand control system based on gaze movements, augmented reality, and myoelectric signals.

BACKGROUND: Controlling a multi-grasp prosthetic hand still remains a challenge. This study explores the influence of merging gaze movements and augmented reality in bionics on improving prosthetic hand control. METHODS: A control system based on gaze movements, augmented reality, and myoelectric signals (i-MYO) was proposed. In the i-MYO, the GazeButton was introduced into the controller to detect the grasp-type intention from the eye-tracking signals, and the proportional velocity scheme based on the i-MYO was used to control hand movement. RESULTS: The able-bodied subjects with no prior training successfully transferred objects in 91.6% of the cases and switched the optimal grasp types in 97.5%. The patient could successfully trigger the EMG to control the hand holding the objects in 98.7% of trials in around 3.2 s and spend around 1.3 s switching the optimal grasp types in 99.2% of trials. CONCLUSIONS: Merging gaze movements and augmented reality in bionics can widen the control bandwidth of prosthetic hand. With the help of i-MYO, the subjects can control a prosthetic hand using six grasp types if they can manipulate two muscle signals and gaze movement.

Influence of a Three-Month Mixed Reality Training on Gait Speed and Cognitive Functions in Adults with Intellectual Disability: A Pilot Study.

People with intellectual disability (ID) are often subject to motor impairments such as altered gait. As gait is a task involving motor and perceptive dimensions, perceptual-motor training is an efficient rehabilitation approach to reduce the risk of falls which grows with age. Virtual, augmented, and mixed reality are recent tools which enable interaction with 3D elements at different levels of immersion and interaction. In view of the countless possibilities that this opens, their use for therapeutic purposes is constantly increasing. Therefore, the aim of this study was to investigate the influence a mixed reality activity could have on motor and cognitive abilities in eighteen adults with intellectual disability. For three months, once a week, they had around 20 min to pop virtual balloons with a finger using a Microsoft HoloLens2® head-mounted mixed-reality device. Motor skills were assessed through gait analysis and cognitive abilities were measured with the Montréal Cognitive Assessment. Both walking speed and cognitive score increased after training. In conclusion, this study demonstrates that mixed reality holds potential to get used for therapeutic purposes in adults with ID.

3D magnetic seed localization for augmented reality in surgery.

PURPOSE: For tumor resection, surgeons need to localize the tumor. For this purpose, a magnetic seed can be inserted into the tumor by a radiologist and, during surgery, a magnetic detection probe informs the distance to the seed for localization. In this case, the surgeon still needs to mentally reconstruct the position of the tumor from the probe's information. The purpose of this study is to develop and assess a method for 3D localization and visualization of the seed, facilitating the localization of the tumor. METHODS: We propose a method for 3D localization of the magnetic seed by extending the magnetic detection probe with a tracking-based localization. We attach a position sensor (QR-code or optical marker) to the probe in order to track its 3D pose (respectively, using a head-mounted display with a camera or optical tracker). Following an acquisition protocol, the 3D probe tip and seed position are subsequently obtained by solving a system of equations based on the distances and the 3D probe poses. RESULTS: The method was evaluated with an optical tracking system. An experimental setup using QR-code tracking (resp. using an optical marker) achieves an average of 1.6 mm (resp. 0.8 mm) 3D distance between the localized seed and the ground truth. Using a breast phantom setup, the average 3D distance is 4.7 mm with a QR-code and 2.1 mm with an optical marker. CONCLUSION: Tracking the magnetic detection probe allows 3D localization of a magnetic seed, which opens doors for augmented reality target visualization during surgery. Such an approach should enhance the perception of the localized region of interest during the intervention, especially for breast tumor resection where magnetic seeds can already be used in the protocol.

Facial augmented reality based on hierarchical optimization of similarity aspect graph.

BACKGROUND: The existing face matching method requires a point cloud to be drawn on the real face for registration, which results in low registration accuracy due to the irregular deformation of the patient's skin that makes the point cloud have many outlier points. METHODS: This work proposes a non-contact pose estimation method based on similarity aspect graph hierarchical optimization. The proposed method constructs a distance-weighted and triangular-constrained similarity measure to describe the similarity between views by automatically identifying the 2D and 3D feature points of the face. A mutual similarity clustering method is proposed to construct a hierarchical aspect graph with 3D pose as nodes. A Monte Carlo tree search strategy is used to search the hierarchical aspect graph for determining the optimal pose of the facial 3D model, so as to realize the accurate registration of the facial 3D model and the real face. RESULTS: The proposed method was used to conduct accuracy verification experiments on the phantoms and volunteers, which were compared with four advanced pose calibration methods. The proposed method obtained average fusion errors of 1.13 ± 0.20 mm and 0.92 ± 0.08 mm in head phantom and volunteer experiments, respectively, which exhibits the best fusion performance among all comparison methods. CONCLUSIONS: Our experiments proved the effectiveness of the proposed pose estimation method in facial augmented reality.

Comparing episodic memory outcomes from walking augmented reality and stationary virtual reality encoding experiences.

Episodic Memory (EM) is the neurocognitive capacity to consciously recollect personally experienced events in specific spatio-temporal contexts. Although the relevance of spatial and temporal information is widely acknowledged in the EM literature, it remains unclear whether and how EM performance and organisation is modulated by self-motion, and by motor- and visually- salient environmental features (EFs) of the encoding environment. This study examines whether and how EM is modulated by locomotion and the EFs encountered in a controlled lifelike learning route within a large-scale building. Twenty-eight healthy participants took part in a museum-tour encoding task implemented in walking Augmented Reality (AR) and stationary Virtual Reality (VR) conditions. EM performance and organisation were assessed immediately and 48-hours after trials using a Remember/Familiar recognition paradigm. Results showed a significant positive modulation effect of locomotion on distinctive EM aspects. Findings highlighted a significant performance enhancement effect of stairway-adjacent locations compared to dead-end and mid-route stimuli-presentation locations. The results of this study may serve as design criteria to facilitate neurocognitive rehabilitative interventions of EM. The underlying technological framework developed for this study represents a novel and ecologically sound method for evaluating EM processes in lifelike situations, allowing researchers a naturalistic perspective into the complex nature of EM.

A hybrid robotic system for zygomatic implant placement based on mixed reality navigation.

BACKGROUNDS: Zygomatic implant (ZI) placement surgery is a viable surgical option for patients with severe maxillary atrophy and insufficient residual maxillary bone. Still, it is difficult and risky due to the long path of ZI placement and the narrow field of vision. Dynamic navigation is a superior solution, but it presents challenges such as requiring operators to have advanced skills and experience. Moreover, the precision and stability of manual implantation remain inadequate. These issues are anticipated to be addressed by implementing robot-assisted surgery and achieved by introducing a mixed reality (MR) navigation-guided hybrid robotic system for ZI placement surgery. METHODS: This study utilized a hybrid robotic system to perform the ZI placement surgery. Our first step was to reconstruct a virtual 3D model from preoperative cone-beam CT (CBCT) images. We proposed a series of algorithms based on coordinate transformation, which includes image-phantom registration, HoloLens-tracker registration, drill-phantom calibration, and robot-implant calibration, to unify all objects within the same coordinate system. These algorithms enable real-time tracking of the surgical drill's position and orientation relative to the patient phantom. Subsequently, the surgical drill is directed to the entry position, and the planned implantation paths are superimposed on the patient phantom using HoloLens 2 for visualization. Finally, the hybrid robot system performs the processed of drilling, expansion, and placement of ZIs under the guidance of the MR navigation system. RESULTS: Phantom experiments of ZI placement were conducted using 10 patient phantoms, with a total of 40 ZIs inserted. Out of these, 20 were manually implanted, and the remaining 20 were robotically implanted. Comparisons between the actual implanted ZI paths and the preoperatively planned ZI paths showed that our MR navigation-guided hybrid robotic system achieved a coronal deviation of 0.887 ± 0.213 mm, an apical deviation of 1.201 ± 0.318 mm, and an angular deviation of 3.468 ± 0.339° This demonstrates significantly better accuracy and stability than manual implantation. CONCLUSION: Our proposed hybrid robotic system enables automated ZI placement surgery guided by MR navigation, achieving greater accuracy and stability compared to manual operations in phantom experiments. Furthermore, this system is expected to apply to animal and cadaveric experiments, to get a good ready for clinical studies.