Purpose: Endoscopic pituitary surgery is a minimally invasive technique to remove pituitary tumours through the nose. Currently, image guidance may be used in the form of a tracked pointer to help surgeons navigate the region and avoid damage to critical structures. However, the pointer method is mentally demanding as the pointer location is displayed in a different modality and disrupts the surgical workflow due to the setup time and frequent tool removal.

Methods: We propose an Augmented Reality (AR) system where information from the pre-operative scan is displayed directly onto the endoscopic video. Our system features an on-board tracking system, allowing for the registration process to be performed automatically.

Results: We evaluated the accuracy of our system and compared it to an AR system that uses an infrared (IR) camera to track an endoscope with reflective markers. Our system gave an accuracy of 1.1 (± 0.4) mm, compared to 2.4 (± 0.9) mm in the IR-tracked endoscope approach.

Conclusion: Our Augmented Reality system is a more compact and transportable setup which outperformed the IR-tracked endoscope. The automatic registration method can save time in the operating room as well as increase AR overlay accuracy, improving the translation of these technologies.

Keywords: Augmented reality; Endoscopic surgery; Minimally invasive surgery; Transsphenoidal pituitary surgery.

© 2025. The Author(s).

目的： 内窥镜垂体手术是一种通过鼻腔移除垂体肿瘤的微创技术。目前，影像引导可能以追踪指针的形式使用，帮助外科医生导航该区域并避免损伤关键结构。然而，指针方法在精神上较为耗力，因为指针的位置显示在不同的模式下，并且由于设置时间和频繁取工具而中断了手术流程。

方法： 我们提出了一种增强现实（AR）系统，在该系统中，术前扫描的信息直接显示在内窥镜视频上。我们的系统具有内置跟踪系统，允许自动完成注册过程。

结果： 我们评估了系统的准确性，并将其与使用红外（IR）相机追踪带有反射标记的内窥镜的AR系统进行了比较。我们的系统精度为1.1（± 0.4）毫米，而IR跟踪内窥镜的方法精度为2.4（± 0.9）毫米。

结论： 我们的增强现实系统是一种更紧凑、便携的设置，并且在性能上优于红外追踪内窥镜。自动注册方法可以在手术室节省时间，提高AR覆盖准确性，从而改善这些技术的应用效果。

关键词： 增强现实；内窥镜手术；微创手术；经蝶窦垂体手术。