## 4 Discussion  
This system provided the benefit of a mixed reality display that was true to the animal model in terms of size and positioning, allowing for effective visualization and understanding of the location of fibroids. This capability has great potential benefit for reducing procedure time and minimizing the number of incisions made. However, for long surgeries, this particular headset (i.e., HoloLens 2) may be burdensome given its weight (566 g). This inconvenience may prevent surgeons from using the Hololens, in its current form, directly in procedures. However, as newer and lighter headsets are being developed  
Figure 3: Illustration of sequential steps to perform a mock myomectomy of an ex vivo animal model using a mixed reality headset as an intra-procedural image-guidance tool. (**A**) Perform _eye tracking user calibration_ to adjust the scene for a higher quality 3D visualization experience; (**B**) Orient the 3D hologram according to the live laparoscopic video; (**C**) Locate the position of the fibroids; (**D**,**E**) Incisise tissue and perform myomectomy; (**F**) Display 3D rendering on 2D monitor. (e.g., NuEyes, RealWear, Magic Leap 2), the same file processing workflow can be used to visualize the renderings on more comfortable headsets. It should be noted that there is a learning curve to the use of the headset and that physicians will need ample training. Thus, creation of training tutorials or demos should be considered to facilitate this learning experience. The learning curve is associated with basic commands for the headset, but also with specific actions for the required task, such as orienting the hologram. These insights are provided by the co-author [PERSON], who has a subspeciality in Minimally Invasive Gynecologic Surgery. She currently serves as the Director of Biotechnology and Innovation at the Fibroid and Adenomyosis Center, where her role is to create innovative ways to improve women's health care, with a specific emphasis on myomas. She currently holds two utility patents, and has two medical devices available to the public. She is also an Assistant Professor of Obstetrics & Gynecology at Weill Cornell Medicine and New York Presbyterian. She was the first MICS fellowship trained surgeon at Weill Cornell Medical Center, and has had a flourishing surgical fibroid practice for over 10 years, during which she has performed over a thousand fibroid surgeries. She is currently, one of the highest volume MICS surgeons at Weill Cornell Medicine. The 3D rendering on a secondary monitor provides some immediate solutions for challenges of the headset, but the benefits of the real life feel of the hologram was lost, which may compromise on desired clinical outcomes such as shorter procedure times. The screen still depicted the number of myomas, but depth was not intuitively understood, requiring rotation of the rendering by another person, needing an additional screen, and extra space for the computer to sit. Very recently, [PERSON] et al. [22] proposed a hybrid simulation and planning platform harnessing Microsoft HoloLens for Cryosurgery. In this work, a qualitative study was carried out to preliminarily evaluate the proposed system for retrospective simulation of two surgical cases. All participants confirmed that using the desktop application and the hybrid simulator is easy and quick to learn, allowing a clear evaluation of the lesion margins and their distance from the adjacent anatomical structures, making the surgical planning easier than with the traditional method. Yet, they noted a prospective, randomized, single-center clinical trial is needed to compare cryotherapy procedures' short- and long-term outcomes. Our work serves as a single evaluation of use of a mixed reality headset for intra-procedural image-guidance during a mock laparoscopic myometomy on an ex-vivo fibroid model. However, since this article is a communication, it has several limitations in its current stage, and we believe these limitations will be the seed for future developments for both our lab and others.