Vision‐Guided Surgical Navigation Using Computer Vision for Dynamic Intraoperative Imaging Updates

ABSTRACT Background Residual disease after endoscopic sinus surgery (ESS) contributes to poor outcomes and revision surgery. Image‐guided surgery systems cannot dynamically reflect intraoperative changes. We propose a sensorless, video‐based method for intraoperative CT updating using neural radiance fields (NeRF), a deep learning algorithm used to create 3D surgical field reconstructions. Methods Bilateral ESS was performed on three 3D‐printed models ( n = 6 sides). Postoperative endoscopic videos were processed through a custom NeRF pipeline to generate 3D reconstructions, which were co‐registered to preoperative CT scans. Digitally updated CT models were created through algorithmic subtraction of resected regions, then volumetrically segmented, and compared to ground‐truth postoperative CT. Accuracy was assessed using Hausdorff distance (surface alignment), Dice similarity coefficient (DSC) (volumetric overlap), and Bland‒Altman analysis (BAA) (statistical agreement). Results Comparison of the updated CT and the ground‐truth postoperative CT indicated an average Hausdorff distance of 0.27 ± 0.076 mm and a 95th percentile Hausdorff distance of 0.82 ± 0.165 mm, indicating sub‐millimeter surface alignment. The DSC was 0.93 ± 0.012 with values >0.9 suggestive of excellent spatial overlap. BAA indicated modest underestimation of volume on the updated CT versus ground‐truth CT with a mean difference in volumes of 0.40 cm 3 with 95% limits of agreement of 0.04‒0.76 cm 3 indicating that all samples fell within acceptable bounds of variability. Conclusions Computer vision can enable dynamic intraoperative imaging by generating highly accurate CT updates from monocular endoscopic video without external tracking. By directly visualizing resection progress, this software‐driven tool has the potential to enhance surgical completeness in ESS for next‐generation navigation platforms.