Every study we could find on 3D and VR surgical planning.
We believe surgical planning is moving from flat 2D slices to true 3D, and the research is starting to show why. So we've gathered every peer-reviewed study, conference abstract and preprint we could find on VR and AR surgical planning since 2017, not just the ones that used our software. That's 631 studies across every platform.
Visualisation of cardiac magnetic resonance-based anatomic models in virtual reality to evaluate candidacy for transcatheter pulmonary valve replacement in surgically palliated right ventricular outflow tracts
Computed from the 631 studies in the library. 2026 is a partial year.
Studies per yearHeadsets named, by yearStudies that name the headset; each row has its own scale.
HoloLens (110 studies)
Quest (54 studies)
Apple Vision Pro (3 studies)
Largest specialties
Neurosurgery112
Congenital heart87
Adult cardiac & structural heart60
Start with a question
Pick a question to see what the studies report, in their authors' words.
Questions people ask
Short answers drawn from the studies in this library. Each study is linked so you can read the original.
Does VR surgical planning reduce operating time?
The time gains in the library are on specific steps. Mixed-reality planning was linked to shorter ischemia time in robot-assisted partial nephrectomy (Duarte 2026), faster flap harvest after perforator mapping (Liu 2025), shorter planning time (Ye 2021), and shorter procedure time for a spinal injection rehearsed in VR (Kim 2026). Results vary by procedure. Where trials measured total operating time, some found similar durations between groups (Shirk 2019, Cumpanas 2025), while a retrospective study reported shorter operations (Zhu 2022).
Several small studies compared them directly and found things to like in VR. Participants preferred a VR liver model over 3D prints and 3D PDFs (Huettl 2021), rated holograms above prints on every category in pediatric heart surgery (Gehrsitz 2021), and judged VSD patch closure feasibility best with VR models in a five-patient double-outlet right ventricle pilot (Peek 2023). In orbital reconstruction, planning with mixed reality was faster and more accurate than a print-based workflow (Dubron 2025). These are small studies, and prints were quicker to read for one task in the liver study.
How long does it take to segment a CT and build a VR model?
It depends on the case and the software. A neurosurgical series reported a mean of 39.4 minutes for hologram segmentation (Colombo 2023), and a later series of aneurysm cases reported 26 minutes on average (Colombo 2026). In a pediatric heart series, AI made it quicker to build the models, but manual corrections were always needed (Lippert 2024).
Studies in the library report that viewing the 3D model changed the plan in anywhere from about 3% to 75% of cases. Higher rates came from complex cases, such as congenital heart defects (68%, Lippert 2024), children with congenital malformations or tumours (75%, Pelizzo 2025), segmentectomy (52%, Bakhuis 2023), and robotic prostatectomy (32%, Shirk 2022). Lower rates came from routine neurosurgical cases (3 of 107, Colombo 2023). The studies report how often plans changed; none shows that the changes led to better patient outcomes.
Does VR surgical planning improve patient outcomes?
Some trials report benefits on specific outcomes. In percutaneous nephrolithotomy, adding a VR model was linked to a higher stone-free rate (33.7% vs 20.2%) and fewer moderate complications (Cumpanas 2025). A TAVI trial reported less access-site bleeding with VR (Kanschik 2026). Other trials found no significant difference in their main clinical measures (Shirk 2022, Duarte 2026), and most were not designed around clinical outcomes, so larger trials are still needed.
Published figures are sparse, and the library holds no formal cost-effectiveness study. One randomized study estimated the cost of a VR model at $112.5 to $255 (Cumpanas 2025). Another reported that the software and headset at its centre cost 80,000 and 9,000 USD (Duarte 2026). In a national survey of urologists, 25% named high cost as a barrier to adoption (Kobayashi 2025).
No dedicated reimbursement code is described in the studies. Authors note there is no CPT code for 3D model creation beyond patient billing (Wake 2021), and that many programs fund these services from imaging department overhead, research or philanthropic funds (Ganigara 2026). Reimbursement varies by payer and health system, so check locally.
What is the evidence for HoloLens in surgical planning?
HoloLens is the headset named most often in the library, and its studies cover many specialties. In a randomized trial of 80 flap patients, mixed-reality perforator localization had a higher recognition rate than color Doppler ultrasound (94.3% vs 82.0%) and flap harvest was faster (Liu 2025). Other studies reported shorter AR tumor-planning time (Van Gestel 2023) and closer agreement with surgical findings for lung artery anatomy (Petrella 2024). Holograms were created in every case of an early neurosurgical feasibility study, and its authors called for further accuracy work (Incekara 2018).
Are there randomized trials of VR surgical planning?
Yes. The library lists 14 randomized trials, from 2019 to 2026, in areas including urology, cardiology, plastic surgery and spine. Examples are Shirk 2019 and Shirk 2022 in robotic prostatectomy, Cumpanas 2025 in kidney stone surgery, Kanschik 2026 in TAVI and Garg 2025 in structural heart interventions. Most are small or add VR to standard planning, and they measure different endpoints, so they are best read one at a time.
Are VR measurements as accurate as CT planning software for TAVI?
In several validation studies, VR measurements agreed closely with standard CT software. Valve-sizing measurements showed no significant differences and strong correlations (Kanschik 2024, Kanschik 2025), and a 50-patient study found excellent agreement for annulus measurements and better concordance with the implanted valve (Carabetta 2025). In left atrial appendage sizing, physicians also rated 3D orientation higher in VR (Heidari 2023). Most of these are single-center feasibility or validation studies.
Yes / No reflect what each study's authors report for this question; they are not Realize Medical claims.
Results
Surgical Repair of Double-Outlet Right Ventricle With Doubly Committed Juxtaarterial Ventricular Septal Defect: The Role of Virtual Reality#
Yoneyama F et al. · Annals of thoracic surgery short reports · 2026
Congenital heart · Case report · n: 1 patient
Used Elucis
Case report of a neonate with double-outlet right ventricle, a doubly committed juxta-arterial ventricular septal defect (VSD), a hypoplastic aortic arch and a patent ductus arteriosus. A VR model was built from CT in Elucis and used in planning the surgical repair, which comprised VSD closure through a transarterial approach, an arterial switch operation and arch repair.
“This case highlights the utility of VR-based planning in optimizing surgical strategy for complex congenital heart defects.”
From the paper · Abstract
Conclusions (3)
VR confirmed defect position beneath both arteriesAnswer: Describes
“Virtual reality (VR) imaging provided detailed visualization, confirming the VSD’s position beneath both great arteries.”
From the paper · Abstract
Neonate had successful repairAnswer: Describes
“The patient underwent successful VSD closure through a transarterial approach, arterial switch operation, and arch repair.”
From the paper · Abstract
Authors judge VR planning useful for strategyAnswer: Yes
“This case highlights the utility of VR-based planning in optimizing surgical strategy for complex congenital heart defects.”
Randomised crossover study in which 15 participants segmented five craniomaxillofacial trauma CT datasets twice, once in Elucis (HP Reverb G2 headset) and once with conventional workstation software, in randomised order with a one-week washout. Segmentation time was recorded and usability was assessed with the System Usability Scale, together with ratings of anatomical recognition and physical fatigue.
“Both platforms received equivalent ratings for anatomical structure recognition and physical fatigue.”
From the paper · Abstract
“The VR platform completed segmentation significantly faster”
72 vs 95 min, p = 0.008
From the paper · Abstract
“The mean difference was 14.83 points in favor of the VR platform, though this did not have statistical significance due to the large variability relative to the observed difference”
SUS 73.00 vs 58.17, p = 0.080
From the paper · Fulltext
Conclusions (3)
Segmentation 23 min faster in VRAnswer: Yes
“The VR platform completed segmentation significantly faster”
72 vs 95 min, p = 0.008
From the paper · Abstract
Usability score difference not significantAnswer: No significant difference
“The mean difference was 14.83 points in favor of the VR platform, though this did not have statistical significance due to the large variability relative to the observed difference”
SUS 73.00 vs 58.17, p = 0.080
From the paper · Full text
Anatomy recognition rated equivalentAnswer: No significant difference
“Both platforms received equivalent ratings for anatomical structure recognition and physical fatigue.”
Visualisation of cardiac magnetic resonance-based anatomic models in virtual reality to evaluate candidacy for transcatheter pulmonary valve replacement in surgically palliated right ventricular outflow tracts#
Retrospective study of 16 patients (median age 15.5 years) with native or surgically palliated right ventricular outflow tracts who were being considered for transcatheter pulmonary valve replacement and had both MR angiography and cardiac CT. Outflow-tract models were segmented in Elucis directly from MR angiography, virtual valves were built to industry dimensions, and a blinded interventional cardiologist judged candidacy in VR; these judgements were set against CT-based industry fit analysis and the procedures performed.
“Median time for model generation was 20.6 minutes (IQR 18.5, 22.0).”
20.6 minutes
From the paper · Abstract
“Modelling may help evaluate transcatheter pulmonary valve replacement candidacy, but must be used in conjunction with other data.”
From the paper · Abstract
“In conclusion, generating virtual models from clinical magnetic resonance angiography datasets is feasible.”
From the paper · Abstract
“Four patients who passed virtual reality screening failed industry screening but underwent successful transcatheter pulmonary valve replacement.”
From the paper · Abstract
Conclusions (3)
Models from MR angiography feasibleAnswer: Yes
“In conclusion, generating virtual models from clinical magnetic resonance angiography datasets is feasible.”
From the paper · Abstract
Median model creation time 20.6 minutesAnswer: Describes
“Median time for model generation was 20.6 minutes (IQR 18.5, 22.0).”
20.6 minutes (IQR 18.5, 22.0)
From the paper · Abstract
Four industry screen failures still received valvesAnswer: Describes
“Four patients who passed virtual reality screening failed industry screening but underwent successful transcatheter pulmonary valve replacement.”
Predictive Performance and Rater Reliability of CT-derived Virtual Reality Models for PDA Stent Planning in Patients with Ductal-Dependent Cyanotic Congenital Heart Disease#
Retrospective study of 42 infants (January 2021 to December 2024) with ductal-dependent pulmonary circulation who had pre-procedural cardiac CT and transcatheter patent ductus arteriosus (PDA) stenting. VR models of the duct and of stents in 4 mm length increments were built in Elucis; a blinded interventional cardiologist used them to choose vascular access and stent size, and these choices were set against the procedures performed. Two blinded operators also measured ductal length and curvature in VR to assess intra- and inter-rater agreement.
“VR-predicted vascular access matched actual access in 36 (85.7%) cases.”
36 (85.7%)
From the paper · Abstract
“VR models were successfully generated for all patients.”
From the paper · Abstract
Conclusions (4)
Predicted access matched actual in 36 of 42Answer: Mixed
“VR-predicted vascular access matched actual access in 36 (85.7%) cases.”
36 (85.7%)
From the paper · Abstract
Exact stent size match in 15 casesAnswer: Mixed
“Stent size prediction matched deployed stents in 15 (35.7%) cases”
15 (35.7%) exact; 88.1% within one size category
From the paper · Abstract
Models generated for all patientsAnswer: Yes
“VR models were successfully generated for all patients.”
From the paper · Abstract
High intra- and inter-rater reliabilityAnswer: Describes
“Intra-rater ICCs were>0.926; inter-rater ICCs were > 0.977.”
Prospective single-centre study of 10 children with complex congenital heart disease whose surgical management remained uncertain after echocardiography and conventional cardiac CT. CT angiograms were reconstructed in Elucis (v1.9) and reviewed on a Meta Quest Pro headset, and the same team's management decisions before and after VR review (corrective surgery, or no surgery/medical management) were recorded and analysed with Cohen's kappa.
“VR reconstruction in seven patients out of ten (70%)”
7 of 10 patients (70%)
From the paper · Fulltext
Conclusions (3)
Management decision changed in 7 of 10 patientsAnswer: Yes
“VR reconstruction in seven patients out of ten (70%)”
7 of 10 patients (70%)
From the paper · Full text
Pre- and post-VR decisions agreed in three patientsAnswer: Describes
“There was an agreement between the pre-VR and post-VR management decisions for three patients”
three of 10 patients, statistically not significant
From the paper · Abstract
VR showed tumor extent, changing plan to medicalAnswer: Yes
“This changed the management decision from surgical to medical, preventing a surgical misadventure.”
Two-Step Parametrial Endometriosis Nodule Excision Using Virtual Reality Technology and 3D Modelling for Surgical Planning#
Sinha R et al. · Case reports in obstetrics and gynecology · 2025
Gynecology · Case report · n: 1 patient
Used Elucis
Case report of a 29-year-old woman with left parametrial deep endometriosis involving the ureter, rectum and vaginal fornix. Her T1/T2 MRI was segmented in Elucis (v1.8.0) and a virtual preoperative surgery was done to plan excision, followed by a two-step robotic (da Vinci Xi) excision with left ureterolysis.
“This allowed the robotic surgeon to plan their detailed surgical approach (two-step excision) and perform the surgery efficiently and effectively, achieving an optimal surgical outcome and minimal surgical complications.”
From the paper · Fulltext
“Her pain VAS score for dysmenorrhea has reduced to 2/10, and there was no dyspareunia (VAS 0/10).”
VAS 2/10; dyspareunia VAS 0/10
From the paper · Fulltext
Conclusions (2)
Model shaped the two-step excision approachAnswer: Yes
“This allowed the robotic surgeon to plan their detailed surgical approach (two-step excision) and perform the surgery efficiently and effectively, achieving an optimal surgical outcome and minimal surgical complications.”
From the paper · Full text
Dysmenorrhea score 2/10 at 18 monthsAnswer: Describes
“Her pain VAS score for dysmenorrhea has reduced to 2/10, and there was no dyspareunia (VAS 0/10).”
Virtual Reality for Pre-Procedural Planning of Interventional Pain Procedures: A Real-World Application Case Series#
Siddarthan IJ et al. · Journal of clinical medicine · 2025
Anesthesia & pain · Case series · n: 6 patients
Realize Medical is acknowledged in this paper for donating access to its software for experiments.
Used Elucis
Medicalholodeck / Medical Imaging XR
Meta Quest / Oculus
Case series of six patients with anatomically complex conditions who had VR-assisted planning of interventional pain procedures (such as peripheral nerve stimulation and nerve blocks) at Weill Cornell Medical Center between August 2022 and December 2024. Patient-specific 3D models were segmented from CT or MRI and reviewed in VR headsets by the proceduralists, and the procedures were then performed under fluoroscopic or ultrasound guidance. Elucis was used for two of the cases and Medical Imaging XR for four.
Conclusions (3)
VR improved anatomy visualization in all six casesAnswer: Describes
“In all cases, VR facilitated the improved visualization of complex anatomies and informed optimal procedural trajectories.”
From the paper · Abstract
Pain relief after VR-planned lead placementAnswer: Describes
“VR enabled precise PNS lead or needle placement, resulting in significant pain reductions postoperatively.”
From the paper · Abstract
One case: VR prompted a safer approachAnswer: Describes
“in one case, VR served to potentially prevent patient harm by providing insight to the proceduralists regarding an alternative approach.”
3D Visualization Technology for Cardiac Transplant Planning in a Patient With Failing Fontan Circulation#
Ganigara M et al. · JACC. Case reports · 2025
Congenital heart · Case report · n: 1 patient
Used Elucis
Valve Index
Case report of a patient with complex single-ventricle anatomy and failing Fontan circulation who was being evaluated for heart transplantation. Cardiac CT was segmented in the FDA-cleared edition of Elucis (v1.7) and viewed on a Valve Index headset to review the anatomy, perform a virtual heart transplant and design virtual baffles before surgery.
“This planning aided the surgical team preparation for the challenge of a complex transplant surgery.”
From the paper · Full text: Case Summary
Conclusions (3)
Virtual planning aided surgical team preparationAnswer: Yes
“This planning aided the surgical team preparation for the challenge of a complex transplant surgery.”
Video abstract describing patient-specific simulation for a patient with a renal mass who was seeking partial nephrectomy: the renal artery, vein, collecting system, kidney and tumour were segmented from CT in Elucis and reviewed in VR on a Meta headset to plan the surgical approach.
Conclusions (3)
Partial nephrectomy completed after VR and hydrogel rehearsalAnswer: Describes
“The procedure was performed successfully the following morning, utilizing clamping of the Renal artery and vein, with 22 minutes of Warm ischemia time and estimated 75 cc of blood loss.”
22 minutes of warm ischemia time, estimated 75 cc of blood loss
From the paper · Abstract
Surgeon valued rehearsal to map bleeding areasAnswer: Yes
“The surgeon found value with rehearsals in the ability to identify areas of heavier vs lighter bleeding prior to transitioning to live surgery”
From the paper · Abstract
Surgeon used digital rehearsal to educate the patientAnswer: Describes
“Here the surgeon educated the patient broadly on the steps of the procedure”
Transcatheter closure of a right pulmonary artery to left atrium fistula using multi-modality image fusion guidance#
Soszyn N et al. · Cardiology in the young · 2024
Congenital heart · Case report · n: 1 patient
Includes an author who is a Realize Medical advisor.
Used Elucis
Case report of a 53-year-old woman with a late-diagnosed right pulmonary artery to left atrium fistula that was closed with a transcatheter device. Before the procedure, a 3D model from cardiac CT was segmented in Elucis to assess the fistula's size and location; separate image-fusion guidance (EchoNavigator/VesselNavigator) was used during the procedure.
Conclusions (4)
3D reconstruction and fusion imaging guided fistula closureAnswer: Yes
“We demonstrate the utility of three-dimensional reconstruction and multi-modality fusion imaging in guiding transcatheter closure of a rare right pulmonary artery-left atrium fistula.”
From the paper · Full text
No residual shunt after device closureAnswer: Describes
“Bubble contrast studies were repeated in the superior caval vein and the right pulmonary artery which demonstrated no residual shunt across the communication from the right pulmonary artery to the left atrium”
From the paper · Full text
CT 3D model overestimated fistula sizeAnswer: No
“Notably, the 3D reconstruction using the cardiac CT dataset overestimated the size of the communication between the RPA and LA.”
From the paper · Full text
Procedure time, contrast and radiation reported lowAnswer: Describes
“with the additional benefit of reducing procedure time as well as total contrast and radiation doses which remained low in this case (105 minutes, 0.9 ml/kg, and 59.1 Gycm2 respectively)”
Immersive 3-Dimensional Visualization Aids Transcatheter Management of a Patient With Multiple Pulmonary Arteriovenous Malformations#
Gurav A et al. · JACC. Case reports · 2024
Congenital heart · Case report · n: 1 patient
Used Elucis
HTC Vive
Case report of a patient with multiple pulmonary arteriovenous malformations who needed complex transcatheter treatment. CT data were segmented in Elucis and reviewed by the interventional team on an HTC Vive Pro headset, alongside a 3D-printed model, to plan the procedure.
“The angulations and take-off of the lobar branches bearing the AVMs could be understood, and catheter approaches were planned.”
“The angulations and take-off of the lobar branches bearing the AVMs could be understood, and catheter approaches were planned.”
From the paper · Full text
Oxygen saturations rose after the procedureAnswer: Describes
“Postprocedure saturations improved to 96% to 98% on room air.”
Postprocedure saturations 96% to 98% on room air
From the paper · Full text
Procedure and fluoroscopy times reportedAnswer: Describes
“The total procedure time was 90 minutes, and fluoroscopy time was 35 minutes.”
90 minutes procedure, 35 minutes fluoroscopy
From the paper · Full text
Shorter procedure claimed without a comparatorAnswer: Describes
“Advanced 3D technologies can improve our ability to understand and treat complex vascular pathologies by helping operators to overcome the learning curve, shorten the duration of the procedure, and limit radiation exposure.”
Virtual Reality Remote Collaboration for Preprocedural Planning of Complex Percutaneous Congenital Interventions: A Case Series#
Salavitabar A et al. · Journal of the Society for Cardiovascular Angiography & Interventions · 2024
Congenital heart · Case series · n: 2 patients
Includes an author who is a Realize Medical advisor.
Used Elucis
Case series of two patients (a young adult with repaired tetralogy of Fallot and a neonate with pulmonary atresia) whose CT angiograms were segmented in Elucis. Interventionalists at different institutions met remotely in VR to review the anatomy and simulate devices before planned percutaneous intervention.
“This technology allows for an enhanced form of interinstitutional mentorship and exchange of ideas in preprocedural preparation for congenital percutaneous interventions.”
From the paper · Full text
Case 1 valve implanted at planned wire positionAnswer: Yes
“A 25-mm Harmony transcatheter pulmonary valve was chosen and implanted successfully with the discussed right pulmonary artery (RPA) wire position”
From the paper · Full text
Predicted spasm occurred in case 2Answer: Describes
“As anticipated by the VR-based discussion, significant distal PDA and proximal LPA spasm occurred, with resultant RPA isolation”
Accuracy and Precision of Mandible Segmentation and Its Clinical Implications: Virtual Reality, Desktop Screen and Artificial Intelligence#
Gruber LJ et al. · Expert Systems with Applications · 2024
Oral & maxillofacial / craniofacial · Comparative study
Realize Medical is acknowledged in this paper for providing a free Elucis licence.
Used Elucis
HTC Vive
3D Slicer / SlicerVR
Comparative study of mandible segmentation from CT by five medical professionals in VR (Elucis with an HTC Vive Pro headset) and on a desktop screen (3D Slicer), and by AI models, each assessed against published reference segmentations from a public dataset. In total 150 models were analysed geometrically, and the authors discuss the implications for virtual surgical planning.
“Among the manual methods, the VR method was faster (15.9 ± 9.0 min) compared to the DS method (21 ± 10.4 min)”
15.9 ± 9.0 vs 21 ± 10.4 min, p = 0.007
From the paper · Fulltext
“VR was rated better than DS when participants were asked to perceive the anatomical structures of the mandible (6.4 vs. 4.5).”
6.4 vs 4.5 (7-point Likert, no test reported)
From the paper · Fulltext
“the manual methods were not associated with significant performance differences, with VR having a score of 4.56 ± 0.45 (mean ± SD), DS 4.33 ± 0.59, and PUBDS 4.55 ± 0.43 (Kruskal–Wallis test, p = 0.11)”
VR segmentation faster than desktop segmentationAnswer: Yes
“Among the manual methods, the VR method was faster (15.9 ± 9.0 min) compared to the DS method (21 ± 10.4 min)”
15.9 ± 9.0 vs 21 ± 10.4 min, p = 0.007
From the paper · Full text
Radiologist accuracy ratings not significantly differentAnswer: No significant difference
“the manual methods were not associated with significant performance differences, with VR having a score of 4.56 ± 0.45 (mean ± SD), DS 4.33 ± 0.59, and PUBDS 4.55 ± 0.43 (Kruskal–Wallis test, p = 0.11)”
VR rated higher for grasping mandible anatomyAnswer: Yes
“VR was rated better than DS when participants were asked to perceive the anatomical structures of the mandible (6.4 vs. 4.5).”
6.4 vs 4.5 (7-point Likert, no test reported)
From the paper · Full text
Manual segmentation more precise than reference and AIAnswer: Yes
“The precision of VR (96.8 %/0.14 mm) and DS (96.6 %/0.15 mm) was superior to PUBDS (94.1 %/0.21 mm) and the AI method (89.2 %/0.60 mm).”
VR 96.8 %/0.14 mm, DS 96.6 %/0.15 mm, PUBDS 94.1 %/0.21 mm, AI 89.2 %/0.60 mm
From the paper · Abstract
Desktop closer to reference segmentation than VRAnswer: No
“the average segmentation-to-segmentation accuracy revealed that DS (91.4 %/0.37 mm [Dice coefficient/ average Hausdorff distance]) was more comparable to PUBDS than to VR (90.1 %/0.44 mm)”
DS 91.4 %/0.37 mm vs VR 90.1 %/0.44 mm (Dice/AVD); ANOVA p < 0.001 across VR, DS and AI
Conference abstract of a pilot in which ten congenital catheter interventions (transcatheter pulmonary and mitral valves, and stenting of pulmonary arteries, aortic coarctation and the patent ductus arteriosus) in patients aged 5 days to 42 years were planned in Elucis from CT angiography, with virtual implants, before being performed in the catheterisation laboratory.
“The feasibility of procedural planning in a virtual arena has proved helpful in our institution in a variety of different interventions.”
From the paper · Full text: Conclusions
Conclusions (2)
All ten planned procedures succeededAnswer: Describes
“Each procedure was successful with no major complications.”
From the paper · Abstract
Authors found virtual planning helpfulAnswer: Yes
“The feasibility of procedural planning in a virtual arena has proved helpful in our institution in a variety of different interventions.”
From Prototype to Practice: Mixed Methods Study of Human-Centered Design and Usability Evaluation of Augmented Reality for Complex Oncology Surgical Workflows#
Matsangidou M et al. · JMIR human factors · 2026
Hepatobiliary & pancreatic (HPB) · Survey/user study
Microsoft HoloLens
Custom Unity app
Mixed-methods human-centred design study of an augmented-reality system (Unity on HoloLens 2, per the full text) for HPB oncology planning, co-designed with 14 health professionals and 10 patients and then usability-tested by 10 hepatobiliary clinicians in simulated tumour board scenarios. The authors report a mean SUS score of 67.25 and clinician-reported improvements in spatial understanding and communication.
“The prototype achieved a mean SUS score of 67.25 (SD 7.95), indicating acceptable usability.”
“Patients with cancer participating in the co-design phase valued the ability to engage with their own anatomy in an emotionally manageable way and reported that interactive visualization improved their understanding and sense of agency.”
From the paper · Abstract
Conclusions (3)
Prototype usability rated acceptable on SUSAnswer: Yes
“The prototype achieved a mean SUS score of 67.25 (SD 7.95), indicating acceptable usability.”
SUS 67.25 (SD 7.95)
From the paper · Abstract
Clinicians reported improved spatial understanding in simulationAnswer: Yes
Patients reported improved understanding and sense of agencyAnswer: Yes
“Patients with cancer participating in the co-design phase valued the ability to engage with their own anatomy in an emotionally manageable way and reported that interactive visualization improved their understanding and sense of agency.”
Augmented Reality, Mixed Reality, Computer Vision, and Three-Dimensional Modeling in Fertility-Preserving Minimally Invasive Gynecologic Surgery: A Scoping Review with Narrative Synthesis#
Karatrasoglou E et al. · Medicina (Kaunas, Lithuania) · 2026
Gynecology · Systematic review
Multiple platforms
Scoping review of 20 studies on AR, MR, computer vision, AI and 3D modelling in fertility-preserving minimally invasive gynaecologic surgery (myomectomy, adenomyomectomy, endometriosis). The authors report that most studies show technical feasibility or planning value, that only two were comparative, and that none showed improved reproductive outcomes.
“Only one study reported a reproductive outcome-pregnancy rates in a retrospective matched series of 34 patients, which did not differ between groups-and no study reported live birth, obstetric, or long-term reproductive-safety outcomes.”
From the paper · Abstract
“Current evidence supports technical feasibility and preoperative planning value but does not demonstrate improvement in reproductive outcomes; here "fertility-preserving" denotes the clinical context of the surgery rather than a demonstrated reproductive benefit.”
From the paper · Abstract
Conclusions (3)
Only one study reported pregnancy rates; no differenceAnswer: No significant difference
“pregnancy rates in a retrospective matched series of 34 patients, which did not differ between groups”
From the paper · Abstract
Feasibility and planning value, no reproductive benefit shownAnswer: Mixed
“Current evidence supports technical feasibility and preoperative planning value but does not demonstrate improvement in reproductive outcomes”
From the paper · Abstract
Only two of eleven patient studies were comparativeAnswer: Describes
“Eleven involved application of the technology in the care of patients; of these, only two were comparative”
Patient-Specific 3D-Printed Models and Mixed-Reality Head-Mounted Display Visualization for Aneurysm Clip Ligation Planning: A Methodological Workflow Study#
Haegler J et al. · Brain sciences · 2026
Neurosurgery · Case series · n: 29 patients
Magic Leap
Brainlab Elements
3D Slicer / SlicerVR
Workflow study of 29 patients having elective aneurysm clip ligation (2020-2021), for whom both mixed reality holograms (Brainlab Elements Viewer on Magic Leap One) and 3D-printed models were prepared from fused CT and 3D rotational angiography. The authors report mean preparation times of 41 minutes for MR versus 109 minutes plus about 15 hours of printing for 3D models, and an OR set-up time of 7 minutes, with limitations including manual registration.
“The mean total preparation time (mean ± standard deviation, SD) was 40.6 ± 10.3 min for MR-HMD visualization and 108.8 ± 17.8 min for 3D-printed models, excluding printing, washing, and curing time.”
40.6 ± 10.3 min
From the paper · Abstract
“MR-HMD setup in the operating room averaged 7.0 ± 2.8 min.”
7.0 ± 2.8 min
From the paper · Abstract
“Identified limitations included manual hologram registration and repositioning after table or patient position changes, as well as the inability to track instruments or interact with the hologram.”
“The mean total preparation time (mean ± standard deviation, SD) was 40.6 ± 10.3 min for MR-HMD visualization and 108.8 ± 17.8 min for 3D-printed models, excluding printing, washing, and curing time.”
“MR-HMD setup in the operating room averaged 7.0 ± 2.8 min.”
7.0 ± 2.8 min
From the paper · Abstract
Manual registration and no instrument trackingAnswer: Describes
“Identified limitations included manual hologram registration and repositioning after table or patient position changes, as well as the inability to track instruments or interact with the hologram.”
Case report of a 77-year-old woman with persistent atrial fibrillation in whom a CT-based left atrial model (GUIDEYE) was viewed in VR (Gravity Sketch, Meta Quest 3) together with modelled Faradrive sheath and Farawave catheter geometry to simulate catheter positioning before pulsed field ablation. Sheath and catheter positions matched the simulation, and residual potentials at the left pulmonary vein carina, flagged as a risk on the VR model, were found on mapping and eliminated with extra applications. The authors note the VR finding did not change the predefined ablation plan but prompted reassessment.
“Consistent with the VR-based prediction, residual potentials were subsequently identified at the left PV carina on high-density mapping and were successfully eliminated with additional applications.”
From the paper · Full text: Discussion
“However, because routine empirical ablation of the left PV carina is not part of our standard strategy, this finding did not lead to a predefined modification of the initial ablation plan.”
From the paper · Full text: Discussion
Conclusions (4)
VR-flagged carina site showed residual potentialsAnswer: Yes
“Consistent with the VR-based prediction, residual potentials were subsequently identified at the left PV carina on high-density mapping and were successfully eliminated with additional applications.”
From the paper · Full text
VR finding did not change ablation planAnswer: No
“However, because routine empirical ablation of the left PV carina is not part of our standard strategy, this finding did not lead to a predefined modification of the initial ablation plan.”
From the paper · Full text
Sheath and catheter positions matched VR simulationAnswer: Yes
“The sheath and catheter positions were consistent with those predicted by the preprocedural VR simulation”
From the paper · Full text
VR simulation took about 10 minutesAnswer: Describes
“The VR simulation process required approximately 10 minutes”
Mixed reality applications in percutaneous stone surgery: A systematic review and meta-analysis of stone-free rate and perioperative complications#
Lo CY et al. · BJUI compass · 2026
Urology · Systematic review
Multiple platforms
Systematic review and meta-analysis of nine studies (774 patients) comparing mixed-reality-assisted PCNL, including immersive VR planning, holographic MR and CT-ultrasound fusion navigation, with standard fluoroscopic or ultrasound guidance. The authors report a modest improvement in stone-free rate (RR 1.09), similar complication rates and no significant difference in puncture or operative time, with heterogeneity limiting generalisability.
“The MR-assisted group had modest improvements in SFR compared to the control group (RR = 1.09; 95% CI 1.00-1.18; p = 0.044; I 2 = 17.3%, p = 0.29).”
RR = 1.09
From the paper · Abstract
“Complication rates were similar between MR-assisted and standard approaches.”
From the paper · Abstract
“There was no statistically significant difference in puncture time between MR-assisted and standard groups (SMD = -0.64; 95% CI -2.22 to 0.93; p = 0.42), with considerable heterogeneity.”
p = 0.42
From the paper · Abstract
Conclusions (5)
Stone-free rate modestly higher with MRAnswer: Yes
“The MR-assisted group had modest improvements in SFR compared to the control group (RR = 1.09; 95% CI 1.00-1.18; p = 0.044; I 2 = 17.3%, p = 0.29).”
RR = 1.09; 95% CI 1.00-1.18; p = 0.044
From the paper · Abstract
No significant difference in operative durationAnswer: No significant difference
“there was no statistically significant difference in operative duration (SMD = −0.22; 95% CI ‐0.66 to +0.23; p = 0.34)”
SMD = −0.22; 95% CI ‐0.66 to +0.23; p = 0.34
From the paper · Abstract
No significant difference in puncture timeAnswer: No significant difference
“There was no statistically significant difference in puncture time between MR-assisted and standard groups (SMD = -0.64; 95% CI -2.22 to 0.93; p = 0.42), with considerable heterogeneity.”
SMD = -0.64; 95% CI -2.22 to 0.93; p = 0.42
From the paper · Abstract
Complication rates similar between approachesAnswer: No significant difference
“Complication rates were similar between MR-assisted and standard approaches.”
From the paper · Abstract
Stone-free rate not significant in RCTsAnswer: No significant difference
“Subgroup analysis of SFR using four RCT‐only studies demonstrated a pooled RR of 1.13 (95% CI 0.98–1.30, p = 0.10), which was not statistically significant”
Bringing paediatric coronary artery abnormalities into view: the role of virtual reality#
Ng CW et al. · European heart journal. Imaging methods and practice · 2026
Congenital heart · Case series · n: 7 patients
Elucis
Meta Quest / Oculus
Case series of seven children (four infants and three teenagers) with congenital or acquired coronary artery abnormalities, including anomalous left coronary artery from the pulmonary artery (ALCAPA), Kawasaki disease aneurysms, a sinus of Valsalva aneurysm and transposition with a single coronary origin. CT coronary angiograms were segmented in Elucis and reviewed on a Meta Quest 3 headset to depict the coronary anatomy.
Pilot randomised trial of 30 patients scheduled for technically challenging lumbar transforaminal epidural steroid injection, in which the operator either rehearsed on a patient-specific 3D VR model from CT the day before (15) or reviewed imaging only (15). The authors report shorter procedure time (216 vs 255 seconds) and fewer fluoroscopic images in the VR group, with no significant differences in needle-bone contacts, intravascular uptake or satisfaction.
“Procedure time was shorter in the VR group than in the control group (215.7 ± 46.8 sec vs 254.5 ± 50.3 sec; mean difference, -38.9 sec; 95% CI, -75.2 to -2.5; p = 0.037).”
p = 0.037
From the paper · Abstract
“Patient satisfaction and intravascular contrast uptake did not differ significantly between groups.”
From the paper · Abstract
Conclusions (3)
Procedure time shorter after VR rehearsalAnswer: Yes
“procedure time was shorter in the VR group than in the control group (215.7 ± 46.8 sec vs 254.5 ± 50.3 sec; mean difference, −38.9 seconds; 95% CI, −75.2 to −2.5; p = 0.037).”
215.7 vs 254.5 sec, p = 0.037
From the paper · Full text
Fewer fluoroscopic image acquisitionsAnswer: Yes
“The number of fluoroscopic image acquisitions was also lower in the VR group (10.27 ± 2.74 vs 13.27 ± 3.65 acquisitions; mean difference, −3.00 acquisitions; 95% CI, −5.41 to −0.59; p = 0.017).”
10.27 vs 13.27 acquisitions, p = 0.017
From the paper · Full text
Needle-bone contacts not significantly lowerAnswer: No significant difference
“the number of needle-bone contacts was numerically lower in the VR group (control vs VR: 2.1 ± 1.3 vs 1.3 ± 1.1), although this difference did not reach statistical significance (p = 0.081).”
Next viewer-development of a software for the spatial computing data glasses apple vision pro for patient-specific preoperative planning and navigation#
Günther C et al. · Frontiers in digital health · 2026
Neurosurgery · Survey/user study
Apple Vision Pro
Development and evaluation of nextViewer, an Apple Vision Pro app for patient-specific neurosurgical planning, with controller-free 3D model manipulation, trajectory drawing, multiplanar finger navigation and multi-user collaboration. Fifteen experienced neurosurgeons gave a mean Likert score of +1.7 (scale -2 to +2).
“The systematic evaluation yielded a highly positive total score of +1.7.”
+1.7
From the paper · Abstract
“Surgeons specifically highlighted the controller-free interaction and the exceptional graphical resolution as significant advantages over legacy visualization systems.”
From the paper · Abstract
“Surgical procedures are easier to understand through the 3D visualization provided by the headset and represent an improvement over conventional multiplanar visualization.”
mean 1.9
From the paper · Fulltext
“The system is suitable for daily use during morning case conferences.”
mean 1.5
From the paper · Fulltext
Conclusions (3)
Surgeons rated the planning app highlyAnswer: Yes
“The systematic evaluation yielded a highly positive total score of +1.7.”
+1.7 (SD = 0.4) on a -2 to +2 scale
From the paper · Abstract
3D headset view rated easier to understandAnswer: Yes
“Surgical procedures are easier to understand through the 3D visualization provided by the headset and represent an improvement over conventional multiplanar visualization.”
mean 1.9
From the paper · Full text
Surgeons agreed it suits daily case conferencesAnswer: Yes
“The system is suitable for daily use during morning case conferences.”
Augmented and virtual reality for preprocedural planning and intraprocedural guidance in transplant hepatic artery stenting#
Gordon AC et al. · Abdominal radiology (New York) · 2026
Interventional radiology · Feasibility study · n: 8 patients
AR/MR, platform not specified
Single-centre pilot study of eight consecutive patients having transplant hepatic artery stenting in whom an AR/VR headset was used for preprocedural planning, and in the last three cases for intraprocedural display of live fluoroscopy. The authors report technical success without major complications in all cases, a median planning time of 4.5 minutes, a perceived change in approach in 6 of 8 cases, and low ratings for headset comfort.
“AR/VR planning represented 3.6% of case time and was perceived to change the approach in 6/8 cases (75%).”
6/8 cases (75%)
From the paper · Abstract
“Headset comfort was lowest-rated.”
From the paper · Abstract
Conclusions (5)
All eight cases technically successfulAnswer: Describes
“All cases were technically suc
cessful without major complications.”
From the paper · Abstract
Perceived approach change in 6 of 8 casesAnswer: Yes
“AR/VR planning represented 3.6% of case time and was perceived to change the approach in 6/8 cases (75%).”
6/8 cases (75%)
From the paper · Abstract
Median planning time 4.5 minutesAnswer: Describes
“Median case, fluoroscopy, and AR/VR planning times were 159.5, 34.8, and 4.5 min, respectively”
planning 4.5 min, 3.6% of case time
From the paper · Abstract
Headset comfort rated lowestAnswer: Describes
“Headset comfort was lowest-rated.”
From the paper · Abstract
Visualization and confidence rated median 5Answer: Yes
“Visualization, workflow integration, confidence, and anatomic understanding each received median scores of 5.”
Comparative evaluation of mixed reality, CTA-based digital guide, and hand-held Doppler for anterolateral thigh perforator localization in head and neck reconstruction#
Zhu H et al. · International journal of oral and maxillofacial surgery · 2026
Exploratory comparison in 12 patients needing anterolateral thigh flaps after oral and maxillofacial tumour resection, in which perforators were mapped preoperatively with hand-held Doppler, a CTA-based digital guide and CTA with mixed reality, against intraoperative findings. The authors report localisation accuracy of 75.7%, 85.3% and 91.2% respectively, the smallest error with CTA-MR, less preparation time than guide fabrication but longer localisation time, and survival of all flaps.
“The accuracy of perforator localization was 75.7% for HHD, 85.3% for CTA-guide, and 91.2% for CTA-MR; sensitivity was 87.5%, 90.6%, and 96.9%, respectively.”
91.2%
From the paper · Abstract
“CTA-MR required less preparation time than guide fabrication but a longer intraoperative localization time than guide placement.”
From the paper · Abstract
“All flaps survived; no donor site complications were observed.”
From the paper · Abstract
Conclusions (3)
Localization accuracy highest with CTA plus MRAnswer: Yes
“The accuracy of perforator localization was 75.7% for HHD, 85.3% for CTA-guide, and 91.2% for CTA-MR; sensitivity was 87.5%, 90.6%, and 96.9%, respectively.”
75.7% vs 85.3% vs 91.2%
From the paper · Abstract
Less preparation time, longer localization timeAnswer: Mixed
“CTA-MR required less preparation time than guide fabrication but a longer intraoperative localization time than guide placement.”
From the paper · Abstract
All flaps survived, no donor complicationsAnswer: Describes
“All flaps survived; no donor site complications were observed.”
Thoracoscopic surgery for congenital pulmonary malformations in infants: a preliminary comparative evaluation of virtual reality-guided preoperative planning versus standard imaging#
Pierucci UM et al. · Surgical endoscopy · 2026
Thoracic · Retrospective cohort · n: 50 patients
VR, platform not specified
Retrospective historical cohort of 50 infants undergoing thoracoscopic resection of congenital pulmonary malformations, comparing standard imaging alone (39) with an added workflow of patient-specific 3D segmentation and immersive VR navigation (11). The authors report no conversions in the VR group versus 10 in the standard group, shorter intensive care and hospital stays, and no redo surgery, while noting case-mix differences and that VR cases came later in the institution's experience.
“Median operative time was 183 versus 248 min (p = 0.42).”
p = 0.42
From the paper · Abstract
“Conversion occurred in 10/39 SI cases and no VR cases (p = 0.045); intraoperative complications occurred in 5/39 and 0/11 (p = 0.20), and postoperative complications in 6/39 and 0/11 (p = 0.16).”
p = 0.045
From the paper · Abstract
“The integrated VR-guided workflow was feasible and associated with favorable perioperative signals.”
From the paper · Abstract
Conclusions (4)
Operative time not significantly differentAnswer: No significant difference
“Median operative time was 183 versus 248 min (p=0.42).”
183 vs 248 min, p=0.42
From the paper · Abstract
No conversions in VR group, 10 in standardAnswer: Yes
“Conversion occurred in 10/39 SI cases and no VR cases (p=0.045)”
10/39 SI vs no VR cases, p=0.045
From the paper · Abstract
Intraoperative complications not significantly differentAnswer: No significant difference
“intraoperative complications occurred in 5/39 and 0/11 (p=0.20)”
Mixed Reality-Assisted Surgical Planning and Patient Education in a Complex Craniovertebral Junction Anomaly: A Case Report#
Rudrappa S et al. · International journal of spine surgery · 2026
Spine · Case report · n: 1 patient
AR/MR, platform not specified
Case report of a 36-year-old woman with basilar invagination and assimilated atlas causing severe cord compression, in whom combined CT and MRI were viewed in a mixed-reality viewer to plan screw trajectories around asymmetric facets and to counsel the patient and family. She underwent posterior C1-C2 reconstruction and fusion, and the authors report full neurological recovery (mJOA 18/18) at one year.
“Using MR, the patient and family were counseled about the need for surgery.”
From the paper · Abstract
“MR also facilitated preoperative surgical planning by improving anatomical understanding, particularly regarding the anatomy of asymmetric facets and screw trajectories.”
“MR also facilitated preoperative surgical planning by improving anatomical understanding, particularly regarding the anatomy of asymmetric facets and screw trajectories.”
From the paper · Abstract
Patient and family counseled with MRAnswer: Describes
“Using MR, the patient and family were counseled about the need for surgery.”
From the paper · Abstract
Improved neurology at one yearAnswer: Describes
“the patient was able to ambulate on her own with improved neurology (modified Japanese Orthopaedic Association score 18/18)”
True-3D Holography for Preoperative Planning in Pediatric Thoracoscopic Lung Segmentectomy#
Suzuki T et al. · Pediatrics international · 2026
Thoracic · Case report
Autostereoscopic/holographic display
Clinical note on 'true-3D' holography for preoperative planning of paediatric thoracoscopic lung segmentectomy (congenital pulmonary airway malformation). Only the title and keywords were openly available, so the system and number of patients could not be confirmed.
Usefulness of virtual reality application in pediatric urology#
Heera T et al. · Pediatric surgery international · 2026
Urology · Retrospective case series · n: 20 patients
ImmersiveTouch
Study of 20 children with complex urological anatomy (of 275 managed in one year) whose CT/MRI scans were reconstructed in an ImmersiveTouch VR environment, with three surgeons rating usefulness on a 1-5 scale. The authors report mean scores of 3.6 for surgical planning, 3.9 for anatomical delineation and higher scores for student teaching (4.2) and patient counselling (4.1), with good inter-rater agreement.
“The mean usefulness score was: anatomical delineation 3.9, haptic tools 3.1, surgical planning 3.6, student training 4.2 and patient counselling 4.1.”
surgical planning 3.6
From the paper · Abstract
Conclusions (3)
Usefulness rated 3.1 to 4.2 of 5Answer: Describes
“The mean usefulness score was: anatomical delineation 3.9, haptic tools 3.1, surgical planning 3.6, student training 4.2 and patient counselling 4.1.”
Case report of a 69-year-old man with a posterosuperior peridevice leak after Watchman left atrial appendage closure. CT-based holograms in the HJPHub mixed-reality system on HoloLens 2 were used before the procedure to assess the left atrial anatomy, choose the transseptal puncture site and anticipate a telescoping catheter technique; the team went back to the MR model during the procedure after TEE navigation failed. The leak was closed with coils, with no residual leak at three months. The authors note the single-case design, the qualitative nature of the MR contribution and the lack of randomised data.
“The HJPHub system enabled three-dimensional assessment of complex anatomy, facilitating optimal transseptal puncture site selection.”
From the paper · Full text: Discussion
“Limitations include single-case observation, precluding generalizability, and the need for longer-term follow-up to assess durability.”
From the paper · Full text: Discussion
Conclusions (3)
Complex peridevice leak closed with coilsAnswer: Yes
“Mixed reality guidance using the validated HJPHub system facilitated successful coil embolization of a challenging posterosuperior PDL following LAAC.”
From the paper · Full text
3D assessment aided puncture site selectionAnswer: Yes
“The HJPHub system enabled three-dimensional assessment of complex anatomy, facilitating optimal transseptal puncture site selection.”
From the paper · Full text
Live 3D echo failed to guide cannulationAnswer: Describes
“Critically, despite real-time TEE navigation, the cavity entry could not be cannulated—even with live 3D TEE.”
Narrative review (last five years) of VR across the PCI pathway: operator training, patient-specific pre-procedural planning and rehearsal, intraprocedural visualization, and patient-centred uses such as anxiety reduction. The authors note heterogeneous, mostly small studies, with patient-specific VR supporting planning of anatomically complex PCI.
“The principal barriers are the absence of robust haptic feedback, cost, limited validation, cybersickness, and a scarcity of outcome-driven randomised trials.”
From the paper · Abstract
Conclusions (3)
Evidence mostly small studies and feasibility reportsAnswer: Describes
“The evidence is heterogeneous and dominated by small studies, feasibility reports, and a growing number of randomised trials in the patient-anxiety domain.”
From the paper · Abstract
Authors say patient-specific VR can support planningAnswer: Describes
“patient-specific VR can support planning in anatomically complex PCI.”
From the paper · Abstract
Haptics, cost and validation limit adoptionAnswer: Describes
“The principal barriers are the absence of robust haptic feedback, cost, limited validation, cybersickness, and a scarcity of outcome-driven randomised trials.”
Virtual reality-assisted 'X-ray vision' planning for chest wall reconstruction and rib fixation#
Kuckelman J et al. · American journal of surgery · 2026
Thoracic · Editorial (no abstract)
VR, platform not specified
Short article (indexed as an editorial) in the American Journal of Surgery on virtual reality-assisted 'X-ray vision' planning for chest wall reconstruction and rib fixation. No abstract was available, so these details are from the title and venue and could not be confirmed.
3D Reconstruction and Holographic XR Navigation in Robot-Assisted Sacrocolpopexy: A Report of Two Cases#
Amano T et al. · The journal of obstetrics and gynaecology research · 2026
Gynecology · Case series · n: 2 patients
AR/MR, platform not specified
Report of two robot-assisted sacrocolpopexy cases in which preoperative 3D reconstruction and holographic extended-reality visualisation were used to assess the vascular anatomy at the sacral promontory and plan mesh fixation, with the images shown intraoperatively via TilePro on the robotic console. The authors report that a vascularly safe region identified preoperatively was reproduced during surgery, and that neither procedure caused vascular injury.
“Preoperative 3D reconstruction and holographic XR visualization may facilitate safer sacral promontory dissection during RSC by improving spatial understanding of patient-specific vascular anatomy and supporting patient-specific surgical planning and intraoperative navigation.”
From the paper · Abstract
Conclusions (2)
Both procedures completed without vascular injuryAnswer: Describes
“Both procedures were completed without vascular injury.”
From the paper · Abstract
Safe region reproduced from holographic imageAnswer: Describes
“The previously identified vascularly safe region was reproduced intraoperatively by referring to the holographic image displayed on the surgeon console”
Augmented and Virtual Reality for Preprocedural Planning in Hepatic Transarterial Interventional Oncology: A Pilot Study in 50 Cases#
Zahra SA et al. · Journal of vascular and interventional radiology · 2026
Interventional radiology · Feasibility study · n: 50 cases
Apple Vision Pro
Single-centre pilot study of 50 transarterial interventional oncology cases (mostly hepatic angiography before yttrium-90 radioembolisation) in which interventional radiologists reviewed patient-specific volume renderings on an Apple Vision Pro headset with Visage Ease VP software before the procedure. The authors report a median planning time of 5 minutes, a change in procedural approach in 46% of cases, high ratings for visualisation and confidence, and low ratings for headset comfort.
“AR/VR planning changed the procedural approach in 23 of 50 cases (46%).”
Mixed Reality as a Tool for Congenital Heart Disease Case Management Discussions#
Gunsaulus M et al. · Pediatric cardiology · 2026
Congenital heart · Survey/user study · n: 12 cases
EchoPixel True 3D
Prospective single-centre study of integrating mixed-reality presentations into multidisciplinary congenital heart case conferences, using EchoPixel True3D with glasses linked to a 3D projector to show CT-derived models of 12 cases. The authors report that 75% of post-presentation respondents felt their understanding of the anatomy improved, and that among surgeons and interventionalists 82% reported improved procedural planning and 57% changed their procedural approach.
“Among surgeons and interventionalists, 82% reported improved procedural planning and 57% altered their procedural approach.”
57%
From the paper · Abstract
“75% felt that MR improved their understanding of the cardiac anatomy, and 89% supported regular use of MR in CMC.”
89%
From the paper · Abstract
“75% felt that MR improved their understanding of the cardiac anatomy”
75%
From the paper · Abstract
Conclusions (3)
57% of operators altered procedural approachAnswer: Yes
“Among surgeons and interventionalists, 82% reported improved procedural planning and 57% altered their procedural approach.”
Extended reality simulator for dynamic visualization and evaluation of stereotactic arrhythmia radioablation (STAR) treatment plans within RAVENTA trial#
Riggio D et al. · European heart journal. Digital health · 2026
Radiation oncology · Technical development · n: 3 patients
Microsoft HoloLens
Custom Unity app
Technical study of an extended reality simulator (Unity, HoloLens 2) that shows cardiac CT, respiratory-binned 4DCT, electroanatomical maps and phase-recomputed dose to evaluate stereotactic arrhythmia radioablation treatment plans in the RAVENTA trial. Tested on three patients, the authors report up to 17.5 mm target motion and positive perceived value for understanding target, anatomy and dose, and for interdisciplinary communication.
“Expert evaluation showed positive perceived utility for target-anatomy-dose understanding, motion interpretation, and multidisciplinary communication.”
From the paper · Abstract
“This proof-of-concept demonstrates the feasibility and potential clinical value of XR-based motion-aware dose visualization for STAR planning.”
From the paper · Abstract
Conclusions (4)
Target motion up to 17.5 mmAnswer: Describes
“Motion analysis revealed PTV centroid displacement amplitudes over the breathing cycle of up to 17.5, 10.2, and 8.9 mm for patients 1, 2, and 3, respectively”
“Expert evaluation showed positive perceived utility for target-anatomy-dose understanding, motion interpretation, and multidisciplinary communication.”
From the paper · Abstract
All six experts agreed on team communicationAnswer: Yes
“All participants reported high agreement for multidisciplinary case discussion, reduction of planning ambiguity, suitability for STAR planning, and team communication compared with the current workflow.”
6/6 high agreement
From the paper · Full text
Proof of concept shown feasibleAnswer: Yes
“This proof-of-concept demonstrates the feasibility and potential clinical value of XR-based motion-aware dose visualization for STAR planning.”
Merging realities: Virtual and augmented platforms utilization for complex chest wall surgery-a case series#
Veit T et al. · The journal of trauma and acute care surgery · 2026
Thoracic · Case series · n: 35 patients
VR, platform not specified
AR/MR, platform not specified
Two-centre case series of 35 consecutive patients having chest wall procedures (mostly rib fracture fixation and chest wall reconstruction). Five thoracic surgeons reviewed CT-based 3D anatomy on a VR/AR headset for planning, and optionally used AR intraoperatively for incision planning and trajectory checks. Combined VR/AR was used in 77% of cases; the authors report no VR/AR-related intraoperative complications and describe the approach as feasible.
“Combined VR/AR was used in 77% of cases, whereas 22% underwent VR-only planning due to early connectivity and AR calibration limitations.”
77%
From the paper · Abstract
“No intraoperative complications related to VR or AR were observed.”
From the paper · Abstract
“Integration of VR and AR platforms for complex chest wall surgery was feasible within our practice.”
From the paper · Abstract
Conclusions (4)
Mean operative time 93 minutesAnswer: Describes
“Mean operative time was 93 minutes.”
93 minutes
From the paper · Abstract
VR/AR integration feasible in practiceAnswer: Yes
“Integration of VR and AR platforms for complex chest wall surgery was feasible within our practice.”
From the paper · Abstract
Combined VR/AR used in 77% of casesAnswer: Yes
“Combined VR/AR was used in 77% of cases, whereas 22% underwent VR-only planning due to early connectivity and AR calibration limitations.”
77%
From the paper · Abstract
No VR/AR-related intraoperative complicationsAnswer: Describes
“No intraoperative complications related to VR or AR were observed.”
Resection of C3 osteochondroma in a 20-year-old male with the combination of virtual reality and 3D printing for preoperative planning: illustrative case#
Abbas A et al. · Journal of neurosurgery. Case lessons · 2026
Spine · Case report · n: 1 patient
3D Slicer / SlicerVR
HTC Vive
SieVRt (Luxsonic)
Illustrative case of a 20-year-old man with hereditary multiple exostoses and an anterior C3 osteochondroma extending into the parapharyngeal space. Planning used patient-specific 3D-printed models and immersive VR (SieVRt on an HTC Vive Pro, models segmented in 3D Slicer), followed by navigated osteotomy. The authors report complete resection without complications and resolution of dysphagia.
“Complete tumor resection was achieved without neurological or vascular complications and without breach of the upper aerodigestive tract, with complete resolution of dysphagia and no recurrence at the 3-month follow-up.”
From the paper · Abstract
Conclusions (2)
Complete resection, dysphagia resolved at 3 monthsAnswer: Describes
“Complete tumor resection was achieved without neurological or vascular complications and without breach of the upper aerodigestive tract, with complete resolution of dysphagia and no recurrence at the 3-month follow-up.”
From the paper · Abstract
Authors report planning value in complex spineAnswer: Describes
“Advanced preoperative planning using 3D printing and VR provide significant value for rare and anatomically complex spinal pathology, especially when multiple surgical services are involved.”
Effect of virtual reality on spatial-anatomical understanding in preoperative liver surgery: a randomized crossover study#
Zolkin A et al. · Scientific reports · 2026
Hepatobiliary & pancreatic (HPB) · Comparative study
Custom Unity app
Randomised crossover study in which 58 medical students analysed 3D liver models of varying complexity in VR and on a desktop display, answering questions on lesion-vessel relationships and segment allocation. The authors report significantly better performance with VR for complex models but comparable results for simple ones, with the VR advantage correlating with visuospatial ability.
“In complex models, VR significantly improved performance compared with desktop visualization (28.0 ± 3.3 vs. 26.4 ± 3.6; p = 0.002, d = 0.46), whereas results for simpler models were comparable.”
p = 0.002
From the paper · Abstract
“These findings indicate that VR is associated with measurable advantages under higher task complexity, supporting its potential role in surgical education and preoperative planning, although the present design cannot isolate which immersive features drive this benefit.”
From the paper · Abstract
Conclusions (2)
VR improved scores on complex models onlyAnswer: Mixed
“In complex models, VR significantly improved performance compared with desktop visualization (28.0 ± 3.3 vs. 26.4 ± 3.6; p = 0.002, d = 0.46), whereas results for simpler models were comparable.”
28.0 ± 3.3 vs. 26.4 ± 3.6, p = 0.002, d = 0.46
From the paper · Abstract
VR advantage correlates with visuospatial abilityAnswer: Yes
“The VR advantage scaled with task complexity and correlated with higher visuospatial ability ( r = 0.31, p = 0.018).”
Non-surgical management of post-Ross left ventricular pseudoaneurysm assisted by virtual reality imaging#
Thejaswi P et al. · Annals of pediatric cardiology · 2026
Congenital heart · Case report · n: 1 patient
VMersive (VR-Learning)
Case report of a 15-year-old boy (previous subpulmonic VSD) having percutaneous transapical device closure of a large left ventricular pseudoaneurysm after a Ross procedure for aortic valve endocarditis, with procedural planning supported by cardiac CT and VR reconstruction (VMersive).
“We report the successful transapical device closure of a large left ventricular pseudoaneurysm following a Ross procedure for aortic valve IE.”
From the paper · Abstract
“As the VR reconstructions had suggested an irregular shape of the orifices earlier, the detection of residual flows above the caudally placed muscular VSD device immediately allowed us to switch to plan B, using a sandwich between two occluders”
From the paper · Fulltext
Conclusions (2)
Transapical closure of pseudoaneurysm reported successfulAnswer: Describes
“We report the successful transapical device closure of a large left ventricular pseudoaneurysm following a Ross procedure for aortic valve IE”
“As the VR reconstructions had suggested an irregular shape of the orifices earlier, the detection of residual flows above the caudally placed muscular VSD device immediately allowed us to switch to plan B, using a sandwich between two occluders”
Virtual reality-based 3D prostate models for robot-assisted radical prostatectomy: a prospective exploratory study of membranous urethral length and early urinary continence recovery#
Azhar RA et al. · BMC urology · 2026
Urology · Prospective cohort · n: 35 patients
VR, platform not specified
Prospective exploratory study of 35 men undergoing robot-assisted radical prostatectomy for whom MRI-based 3D prostate models were viewed in VR headsets and/or on the robotic console for planning and intraoperative reference. The authors report near-perfect agreement of the models with histopathology for extraprostatic extension and seminal vesicle invasion, and an association between model-measured membranous urethral length and early continence recovery.
“VR 3D models showed almost perfect agreement with the final histopathology for extraprostatic extension (EPE) (κ = 0.88; accuracy 94.3%) and perfect agreement for SVI (κ = 1.00).”
κ = 0.88
From the paper · Abstract
“VR-based 3D prostate models may represent a useful adjunct for surgical planning in RARP and could help inform nerve-sparing strategies.”
From the paper · Abstract
“These exploratory findings should be interpreted with caution and require confirmation in larger, multicenter prospective studies with longer follow-up periods.”
From the paper · Abstract
“Social continence recovery was observed in 30 (85.7%) and 32 (91.4%) patients at 3 and 6 months post-operatively, respectively.”
30 (85.7%) at 3 months, 32 (91.4%) at 6 months
From the paper · Fulltext
Conclusions (3)
Models agreed with histopathology for EPE and SVIAnswer: Yes
“VR 3D models showed almost perfect agreement with the final histopathology for extraprostatic extension (EPE) (κ = 0.88; accuracy 94.3%) and perfect agreement for SVI (κ = 1.00).”
EPE κ = 0.88, accuracy 94.3%; SVI κ = 1.00
From the paper · Abstract
Social continence recovery at 3 and 6 monthsAnswer: Describes
“Social continence recovery was observed in 30 (85.7%) and 32 (91.4%) patients at 3 and 6 months post-operatively, respectively.”
30 (85.7%) at 3 months, 32 (91.4%) at 6 months
From the paper · Full text
14 mm urethral length cutoff tied to continenceAnswer: Describes
“Receiver operating characteristic (ROC) curve analysis identified an optimal MUL cutoff of 14 mm associated with social continence recovery at 3 months, with an area under the curve (AUC) of 0.86, a sensitivity of 89%, and a specificity of 68%”
Immersive Three-Dimensional Visualization as a Routine Tool for Complex Congenital Cardiac Surgical Planning: A Perspective#
Ganigara M et al. · Pediatric cardiology · 2026
Congenital heart · Narrative review
Multiple platforms
Perspective article arguing for case-selected, routine use of immersive 3D visualisation (CT segmentation, virtual reality and 3D printing) in planning complex congenital cardiac surgery. The authors note that current evidence is modest and mostly single-centre, discuss the human and institutional factors that affect real-world usefulness, and propose criteria for adoption while calling for prospective outcome data.
“Current evidence, though modest and largely single-centre, consistently shows that 3D models can faithfully represent complex anatomy and that clinicians repeatedly report improved comprehension of spatial relationships through their use.”
From the paper · Abstract
“Prospective outcome data are needed; in their absence, thoughtful incorporation of these tools into surgical planning workflows represents a clinically rational approach.”
“Current evidence, though modest and largely single-centre, consistently shows that 3D models can faithfully represent complex anatomy and that clinicians repeatedly report improved comprehension of spatial relationships through their use.”
From the paper · Abstract
Prospective outcome data still neededAnswer: Describes
“Prospective outcome data are needed; in their absence, thoughtful incorporation of these tools into surgical planning workflows represents a clinically rational approach.”
Mixed reality improves agreement on surgical approach selection and patient positioning in tibial plateau fracture planning compared to CT, 3DCT and 3D printing#
Dust T et al. · European journal of trauma and emergency surgery · 2026
Orthopedics · Comparative study · n: 22 cases
Microsoft HoloLens
Comparative study in which 12 orthopaedic trauma surgeons assessed 22 surgically treated tibial plateau fractures with CT, 3D CT, 3D-printed models and mixed reality on HoloLens 2, choosing treatment concept, patient positioning and surgical approach. The authors report that MR gave the highest interobserver agreement for surgical approach and positioning, especially among junior surgeons, while agreement on treatment concept was high with all modalities.
“Mixed Reality (MR) improved interobserver agreement in preoperative planning for tibial plateau fractures, particularly for surgical approach selection and patient positioning.”
From the paper · Abstract
“These effects were most pronounced among less experienced raters, highlighting MR's role as a cognitive support tool and a promising instrument in surgical education.”
From the paper · Abstract
Conclusions (3)
Approach agreement similar across all modalitiesAnswer: Describes
“Percentage match (PM) was 29% for both CT and 3DCT, increased to 33% for 3D-printed models, and reached 32% for MR.”
PM 29% CT and 3DCT, 33% 3D print, 32% MR, not tested
From the paper · Full text
Positioning agreement 57% with MR, 46% with CTAnswer: Describes
“Across all raters, PM was 46% for both CT and 3DCT, increased to 53% with 3D-printed models, and further increased to 57% with MR.”
PM 46% CT and 3DCT, 53% 3D print, 57% MR, not tested
From the paper · Full text
Junior surgeons' approach agreement rose with MRAnswer: Describes
“In this subgroup, PM increased from 27% with CT and 3DCT to 34% with 3D-printed models and to 39% with MR, while kappa values increased from 0.19 to 0.28.”
PM 27% CT, 34% 3D print, 39% MR; kappa 0.19 to 0.28, not tested
Virtual reality modeling for multidisciplinary surgical planning for complex single ventricular physiology#
Nathan A et al. · The international journal of cardiovascular imaging · 2026
Congenital heart · Case report · n: 1 patient
VR, platform not specified
Case report of a 34-month-old child with borderline single-ventricle physiology, in whom a CT-based VR model was used to estimate ventricular size and simulate a virtual biventricular repair. This showed inadequate outflow tracts after patching and baffling, so Fontan completion was confirmed. The authors highlight its value for multidisciplinary consensus.
“We report how the use of a 3-dimensional virtual reality model informed an accurate estimation of a 34-month-old child's ventricular chamber size to confirm Fontan completion.”
From the paper · Abstract
“This case demonstrates the implications of virtual reality for congenital heart disease surgical planning, providing a shared, intuitive platform for multidisciplinary discussion and consensus-building among surgeons, cardiologists, imagers, and anesthesiologists.”
From the paper · Abstract
“model simulated a virtual biventricular repair and demonstrated inadequate outflow tracts after patching and baffle”
From the paper · Abstract
Conclusions (3)
VR model informed ventricular size estimateAnswer: Yes
“We report how the use of a 3-dimensional virtual reality model informed an accurate estimation of a 34-month-old child”
Report of an 'Avatar Patient' framework for staged separation of total vertical craniopagus twins: coregistered multimodal imaging produced both immersive, multiuser VR models in a collaborative metaverse and operable multimaterial physical simulators, both updated after each surgical stage. The authors report that it reshaped the multistep approach and supported venous partition and reconstruction planning.
“The integrated simulation reshaped the multistep approach, allowing venous partition strategies and refined cranial reconstruction planning to be discussed, replicated, and enhanced multidisciplinarily.”
From the paper · Abstract
Conclusions (2)
Simulation reshaped the multistep separation approachAnswer: Yes
“The integrated simulation reshaped the multistep approach, allowing venous partition strategies and refined cranial reconstruction planning to be discussed, replicated, and enhanced multidisciplinarily.”
From the paper · Abstract
Updated models anticipated anatomic change between stagesAnswer: Yes
“Iterative model updating allowed anticipation of anatomic evolution between steps and facilitated scenario testing under alternative surgical hypotheses.”
Hyperaccuracy Three-Dimensional Model and Augmented Reality/Mixed Reality for Robot-Assisted Retroperitoneal Lymph Node Dissection in Testicular Cancer#
Angerer M et al. · The international journal of medical robotics + computer assisted surgery · 2026
Urology · Case report · n: 1 patient
AR/MR, platform not specified
Case report of a 35-year-old man with recurrent interaortocaval seminoma in whom a hyper-accuracy 3D model built with Avatar Medical software was used for preoperative planning and intraoperative AR navigation during robot-assisted retroperitoneal lymph node dissection. The authors report that the model identified a renal arterial branch next to the tumour, and that surgery took 76 minutes with 30 mL blood loss, no complications and no recurrence at nine months.
“HA3D modeling enabled precise preoperative identification of a critical renal arterial branch adjacent to the tumor, facilitating safe dissection.”
From the paper · Abstract
“This proof-of-concept case demonstrates successful integration of HA3D virtual models and AR into R-RPLND workflow, potentially enhancing anatomical visualization, surgical planning, and procedural safety.”
From the paper · Abstract
Conclusions (3)
Renal artery branch found before surgeryAnswer: Yes
“HA3D modeling enabled precise preoperative identification of a critical renal arterial branch adjacent to the tumor, facilitating safe dissection.”
From the paper · Abstract
3D model and AR integrated into robotic workflowAnswer: Yes
“This proof-of-concept case demonstrates successful integration of HA3D virtual models and AR into R-RPLND workflow, potentially enhancing anatomical visualization, surgical planning, and procedural safety.”
From the paper · Abstract
76 min, 30 mL blood loss, no complicationsAnswer: Describes
“R‐RPLND was completed in 76 min with minimal blood loss (30 mL) and no complications.”
The Role of Virtual and Augmented Reality in Transsphenoidal Surgical Approaches to the Sellar and Parasellar Area-A Systematic Review#
Bechev K et al. · Journal of clinical medicine · 2026
Neurosurgery · Systematic review
Multiple platforms
PRISMA systematic review (2015-2025) of 52 studies of VR and AR in transsphenoidal surgery of the sellar and parasellar region (12 clinical, 30 simulation/technology, 10 morphological). The authors report that VR reconstructions were associated with better preoperative spatial orientation and AR with intraoperative navigation benefits, but that the evidence base is early-phase and heterogeneous.
“VR-based three-dimensional reconstructions were consistently associated with improved preoperative spatial orientation and anatomical landmark recognition.”
From the paper · Abstract
“However, the majority of included studies were small observational cohorts, simulation studies, or expert overviews, with substantial heterogeneity in methodology, technology platforms, and outcome measures, precluding quantitative meta-analysis.”
From the paper · Abstract
“VR platforms showed high effectiveness in surgical training, with shorter learning curves and improved technical performance.”
From the paper · Abstract
Conclusions (4)
VR linked to improved spatial orientationAnswer: Yes
“VR-based three-dimensional reconstructions were consistently associated with improved preoperative spatial orientation and anatomical landmark recognition.”
From the paper · Abstract
AR aided navigation, shorter time to target reportedAnswer: Yes
“AR systems demonstrated a meaningful contribution to intraoperative navigation, with reported reductions in time to target and improved visualization of critical neurovascular structures.”
From the paper · Abstract
VR training reported shorter learning curvesAnswer: Yes
“VR platforms showed high effectiveness in surgical training, with shorter learning curves and improved technical performance.”
“However, the majority of included studies were small observational cohorts, simulation studies, or expert overviews, with substantial heterogeneity in methodology, technology platforms, and outcome measures, precluding quantitative meta-analysis.”
First evaluation of augmented and mixed reality in open liver surgery#
Lamadé W et al. · Minimally invasive therapy & allied technologies · 2026
Hepatobiliary & pancreatic (HPB) · Retrospective case series · n: 5 patients
Microsoft HoloLens
HoloCare Studio
Retrospective evaluation of quality assurance data from five patients having open liver resection, in whom HoloCare Studio holograms on HoloLens 2 were used for preoperative planning and intraoperative navigation. The authors report low cognitive workload (NASA-TLX about 14) and excellent usability (SUS about 96), and that the system improved tumour localisation and understanding of vascular anatomy.
“The HoloCare™ MXR system was seamlessly integrated into all five cases and improved tumor localization and understanding of vascular anatomy.”
From the paper · Abstract
“Mean SUS scores were 96.0 preoperatively and 95.5 postoperatively, reflecting excellent usability.”
96.0
From the paper · Abstract
“MXR integration into open hepatic surgery is feasible, fast, imposes minimal cognitive workload, and is well accepted.”
From the paper · Abstract
Conclusions (3)
Improved tumor localization and vascular understandingAnswer: Yes
“The HoloCare™ MXR system was seamlessly integrated into all five cases and improved tumor localization and understanding of vascular anatomy.”
From the paper · Abstract
Mean SUS 96.0 before, 95.5 after surgeryAnswer: Yes
“Mean SUS scores were 96.0 preoperatively and 95.5 postoperatively, reflecting excellent usability.”
SUS 96.0 pre vs 95.5 post
From the paper · Abstract
Feasible, low workload and well acceptedAnswer: Yes
“MXR integration into open hepatic surgery is feasible, fast, imposes minimal cognitive workload, and is well accepted.”
Neuroplastic and Augmented Reality Integration in Moyamoya Revascularization: A Reconstructive Microsurgical Paradigm#
Wu CT et al. · Seminars in plastic surgery · 2026
Neurosurgery · Narrative review
Multiple platforms
Narrative review of collaboration between neurosurgeons and plastic microsurgeons in moyamoya revascularization, and of how AR can support 3D visualization, microvascular simulation, planning, intraoperative guidance and training.
From planning to execution: Interactive virtual-reality assisted craniotomy planning in meningioma surgery#
Lehmann S et al. · Brain & spine · 2026
Neurosurgery · Validation study · n: 83 patients
Microsoft HoloLens
Magic Leap
Study of 83 meningioma patients whose craniotomy was planned and demonstrated preoperatively in interactive VR on Magic Leap 2 or HoloLens 2, comparing the planned approach with the craniotomy actually performed. The authors report mean deviations of about 16-18% in relative craniotomy size, statistical equivalence of size ratios, and changes in burr-hole number or position in 9.6% and 3.6% of procedures, which they interpret as high transferability of the plan.
“The percentage deviation between both groups was 5.9%, indicating high transferability of preoperative planning.”
5.9%
From the paper · Abstract
Conclusions (4)
Craniotomy size ratios deviated 15.9% and 17.5%Answer: Describes
“the mean anterior-posterior (AP)-ratio was 0.40 in iVR-group vs 0.41 in Real-group with 17.5% mean deviation, while the mean lateral ratio was 0.45 vs 0.49 with 15.9% mean deviation”
AP 0.40 vs 0.41, 17.5% deviation; lateral 0.45 vs 0.49, 15.9% deviation
From the paper · Abstract
Equivalence reported for both ratios; table disputes lateralAnswer: Mixed
“In testing for equality (TOST-test) both AP and lateral-ratio deviation showed significant results”
AP p = 0.015; lateral p = 0.041 (Table 4: equivalence not shown, p = 0,0411)
From the paper · Abstract
Burr holes differed in number in 9.6%Answer: Describes
“In 9.6% of procedures, a diverging number of burr holes were used, in 3.6% the position was altered from iVR-group to Real-group.”
9.6% number, 3.6% position
From the paper · Abstract
Group geometric index differed by 5.9%Answer: Describes
“The geometrical index was 0.423 for iVR group and 0.448 for Real-group.”
Mixed reality applied to surgical planning and tailoring of carotid endarterectomies#
Colombo E et al. · Acta neurochirurgica · 2026
Vascular · Prospective cohort · n: 49 patients
3D Slicer / SlicerVR
Microsoft HoloLens
Prospective series of 49 carotid endarterectomies in which 3D reconstructions from CTA/MRA were overlaid on the positioned patient with mixed-reality glasses after the initial skin incision was drawn, to tailor the approach. The authors report that the supervising surgeon shortened the planned skin incision in 16 cases (33%), with mean preparation time of 17 minutes and good usability scores.
“The supervising surgeon significantly altered (shortening) the skin incision in 16 cases (33%).”
33%
From the paper · Abstract
“Higher scores were given to the domains Ease of Use and Satisfaction.”
From the paper · Abstract
“Future research should focus on quantification of the benefits in surgical training and assess the impact on surgical outcomes.”
From the paper · Abstract
Conclusions (2)
Skin incision shortened in 16 of 49 casesAnswer: Yes
“Tailoring the skin incision, i.e. shortening it to focus on the position of the bifurcation, based on intraoperative 3D reconstruction visualization was performed in 16 cases (33%).”
16 cases (33%)
From the paper · Full text
3D reconstruction preparation took 17 minAnswer: Describes
“Mean 3D reconstruction preparation time was 17 ± 8 min.”
Exploring the advantages of mixed reality technology in Robot-assisted laparoscopic partial adrenalectomy#
Zou XC et al. · World journal of surgical oncology · 2026
Urology · Retrospective cohort · n: 82 patients
Microsoft HoloLens
Smartphone / tablet AR
Retrospective comparison of 82 patients undergoing robot-assisted partial adrenalectomy: 32 whose CT-based virtual models were used for planning and intraoperative guidance via a 3D tablet and HoloLens, and 50 with conventional CT. The authors report slightly shorter operation time, lower blood loss, faster return of bowel function and shorter hospital stay with MR, but caution that the clinical significance is limited and the design is retrospective.
“Postoperative statistics indicated that the operation time for the MR group was significantly shorter than that of the control group (102.00(98.00 103.00) minutes vs. 103.50(101.00 106.75) minutes, p = 0.017).”
p = 0.017
From the paper · Abstract
“The estimated intraoperative blood loss was also lower in the MR group compared to the control group (58.50(53.00 63.00) ml vs. 77.00(72.00 86.00) ml, p < 0.001).”
p < 0.001
From the paper · Abstract
“However, the clinical significance of these observed differences remains limited, and the findings should be interpreted cautiously due to the retrospective study design.”
From the paper · Abstract
Conclusions (4)
Primary endpoint: operation time modestly shorterAnswer: Yes
“the operation time for the MR group was significantly shorter than that of the control group”
102.00 vs 103.50 min, p = 0.017
From the paper · Abstract
Estimated blood loss lower with mixed realityAnswer: Yes
“blood loss was also lower in the MR group compared to the control group”
A review of head-mounted devices for surgical education, preoperative planning and intraoperative navigation#
Singh R et al. · Updates in surgery · 2026
Multi-specialty · Systematic review
Multiple platforms
Systematic review (PRISMA) of 33 studies from 2019 to 2025 on head-mounted VR, AR and MR devices in surgical education, preoperative planning and intraoperative navigation. The authors report that 42% of studies addressed preoperative planning, 27% simulation training and 18% navigation, and note small samples and non-standardised outcomes.
“Typical limitations were small participant sizes, non-standardized outcome measures, and a lack of unified assessment frameworks.”
From the paper · Abstract
“Reported benefits of HMD platforms included enhanced immersion, improved spatial orientation, procedural accuracy, and replication of surgical scenarios, exceeding the value of traditional approaches. HMD-based platforms provide significant advantages in surgical education and practice, facilitating superior simulation experiences, preoperative planning, and intraoperative navigation.”
From the paper · Abstract
Conclusions (3)
Preoperative planning was the most studied useAnswer: Describes
“Most included studies emphasized simulation-driven training protocols (27%) and modules for preoperative surgical planning (42%), with only a minority addressing intraoperative navigation systems (18%).”
“Reported benefits of HMD platforms included enhanced immersion, improved spatial orientation, procedural accuracy, and replication of surgical scenarios, exceeding the value of traditional approaches.”
From the paper · Abstract
Small samples and non-standardised outcomesAnswer: Describes
“Typical limitations were small participant sizes, non-standardized outcome measures, and a lack of unified assessment frameworks.”
Artificial intelligence, extended reality and computational modelling in cross-sectional cardiovascular imaging in congenital heart disease: a narrative review#
Raimondi F et al. · Cardiovascular diagnosis and therapy · 2026
Congenital heart · Narrative review
Multiple platforms
Narrative review of artificial intelligence, extended reality and computational modelling applied to CT and cardiac MRI in congenital heart disease, based on a targeted PubMed search covering 2014 to October 2025. The authors note that XR is used to improve spatial understanding and pre-procedural planning, but that most evidence comes from single-centre feasibility studies.
“XR technologies enhance spatial understanding and pre-procedural planning, while computational modelling and three-dimensional (3D) printing enable patient-specific haemodynamic simulation and procedural rehearsal.”
From the paper · Abstract
“However, most evidence derives from feasibility and single-centre studies, and lesion-specific external validation remains limited.”
From the paper · Abstract
Conclusions (3)
XR described as aiding spatial understanding and planningAnswer: Yes
“XR technologies enhance spatial understanding and pre-procedural planning, while computational modelling and three-dimensional (3D) printing enable patient-specific haemodynamic simulation and procedural rehearsal.”
From the paper · Abstract
Evidence mostly feasibility and single-centre studiesAnswer: Describes
“However, most evidence derives from feasibility and single-centre studies, and lesion-specific external validation remains limited.”
From the paper · Abstract
Clinical outcome benefit still to be shownAnswer: Describes
“Demonstration of clinical outcome benefit will be essential for widespread adoption.”
Retrospective study of 102 patients who had laparoscopic or robotic minimally invasive hepatectomy, 47 with extended reality (VR/MR) assistance for planning and guidance and 55 without. The authors report that the XR group had more difficult and more anatomical resections, with no significant differences in blood loss or severe complications.
“Nevertheless, the estimated blood loss (median 150 mL vs. 100 mL, P = 0.054) and incidence of severe complications (6.4% vs. 0%, P = 0.094) did not differ significantly between the XR and non-XR groups.”
P = 0.054
From the paper · Abstract
“Subgroup analyses of the robotic and laparoscopic procedures showed similar trends in safety outcomes.”
From the paper · Abstract
Conclusions (2)
No significant difference in blood loss or complicationsAnswer: No significant difference
“Nevertheless, the estimated blood loss (median 150 mL vs. 100 mL, P=0.054) and incidence of severe complications (6.4% vs. 0%, P=0.094) did not differ significantly between the XR and non-XR groups.”
150 vs 100 mL, P=0.054; 6.4% vs 0%, P=0.094
From the paper · Abstract
XR group had harder, more anatomical resectionsAnswer: Describes
“The XR group had significantly higher IWATE difficulty scores (median 6 vs. 4, P<0.001) and a greater proportion of anatomical resections (57.4% vs. 27.3%, P=0.003).”
Two-centre proof-of-concept study of 24 paediatric and adult patients scheduled for resternotomy, whose CTA was segmented (D2P) and reviewed preoperatively in stereoscopic VR on an HTC Vive; surgical plans were not altered by protocol. In questionnaires, XR showed no significant benefit over CTA for resternotomy anatomical data, but surgeons rated it more helpful for understanding anatomy and decision-making in paediatric cases, especially senior surgeons.
“The findings indicated no significant benefit of XR over CTA in terms of resternotomy anatomical data.”
From the paper · Abstract
“senior physicians rated the XR as less accurate for adult patients than did residents, but the ratings were high in both groups for pediatric cases.”
From the paper · Abstract
“Overall, senior physicians reported that XR influenced their surgical decisions more, suggesting that the utility of XR varies with physician experience and patient age.”
From the paper · Abstract
Conclusions (4)
No significant benefit of XR over CTAAnswer: No significant difference
“The findings indicated no significant benefit of XR over CTA in terms of resternotomy anatomical data.”
From the paper · Abstract
Senior surgeons found XR more useful in pediatricsAnswer: Yes
“whereas for surgical decision-making, XR was seen as more beneficial in pediatric cases, particularly by senior surgeons.”
senior surgeons estimated mean 8.33 pediatric vs 1.00 adult
From the paper · Abstract
Seniors more inclined than residents to modify plansAnswer: Yes
“Overall, senior physicians reported that XR influenced their surgical decisions more, suggesting that the utility of XR varies with physician experience and patient age.”
64.29% senior vs 7.14% residents, P = 0.0075
From the paper · Abstract
Anatomy understanding higher in pediatric than adult casesAnswer: Yes
“The XR models improved the surgeons’ understanding of chest anatomy in pediatrics more than in adult patients”
Prospective study of 20 patients with complex congenital heart disease (mainly double outlet right ventricle and transposition variants) considered for biventricular or 1.5-ventricle repair with intraventricular tunnelling. CT-based digital twins were analysed in VR to plan the pathway and design virtual baffles, which were converted into 3D-printed and paper templates used as surgical guides. The authors report that all repairs were achieved as planned, with baffle geometry deviating less than 10%, no operative mortality and no residuals or reinterventions at a median of 20 months.
“Morphometrics of virtual, 3-dimensional printed, and paper-printed baffles were identical and successfully used as surgical guides; deviation from predicted geometry was less than 10%.”
10%
From the paper · Abstract
“Median hospital stay was 10 days (interquartile range, 8-16) with no operative mortality.”
From the paper · Abstract
“Workflow for creating paper-printable baffle templates shows great promise.”
From the paper · Abstract
Conclusions (2)
Virtual and printed baffles matched; under 10% deviationAnswer: Yes
“Morphometrics of virtual, 3-dimensional printed, and paper-printed baffles were identical and successfully used as surgical guides; deviation from predicted geometry was less than 10%.”
deviation from predicted geometry less than 10%
From the paper · Abstract
Median stay 10 days, no operative mortalityAnswer: Describes
“Median hospital stay was 10 days (interquartile range, 8-16) with no operative mortality.”
Augmented Reality Based 3D Modelling for Sentinel Lymph Node Localization in Cutaneous Melanoma: A Pilot Study#
Adawi Q et al. · Journal of Surgical Oncology · 2026
General & GI surgery · Prospective cohort · n: 10 patients
AR/MR, platform not specified
Prospective pilot study of 10 melanoma patients having sentinel lymph node biopsy, in which SPECT/CT lymphoscintigraphy was segmented into patient-specific 3D models that were projected onto the patient through an AR headset and reviewed by the surgeon before incision. The authors report a median deviation of 12 mm (range 0-40 mm) from the gamma-probe position, with 43% of cases within 10 mm, and no AR-related complications.
“The median deviation between AR3D model and the gamma probe localization was 12 mm (range 0-40 mm), with 43% of cases ≤ 10 mm.”
12 mm
From the paper · Abstract
“No AR-related complications occurred.”
From the paper · Abstract
“Although accuracy varied, in nearly half of the cases, AR3D model was within 10 mm of the gamma probe detection.”
From the paper · Abstract
“The technique showed promising alignment with standard gamma‐probe detection and improved spatial understanding in the pre‐incision phase.”
From the paper · Fulltext
Conclusions (2)
Median 12 mm from gamma probe positionAnswer: Mixed
“The median deviation between AR3D model and the gamma probe localization was 12 mm (range 0-40 mm), with 43% of cases ≤ 10 mm.”
median 12 mm (range 0-40 mm), 43% of cases ≤ 10 mm
From the paper · Abstract
No AR-related complications in 10 patientsAnswer: Describes
3D Virtual reality assessment of right ventricle-pulmonary artery conduit dilation and coronary compression risk: a retrospective bi-center feasibility study#
Hochstein D et al. · Frontiers in cardiovascular medicine · 2026
Congenital heart · Retrospective case series · n: 19 patients
HTC Vive
Retrospective two-centre feasibility study of 19 children evaluated for RV-PA conduit dilation and stenting, whose cardiac CT data were reviewed as 3D models in virtual reality (HTC Vive, per the full text) by two cardiologists to measure conduit-coronary distances before and after simulated balloon expansion. The authors report good inter-operator agreement and that both cardiologists rated VR significantly better than CT alone for planning.
“VR-based anatomical measurements demonstrated strong inter-operator agreement (intraclass correlation coefficient >0.7 across most parameters).”
>0.7
From the paper · Abstract
“VR model generation was technically successful in all cases, with intuitive user interface performance and rapid rendering times.”
From the paper · Abstract
“Patient-specific 3D VR modeling is technically feasible and provides clinically meaningful advantages for planning RV-PA conduit interventions.”
From the paper · Abstract
Conclusions (5)
VR rated higher than CT for coronary courseAnswer: Yes
“Both cardiologists rated VR significantly superior to CT alone for delineating coronary trajectories and assessing compression risk”
mean score 4.58 vs. 3.78, p < 0.0001
From the paper · Abstract
Strong inter-operator agreement on most VR measurementsAnswer: Yes
“VR-based anatomical measurements demonstrated strong inter-operator agreement (intraclass correlation coefficient >0.7 across most parameters).”
ICC >0.7
From the paper · Abstract
VR models built successfully in all casesAnswer: Yes
“VR model generation was technically successful in all cases, with intuitive user interface performance and rapid rendering times.”
From the paper · Abstract
Dilation decision rating not significantly different from CTAnswer: No significant difference
“However, VR did not significantly outperform CT in influencing the decision to proceed with dilation”
3.55 vs. 3.90, p = 0.169
From the paper · Full text
Cardiologists reported positive usability, no low scoresAnswer: Yes
“Both cardiologists reported a consistently positive experience using the VR models, with no questionnaire item receiving a low score (≤3).”
Designing a Collaborative Immersive Visualization System for Radiation Treatment Planning Teams#
Tran K et al. · IEEE transactions on visualization and computer graphics · 2026
Radiation oncology · Technical development
VR, platform not specified
Visualisation design study of a networked, multi-user immersive VR system for radiation treatment (proton therapy) plan review, combining interactive volume rendering, slicing, surface rendering, avatars and three modes of plan comparison. The authors report several advantages over current practice from multi-year iterative development and a mock plan-review meeting.
“Results and feedback from multi-year iterative development with users and a summative field deployment in the form of a mock plan-review meeting reveal several advantages relative to current clinical practice and suggest directions for future work.”
From the paper · Abstract
Conclusions (1)
Mock plan review reported advantages, no comparatorAnswer: Describes
“Results and feedback from multi-year iterative development with users and a summative field deployment in the form of a mock plan-review meeting reveal several advantages relative to current clinical practice and suggest directions for future work.”
Randomised controlled trial of 140 TAVI patients (Düsseldorf, 2024) with preprocedural planning by 3mensio CT software alone or supplemented with VR software. Interventionalists rated VR better for 3D understanding, depth perception, plaque and iliofemoral tortuosity. Procedural data did not differ, but the VR group had a lower rate of access-site bleeding.
“VR was superior to 3mensio software with respect to the 3-dimensional understanding (P<0.001).”
P<0.001
From the paper · Abstract
“There were no significant differences in procedural data between the 2 groups.”
From the paper · Abstract
“However, the VR group had a lower rate of bleeding at the access site (P<0.05).”
P<0.05
From the paper · Abstract
Conclusions (3)
VR rated higher for 3D understandingAnswer: Yes
“VR was superior to 3mensio software with respect to the 3-dimensional understanding (P<0.001).”
1.3±0.6 vs 2.0±0.6, P<0.001
From the paper · Abstract
Procedural data did not differ between groupsAnswer: No significant difference
“There were no significant differences in procedural data between the 2 groups.”
procedure duration 64.3±17.8 vs 65.4±13.0 min, P = 0.182
From the paper · Abstract
Lower access-site bleeding in VR groupAnswer: Yes
“However, the VR group had a lower rate of bleeding at the access site (P<0.05).”
Left bundle branch pacing in anatomically repaired congenitally corrected transposition of the great arteries: a case report#
Ramdat Misier NL et al. · European heart journal. Case reports · 2026
Congenital heart · Case report · n: 1 patient
VR, platform not specified
3D printing
Case report of left bundle branch area pacing in a 12-year-old with congenitally corrected transposition after a double switch operation with Rastelli repair. CT-derived 3D reconstructions were 3D printed and loaded into a virtual reality environment to understand the anatomy and simulate the procedure; the lead was placed across the Senning baffle and paced QRS duration fell from 219 to 138 ms. Systemic ventricular function did not recover enough to avoid heart transplantation two months later. The authors call pre-procedural planning with 3D modelling crucial.
“Rigorous pre-procedural planning with 3D modelling was crucial to overcome the technical and diagnostic challenges in this complex congenital heart disease.”
From the paper · Abstract
“Despite early symptomatic improvement, systemic ventricular function did not recover sufficiently to obviate the need for heart transplantation, which was successfully performed two months post-procedure.”
From the paper · Abstract
Conclusions (3)
Left bundle branch pacing feasible after repairAnswer: Yes
“We demonstrate the feasibility of LBB area pacing in anatomically repaired CCTGA.”
From the paper · Abstract
Authors call 3D planning crucialAnswer: Yes
“Rigorous pre-procedural planning with 3D modelling was crucial to overcome the technical and diagnostic challenges in this complex congenital heart disease.”
From the paper · Abstract
Ventricular function did not recover; transplant neededAnswer: Describes
“Despite early symptomatic improvement, systemic ventricular function did not recover sufficiently to obviate the need for heart transplantation, which was successfully performed two months post-procedure.”
Single-centre evaluation of the B-onic Platform at La Paz University Hospital, an integrated workflow of CAD planning, 3D-printed biomodels and guides, and immersive extended-reality validation (NavigatorPro XR), covering 308 consecutive surgical plans from 2020 to 2024 compared with historical controls. The authors report shorter planning and operative times, fewer complications and rehospitalisations, and that XR validation halved validation time for guides and implants.
“Mean preoperative planning time was reduced by 34% (-42 h; 95% CI: -48 to -36 h; p < 0.01) compared with historical controls.”
34%
From the paper · Abstract
“The 30-day postoperative complication rate decreased from 12.9% to 10.7% (absolute reduction 2.2%; 95% CI: 0.2-4.1%; p = 0.037), while rehospitalization rates declined from 9.1% to 4.3% (p = 0.012).”
12.9%
From the paper · Abstract
“Ninety-two percent of surveyed surgeons reported improved 3D anatomical understanding and enhanced intraoperative safety.”
Ninety-two percent
From the paper · Abstract
Conclusions (5)
Planning time reduced versus historical controlsAnswer: Yes
“Mean preoperative planning time was reduced by 34%”
34%, p < 0.01
From the paper · Abstract
Operative duration 45 min shorterAnswer: Yes
“Mean operative duration decreased from 226 ± 74 min to 181 ± 61 min”
226 vs 181 min, p < 0.001
From the paper · Abstract
30-day complications and rehospitalization both fellAnswer: Yes
“The 30-day postoperative complication rate decreased from 12.9% to 10.7% (absolute reduction 2.2%; 95% CI: 0.2–4.1%; p = 0.037), while rehospitalization rates declined from 9.1% to 4.3% ( p = 0.012).”
12.9% to 10.7%, p = 0.037; 9.1% to 4.3%, p = 0.012
From the paper · Abstract
XR validation time halved for guides and implantsAnswer: Yes
“halved validation time for guides and implants”
71.8 vs 35.6 h, p < 0.001
From the paper · Abstract
Surgeons reported improved 3D anatomical understandingAnswer: Yes
“Ninety-two percent of surveyed surgeons reported improved 3D anatomical understanding”
Extended Reality in Neurosurgery : Surgical Planning, Navigation, Education, and Patient Communication#
Roh TH et al. · Journal of Korean Neurosurgical Society · 2026
Neurosurgery · Narrative review
Multiple platforms
Narrative review of extended reality in neurosurgery across surgical planning and visualization, intraoperative navigation, education and patient communication, including AI-based segmentation, with emphasis on paediatric neurosurgery.
“Furthermore, XR-enhanced patient communication tools have improved comprehension of complex neurosurgical procedures and informed consent quality.”
From the paper · Abstract
“Despite current limitations including hardware constraints, workflow integration challenges, and the need for larger validation studies, XR technologies hold substantial promise for advancing pediatric neurosurgical care.”
“Furthermore, XR-enhanced patient communication tools have improved comprehension of complex neurosurgical procedures and informed consent quality.”
From the paper · Abstract
Review reports submillimeter AR navigation accuracyAnswer: Describes
“Modern AR navigation systems, utilizing both optical see-through and video see-through head-mounted displays, have demonstrated submillimeter accuracy in recent clinical studies.”
“Despite current limitations including hardware constraints, workflow integration challenges, and the need for larger validation studies, XR technologies hold substantial promise for advancing pediatric neurosurgical care.”
Mixed Reality-Assisted Thoracic Endovascular Aortic Repair: A Retrospective Study on Efficacy and Safety#
Gu JJ et al. · Annals of noninvasive electrocardiology · 2026
Vascular · Retrospective cohort · n: 46 patients
Microsoft HoloLens
Retrospective comparison of 46 patients with aortic dissection undergoing thoracic endovascular aortic repair, 23 with HoloLens mixed-reality models (Star Map system) for preoperative analysis, communication and intraoperative path guidance and 23 with conventional CTA. The authors report shorter operation duration, fewer fluoroscopy runs and fewer stent adjustments in the MR group.
“Compared with the control group, the MR group exhibited significantly shorter operation duration (70.91 ± 8.533 vs. 77.48 ± 8.474 min, Z = -2.785, p = 0.005)”
p = 0.005
From the paper · Abstract
“Multimodal MR has an important auxiliary role in patient education, surgical planning, and accurate positioning of the surgical approach.”
From the paper · Abstract
“there was no significant difference in postoperative hospital stay between the two groups”
2.52 ± 0.593 vs 2.65 ± 0.647 days, p = 0.498
From the paper · Fulltext
Conclusions (4)
Operation significantly shorter with MRAnswer: Yes
“the MR group exhibited significantly shorter operation duration (70.91 ± 8.533 vs. 77.48 ± 8.474 min”
70.91 ± 8.533 vs 77.48 ± 8.474 min, p = 0.005
From the paper · Abstract
Fewer fluoroscopy runs with MRAnswer: Yes
“fewer fluoroscopy times (3.74 ± 1.214 vs. 5.61 ± 1.530”
3.74 ± 1.214 vs 5.61 ± 1.530, p < 0.001
From the paper · Abstract
Fewer stent adjustments with MRAnswer: Yes
“less stent adjustments (1.65 ± 1.152 vs. 2.91 ± 1.411”
1.65 ± 1.152 vs 2.91 ± 1.411, p = 0.006
From the paper · Abstract
Hospital stay not significantly differentAnswer: No significant difference
“there was no significant difference in postoperative hospital stay between the two groups”
An Augmented Reality-Based Navigation System for Stereotactic Brain Biopsy with Multi-Objective Path Planning and Hybrid Registration#
Zhang T et al. · Brain sciences · 2026
Neurosurgery · Technical development
3D Slicer / SlicerVR
Microsoft HoloLens
Technical development of an AR system for stereotactic brain biopsy in which a multi-objective optimization model automatically computes and displays optimal biopsy paths in a 3D anatomical scene (built with 3D Slicer), which are then overlaid on the patient through HoloLens 2 after QR-code and landmark registration. In expert and phantom testing, the authors report better adherence to safety criteria than manual planning and a target registration error of 2.3 mm.
“An expert study across four common brain tumor locations demonstrated that the MOO model significantly outperformed manual methods in satisfying safety criteria.”
From the paper · Abstract
“The hybrid registration reduced the mean fiducial registration error (FRE) from 4.19 ± 1.11 mm to 2.37 ± 0.91 mm (p < 0.001)”
p < 0.001
From the paper · Abstract
Conclusions (4)
Algorithm outperformed manual paths on safety criteriaAnswer: Yes
“An expert study across four common brain tumor locations demonstrated that the MOO model significantly outperformed manual methods in satisfying safety criteria.”
From the paper · Abstract
Hybrid registration cut fiducial error on phantomAnswer: Yes
“The hybrid registration reduced the mean fiducial registration error (FRE) from 4.19 ± 1.11 mm to 2.37 ± 0.91 mm (p < 0.001)”
FRE 4.19 vs 2.37 mm, p < 0.001
From the paper · Abstract
AR paths closer to vessels than manualAnswer: Mixed
“Compared with manual planning, the AR-based method significantly reduced the minimum distances to blood vessels and M1 by 4.96% and 5.44%, respectively, while no significant differences were observed in the remaining metrics.”
vessel distance 4.96%, M1 distance 5.44% smaller
From the paper · Full text
Planning time 7.91 min manual, 6.65 min ARAnswer: Describes
“The mean time for manual planning was 7.91 ± 1.04 min, compared with 6.65 ± 1.59 min for AR-based planning.”
The digital evolution of surgical planning: a systematic review of immersive and interactive technologies#
Khubzan WD et al. · Frontiers in surgery · 2026
Multi-specialty · Systematic review
Multiple platforms
PROSPERO-registered systematic review of 30 studies (1,270 participants) on VR, AR and MR in preoperative or intraoperative surgical planning. The authors report that VR was most common and prompted plan changes in 32 to 52% of cases, while AR and MR were associated with better procedural accuracy and intraoperative workflow; heterogeneity precluded meta-analysis.
“VR was the most utilized technology (17 studies), improving spatial understanding and prompting plan modifications in 32%-52% of cases (e.g., lung segmentectomies, TAVR).”
32%-52%
From the paper · Abstract
“AR (8 studies) enhanced intraoperative accuracy, reducing pedicle screw placement errors (98% vs. 91.7% control) and procedure times (e.g., 50% faster spinal screw placement).”
98%
From the paper · Abstract
“Heterogeneity in study designs and outcomes limited meta-analysis.”
From the paper · Abstract
“Among the 16 studies assessing efficiency, 13 (81%) reported measurable reductions in time-related outcomes, including operative time, planning time, or fluoroscopy exposure.”
13 of 16 studies (81%)
From the paper · Fulltext
Conclusions (3)
16 of 17 accuracy studies favoured immersive toolsAnswer: Yes
“Across the 17 studies reporting accuracy outcomes, 16 (94%) demonstrated a favorable directional effect for immersive technologies compared with conventional approaches.”
16 of 17 studies (94%)
From the paper · Full text
13 of 16 studies reported time reductionsAnswer: Yes
“Among the 16 studies assessing efficiency, 13 (81%) reported measurable reductions in time-related outcomes, including operative time, planning time, or fluoroscopy exposure.”
13 of 16 studies (81%)
From the paper · Full text
Plan modified in 30%–52% of casesAnswer: Yes
“Across the 12 studies evaluating decision impact, immersive technologies resulted in surgical plan modifications in approximately 30%–52% of cases”
Practitioners' Perceptions of Augmented and Virtual Reality in Endodontic Treatment Planning: A Pilot Study#
Reymus M et al. · International endodontic journal · 2026
Dental · Comparative study · n: 2 patients
Meta Quest / Oculus
Smartphone / tablet AR
Pilot study introducing VirtualEndo, a Blender add-on that converts AI-segmented CBCT into AR and VR formats, in which 30 dentists evaluated two challenging endodontic cases with conventional CBCT, screen-based 3D segmentation, iPad AR and Meta Quest 3 VR in randomised order. The authors report that 3D methods were perceived as superior to 2D CBCT, with screen-based segmentation preferred for workflow and immersive methods seen as promising.
“Conventional CBCT was rated significantly inferior to Segmentation, VR, and AR for information extraction (canal course: W = 0.68; canal number: W = 0.56) and usability (W = 0.40).”
W = 0.40
From the paper · Abstract
“No significant differences existed between the three advanced visualisation methods.”
From the paper · Abstract
“Segmentation was most frequently selected as clinically most relevant (40%), followed by VR (20%).”
40%
From the paper · Abstract
Conclusions (3)
Conventional CBCT rated inferior to 3D methodsAnswer: Yes
“Conventional CBCT was rated significantly inferior to Segmentation, VR, and AR for information extraction (canal course: W = 0.68; canal number: W = 0.56) and usability (W = 0.40).”
canal course W = 0.68; canal number W = 0.56; usability W = 0.40
From the paper · Abstract
No significant differences between the 3D methodsAnswer: No significant difference
“No significant differences existed between the three advanced visualisation methods.”
From the paper · Abstract
Segmentation most often chosen as clinically relevantAnswer: Describes
“Segmentation was most frequently selected as clinically most relevant (40%), followed by VR (20%).”
Technical Feasibility of Virtual Reality-Enhanced Three-Dimensional Rotational Angiography: A Retrospective Analysis of a Novel Imaging Approach for Interventional Procedures in the Pediatric Cardiac Catheterization Laboratory#
Szeliga J et al. · Pediatric cardiology · 2026
Congenital heart · Retrospective case series · n: 62 procedures
VR, platform not specified
Retrospective single-centre study of 62 paediatric cardiac catheterisations in which VR models were generated from 3D rotational angiography datasets and compared with conventional workstation 3D models for anatomical assessment, procedural simulation and fluoroscopic projection planning. The authors report that VR models were generated in all cases in a few minutes, and that visualisation of target anatomy, procedural simulation and projection planning were feasible in 98%, 94% and 100% of cases.
“Median VR processing times were 3.0 min for model generation, 5.0 min for refinement, 4.0 min for procedural simulation, and 7.0 min for extended anatomical analysis, defined as immersive evaluation of anatomical structures beyond the primary contrast-opacified target region.”
3.0 min
From the paper · Abstract
“Visualization of target anatomy was feasible in 98%, beyond-target region in 84%, procedural simulation in 94%, and projection planning in all cases.”
98%
From the paper · Abstract
Conclusions (2)
Target anatomy visualization feasible in 98% of casesAnswer: Yes
“Visualization of target anatomy was feasible in 98%, beyond-target region in 84%, procedural simulation in 94%, and projection planning in all cases.”
98%, 84%, 94%
From the paper · Abstract
Median VR step times 3.0 to 7.0 minutesAnswer: Describes
“Median VR processing times were 3.0 min for model generation, 5.0 min for refinement, 4.0 min for procedural simulation, and 7.0 min for extended anatomical analysis, defined as immersive evaluation of anatomical structures beyond the primary contrast-opacified target region.”
Virtual Reality in Neurosurgery: Advancing Training, Education, and Surgical Planning#
Saher L et al. · Asian journal of neurosurgery · 2026
Neurosurgery · Narrative review
Multiple platforms
Literature review (PubMed, Google Scholar and Cochrane to March 2025) of VR in neurosurgery, covering simulators, training, planning and decision-making, and AI integration. It discusses barriers including cost, user discomfort and the lack of ethical protocols.
“High cost, lack of numerous skilled operators, user discomfort, and no proper ethical protocols are critical hindrances that need to be addressed.”
From the paper · Abstract
Conclusions (2)
Cost, operator skills and discomfort limit VR accessAnswer: Describes
“High cost, lack of numerous skilled operators, user discomfort, and no proper ethical protocols are critical hindrances that need to be addressed.”
From the paper · Abstract
Review reports VR improved planning and trainingAnswer: Describes
“The findings highlight how VR has enhanced the neurosurgical field through various simulators, optimized strategies and planning and decision making, and improved surgical training.”
Immersive Virtual Reality 3-Dimensional Model for Rectal Cancer Surgical Planning#
Mazirka P et al. · Diseases of the colon and rectum · 2026
General & GI surgery · Technical note
VR, platform not specified
Article in Diseases of the Colon & Rectum on an immersive virtual reality 3D model for planning rectal cancer surgery. No abstract was available, so these details are from the title and venue and could not be confirmed.
Narrative review (PubMed to July 2025; 14 studies) of AR and MR in cardiac surgery, grouped into preoperative planning, intraoperative navigation, functional guidance, robotic integration and rehabilitation.
“Early clinical and preclinical evidence supports AR/MR feasibility and utility for visualization and orientation in cardiac surgery.”
From the paper · Abstract
Conclusions (2)
Early evidence supports AR/MR feasibility in cardiac surgeryAnswer: Yes
“Early clinical and preclinical evidence supports AR/MR feasibility and utility for visualization and orientation in cardiac surgery.”
From the paper · Abstract
Reported benefits mostly user-reported, not objectively measuredAnswer: Describes
“Reported improvements in intraoperative orientation, decision-making, communication, and cognitive load were largely clinician- or user-reported rather than assessed using standardized objective instruments.”
Contribution of Virtual Reality to Surgical Decision-Making for Evaluating Vascular Contraindications in Malignant Head and Neck Tumors#
Munoglu A et al. · Surgical innovation · 2026
ENT / head & neck · Retrospective cohort · n: 27 patients
VR, platform not specified
Retrospective single-centre study of 27 patients with head and neck cancer metastases involving the peri-carotid region, 20 of whom had CT reviewed with 3D-VR reconstruction as well as 2D, with surgeon questionnaires and tumour board decisions analysed. The authors report that no anatomical factor predicted surgical failure or contraindication, that 86% of individual surgeon decisions were unchanged by 3D review, and that 1 of 20 tumour board decisions changed.
“In MTB, 1 of 20 decisions (5%) was modified after 3D review”
5%
From the paper · Abstract
“It primarily functions as an interactive educational tool supplementing traditional imaging in complex surgical planning.”
From the paper · Abstract
Conclusions (5)
No anatomical factor predicted failureAnswer: No significant difference
“No anatomical factor predicted outcomes, but fat plane preservation is a potentially valuable and easily seen 3D sign.”
From the paper · Abstract
Fat plane preservation: trend only, not significantAnswer: No significant difference
“Preservation of a fat plane in 3D showed a trend toward lower surgical failure (OR = 0.5, P = 0.12).”
OR = 0.5, P = 0.12
From the paper · Abstract
Most surgeon decisions unchanged by 3D reviewAnswer: Mixed
“From 111 surgeon questionnaires, 86% of decisions remained unchanged between 2D and 3D, with 15 changes (9 toward indication, 6 toward contraindication).”
The emerging role of mixed reality and artificial intelligence in sarcoma care: A systematic review#
Joshi S et al. · European journal of surgical oncology · 2026
Orthopedics · Systematic review
Multiple platforms
Systematic review of 23 studies on artificial intelligence and mixed reality in sarcoma care. The authors report that MR was used for preoperative planning in three studies, intraoperative navigation in two and surgical training in two, and that the evidence is mostly preliminary.
“MR was used in preoperative planning (n = 3), intraoperative navigation (n = 2), and surgical training (n = 2).”
From the paper · Abstract
“However, the literature remains heterogeneous, consisting mostly of preliminary studies with limited statistical power.”
From the paper · Abstract
Conclusions (2)
Mixed reality used for planning, navigation, trainingAnswer: Yes
“MR was used in preoperative planning (n = 3), intraoperative navigation (n = 2), and surgical training (n = 2).”
planning n = 3, navigation n = 2, training n = 2
From the paper · Abstract
Literature heterogeneous with limited statistical powerAnswer: Describes
“However, the literature remains heterogeneous, consisting mostly of preliminary studies with limited statistical power.”
Circumferential venous sinus: an innovative separation method for total vertical type II craniopagus twins#
Mufarrej G et al. · Journal of neurosurgery. Pediatrics · 2026
Neurosurgery · Case report · n: 1 patient (twin pair)
VR, platform not specified
Technical note of staged separation (7 operations) of total vertical type II craniopagus twins aged 3 years 9 months who shared a circumferential venous sinus. Advanced imaging, 3D modelling and collaborative VR planning in a shared virtual environment ('metaverse') between Brazil and the UK guided the strategy. The authors report successful separation with independent circulations and recovery.
“The final separation, completed in 2 stages over 31 hours, resulted in successful independent circulations and recovery.”
From the paper · Abstract
Conclusions (2)
Separation done in 2 stages over 31 hoursAnswer: Describes
“The final separation, completed in 2 stages over 31 hours, resulted in successful independent circulations and recovery.”
2 stages over 31 hours
From the paper · Abstract
Authors report sinus division without neurological compromiseAnswer: Describes
“This innovative approach allowed division of the shared venous sinus without neurological compromise.”
Randomised trial (REALITATEM) of 45 patients with renal masses undergoing robot-assisted partial nephrectomy with or without mixed reality (models planned in Brainlab Elements and viewed on Magic Leap 1). The authors report shorter ischaemia time (by 3.8 minutes) and more selective clamping with MR, with no difference in complications or renal function.
“Analyses indicated statistically significant difference in ischemia time favoring RG (p = 0.045), with a mean difference of 3.8 minutes.”
p = 0.045
From the paper · Abstract
“No difference was detected regarding complication rate.”
From the paper · Abstract
“This RCT demonstrates the feasibility and safety of MIXREAL in RAPN, as well as its potential to support intraoperative decision-making.”
From the paper · Abstract
Conclusions (4)
Ischemia time 3.8 min shorter with MRAnswer: Yes
“Analyses indicated statistically significant difference in ischemia time favoring RG (p = 0.045), with a mean difference of 3.8 minutes.”
14.6 vs 18.4 min, p = 0.045
From the paper · Abstract
Selective clamping used in 5 MR cases onlyAnswer: Yes
“in RG there were 5 selective clamping cases, while in the GC, none (p = 0.013)”
5 cases vs none, p = 0.013
From the paper · Full text
No difference in complication rateAnswer: No significant difference
“No difference was detected regarding complication rate.”
From the paper · Abstract
No difference in total surgical timeAnswer: No significant difference
“In this study there was no statistical difference for TST (total surgical time).”
Three-Dimensional Reconstruction and Extended Reality in Thoracic Surgery: Japanese Expert Recommendations From the Anatomy on the Border Expert Consensus Meeting#
Kudo Y et al. · Asian journal of endoscopic surgery · 2026
Thoracic · Survey/user study
Multiple platforms
Japanese expert consensus based on a survey of 125 certified thoracic surgery centres (50 responded) and a literature search on 3D reconstruction and extended reality. The authors report that 96% of responding centres used 3D imaging, mainly for simulation, while only 8% had adopted XR and most rated its usefulness as uncertain; they recommend 3D imaging as standard for complex resections and see XR as promising.
“For XR, awareness was moderate, but adoption remained limited (8%).”
8%
From the paper · Abstract
“Among respondents, 74% rated its usefulness as uncertain, while only a small proportion found it clearly useful for preoperative simulation, intraoperative localization, and education.”
74%
From the paper · Abstract
Conclusions (4)
96% of centers used 3D imagingAnswer: Describes
“3D imaging was used by 96% of the institutions, and 72% used it in all cases.”
96%; 72% in all cases
From the paper · Abstract
XR adoption limited to 8%Answer: No
“For XR, awareness was moderate, but adoption remained limited (8%).”
8%
From the paper · Abstract
74% rated XR usefulness uncertainAnswer: No
“Among respondents, 74% rated its usefulness as uncertain, while only a small proportion found it clearly useful for preoperative simulation, intraoperative localization, and education.”
74%
From the paper · Abstract
Literature links 3D planning to less blood lossAnswer: Yes
“Literature search showed that 3D‐planning reduces blood loss, operative time, and complications in segmentectomy”
Extended reality for perforator visualization in deep inferior epigastric perforator autologous breast reconstruction: A systematic review#
Zijlstra K et al. · JPRAS open · 2026
Plastic & reconstructive · Systematic review
Multiple platforms
Systematic review of 10 articles on extended reality (VR, AR projection and AR glasses) for perforator visualisation in DIEP flap breast reconstruction. The authors report perforator identification rates of 61.7% to 100%, shorter perforator localisation time with AR than handheld Doppler, no added cost or complications, and note that comparisons were not made against CTA.
“XR use decreased operative time, with AR reducing intraoperative perforator localization time from 20 min using handheld Doppler US to 2.3 min.”
2.3 min
From the paper · Abstract
“The use of XR did not result in significant additional costs, and no differences in complication rates were identified.”
From the paper · Abstract
“XR may assist surgeons in perioperative perforator visualization during DIEP flap breast reconstruction by enhancing anatomical understanding.”
From the paper · Abstract
Conclusions (4)
Perforator identification rate 61.7% to 100%Answer: Mixed
“Perforator identification using XR ranged from 61.7 % to 100 %, with AR outperforming handheld Doppler ultrasound (US) in several studies.”
61.7% to 100%
From the paper · Abstract
AR localization time 2.3 min versus 20 minAnswer: Yes
“XR use decreased operative time, with AR reducing intraoperative perforator localization time from 20 min using handheld Doppler US to 2.3 min.”
20 min with handheld Doppler US vs 2.3 min with AR
From the paper · Abstract
No added cost or complication differenceAnswer: No significant difference
“The use of XR did not result in significant additional costs, and no differences in complication rates were identified.”
From the paper · Abstract
XR may aid anatomical understandingAnswer: Describes
“XR may assist surgeons in perioperative perforator visualization during DIEP flap breast reconstruction by enhancing anatomical understanding.”
Patient-Specific Computed Tomography-Based Three-Dimensional Spine Trauma Models for Preoperative Planning in Virtual Reality and 3D Printing: An EANS Young Neurosurgeons' Network Study#
Trandzhiev M et al. · Journal of neurological surgery. Part A, Central European neurosurgery · 2026
Spine · Technical development · n: 37 patient models
VR, platform not specified
Multicentre EANS young neurosurgeons' study that built a library of 37 patient-specific 3D spine trauma models from CT using open-source software (Horos), classified by the AO Spine system and exported for VR and 3D printing. A remote case discussion in a collaborative VR environment was shown as proof of concept.
Merging Robotics and Virtual Reality for Brain Tumor Surgery: A New Frontier in Surgical Innovation#
Karimi A et al. · World neurosurgery · 2026
Neurosurgery · Narrative review
Multiple platforms
Narrative review of combining robotics (e.g., da Vinci, ROSA, NeuroMate) with VR platforms (e.g., Surgical Theater, NeuroVR) in brain tumour surgery for planning and intraoperative guidance, discussing costs, lack of haptics and learning curves.
“However, challenges like high costs, lack of haptic feedback, and steep learning curves limit widespread use.”
From the paper · Abstract
Conclusions (1)
Cost, no haptics, learning curve limit useAnswer: Describes
“However, challenges like high costs, lack of haptic feedback, and steep learning curves limit widespread use.”
Augmented and Virtual Reality in Open Neurovascular Surgery: A Systematic Review of the Literature#
Saemann A et al. · World neurosurgery · 2026
Neurosurgery · Systematic review
Multiple platforms
PRISMA systematic review (2000-July 2024) of 43 studies of AR (10) or VR (32) or both (1) in open neurovascular surgery. Surgical planning was the most frequent application (67%). The authors note that improvements were mostly in surrogate or subjective measures, and call for comparative studies with clinical endpoints.
“Where quantitative outcomes were reported, improvements most commonly involved planning accuracy, task efficiency (e.g., clip/operative time), and user-rated usefulness; patient-level outcomes were infrequently reported and variably defined.”
From the paper · Abstract
“However, evidence remains heterogeneous and largely based on surrogate or subjective measures.”
From the paper · Abstract
Conclusions (2)
Evidence mostly surrogate or subjective measuresAnswer: Describes
“However, evidence remains heterogeneous and largely based on surrogate or subjective measures.”
From the paper · Abstract
Reported gains in planning accuracy and efficiencyAnswer: Yes
“Where quantitative outcomes were reported, improvements most commonly involved planning accuracy, task efficiency (e.g., clip/operative time), and user-rated usefulness; patient-level outcomes were infrequently reported and variably defined.”
Assessing the impact of virtual reality on surgeons' mental models of complex congenital heart cases#
Bethke E et al. · International journal of computer assisted radiology and surgery · 2026
Congenital heart · Qualitative/user study
HTC Vive
Meta Quest / Oculus
Qualitative study in which surgeons reviewed real complex congenital heart cases in VR before surgery while thinking aloud, followed by the NASA task-load index. The authors report a significant rise in self-reported confidence in understanding the anatomy after VR (p = 0.012), recurring patterns of 3D exploration and low reported cognitive load.
“We find a significant increase in reported physician confidence in understanding of the patient anatomy from before VR to after (p = 0.012) and identified several common patterns of 3D exploration of the anatomy in VR.”
p = 0.012
From the paper · Abstract
“Physicians also reported low cognitive stress on the NASA-TLX.”
From the paper · Abstract
Conclusions (4)
Anatomy confidence rose after VRAnswer: Yes
“We find a significant increase in reported physician confidence in understanding of the patient anatomy from before VR to after (p = 0.012) and identified several common patterns of 3D exploration of the anatomy in VR.”
p = 0.012
From the paper · Abstract
Low cognitive stress reported on NASA-TLXAnswer: Yes
“Physicians also reported low cognitive stress on the NASA-TLX.”
From the paper · Abstract
Approach confidence change not significantAnswer: No significant difference
“no statistically significant change in reported confidence in the surgical approach from before to after the VR session (p = 0.310)”
p = 0.310
From the paper · Full text
Mental demand lower in VR than conferenceAnswer: Yes
“A Welch’s t test comparing the mean mental demands in surgical conference vs VR for the 7 sessions where this was collected shows a significant decrease (p = 0.016), indicating the physicians had an easier time understanding the patient anatomy in VR than by reviewing traditional medical imaging.”
Advancements in 3D modeling technologies for congenital heart disease: integrating 3D printing, virtual reality, and holograms#
Bertelli F et al. · Pediatric radiology · 2026
Congenital heart · Narrative review
Multiple platforms
Review of 3D printing, virtual reality, mixed reality and holograms for visualising congenital heart disease anatomy. It covers software options, costs and resource needs for centres of different sizes, and gives practical guidance on adopting these tools.
Prospective study of 25 unruptured MCA aneurysms prepared for clipping with mixed reality holograms (Lumi on HoloLens 2), matched with 25 cases prepared without MxR. The authors report a mean hologram preparation time of 26 minutes, approach or head-position changes in 2 cases (8%), a shorter mean incision-to-closure time (203 vs. 229 minutes; confidence interval crossing zero), and acceptable usability.
“In 2 cases (8%), surgical planning with MxR led to the modification of the approach or the head's positioning.”
2 cases (8%)
From the paper · Abstract
“The mean craniotomy diameter and mean surgical preparation time did not differ significantly.”
From the paper · Abstract
“Mean scores for Usefulness, Ease of Use, Ease of Learning, and Satisfaction were equal or above 5 for 80% of the interviewed surgeons”
80%
From the paper · Abstract
Conclusions (4)
Surgical time shorter, not significantAnswer: No significant difference
“the mean total surgical time of the MxR group was found to be shorter than that of the non-MxR group although without statistical significance”
203 ± 64 minutes vs 229 ± 78 minutes, 95% CI [−20, 58]
From the paper · Full text
Approach or positioning changed in 2 casesAnswer: Yes
“In 2 cases (8%), surgical planning with MxR led to the modification of the approach or the head's positioning.”
2 cases (8%)
From the paper · Abstract
80% of surgeons rated usability 5 or aboveAnswer: Yes
“Mean scores for Usefulness, Ease of Use, Ease of Learning, and Satisfaction were equal or above 5 for 80% of the interviewed surgeons”
80%
From the paper · Abstract
Hologram preparation took 25 minutes on averageAnswer: Describes
“The mean hologram preparation time was 25 ± 10 minutes, ranging from a minimum of 20 minutes to a maximum of 60 minutes.”
Holographic Deep Inferior Epigastric Perforator Exploration in Mixed Reality using Real-Time Cinematic Rendering#
Necker FN et al. · Aesthetic plastic surgery · 2026
Plastic & reconstructive · Technical development
Microsoft HoloLens
Technical description of a workflow that shows photorealistic cinematic renderings of CT angiography as interactive holograms on a Microsoft HoloLens for exploring DIEP flap perforator anatomy. The authors describe real-time adjustment and virtual dissection of the rectus abdominis to show the subcutaneous and intramuscular course of perforators, run by the surgeon with a laptop and headset.
“Using different visualization settings, the spatial relationship of perforators to surrounding anatomical structures-especially the subcutaneous tissue and the Rectus Abdominis Muscle-can be understood more intuitively.”
From the paper · Abstract
“Our technique can be performed by surgeons independently with a laptop and a Microsoft HoloLens, making CT angiography data more accessible and practical for use in plastic surgery.”
From the paper · Abstract
Conclusions (2)
Perforator relations can be understood more intuitivelyAnswer: Yes
“Using different visualization settings, the spatial relationship of perforators to surrounding anatomical structures-especially the subcutaneous tissue and the Rectus Abdominis Muscle-can be understood more intuitively.”
From the paper · Abstract
Surgeons can run the workflow independentlyAnswer: Yes
“Our technique can be performed by surgeons independently with a laptop and a Microsoft HoloLens, making CT angiography data more accessible and practical for use in plastic surgery.”
Review of artificial intelligence and extended reality in TAVR, covering AI for ECG, echo and CT assessment and risk prediction, and AR/VR/MR for spatial visualization, pre-procedural planning and real-time guidance, with the need for standards, regulation and ethics.
“Immersive XR technologies, including augmented, virtual, and mixed reality, improve spatial visualization of complex cardiac anatomy and support real-time procedural guidance.”
From the paper · Abstract
“Despite these advancements, standardized protocols, regulatory frameworks, and ethical safeguards remain necessary for widespread clinical adoption.”
Virtual Reality in Neonatal Ductal Stenting: A New Era in Preprocedural Planning for Ductus Arteriosus Stenting in Complex Congenital Heart Defects with Duct-Dependent Pulmonary Circulation#
Szeliga J et al. · Pediatric cardiology · 2026
Congenital heart · Retrospective case series · n: 6 patients
VMersive (VR-Learning)
Single-centre retrospective study of six neonates with duct-dependent pulmonary circulation in whom CT-derived models generated automatically by VMersive were assessed on VR headsets before ductus arteriosus stenting and compared with angiography. The authors report that VR classification of duct morphology agreed with angiography, that VR measured longer ducts and higher curvature than angiography, and that VR-suggested projections were a median 12 degrees from the final projections.
“Length and curvature: VR-derived [L1] values were significantly longer than angiographic measurements (mean: 28.93 mm vs. 24.14 mm; p = 0.038).”
p = 0.038
From the paper · Abstract
“Projection planning: Median angular deviation between VR-recommended and final procedural projections was 12° (range: 6-30°, p = 0.259).”
12°
From the paper · Abstract
“In patients with anomalous pulmonary venous return, VR clarified spatial relationships and potential compression risk.”
From the paper · Abstract
“In another case, VR reconstruction identified a persistent vertical vein connecting the left superior vena cava and the left atrium, providing essential anatomical insight for planning both DA stenting and static atrial septostomy as the first stage of palliation for a complex congenital defect”
From the paper · Fulltext
Conclusions (5)
VR duct length longer than angiographyAnswer: Describes
“Length and curvature: VR-derived [L1] values were significantly longer than angiographic measurements (mean: 28.93 mm vs. 24.14 mm; p = 0.038).”
28.93 mm vs. 24.14 mm; p = 0.038
From the paper · Abstract
VR projections median 12 degrees from finalAnswer: Describes
“Projection planning: Median angular deviation between VR-recommended and final procedural projections was 12° (range: 6-30°, p = 0.259).”
“In patients with anomalous pulmonary venous return, VR clarified spatial relationships and potential compression risk.”
From the paper · Abstract
VR found vein that shaped staged planAnswer: Yes
“In another case, VR reconstruction identified a persistent vertical vein connecting the left superior vena cava and the left atrium, providing essential anatomical insight for planning both DA stenting and static atrial septostomy as the first stage of palliation for a complex congenital defect”
From the paper · Full text
VR access matched initial operator choice in 3/6Answer: Mixed
“Vascular access: VR-predicted access matched initial operator choice in 3/6 cases (50%), rising to 5/6 (83%) when reinterventions were included.”
Abdominal mixed reality visualization based on quadric error metric simplification#
Zhang W et al. · 2026 9th International Conference on Advanced Electronic Technology, Computers and Software Engineering (AETCSE) · 2026
General & GI surgery · Technical development
Microsoft HoloLens
Conference paper proposing a curvature-weighted mesh simplification method to keep anatomical detail in abdominal models for mixed-reality surgical planning on Microsoft HoloLens 2. The authors report lower distance and volume errors than benchmark methods and stable frame rates above 55 fps.
Conclusions (2)
Mesh error below most benchmark methodsAnswer: Mixed
“The results show that the proposed method achieves an average distance error of 0.0085 and a volume preservation error of 0.0889%”
average distance error 0.0085; volume error 0.0889%
From the paper · Abstract
Frame rate above 55 fps on headsetAnswer: Yes
“the reconstructed models maintain a stable interactive frame rate of over 55 frames per second”
Narrative review of augmented, virtual and mixed reality in oral and maxillofacial surgery across training, preoperative planning, intraoperative navigation and patient communication. For planning, the authors report that immersive 3D visualisation improves spatial understanding and supports waferless, guide-based and patient-specific workflows.
“In planning, immersive three-dimensional visualisation improves spatial understanding and supports waferless, guide-based, and patient-specific workflows.”
From the paper · Abstract
“In patient communication, patient-specific VR, AR, and MR visualisations improve understanding and satisfaction and reduce anxiety during informed consent.”
From the paper · Abstract
“XR offers tangible benefits across the OMFS pathway, yet evidence is constrained by small heterogeneous studies, registration and ergonomic challenges, novelty bias, and limited long-term clinical data.”
From the paper · Abstract
Conclusions (4)
Immersive 3D improves spatial understanding in planningAnswer: Yes
“In planning, immersive three-dimensional visualisation improves spatial understanding and supports waferless, guide-based, and patient-specific workflows.”
“In patient communication, patient-specific VR, AR, and MR visualisations improve understanding and satisfaction and reduce anxiety during informed consent.”
From the paper · Abstract
Training outcomes at least equal to conventionalAnswer: Yes
“In training, immersive VR and haptic simulators provide risk-free, repeatable, objectively assessed practice and yield outcomes that are non-inferior and often superior to conventional methods.”
From the paper · Abstract
Evidence limited by small heterogeneous studiesAnswer: Mixed
“XR offers tangible benefits across the OMFS pathway, yet evidence is constrained by small heterogeneous studies, registration and ergonomic challenges, novelty bias, and limited long-term clinical data.”
Preprint of a prospective controlled study comparing LiverXR-Plan, an extended reality platform combining 3D reconstruction and hemodynamic simulation, with 2D CT for hepatic surgical planning tasks in 52 medical students and 47 residents. The authors report higher anatomical accuracy, shorter task time and lower workload with XR.
“Accuracy improved from 32.69% to 100% (students) and 74.47% to 100% (residents); time reduced by 54.40% and 51.12%.”
74.47% to 100%
From the paper · Abstract
“LiverXR-Plan enhances surgical planning competency and shifts liver surgery education from experience-dependent to data-driven decision-making.”
From the paper · Abstract
“The implementation of the LiverXR-Plan system significantly reduced the overall preoperative planning time across both cohorts.”
37.24 to 17.33 min (students); 31.61 to 18.37 min (residents)
From the paper · Fulltext
Conclusions (4)
Anatomical identification accuracy rose to 100%Answer: Yes
“Accuracy improved from 32.69% to 100% (students) and 74.47% to 100% (residents)”
32.69% to 100% (students); 74.47% to 100% (residents)
From the paper · Abstract
Planning time significantly reduced in both cohortsAnswer: Yes
“The implementation of the LiverXR-Plan system significantly reduced the overall preoperative planning time across both cohorts.”
37.24 to 17.33 min (students); 31.61 to 18.37 min (residents)
From the paper · Full text
Physical and mental workload significantly lowerAnswer: Yes
“the LiverXR-Plan system significantly reduced both physical and mental workload compared to traditional methods”
Immersive extended reality (XR) in oncology: a scoping review of virtual reality (VR) and mixed reality (MR) applications for 3D solid tumor visualization#
Afroz S, Zhang L · Frontiers in Virtual Reality · 2026
PRISMA-ScR scoping review of 30 studies (2020-2025) on immersive VR and mixed-reality 3D visualisation of solid tumours for surgical planning, anatomy and education. The authors report that XR improved surgeon confidence and changed surgical strategy in several studies, but most were small single-centre feasibility studies with inconsistent hardware reporting and few quantitative endpoints.
“While XR technologies improved surgeon confidence and altered surgical strategies in several cases, most studies were small and single-center feasibility evaluations.”
From the paper · Abstract
“While there is still limited evidence of clinical impact, these findings are helpful for researchers and clinicians.”
From the paper · Abstract
“Across all studies, 70% reported improved spatial understanding”
70% of studies
From the paper · Fulltext
“However, there is limited robust evidence linking immersive visualization to long-term clinical outcomes.”
From the paper · Fulltext
Conclusions (3)
40% of studies reported surgical plan changesAnswer: Yes
“40% reported modifications to surgical plans or intraoperative approaches”
40% of studies
From the paper · Full text
70% of studies reported improved spatial understandingAnswer: Yes
“Across all studies, 70% reported improved spatial understanding”
70% of studies
From the paper · Full text
Little evidence on long-term clinical outcomesAnswer: Describes
“However, there is limited robust evidence linking immersive visualization to long-term clinical outcomes.”
Mixed Reality spatial computing for preoperative surgical planning in orthopedic oncology: review of 72 cases and evolution of clinical implementation#
Wong KC et al. · Exploration of Digital Health Technologies · 2026
Orthopedics · Retrospective case series · n: 72 patients
AR/MR, platform not specified
3D Slicer / SlicerVR
Materialise Mimics
Review of 72 orthopaedic oncology patients (July 2021 to November 2025) in whom tumour models built in 3D Slicer or Mimics were viewed as mixed-reality holograms overlaid on the patient through a proprietary MR platform before skin incision, after conventional 2D assessment. The authors report better spatial awareness of the pathoanatomy and lower NASA-TLX workload with the holograms, and describe technical issues met during clinical implementation.
“A Likert-scale questionnaire showed that the MR 3D hologram group outperformed the 2D group across all aspects of spatial awareness of the patient’s pathoanatomy and was viewed as a more effective tool for preoperative planning.”
From the paper · Abstract
“Regarding NASA-TLX scores, the overall cognitive workload during preoperative assessment was lower in the MR 3D hologram group.”
From the paper · Abstract
“Since December 2024, generating cinematic-rendered 3D models with the upgraded MR software platform (version 2) has taken an average of 61 minutes (49–156).”
61 minutes
From the paper · Abstract
Conclusions (4)
Spatial awareness rated higher with 3D hologramsAnswer: Yes
“the MR 3D hologram group outperformed the 2D group across all aspects of spatial awareness of the patient’s pathoanatomy”
From the paper · Abstract
Lower cognitive workload with holograms, no testAnswer: Yes
“the overall cognitive workload during preoperative assessment was lower in the MR 3D hologram group (median 170 [IQR 30]) compared to the 2D group (median 310 [IQR 40])”
median 170 [IQR 30] vs 310 [IQR 40]
From the paper · Full text
Model generation averaged 61 minutesAnswer: Describes
MRI SmarT: A Novel Multi-Modal Approach to Tumor Detection and Surgical Planning#
Wang CX · Autonomous Intelligent Systems · 2026
Neurosurgery · Technical development
Meta Quest / Oculus
Conference paper describing MRI SmarT, an extended-reality preoperative planning tool for brain tumour surgery on Meta Quest 2 that combines deep-learning segmentation of public MRI datasets (BraTS), 3D visualisation and strategy prediction.
Conclusions (1)
Three-stage planning tool built on public datasetsAnswer: Describes
“stage development of segmentation, visualization, and prediction using publicly available datasets of BRaTS18, BRaTS20, BOLD5000, of over 7000 sample datasets.”
Surgilink-Mr: Bounded Planar Cutting and Bidirectional CT-Mesh Interaction for Surgical Mixed Reality Planning and Training#
Trioux A et al. · Image, Video, and Multidimensional Signal Processing Workshop · 2026
Multi-specialty · Technical development · n: 10 clinicians
AR/MR, platform not specified
Conference paper introducing SurgiLink-MR, a standalone mixed-reality system for organ-centred surgical planning and anatomy training with bounded planar cutting for resection preview and two-way linking between a 3D organ mesh and tri-planar CT slices. The authors report positive ratings (4.2 to 4.9 of 5) for accuracy, responsiveness and usefulness in a pilot with 10 clinicians.
“A subjective pilot study with 10 clinicians (4 experienced, 6 less experienced; roles: surgeons/trainees), conducted following ITU-R BT.500-15 methodology, reports consistently positive ratings (4.2-4.9/5 on a 5-point Likert scale) on perceived accuracy, responsiveness, and usefulness, indicating potential for clinical and educational scenarios.”
4.2-4.9/5
From the paper · Abstract
Conclusions (1)
Ten clinicians rated the system positivelyAnswer: Yes
“reports consistently positive ratings (4.2–4.9/5 on a 5-point Likert scale) on perceived accuracy, responsiveness, and usefulness”
The Emerging Reality: A Narrative Review of Virtual, Augmented, and Mixed Reality in Modern Spine Surgery#
Rudrappa S et al. · Indian Spine Journal · 2026
Spine · Narrative review
Multiple platforms
Narrative review of VR, AR and MR in spine surgery, covering patient-specific VR rehearsal before surgery, AR/MR intraoperative guidance, education and patient consent.
“Several studies have suggested high levels of accuracy with their use.”
From the paper · Abstract
“Some clinicians feel it can also help patients understand procedures better during the consent process.”
From the paper · Abstract
Conclusions (2)
Studies suggest high accuracyAnswer: Yes
“Several studies have suggested high levels of accuracy with their use.”
From the paper · Abstract
Some clinicians feel consent understanding improvesAnswer: Yes
“Some clinicians feel it can also help patients understand procedures better during the consent process.”
Three-Dimensional Imaging, Printing, and Mixed Reality in Surgical Oncology: A Feasibility and Implementation Framework at a Comprehensive Cancer Center#
Oudeh A et al. · Preprints.org · 2026
Multi-specialty · Preprint (experience report)
AR/MR, platform not specified
Preprint describing implementation of 3D reconstruction, 3D printing and augmented reality across seven case groups in surgical oncology (paediatric, head and neck, urologic, gynaecologic, thoracic) at a comprehensive cancer center. The authors report that AR-assisted 3D reconstruction was built into the planning workflow for some patients and describe the teams' views on usefulness.
“Segmentation-based visualization was implemented for preoperative planning in two patients with skull-based malignancies; the surgical team described the 3D workflow as useful for operative planning.”
From the paper · Abstract
“Across diverse oncologic contexts and surgical specialties, 3D reconstruction, printing, and AR were successfully integrated into existing perioperative workflows, with each modality selected based on the specific clinical problem at hand.”
From the paper · Abstract
Conclusions (2)
Skull-base team called 3D workflow useful for planningAnswer: Yes
“Segmentation-based visualization was implemented for preoperative planning in two patients with skull-based malignancies; the surgical team described the 3D workflow as useful for operative planning.”
From the paper · Abstract
3D reconstruction, printing and AR integrated into workflowsAnswer: Yes
“Across diverse oncologic contexts and surgical specialties, 3D reconstruction, printing, and AR were successfully integrated into existing perioperative workflows, with each modality selected based on the specific clinical problem at hand.”
Preprint review of 3D printing and extended reality for surgical planning and simulation in cardiovascular disease. The authors describe XR as providing immersive exploration of volumetric imaging that supports pre-surgical planning, and discuss limitations and future directions.
Training the Surgical Mind: How Mixed Reality Shapes Neurosurgical Residents Approach Planning#
Lehmann S et al. · Brain and Spine · 2026
Neurosurgery · Conference abstract
AR/MR, platform not specified
Brain and Spine 2026 meeting abstract from the Leipzig group on how mixed reality shapes neurosurgical residents' approach planning. Title-only record: no abstract was openly available from the sources searched, so details could not be confirmed.
Randomised study of 40 patients undergoing sinus venosus defect closure (20), pulmonary artery stenting (12) or percutaneous pulmonary valve implantation (8), with planning by CT alone or CT plus VR (VMersive). A junior cardiologist using CT plus VR deviated less from the procedural plan than when using CT alone, comparable to a senior cardiologist's CT-only plans. VR did not affect procedure time or contrast volume.
“Adding VR reduced plan deviations and was comparable to those of the senior cardiologist (P = 0.233), indicating enhanced understanding by an early-career operator.”
P = 0.233
From the paper · Abstract
“No significant differences in planning accuracy were observed between the methods in PPVI or PA stenting.”
From the paper · Abstract
“Despite VR's potential to simplify the intervention, it did not affect procedural duration or contrast volume in this early experience.”
From the paper · Abstract
“Thus, there was no significant difference in the procedural outcomes between the groups.”
From the paper · Fulltext
Conclusions (4)
No difference in primary procedural outcomesAnswer: No significant difference
“Thus, there was no significant difference in the procedural outcomes between the groups.”
From the paper · Full text
Junior plan deviation lower with added VRAnswer: Yes
“Adding VR reduced plan deviations and was comparable to those of the senior cardiologist ( P = 0.233)”
Friedman P = 0.0195; junior CT alone vs CT + VR 0.0210; CT + VR vs senior P = 0.233
From the paper · Abstract
Procedure time and contrast volume unchangedAnswer: No significant difference
“Despite VR’s potential to simplify the intervention, it did not affect procedural duration or contrast volume in this early experience.”
procedural time P = 0.897
From the paper · Abstract
No plan-deviation difference in PPVI or stentingAnswer: No significant difference
“No significant differences in planning accuracy were observed between the methods in PPVI or PA stenting.”
Extended Reality in Medical Diagnosis and Surgical Planning#
Raisamo R et al. · Studies in health technology and informatics · 2025
Multi-specialty · Experience report
VR, platform not specified
Summary of a series of the authors' experimental studies using extended reality (VR, AR and MR) for medical diagnosis and surgical planning with 3D imaging. The authors report that XR improved understanding of medical data through efficient interaction techniques and clear visualisation.
“The results demonstrate that XR technologies can improve medical data understanding, for example, by providing efficient interaction techniques and clear visualizations.”
From the paper · Abstract
Conclusions (1)
Authors report XR can improve data understandingAnswer: Describes
“The results demonstrate that XR technologies can improve medical data understanding, for example, by providing efficient interaction techniques and clear visualizations.”
3-dimensional reconstruction and mixed reality in thoracic surgery: a narrative review and user guide#
Pohlman A et al. · Journal of thoracic disease · 2025
Thoracic · Narrative review
Multiple platforms
Narrative review and user guide on 3D reconstruction, 3D printing and VR/AR in thoracic surgery, covering how models are built, indications, FDA-cleared platforms and surgeon perceptions. The authors list model accuracy, limited evidence, slow uptake and cost as the main limitations.
“Currently, the primary limitations are varying accuracy of models, available evidence for use, uptake by surgeons, and cost of the technology.”
From the paper · Abstract
Conclusions (2)
Main limits: accuracy, evidence, uptake, costAnswer: Describes
“Currently, the primary limitations are varying accuracy of models, available evidence for use, uptake by surgeons, and cost of the technology.”
From the paper · Abstract
Further study of development, use, safety neededAnswer: Describes
“Further study into their development, use, and safety will be vital in the coming years.”
Extended reality in skull base surgery: a systematic literature review#
Sanker V et al. · Frontiers in surgery · 2025
Neurosurgery · Systematic review
Multiple platforms
Systematic review (to March 2024) of 21 original studies using AR (13), VR (4) or MR (4) for planning or training in skull base surgery. It reports registration accuracies of 2.5-10.75 mm for AR and about 5.8 mm for MR, and concludes that the technologies need substantial improvement.
“Augmented reality has demonstrated varying degrees of effectiveness, with mean registration accuracy reported between 2.5 and 10.75 mm.”
From the paper · Abstract
Conclusions (3)
AR registration error ranged 2.5 to 10.75 mmAnswer: Mixed
“Augmented reality has demonstrated varying degrees of effectiveness, with mean registration accuracy reported between 2.5 and 10.75 mm.”
“Although the use of XR in skull base surgery shows promise, the technologies associated with these modalities require substantial improvement before XR is a stable component of the neurosurgical toolbox.”
Virtual Reality to Enhance Understanding of Congenital Heart Disease#
Narasimhan SL et al. · Journal of cardiovascular development and disease · 2025
Congenital heart · Retrospective case series + survey · n: 9 patients
Elucis Next (research software, not FDA-cleared)
Retrospective study of nine children with extracardiac congenital heart abnormalities (vascular rings, pericardial teratomas, a left pulmonary artery sling, an aortopulmonary window and a right superior vena cava draining to the left atrium). CT angiograms were segmented in Elucis Next (v1.10) and the VR videos were presented at weekly heart-centre conferences; heart-centre staff were then surveyed about the role of VR in clinical practice.
Validation study of 50 consecutive TAVI candidates comparing annulus and LVOT measurements from a novel immersive VR application (Vea, headset and controller) with standard CT tools (3mensio, Horos). The authors report excellent consistency (ICC 0.93 for the annulus, 0.90 for the LVOT) and better prosthesis size selection, with net reclassification gain over conventional CT.
“The intraclass correlation coefficient (ICC) confirmed excellent consistency for annular measurements (ICC = 0.93), while the concordance correlation coefficient indicated very good overall agreement (CCC = 0.83, 95% CI 0.73-0.90).”
ICC = 0.93
From the paper · Abstract
“Similarly, LVOT measurements obtained with VEA showed strong correlation with CT values, with good consistency (ICC = 0.90) and good overall agreement (CCC = 0.77, 95% CI 0.64-0.86).”
ICC = 0.90
From the paper · Abstract
“VEA-based planning improved prosthesis size selection accuracy, achieving higher concordance with implanted valves and a significant net reclassification gain over conventional CT.”
From the paper · Abstract
Conclusions (3)
Annulus measurements agreed closely with CTAnswer: Yes
“The intraclass correlation coefficient (ICC) confirmed excellent consistency for annular measurements (ICC = 0.93)”
ICC = 0.93
From the paper · Abstract
Valve sizing error lower than CT planningAnswer: Yes
“the mean absolute error (MAE) relative to the implanted valve size was 1.16 mm for CT-based planning and 0.74 mm for VEA-based planning”
MAE 1.16 vs 0.74 mm, p = 0.014
From the paper · Full text
No size gain for non-structural imaging operatorsAnswer: No significant difference
“no improvements were found using VEA when the planning was performed by expert operators in advanced cardiac imaging with no direct experience with structural heart interventions”
Retrospective cohort of 159 patients (163 aneurysms) who had elective clipping of unruptured intracranial aneurysms at Basel (2009-2024), comparing those planned with the SpectoMedical VR platform with those planned without. The authors report smaller craniotomies (13.2 vs. 20.3 cm², about 6.2 cm² smaller on multivariable analysis) and shorter hospital stay with VR planning, and a non-significant reduction in operative time.
“VR-based surgical planning was associated with significantly smaller craniotomy sizes and shorter hospital stays.”
From the paper · Abstract
“Operative time was shorter in the VR group but lacked statistical significance”
From the paper · Abstract
“It results in an intraoperative déjà-vu effect for the surgeon, which supports its use as a valuable adjunct in preoperative planning.”
From the paper · Abstract
Conclusions (3)
Smaller craniotomy and shorter hospital stayAnswer: Yes
“VR-based surgical planning was associated with significantly smaller craniotomy sizes and shorter hospital stays.”
20.31 vs 13.22 cm2, p = 0.007; 10.04 vs 7.89 days, p = 0.031
From the paper · Abstract
Operative time not significantly shorterAnswer: No significant difference
“Operative time was shorter in the VR group but lacked statistical significance”
226.41 vs 207.93 min, p = 0.160
From the paper · Abstract
Keyhole approaches used more oftenAnswer: Yes
“Minipterional and sylvian keyhole craniotomies were used significantly more in the VR group”
Augmented reality and 3D modeling for preoperative planning in microsurgical resection of brain arteriovenous malformations: A proof-of-concept study#
Konovalov A et al. · Surgical neurology international · 2025
Neurosurgery · Case series · n: 20 patients
Microsoft HoloLens
Medgital
Prospective proof-of-concept series of 20 patients with Spetzler-Martin grade II-IV AVMs, planned with 3D segmentation (Inobitec) and AR on HoloLens 2 (Medgital software) with QR-code registration. The authors report complete resection in all cases, a target registration error of 0.5 cm with QR codes versus 1.2 cm with craniometric points, and mean modelling and AR set-up times of about 15 and 13 minutes.
“Preoperative modeling required 15.3 ± 5.1 min, while AR navigation averaged 12.7 ± 3.2 min.”
15.3 ± 5.1 min
From the paper · Abstract
“Our findings support the feasibility of AR-assisted 3D planning as an adjunctive tool for AVM microsurgery.”
From the paper · Abstract
“Complete AVM resection was achieved in all cases (100%).”
all cases (100%)
From the paper · Abstract
Conclusions (4)
Complete resection in all 20 patientsAnswer: Describes
“Complete AVM resection was achieved in all cases (100%).”
all cases (100%)
From the paper · Abstract
Modelling 15.3 min, AR navigation 12.7 minAnswer: Describes
“Preoperative modeling required 15.3 ± 5.1 min, while AR navigation averaged 12.7 ± 3.2 min.”
15.3 ± 5.1 min; 12.7 ± 3.2 min
From the paper · Abstract
Registration error 0.5 cm with QR codeAnswer: Describes
“TRE: 0.5 ± 0.3 cm with QR-code vs. 1.2 ± 0.5 cm with craniometric points”
TRE 0.5 ± 0.3 vs 1.2 ± 0.5 cm
From the paper · Abstract
Authors call the approach feasibleAnswer: Yes
“Our findings support the feasibility of AR-assisted 3D planning as an adjunctive tool for AVM microsurgery.”
The Evolution of Spatial Computing in Spine Surgery: Tracing the Historical Arc to Present Day Implementation#
Elsayed GA et al. · World neurosurgery · 2025
Spine · Narrative review
Multiple platforms
Historical narrative review tracing spatial computing in spine surgery from stereotactic frames and early imaging to AR, VR, robotics and AI. The authors describe intraoperative imaging and robotic platforms, and AI-driven planning tools and VR-based simulation, as refining surgical technique.
Advancing Spine Surgery: Innovations for Spatial Computing Integration#
Elsayed GA et al. · World neurosurgery · 2025
Spine · Narrative review
Multiple platforms
Narrative review of innovations needed across the spine surgery workflow to support spatial computing, including AI-assisted diagnosis, imaging protocols for 3D reconstruction, VR-based preoperative planning and patient-specific simulation, and intraoperative technologies. The authors note remaining challenges in clinical validation, cost-effectiveness and ethics.
“However, challenges remain, particularly with respect to clinical validation, cost-effectiveness, and ethical considerations.”
Endoscopy E-Video case of a 76-year-old with pancreatic head cancer after failed ERCP, in whom CT-derived VR models in Holoeyes MD on a Meta Quest 3 were sectioned to match the expected EUS view and simulate the needle path before EUS-guided hepaticogastrostomy. The authors report that this clarified the target duct and its relationships.
“Switching to a whole-tree view clarified the duct caliber, curvature, distance to the common bile duct, and relationships with adjacent organs, helping predict guidewire direction and avoid unfavorable angles.”
From the paper · Full text: main text
“A post-placement VR model showed visual concordance between the planned trajectory and the final stent path ( Video 1 ).”
From the paper · Full text: main text
Conclusions (3)
VR distance matched intraprocedural EUS caliperAnswer: Yes
“Quantitatively, the gastric wall-to-B3 distance in VR (3.07 cm) closely matched the intraprocedural EUS on-screen caliper value (approximately 3.0 cm)”
3.07 cm VR vs approximately 3.0 cm EUS
From the paper · Full text
Whole-tree view clarified duct anatomyAnswer: Yes
“Switching to a whole-tree view clarified the duct caliber, curvature, distance to the common bile duct, and relationships with adjacent organs, helping predict guidewire direction and avoid unfavorable angles.”
From the paper · Full text
Procedure completed with no adverse eventsAnswer: Describes
“cholangiography, smooth guidewire advancement into the common bile duct, tract dilation, and plastic stent placement were all completed successfully with no intra- or postprocedural adverse events”
Transforming Care in Congenital Heart Disease: The Role of Extended Reality in Family and Trainee Education and Procedural Planning#
Gunsaulus M et al. · Current cardiology reports · 2025
Congenital heart · Narrative review
Elucis
EchoPixel True 3D
VSI HoloMedicine (apoQlar)
Microsoft HoloLens
Narrative review of extended reality (VR, AR and mixed reality) in congenital heart disease, covering patient and family education, trainee teaching, and surgical and transcatheter procedural planning. The authors describe their own centre's use of Elucis in multidisciplinary case conferences and for surgical rehearsal, alongside other platforms (EchoPixel, and apoQlar software on HoloLens 2).
Clinical Practice and Survey of Three-Dimensional Images, Virtual Reality, Augmented Reality and Mixed Reality for Robotic-Assisted Surgery in Urology-"Anatomy on the Border" Expert Consensus Meeting#
Kobayashi S et al. · Asian journal of endoscopic surgery · 2025
Urology · Survey/user study
VR, platform not specified
Nationwide online survey by the Japan Society for Endoscopic Surgery of urologists certified in laparoscopic and robotic surgery about their use of 3D images, VR, AR and MR, with an expert consensus. The authors report that most of the 32 responding urologists used 3D imaging for preoperative evaluation, while VR/AR/MR were used mainly for simulation (19%) and navigation (16%) and 51% had never used them, with cost and data-processing effort cited as barriers.
“Thirty-two urologists surveyed reported using 3D imaging for preoperative evaluation (84%) and to understand anatomy (75%), with 97% reporting clinical benefits and 85% indicating that it improved the quality of surgery.”
97%
From the paper · Abstract
“While 63% expressed interest in these technologies, 51% reported never having used them.”
51%
From the paper · Abstract
“Among the barriers to adoption, 25% cited high cost, 24% cited the effort required for data processing, and 14% cited the difficulty of use.”
25%
From the paper · Abstract
Conclusions (3)
Most urologists report clinical benefit from 3D imagesAnswer: Yes
“with 97% reporting clinical benefits and 85% indicating that it improved the quality of surgery”
97%, 85%
From the paper · Abstract
Half never used VR, AR or MRAnswer: Mixed
“While 63% expressed interest in these technologies, 51% reported never having used them.”
63% interest, 51% never used
From the paper · Abstract
Cost and data effort cited as barriersAnswer: Describes
“Among the barriers to adoption, 25% cited high cost, 24% cited the effort required for data processing, and 14% cited the difficulty of use.”
Interdisciplinary Collaborative Virtual Reality Planning for Chest Wall Resection and Reconstruction for Sarcoma and Other Large Chest Wall Malignancies Enhanced by Automated AI Segmentation: A Retrospective Comparative Analysis#
Schnorr P et al. · Zentralblatt fur Chirurgie · 2025
Thoracic · Retrospective case series · n: 8 patients
Medicalholodeck / Medical Imaging XR
Retrospective analysis of eight complex chest wall resections planned collaboratively by an interdisciplinary team in the Medical Imaging XR VR platform with AI auto-segmentation, comparing predicted resection extent, defect size and reconstruction with intraoperative findings. The authors report that actual resection exceeded the VR prediction in three cases and planning exceeded resection in half, with good user-experience scores and little cybersickness, and advise treating VR as complementary.
“Planning exceeded resection in 50% of cases by up to 24% and one case (12.5%) showed a large overestimation in VR.”
“Workspace perception was favorable (mean 4.9/6), and cybersickness remained low.AI-enhanced VR planning enables interdisciplinary collaboration and can improve spatial understanding in complex chest wall surgery.”
9/6
From the paper · Abstract
Conclusions (4)
Resection exceeded VR prediction in 3 of 8Answer: No
“In 3 cases (37.5%), the actual resection exceeded the VR-predicted extent due to underestimated tumor infiltration.”
3 cases (37.5%)
From the paper · Abstract
Planning overestimated resection in half of casesAnswer: No
“Planning exceeded resection in 50% of cases by up to 24% and one case (12.5%) showed a large overestimation in VR.”
50% of cases, up to 24%
From the paper · Abstract
High user experience scores for stimulation and noveltyAnswer: Yes
The potential of Real-Time rendered-volume 3D Imaging in immersive virtual-reality (VR) for surgical planning in infants with congenital thoracic malformation (CTM)#
Zalepugas D et al. · Computational and structural biotechnology journal · 2025
Thoracic · Comparative study · n: 14 patients
Medicalholodeck / Medical Imaging XR
Retrospective reader study of 14 infants operated on for suspected congenital thoracic malformations, in which eight surgeons assessed each case with 2D CT and with real-time volume-rendered immersive VR models, separated by a washout period. The authors report equal sensitivity, more frequent detection of multilobar involvement and mediastinal shift with VR, more lobectomy recommendations, longer evaluation time and higher accuracy in predicting the procedure performed (95% vs 84%).
“Surgical planning differed significantly, with VR prompting more lobectomy recommendations (57 % vs. 50 %, p = 0.046).”
p = 0.046
From the paper · Abstract
“VR required longer evaluation times (203.2 ± 117.4 s vs. 124.1 ± 69.7 s, p < 0.001) but demonstrated higher prediction accuracy for the surgical procedure (95 % vs. 84 %).”
95 %
From the paper · Abstract
“While time demands remain a limitation, VR as a digital twin aligns with precision medicine and smart hospital paradigms.”
From the paper · Abstract
Conclusions (4)
Equal sensitivity with VR and 2D CTAnswer: No significant difference
“Both VR and conventional imaging achieved 100 % sensitivity in pathology detection.”
100 % sensitivity in both
From the paper · Abstract
VR prompted more lobectomy recommendationsAnswer: Yes
“Surgical planning differed significantly, with VR prompting more lobectomy recommendations (57 % vs. 50 %, p = 0.046).”
57 % vs. 50 %, p = 0.046
From the paper · Abstract
Procedure prediction not significantly differentAnswer: No significant difference
“performance was slightly higher with VR (80.4 % vs. 75.0 %), but this difference did not reach statistical significance (p = 0.424)”
80.4 % vs. 75.0 %, p = 0.424
From the paper · Full text
VR evaluation took longer than 2D CTAnswer: No
“VR required longer evaluation times (203.2 ± 117.4 s vs. 124.1 ± 69.7 s, p < 0.001)”
Usability Evaluation of a Mixed Reality Platform in Pediatric Interventional Cardiology by Specialist Physicians: Mixed Methods Study#
Chilanga CC et al. · JMIR formative research · 2025
Congenital heart · Survey/user study
CardioVision (HARMONIC)
Mixed-methods usability study of CardioVision, VR/MR software for paediatric interventional cardiology, in which eight specialist physicians from four countries tested it on their own submitted cases and six were interviewed. All valued the visualization; 75% rated it positively for decision support and 63% for complex case preparation.
“Overall, most participants (6/8, 75%) rated the system positively for decision-making support and 5/8 (63%) for complex case preparation.”
6/8, 75%
From the paper · Abstract
“All participants agreed that the software could be a valuable tool for educating medical students.”
From the paper · Fulltext
Conclusions (3)
Most physicians rated decision support positivelyAnswer: Yes
“Overall, most participants (6/8, 75%) rated the system positively for decision-making support and 5/8 (63%) for complex case preparation.”
6/8, 75%; 5/8, 63%
From the paper · Abstract
All users rated structure visualization positivelyAnswer: Yes
“The highest positive feedback was in the visualization of structures, where all users agreed or strongly agreed (100%).”
100%
From the paper · Full text
Interviewees said it could help teachingAnswer: Describes
“All participants agreed that the software could be a valuable tool for educating medical students.”
Benefit of virtual reality during visceral artery aneurysms open and endovascular surgery planning#
Donzel D et al. · Journal of vascular surgery cases and innovative techniques · 2025
Vascular · Comparative study · n: 10 patients
VR, platform not specified
Pilot study in which ten surgeons each analysed three of ten visceral artery aneurysm cases with 2D CT reconstructions and then with 3D VR in a headset running Avatar Medical Vision, choosing open or endovascular repair. The authors report that surgeons found VR improved assessment of location, anatomy and collaterals, and that the chosen procedure changed in 15% of assessments after VR.
“The choice of procedure (OR vs EP) was modified in 15% of cases after 3D VR analysis.”
15%
From the paper · Abstract
“Surgeons reported enhanced VAA location, anatomy assessment, and collateral diagnosis (83%, 90%, and 76%, respectively) using VR.”
83%
From the paper · Abstract
“The learning curve is short, and the analysis process is not time consuming.”
From the paper · Abstract
Conclusions (4)
Surgical approach changed in 4 of 29 analysesAnswer: Yes
“After the 3D VR analysis, a different surgical approach was chosen by the surgeon in 4 of the 29 analyzed cases (13.7%).”
4 of 29 (13.7%)
From the paper · Full text
Most surgeons reported improved aneurysm and collateral assessmentAnswer: Yes
“Surgeons reported enhanced VAA location, anatomy assessment, and collateral diagnosis (83%, 90%, and 76%, respectively) using VR.”
83%, 90%, 76%
From the paper · Abstract
Efferent branch count differed in seven casesAnswer: Describes
“In seven cases (24.1%), the number of identified efferent branches differed between the 2D and the 3D VR analyses.”
7 cases (24.1%)
From the paper · Full text
Most surgeons reported easier planningAnswer: Yes
“Most surgeons reported improved surgical procedure planning and easier anticipation of potential surgical difficulties (62.1% and 72.4%, respectively).”
Utility of Three-Dimensional Holographic Workstation for Preoperative Simulation of Complex Congenital Heart Surgery#
Takao H et al. · Interdisciplinary CardioVascular and Thoracic Surgery · 2025
Congenital heart · Case report · n: 1 patient
EchoPixel True 3D
Case report of a 7-month-old with false Taussig-Bing anomaly and partial AVSD, in whom a holographic workstation (EchoPixel True3D PreOP) was used for ventricular volume assessment and simulation of intraventricular rerouting with a virtual baffle. The authors report that this supported a successful biventricular repair rather than a single-ventricle pathway.
“The patient underwent successful biventricular repair via the Rastelli procedure and AVSD repair.”
From the paper · Abstract
“The holographic workstation proved cost-effective and may help determine biventricular repair viability in complex congenital heart diseases.”
From the paper · Abstract
“was initially considered for the single-ventricle pathway. However, preoperative evaluation using a holographic workstation enabled precise ventricular volume assessment and intraventricular rerouting simulation. A virtual baffle confirmed the feasibility of biventricular repair.”
From the paper · Abstract
“The preoperative estimate of right ventricular volume (10.4 mL) was slightly lower than the postoperative MRI measurement (12.2 mL)”
10.4 mL estimated vs 12.2 mL postoperative MRI
From the paper · Fulltext
Conclusions (4)
Successful biventricular repair after holographic simulationAnswer: Describes
“The patient underwent successful biventricular repair via the Rastelli procedure and AVSD repair”
From the paper · Abstract
Plan moved from single-ventricle to biventricularAnswer: Yes
“was initially considered for the single-ventricle pathway. However, preoperative evaluation using a holographic workstation enabled precise ventricular volume assessment and intraventricular rerouting simulation. A virtual baffle confirmed the feasibility of biventricular repair.”
Mixed reality enhances interobserver reliability in tibial plateau fracture classification compared to computed tomography, 3D computed tomography and 3D printing#
Dust T et al. · Journal of experimental orthopaedics · 2025
Orthopedics · Validation study · n: 22 cases
Microsoft HoloLens
Reliability study in which 12 surgeons (six junior, six senior) classified 22 tibial plateau fractures using CT, 3D CT reconstructions, 3D-printed models and mixed-reality holograms on HoloLens 2. The authors report that MR gave the highest interobserver reliability for the AO/OTA, ten-segment and revisited Schatzker classifications, with the largest benefit among less experienced surgeons.
“Diagnostic confidence for AO/OTA differed significantly between modalities (p = 0.045), with the highest values observed for 3DP (76%) and MR (58%) compared to CT (47%).”
p = 0.045
From the paper · Abstract
“MR improved classification reliability and diagnostic confidence for tibial plateau fractures compared to CT, 3DCT and 3DP.”
From the paper · Abstract
“The effect was most evident in less-experienced surgeons, indicating MR's value for surgical training and preoperative planning.”
From the paper · Abstract
Conclusions (3)
MR kappa highest in two of three systemsAnswer: Mixed
“MR demonstrated the highest interobserver reliability for all classification systems”
AO/OTA 0.43 vs. 0.32 for CT; revisited Schatzker 0.43 vs. 0.24; 10-segment kappa 0.17 (MR) vs. 0.18 (3D print)
From the paper · Abstract
AO/OTA diagnostic confidence differed between modalitiesAnswer: Yes
“Diagnostic confidence for AO/OTA differed significantly between modalities”
p = 0.045; 3DP (76%), MR (58%), CT (47%)
From the paper · Abstract
Schatzker reliability gain, but confidence declinedAnswer: Mixed
“Revisited Schatzker showed the largest reliability gain, though confidence declined compared to 3DP (59% vs. 34%).”
Virtual reality-assisted preoperative planning for pediatric thoracoscopic segmentectomy: a retrospective study#
Wang Y et al. · BMC pediatrics · 2025
Thoracic · Retrospective case series · n: 19 patients
Medicalholodeck / Medical Imaging XR
Retrospective study of 19 children with congenital cystic lung malformations who underwent thoracoscopic segmentectomy after immersive rehearsal of patient-specific 3D models in a head-mounted VR display using Medicalholodeck. The authors report that all operations were completed thoracoscopically without conversion, and that recovery was satisfactory at 6 months with no recurrence.
“All procedures (100%) were completed thoracoscopically without conversion.”
100%
From the paper · Abstract
“HMD-VR enables precise spatial mapping of complex pediatric pulmonary anatomy, facilitating safe thoracoscopic segmentectomies even for multi-segmental lesions.”
From the paper · Abstract
Conclusions (5)
All 19 operations completed thoracoscopicallyAnswer: Describes
“All procedures (100%) were completed thoracoscopically without conversion.”
100%
From the paper · Abstract
Authors report precise spatial mapping of anatomyAnswer: Yes
“HMD-VR enables precise spatial mapping of complex pediatric pulmonary anatomy, facilitating safe thoracoscopic segmentectomies even for multi-segmental lesions.”
From the paper · Abstract
Operative time 116.3 min, blood loss 29.5 mlAnswer: Describes
“Mean operative time was 116.3 ± 45.5 min with blood loss of 29.5 ± 20.6 ml.”
116.3 ± 45.5 min, 29.5 ± 20.6 ml
From the paper · Abstract
Assessors rated VR anatomy clearer than CTAnswer: Yes
“Two independent assessors concurred that VR models provided enhanced visualization of fine segmental bronchial branching patterns and spatial relationships with pulmonary vasculature, significantly improving three-dimensional comprehension of complex anatomy.”
From the paper · Full text
Combined segmentectomy: longer stay, more blood lossAnswer: Yes
“hospital stay, intraoperative blood loss, operative time, and duration of chest tube drainage were significantly higher than for single segmentectomies”
Optimizing the Workflow of Superficial Temporal Artery Mapping in Extracranial-Intracranial Bypass Surgery Using Mixed Reality: A Proof-of-Concept Study#
Bhatia S et al. · World neurosurgery · 2025
Neurosurgery · Validation study · n: 7 patients
Medivis SurgicalAR
AR/MR, platform not specified
Proof-of-concept study in 7 patients having STA-MCA bypass, in which CT angiography was superimposed on the patient with MEDIVIS SurgicalAR to map the superficial temporal artery before incision, compared with Doppler mapping. The authors report faster mapping with MR (similar once registration time was included) and a mean deviation of 4.5 mm between the two maps.
“MR mapping of the STA was faster than Doppler mapping (11.3 ± 1.47 vs. 67.2 ± 17.6 seconds; P = 0.001).”
P = 0.001
From the paper · Abstract
“When considering the time to register, the overall time for MR mapping was similar to Doppler (79.2 ± 39.8 vs. 67.2 ± 17.6 seconds; P = 0.78).”
P = 0.78
From the paper · Abstract
“Overall, the MR and Doppler maps demonstrated comparable alignment, with an average deviation of 4.46 ± 2.64 mm along the entire course of the mapped vessel.”
4.46 ± 2.64 mm
From the paper · Abstract
Conclusions (3)
Mapping faster than Doppler, excluding registrationAnswer: Yes
“MR mapping of the STA was faster than Doppler mapping (11.3 ± 1.47 vs. 67.2 ± 17.6 seconds; P = 0.001).”
11.3 ± 1.47 vs. 67.2 ± 17.6 seconds, P = 0.001
From the paper · Abstract
Overall time with registration not significantAnswer: No significant difference
“When considering the time to register, the overall time for MR mapping was similar to Doppler (79.2 ± 39.8 vs. 67.2 ± 17.6 seconds; P = 0.78).”
79.2 ± 39.8 vs. 67.2 ± 17.6 seconds, P = 0.78
From the paper · Abstract
Maps comparable, 4.46 mm mean deviationAnswer: Yes
“Overall, the MR and Doppler maps demonstrated comparable alignment, with an average deviation of 4.46 ± 2.64 mm along the entire course of the mapped vessel.”
Study of 29 patients scheduled for Venus P-valve transcatheter pulmonary valve implantation (26 implanted), in which two operators planned valve sizing on CT-derived holographic models (ARTICOR) viewed with mixed-reality headsets. The authors report 96% concordance with the implanted valve length, 92% for approach and 50% for valve diameter, and inter-operator agreement of 60% for diameter and 88% for length.
“Predictions using holographic models showed 96 % concordance for implanted valve length, type of the approach (92 %) and 50 % concordance for valve diameter.”
96 %
From the paper · Abstract
“These results highlight the potential of MxR for improving TPVI planning, though the limited accuracy for valve diameter suggests a need for further advancements, such as computational modeling or machine learning, to optimize procedural outcomes in interventional cardiology.”
From the paper · Abstract
Conclusions (2)
High length concordance, 50% for diameterAnswer: Mixed
“Holographic models achieved 96 % (n = 25/26) concordance in predicting valve length, type of the approach (92 %) and 50 % (n = 13/26) concordance for diameter.”
Extended reality in the changing landscape of cranial neurosurgery: Role of image fusions and connectomics in precision and safety#
Singh G et al. · Journal of clinical neuroscience · 2025
Neurosurgery · Narrative review
Multiple platforms
Narrative review of extended reality in cranial neurosurgery, covering preoperative rehearsal, simulation and intraoperative augmentation, the role of image fusion and connectomics (e.g., Surgical Theater, Quicktome), training, telecollaboration and ethical issues.
Innovative Integration of 4D Cardiovascular Reconstruction and Hologram: Framework Development of a New Visualization Tool for Coronary Artery Bypass Grafting Planning#
Framework development study using preoperative 4D cardiac CT angiography from 14 CABG patients to build dynamic models (chambers, epicardial fat, coronary arteries with calcium, adhesion motion analysis) displayed as naked-eye holograms on a Looking Glass light-field display. Thirteen cardiac surgeons rated its planning utility at 4.57/5, and hologram-based adhesion scores in 21 patients correlated with intraoperative findings (r = 0.786).
“Cardiac surgeons highly rated the visualization tool for its utility in preoperative planning, with a mean Likert score of 4.57/5.0 (SD 0.5).”
4.57/5.0
From the paper · Abstract
“The hologram-based scoring of pericardial adhesions showed a strong correlation with intraoperative findings (correlation coefficient r=0.786; P<.001).”
r=0.786
From the paper · Abstract
“It produces high-quality, clinically relevant, dynamic holograms from patient-specific volumetric data, with clinical feedback confirming its practicality and effectiveness for preoperative surgical planning.”
From the paper · Abstract
Conclusions (3)
Surgeons rated planning utility 4.57 of 5Answer: Yes
“Cardiac surgeons highly rated the visualization tool for its utility in preoperative planning, with a mean Likert score of 4.57/5.0 (SD 0.5).”
4.57/5.0 (SD 0.5)
From the paper · Abstract
Hologram adhesion score correlated with intraoperative findingsAnswer: Yes
“The hologram-based scoring of pericardial adhesions showed a strong correlation with intraoperative findings (correlation coefficient r=0.786; P<.001).”
r=0.786; P<.001
From the paper · Abstract
Preprocessing took about 15 minutes per patientAnswer: Describes
“The preprocessing time for each patient dataset requires approximately 15 min, making it clinically feasible for use in preoperative planning.”
Utilising a Novel Virtual Reality System for Orthopaedic Pre-operative Trauma Planning#
Waugh D et al. · Cureus · 2025
Orthopedics · Technical report
Medicalholodeck / Medical Imaging XR
Meta Quest / Oculus
Technical report describing a low-cost VR system (Medical Imaging XR on a consumer gaming headset) that lets orthopaedic surgeons view patient-specific CT fracture anatomy alongside the supplier's virtual implant files, to plan fixation of complex trauma. Functionality was demonstrated; a usefulness evaluation is planned.
“We have been able to demonstrate proof of functionality in what we believe is a very useful tool to aid trauma and orthopaedic pre-operative surgical planning and execution going forward.”
From the paper · Abstract
Conclusions (3)
Proof of concept for VR trauma planningAnswer: Describes
“Here, we present a proof-of-concept in the use of a novel VR system allowing the visualisation of patient-specific imaging with an implant .STL files, facilitating 3D trauma visualisation and planning for complex trauma.”
From the paper · Full text
Usefulness testing left for future workAnswer: Describes
“In the future, we will look to demonstrate perceived usefulness by the orthopaedic team for fracture understanding and trauma planning.”
From the paper · Full text
Extra hardware cost reportedAnswer: Describes
“The total cost of additional hardware was £1047.00”
Systematic review of 164 studies on extended reality (VR/AR/MR) in cardiovascular medicine, with PubMed and Web of Science searched to July 2024. The authors group the studies into education (31), training (36), peri-procedural care including planning (78) and rehabilitation (16). They describe the designs as very heterogeneous and call for randomized trials.
“However, these technologies are still in development, and randomized controlled trials are urgently needed to identify their benefits and limitations.”
“However, these technologies are still in development, and randomized controlled trials are urgently needed to identify their benefits and limitations.”
From the paper · Abstract
Study designs very heterogeneousAnswer: Describes
“Overall, the publications were characterized by very heterogeneous study designs.”
Endoscopy E-Video case of a 76-year-old man with acute cholecystitis, in whom an MRI-based 3D biliary model (SYNAPSE VINCENT, Holoeyes MD) viewed on a Meta Quest 3 headset was reviewed before endoscopic transpapillary gallbladder drainage. The authors report that the model helped guidewire insertion into the gallbladder.
“The mixed-reality-based 3D anatomical model clearly visualized the anatomical configuration through rotation, which allowed the endoscopists to accurately identify the cystic duct and advance the guidewire into the gallbladder ( Fig. 5 a ).”
From the paper · Full text: main text
“The technology provided enhanced spatial understanding and real-time procedural support, suggesting its potential as an innovative educational and clinical tool for pancreaticobiliary endoscopists.”
From the paper · Full text: main text
Conclusions (2)
Model aided guidewire entry into gallbladderAnswer: Yes
“The mixed-reality-based 3D anatomical model clearly visualized the anatomical configuration through rotation, which allowed the endoscopists to accurately identify the cystic duct and advance the guidewire into the gallbladder ( Fig. 5 a ).”
“The technology provided enhanced spatial understanding and real-time procedural support, suggesting its potential as an innovative educational and clinical tool for pancreaticobiliary endoscopists.”
Role of mixed reality in the workflow of complex neurooncological surgeries: a case analysis in thalamic surgery#
Zanuttini L et al. · Acta neurochirurgica · 2025
Neurosurgery · Retrospective case series · n: 9 patients (10 procedures)
Augmedit Lumi
Microsoft HoloLens
3D Slicer / SlicerVR
Retrospective study of 9 patients (10 procedures, 2022-2024) with thalamic tumours, whose patient-specific holograms (segmented with Lumi and 3D Slicer, viewed on HoloLens 2) were used preoperatively to simulate and choose the approach and intraoperatively to check it. The authors report a mean extra segmentation time of 45 minutes, a mean extent of resection of 94.9%, and one permanent new deficit.
“The additional planning time for segmentation averaged 45 min.”
45 min
From the paper · Abstract
“The mean extent of resection achieved was 94.88% (range: 78.6%-100%).”
94.88%
From the paper · Abstract
“Integrating MxR into the preoperative workflow for microsurgical removal of complex thalamic tumors proved to be a valuable tool for surgical planning, risk assessment, and intraoperative guidance.”
From the paper · Abstract
Conclusions (4)
Valuable for planning, risk assessment and guidanceAnswer: Yes
“Integrating MxR into the preoperative workflow for microsurgical removal of complex thalamic tumors proved to be a valuable tool for surgical planning, risk assessment, and intraoperative guidance.”
From the paper · Abstract
All critical structures segmented for simulationAnswer: Yes
“All critical structures were successfully segmented, allowing effective surgical simulation and approach selection”
From the paper · Abstract
Extra segmentation time averaged 45 minutesAnswer: Describes
“The additional planning time for segmentation averaged 45 min.”
45 min
From the paper · Abstract
Mean extent of resection 94.88%Answer: Describes
“The mean extent of resection achieved was 94.88% (range: 78.6%–100%).”
The Role of Extended Reality in Orthodontic Treatment Planning and Simulation-A scoping Review#
Marya A et al. · International dental journal · 2025
Dental · Scoping review
Multiple platforms
Scoping review of 19 studies on extended reality in orthodontics (13 VR, 5 AR, 1 MR), covering treatment planning, bracket placement, surgical simulation, student training and patient education. The authors report gains in spatial awareness, accuracy and motivation and reductions in patient anxiety, but note small samples, heterogeneity and little long-term outcome data.
“The most frequently reported positive outcomes across these diverse applications include enhanced spatial awareness, clinical accuracy, learner motivation and reductions in patient anxiety.”
From the paper · Abstract
“Critically, the current evidence base, while promising, is constrained by predominantly small sample sizes across studies, significant methodological heterogeneity hindering meta-analysis, and a paucity of robust, long-term clinical outcome data.”
From the paper · Abstract
Conclusions (3)
Reported gains in spatial awareness and accuracyAnswer: Yes
“The most frequently reported positive outcomes across these diverse applications include enhanced spatial awareness, clinical accuracy, learner motivation and reductions in patient anxiety.”
From the paper · Abstract
Small samples and little long-term outcome dataAnswer: Describes
“Critically, the current evidence base, while promising, is constrained by predominantly small sample sizes across studies, significant methodological heterogeneity hindering meta-analysis, and a paucity of robust, long-term clinical outcome data.”
AI-Enhanced 3D Models in Global Virtual Reality Case Conferences for Surgical Care in a Low-Income Country: Exploratory Study#
Obst M et al. · JMIR formative research · 2025
Plastic & reconstructive · Feasibility study · n: 15 patients
Meta Quest / Oculus
Exploratory study at a surgical camp in Uganda in which smartphone photographs of 15 patients needing reconstructive surgery were turned into AI-enhanced 3D models and discussed in virtual case conferences by surgeons in Uganda and Germany wearing VR headsets, who marked surgical approaches on the models. The authors report under 8 minutes per case for data capture and model creation, sufficient model quality and good user experience.
“The process was time-efficient, with a total of under 8 minutes per case for data acquisition and model creation, and resource-efficient with surgeons reporting sufficient quality of smartphone-derived models.”
8 minutes
From the paper · Abstract
“The findings indicate that AI-enhanced 3D imaging and immersive virtual communication platforms are valuable tools for integrative surgical case assessments.”
From the paper · Abstract
“While the study demonstrates the feasibility of this approach, further research is needed to explore a broader application and impact of these technologies in global health.”
From the paper · Abstract
Conclusions (5)
Remote VR case conferences shown feasibleAnswer: Yes
“While the study demonstrates the feasibility of this approach, further research is needed to explore a broader application and impact of these technologies in global health.”
From the paper · Abstract
Capture and modeling under 8 minutes per caseAnswer: Yes
“The process was time-efficient, with a total of under 8 minutes per case for data acquisition and model creation”
under 8 minutes per case
From the paper · Abstract
All four surgeons rated models high qualityAnswer: Yes
“all 4 participating surgeons (4/4, 100%) strongly agreed that the 3D reconstructed models were of high quality”
4/4, 100%
From the paper · Full text
Virtual case conferences took about 3 minutesAnswer: Describes
“The median time for virtual case conferences was 3 minutes and 1 second, with a range from 1 minute and 33 seconds to 8 minutes and 14 seconds.”
median 3 minutes and 1 second
From the paper · Full text
Small lesions depicted less accurately than largeAnswer: Mixed
“The accuracy of 3D reconstruction and representation of smaller lesions, such as small lipomas and ganglions, was limited, whereas larger entities were depicted with great accuracy.”
Narrative review of artificial intelligence, extended reality and imaging advances for preoperative planning in hepato-biliary surgery. The authors discuss AI for risk prediction and automated 3D modelling, XR-based visualisation and navigation, and call for standardised reporting of AI and XR studies.
B-onic Suite: An Integrated Platform for Personalized Medical Devices, Real-Time Surgical Planning, and Enhanced Intraoperative Navigation#
Martín Cubillo C et al. · Studies in health technology and informatics · 2025
Multi-specialty · Technical development
VR, platform not specified
Description of the B-onic Suite, an integrated platform at La Paz University Hospital combining surgical planning, regulatory-compliant 3D-printed patient-specific devices and intraoperative navigation, with an extended-reality module (NavigatorPro XR) for immersive planning and collaboration. The authors report reduced planning times and improved accuracy in routine use.
“Deployed in routine clinical workflows at La Paz University Hospital, the platform has demonstrated reduced preoperative planning times and improved surgical accuracy.”
From the paper · Abstract
Conclusions (1)
Shorter planning times claimed, no data reportedAnswer: Yes
“Deployed in routine clinical workflows at La Paz University Hospital, the platform has demonstrated reduced preoperative planning times and improved surgical accuracy.”
Advancing Neuroblastoma Surgery through the Clinical Integration of Virtual Reality and Indocyanine Green Fluorescence-Guided Imaging: A Case Report#
Paraboschi I et al. · European journal of pediatric surgery reports · 2025
General & GI surgery · Case report · n: 1 patient
Meta Quest / Oculus
Case report of a 12-month-old girl with cloacal malformation and a right adrenal neuroblastoma, in whom the surgical team explored patient-specific 3D models in an Oculus Quest 2 headset before resection, combined with ICG fluorescence for intraoperative vascular mapping. The authors report uneventful recovery and no residual macroscopic disease on follow-up imaging.
“The procedure incorporated VR for navigation and ICG fluorescence for real-time vascular mapping, facilitating precise dissection and preservation of critical structures.”
From the paper · Abstract
“While current limitations include the lack of real-time image overlay and inadequate visualization of tumor margins, future advancements in navigation systems and targeted probes may overcome these barriers and significantly improve oncologic outcomes.”
From the paper · Abstract
Conclusions (3)
Uneventful recovery after resectionAnswer: Describes
“The patient's postoperative recovery was uneventful, and she was discharged in stable condition.”
From the paper · Abstract
No residual macroscopic disease at follow-upAnswer: Describes
“Follow-up evaluations (i.e., MRI, mIBG) showed no evidence of residual macroscopic disease.”
From the paper · Abstract
No real-time overlay or tumor margin viewAnswer: Describes
“While current limitations include the lack of real-time image overlay and inadequate visualization of tumor margins”
Feasibility of Mixed Reality-assisted physician-modified endografts#
Hatzl J et al. · Journal of vascular surgery cases and innovative techniques · 2025
Vascular · Technical development (phantom)
Magic Leap
Brainlab Elements
Phantom study of a mixed reality workflow (Brainlab prototype software, Magic Leap 2) for marking fenestrations when planning physician-modified endografts, with 128 markings by 32 observers and a comparison against the conventional method by 12 observers. The authors report accuracy of about 1 mm, fewer reattempts and shorter time than the conventional method, and high usability.
“In the comparative analysis, the MxR group showed comparable accuracy to the conventional method but required fewer reattempts (3 vs 10) and less time (6.7 vs 14.6 minutes; P < .01).”
6.7 vs 14.6 minutes
From the paper · Abstract
“SUS and PSSUQ scores indicated high usability (84.2/100 and 1.8/7, respectively).”
84.2/100
From the paper · Abstract
“At least in this experimental setup, it outperformed the conventional method in usability and speed, supporting its potential for broader clinical applications.”
From the paper · Abstract
Conclusions (4)
Feasibility markings deviated 1.0 to 1.5 mmAnswer: Describes
“In the feasibility test, mean deviations from ideal positions were 1.3 mm (F1), 1.0 mm (F2), 1.0 mm (F3), and 1.5 mm (F4).”
1.3 mm (F1), 1.0 mm (F2), 1.0 mm (F3), 1.5 mm (F4)
From the paper · Abstract
Fenestration marking faster than conventional methodAnswer: Yes
“required fewer reattempts (3 vs 10) and less time (6.7 vs 14.6 minutes; P < .01)”
6.7 vs 14.6 minutes, P < .01; reattempts 3 vs 10
From the paper · Abstract
Usability score higher than conventional methodAnswer: Yes
“Usability ratings were significantly higher for MxR (SUS, 85.1 vs 43.2; P < .01).”
SUS 85.1 vs 43.2, P < .01
From the paper · Abstract
Accuracy comparable to conventional methodAnswer: No significant difference
“the MxR group showed comparable accuracy to the conventional method”
Current Applications and Limitations of Augmented Reality in Urological Surgery: A Practical Primer and 'State of the Field#
Wang VL et al. · Current urology reports · 2025
Urology · Narrative review
Multiple platforms
Narrative review and primer on how augmented-reality surgical guidance works, summarising urology studies from 2021 to 2025 that range from preoperative planning to intraoperative use in prostatectomy, nephrolithotomy and renal transplantation. The authors note automated registration advances and a trend towards larger prospective studies of intraoperative AR/MR.
Narrative review of mixed reality, augmented reality and artificial intelligence in complex liver surgery, including hepatectomy and liver transplantation. The authors describe uses of MR/AR for visualisation, preoperative planning and patient education, and of AI for intraoperative feedback and navigation.
Preoperative virtual reality-guidance for safe gastric endoscopic full-thickness resection with a suitable closure strategy#
Nishiyama N et al. · Endoscopy · 2025
General & GI surgery · Case report (video/image) · n: 1 patient
Meta Quest / Oculus
Holoeyes MD
Short image/video report in which CT-derived 3D polygon models were viewed with the Holoeyes XR system on a Meta Quest 3 headset to confirm tumour location and plan a safe gastric endoscopic full-thickness resection and closure strategy.
“The tumor location was confirmed close to the liver, and a feeding artery and vein were identified from the forward and retroflexed views ( Fig. 3 , Fig. 4 a,b ). gEFTR ( Video 1 ) was then completed safely, with no bleeding.”
From the paper · Full text: main text
“VR systems using 3D holograms could be useful for safe and reliable gEFTR, with greater operator confidence.”
From the paper · Full text: main text
Conclusions (3)
Resection completed safely without bleedingAnswer: Describes
Novel planning pipeline utilizing the Surgical Theater system for pediatric epilepsy surgery#
Shields LBE et al. · Epilepsia open · 2025
Neurosurgery · Experience report · n: 85 patients
Surgical Theater
Institutional report on using the Surgical Theater system for 85 patients in a paediatric epilepsy service. Multiple phase I datasets were merged into a single layered 3D model for collaborative phase II and surgical planning, VR rehearsal of complex procedures, and intraoperative AR navigation. Four illustrative cases are presented, along with use for family education.
“The multi-layered and 3D model of the ST system facilitates epilepsy decision-making for both diagnosis and treatment, enhances surgical navigation, and even allows, in a robust virtual reality (VR) environment, the practice of complex surgical procedures.”
From the paper · Abstract
“These models also facilitate patient and family education, which may reduce their anxiety.”
From the paper · Abstract
Conclusions (3)
Layered 3D model supports epilepsy decision-makingAnswer: Yes
“The multi-layered and 3D model of the ST system facilitates epilepsy decision-making for both diagnosis and treatment, enhances surgical navigation, and even allows, in a robust virtual reality (VR) environment, the practice of complex surgical procedures.”
From the paper · Abstract
Used in 85 pediatric epilepsy surgeriesAnswer: Describes
“As of April 2025, the ST system has been utilized in 85 pediatric epilepsy surgeries at our institution.”
85 surgeries
From the paper · Full text
Models may help family education, no dataAnswer: Describes
“These models also facilitate patient and family education, which may reduce their anxiety.”
Virtual reality-augmented differentiable simulations for digital twin applications in surgical planning#
Cremese R et al. · Scientific reports · 2025
Multi-specialty · Technical development
VR, platform not specified
Technical paper presenting a 'digital twin' surgical-planning method that generates candidate instrument trajectories within segmented medical images using a differentiable stochastic simulator, and shows them overlaid on the images in a custom VR viewer. Surgeons can explore and adjust the paths interactively. No patient study is reported.
Conclusions (2)
Laplace initialization raised simulated success rate, no statisticsAnswer: Describes
“Once the field is optimized, Laplace initialization leads to higher success rate (the target was considered reached for minimum distances below 1% of the distance between origin and target) and slightly shorter first time to target.”
“Proving medical efficiency will imply studies involving interventions performed with and without these systems by the same surgeons in cases with the same challenges, which will take time.”
A Comprehensive Review of Food and Drug Administration (FDA)-Cleared Virtual Reality Technologies in Radiology#
Avakian A · Cureus · 2025
Multi-specialty · Narrative review
Dextroscope
Ceevra Reveal
VSI HoloMedicine (apoQlar)
Narrative review of seven FDA-cleared VR systems with radiology applications (Ceevra Reveal 3+, VSI HoloMedicine, Dextroscope, Dextrobeam and three Viatronix V3D products), drawing on regulatory documents and published evaluations. The authors describe their clinical functions for interpretation, procedural planning and collaboration, and the challenges of implementation.
Conclusions (3)
Seven of 69 FDA-cleared VR/AR devices serve radiologyAnswer: Describes
“As of 2024, the U.S. Food and Drug Administration (FDA) has cleared 69 devices categorized under virtual and augmented reality. This review focuses on the seven VR systems with direct applications in radiology”
69 devices; seven VR systems
From the paper · Abstract
Early evaluations suggest possible gains over 2D imagingAnswer: Describes
“early evaluations suggest that FDA-cleared platforms may improve spatial understanding, interprofessional communication, and learning outcomes when compared to conventional 2D imaging workflows”
From the paper · Full text
Evidence base limited in scope and sizeAnswer: Describes
“most studies to date have been limited in scope, sample size, or generalizability”
Comparison between mixed reality with artificial algorithms and ultrasound in localization of anterior thigh flap perforators: a prospective randomized controlled study#
Randomised controlled trial of 80 patients having anterolateral thigh (ALT) perforator flap surgery, comparing preoperative perforator localisation with a HoloLens 2 mixed-reality overlay of a CTA-based 3D model (registered to the leg with a localisation device and an AI matching algorithm) against colour Doppler ultrasound (40 per group). The authors report a higher perforator recognition rate (94.3% vs 82.0%), a smaller distance between marked and actual exit points (1.5 vs 2.7 mm) and shorter flap harvest time (52 vs 68 min) with MR; flap complications occurred in both groups.
“Recognition rates were 94.3% in the MR group and 82.0% in the CDU group (P = 0.008).”
P = 0.008
From the paper · Abstract
“Flap harvest times averaged 52 and 68 min, respectively (P < 0.0001).”
P < 0.0001
From the paper · Abstract
“In the MR group, one flap developed an infection and another necrosis, while in the CDU group, one flap had a crisis, and two experienced necrosis.”
From the paper · Abstract
Conclusions (4)
Higher perforator recognition rate than ultrasoundAnswer: Yes
“Recognition rates were 94.3% in the MR group and 82.0% in the CDU group ( P = 0.008).”
94.3% vs 82.0%, P = 0.008
From the paper · Abstract
Marked points closer to actual exit pointsAnswer: Yes
“The average distance between marked and actual exit points was 1.5 mm vs. 2.7 mm ( P < 0.0001).”
1.5 vs 2.7 mm, P < 0.0001
From the paper · Abstract
Flap harvest shorter than with ultrasoundAnswer: Yes
“Flap harvest times averaged 52 and 68 min, respectively ( P < 0.0001).”
52 vs 68 min, P < 0.0001
From the paper · Abstract
Flap survival not significantly differentAnswer: No significant difference
“Perforator flaps survived, n (%) 39 (97.5%) 38 (95%) 0.999”
Prospective trial of 130 patients with extracerebral tumours, comparing an AI-assisted 3D colour image fusion workflow (FastSurfer, Raidionics-Slicer) displayed by Sina AR projection with manual monochrome image fusion. The authors report faster and more accurate segmentation, and in the AI/colour group shorter operations, less blood loss, more gross-total resections, fewer complications and better mRS scores.
“Clinically, group A demonstrated significant advantages with shorter operative duration, reduced intraoperative blood loss, higher rate of gross-total resection, lower complication incidence, and better postoperative mRS scores (all p < 0.05).”
p < 0.05
From the paper · Abstract
Conclusions (1)
Shorter surgery, less blood loss, fewer complicationsAnswer: Yes
“Clinically, group A demonstrated significant advantages with shorter operative duration, reduced intraoperative blood loss, higher rate of gross-total resection, lower complication incidence, and better postoperative mRS scores (all p < 0.05).”
Navigating Complexity: Advanced Visualization for Müllerian Anomalies and its Implications for Diagnoses and Surgical Planning#
From A et al. · Journal of pediatric and adolescent gynecology · 2025
Gynecology · Case report · n: 1 patient
Elucis Next (research software, not FDA-cleared)
Case report of a 23-year-old woman with an obstructive Müllerian anomaly (proximal vaginal agenesis and a unicornuate uterus with a non-communicating rudimentary horn) who had a total abdominal hysterectomy with bilateral ureterolysis. High-resolution T2-weighted MRI taken one week before surgery was segmented in ElucisNext after the operation, and the 3D model was reviewed in VR retrospectively.
Exploring the impact of virtual reality on education, surgical planning, and interdisciplinary collaboration for clinicians in head and neck oncology#
Dubray-Vautrin A et al. · Oral oncology · 2025
ENT / head & neck · Narrative review
Multiple platforms
Narrative review of virtual reality in head and neck oncology covering surgical training, tumour contouring and flap planning, patient-specific models and shared virtual tumour boards. The authors conclude that more research is needed on its effect on surgical outcomes and education.
“Additionally, VR enhances collaborative decision-making in tumor boards by enabling multidisciplinary teams to visualize medical images in a shared virtual space.”
From the paper · Abstract
“Despite its potential, further research is needed to assess the full impact of VR technologies on surgical outcomes and educational efficacy in head and neck oncology decision making.”
The use of extended reality in microsurgical free flap planning - A systematic review#
Rasmussen KH et al. · JPRAS open · 2025
Plastic & reconstructive · Systematic review
Multiple platforms
Systematic review of extended reality for vascular visualisation in planning microsurgical free flaps, identifying 7 VR and 26 AR articles. The authors report that VR gave better visualisation and was more time-efficient than CT angiography, that AR was more accurate and faster than Doppler ultrasound, and that evidence levels were limited.
“Virtual reality demonstrated better visualization of patient-specific anatomy and was more time efficient than CT angiography.”
From the paper · Abstract
“Augmented reality was found to be more accurate and time efficient than Doppler ultrasound.”
From the paper · Abstract
“However, successful XR implementation necessitates a well-designed workflow.”
From the paper · Abstract
Conclusions (3)
Review: VR more time efficient than CTAAnswer: Yes
“Virtual reality demonstrated better visualization of patient-specific anatomy and was more time efficient than CT angiography.”
From the paper · Abstract
Review: AR more accurate than Doppler ultrasoundAnswer: Yes
“Augmented reality was found to be more accurate and time efficient than Doppler ultrasound.”
From the paper · Abstract
Clinical value of XR remains uncertainAnswer: Describes
“However, the clinical value of XR in this field remains uncertain due to the limitations in the current literature, including potential biases and low levels of evidence.”
Virtual reality-guided simulation of brachytherapy: Two case reports#
Okuma K et al. · Journal of contemporary brachytherapy · 2025
Radiation oncology · Case series · n: 2 patients
3D Slicer / SlicerVR
Meta Quest / Oculus
Report of two patients needing complex interstitial brachytherapy (a recurrent iliac tumour invading the sacrum, and floor-of-mouth cancer), in whom VR pre-simulation was used to plan applicator and needle placement. The authors report that VR aided multidisciplinary communication, optimised puncture and supported consistent needle insertion.
“VR pre-simulation facilitated multi-disciplinary communication and optimized puncture, leading to a safer and more accurate procedure.”
From the paper · Abstract
“VR pre-simulation enabled precise needle insertion and facilitated procedural consistency, even among radiation oncologists unfamiliar with head and neck brachytherapy.”
From the paper · Abstract
“A preliminary brachytherapy treatment plan was generated in Oncentra, incorporating the VR-based findings.”
From the paper · Fulltext
Conclusions (4)
Authors report safer, more accurate punctureAnswer: Yes
“VR pre-simulation facilitated multi-disciplinary communication and optimized puncture, leading to a safer and more accurate procedure.”
“VR pre-simulation enabled precise needle insertion and facilitated procedural consistency, even among radiation oncologists unfamiliar with head and neck brachytherapy.”
From the paper · Abstract
VR findings entered the treatment planAnswer: Yes
“A preliminary brachytherapy treatment plan was generated in Oncentra, incorporating the VR-based findings.”
From the paper · Full text
Several specialties agreed needle paths in VRAnswer: Describes
“This simulation allowed real-time interaction and multi-disciplinary discussion, leading to a consensus on the safest and most effective needle insertion strategy.”
Multi-volume rendering using depth buffers for surgical planning in virtual reality#
Faludi B et al. · International journal of computer assisted radiology and surgery · 2025
Multi-specialty · Technical development
Custom Unity app
Technical paper describing a multi-volume ray-marching renderer for surgical planning in VR that uses depth buffers to render many separately segmented sub-volumes with correct occlusion. The authors report that it maintained 90 frames per second on a desktop VR system with more than twenty volumes across three use cases.
“We show that the presented approach can avoid dropped frames at the typical update rate of 90 frames per second of a desktop-based VR system and, therefore, provide a comfortable user experience even in the presence of more than twenty individual volumes.”
From the paper · Abstract
Conclusions (2)
Kept 90 fps with over twenty volumesAnswer: Yes
“We show that the presented approach can avoid dropped frames at the typical update rate of 90 frames per second of a desktop-based VR system and, therefore, provide a comfortable user experience even in the presence of more than twenty individual volumes.”
90 frames per second, more than twenty volumes
From the paper · Abstract
Segment extraction lowered frame rate by datasetAnswer: Describes
“Extracting the segmented regions resulted in a frame rate drop of 71 % for the scoliosis dataset (20 vertebrae), 25 % for the fracture case (5 bone fragments), and a negligible 4 % for the aneurysm case when compared to rendering the whole dataset at once.”
Evaluating virtual reality as a tool for improving surgical planning in spinal tumors#
Nantenaina TNH et al. · International journal of computer assisted radiology and surgery · 2025
Spine · Comparative study · n: 6 patients
VR, platform not specified
Exploratory user study in which eight neurosurgeons planned six spinal tumour resections with both VR and conventional computer visualisation, assessed with questionnaires based on a work domain analysis. The authors report that surgeons perceived more anatomical-functional information and identified more structures in VR, and selected approaches more precisely.
“Furthermore, surgeons selected additional anatomical structures to be traversed to reach the tumor when using VR, leading to a more precise selection of surgical approaches.”
From the paper · Abstract
“VR can be a promising tool for surgical planning by providing an immersive and interactive perspective that enhances understanding of anatomy.”
From the paper · Abstract
“However, our finding is from an exploratory study, more clinical cases should be conducted to demonstrate its feasibility and reliability.”
From the paper · Abstract
Conclusions (3)
More anatomical-functional information perceived in VRAnswer: Yes
“VR made it easier to perceive a greater number of anatomical-functional information compared to computer visualization.”
From the paper · Abstract
More anatomical structures identified in VRAnswer: Yes
“Surgeons identified a greater anatomical structure with VR compared to computer visualization.”
From the paper · Abstract
More precise approach selection with VRAnswer: Yes
“Furthermore, surgeons selected additional anatomical structures to be traversed to reach the tumor when using VR, leading to a more precise selection of surgical approaches.”
Feasibility study of 20 patients who had valve-in-valve TAVI, comparing VR measurements (VMersive on a Meta Quest 2) with 3mensio CT analysis by blinded analysts. Eight physicians graded planning with and without VR. The authors report no significant measurement differences, strong correlations (r 0.874-0.994), good-to-excellent reliability, and better understanding of the prosthesis, coronary distances and sinotubular junction in VR.
“The analysis showed no significant differences between the measurements and strong correlations with correlation coefficients between 0.874 and 0.994, P < 0.001.”
between 0.874 and 0.994
From the paper · Abstract
“Furthermore, VR enabled a superior visual understanding of the bioprosthesis and the distances between the virtual prosthesis and the coronaries as well as the sinotubular junction.”
From the paper · Abstract
“Further studies are needed to assess the impact on patient outcomes.”
From the paper · Abstract
“they could imagine using them regularly”
From the paper · Fulltext
Conclusions (3)
VR measurements agreed with standard CT softwareAnswer: Yes
“The analysis showed no significant differences between the measurements and strong correlations with correlation coefficients between 0.874 and 0.994, P < 0.001.”
correlation coefficients 0.874 to 0.994, P < 0.001
From the paper · Abstract
Raters rated spatial understanding higher in VRAnswer: Yes
“VR gives the users a better understanding of the spatial relationships between the cardiac and extracardiac structures”
Likert 1.0 ± 0 vs. 2.9 ± 0.8, P = 0.007
From the paper · Full text
Standard software preferred for choosing prosthesisAnswer: No
“3mensio was the preferred method for selecting the new prosthesis”
The Role of Virtual Reality, Augmented Reality and Mixed Reality in Modernizing Free Flap Reconstruction Techniques#
Heredero S et al. · Oral and maxillofacial surgery clinics of North America · 2025
Plastic & reconstructive · Narrative review
Multiple platforms
Narrative review of virtual, augmented and mixed reality in bone and soft-tissue free flap reconstruction, covering preoperative planning, flap selection and design, osteotomies and training. The authors describe recent developments and how they connect digital planning with surgical practice.
Preoperative Immersive Virtual Reality Planning and Simulation of Bronchoscopic Lung Volume Reduction Using Endobronchial Valves#
Okachi S et al. · Respirology case reports · 2025
Thoracic · Case report · n: 1 patient
VR, platform not specified
Case report of a 74-year-old man with severe emphysema in whom the physician used VR planning from imaging to visualise the bronchial tree, measure airways and simulate placement of endobronchial valves in the right middle lobe before bronchoscopic lung volume reduction. A 5.5 valve was placed without complications, and the authors describe VR as aiding airway assessment and valve sizing.
“VR enhanced procedural planning by improving airway assessment, optimising valve sizing, and reducing cognitive load, leading to increased efficiency and operator confidence.”
From the paper · Abstract
“Further research is warranted to validate the utility of VR in bronchoscopic interventions.”
From the paper · Abstract
“The total procedure time, from scope insertion to withdrawal, was 34 min.”
34 min
From the paper · Fulltext
Conclusions (5)
Authors report improved airway assessment and valve sizingAnswer: Yes
“VR enhanced procedural planning by improving airway assessment, optimising valve sizing, and reducing cognitive load, leading to increased efficiency and operator confidence.”
From the paper · Abstract
Size 4.0 valve too large; size 5.5 placedAnswer: Describes
“a size 4.0 valve was too large for the right B4 bronchus, and a size 5.5 valve was successfully placed at the B4/5 bronchus”
right B4 3.4 × 3.1 mm
From the paper · Full text
Procedure took 34 minutesAnswer: Describes
“The total procedure time, from scope insertion to withdrawal, was 34 min.”
34 min
From the paper · Full text
No complications, including pneumothoraxAnswer: Describes
“The patient remained stable postoperatively without complications, including pneumothorax.”
From the paper · Full text
Authors call for further validation researchAnswer: Describes
“Further research is warranted to validate the utility of VR in bronchoscopic interventions.”
Utilizing virtual reality for resection of recurrent ventral, extramedullary cervical meningioma#
Rajendran R et al. · Surgical neurology international · 2025
Spine · Case report · n: 1 patient
VR, platform not specified
Case report of a 43-year-old woman with recurrent ventral C5-C6 intradural meningioma. A patient-specific VR model led the surgeons to change from an anterior to a posterior approach, and VR guidance was used with neuronavigation during hemilaminectomy and resection followed by fusion. The authors report significant neurological improvement and no recurrence.
“Initial surgical planning favored an anterior approach, but VR-assisted mapping demonstrated that a posterior approach would provide greater exposure while minimizing disruption to surrounding structures”
From the paper · Fulltext
“Postoperatively, the patient had significant neurological improvement, and follow-up studies showed no tumor recurrence.”
From the paper · Abstract
Conclusions (2)
Planned approach changed from anterior to posteriorAnswer: Yes
“Initial surgical planning favored an anterior approach, but VR-assisted mapping demonstrated that a posterior approach would provide greater exposure while minimizing disruption to surrounding structures”
From the paper · Full text
Neurological improvement and no recurrence in one patientAnswer: Describes
“Postoperatively, the patient had significant neurological improvement, and follow-up studies showed no tumor recurrence.”
Retrospective comparison of paediatric oncology operations (pulmonary metastases, sacrococcygeal, bone, chest wall and soft-tissue tumours) performed with the CarnaLife Holo mixed-reality system for preoperative planning and intraoperative use (9 patients) or without it. The authors report generally comparable operative and hospitalisation times, with a slight increase in procedure time in a few MR cases.
“Although a slight increase in procedure time was observed in a few cases, MR did not significantly prolong SP or H.”
From the paper · Abstract
Conclusions (3)
Procedure time comparable to controls, not statistically testedAnswer: No significant difference
“Although a slight increase in procedure time was observed in a few cases, MR did not significantly prolong SP or H.”
From the paper · Abstract
Hospital stay comparable to controls, not statistically testedAnswer: No significant difference
“Similarly, our results indicate that the use of AR and MR does not significantly affect hospital stay compared to traditional methods.”
From the paper · Full text
No medical complications in mixed reality groupAnswer: Describes
“No medical complications were observed in this group”
Technical note on 10 consecutive flow-augmentation EC-IC bypass cases (2022-2023) prepared with interactive 3D mixed reality holograms and compared with a matched retrospective cohort without MxR. The authors report a mean hologram preparation time of 36 minutes, no differences in bypass flow or craniotomy diameter, and faster delineation of the superficial temporal artery than by manual or Doppler methods.
“Mean holographic preparation time was 36 +/- 12 minutes.”
36 +/- 12 minutes
From the paper · Abstract
“Meantime to delineate the superficial temporal artery with MxR was significantly lower than that required manually (mean difference 5 minutes; 95% confidence interval: 0.3-10.3) and with Doppler (mean difference 4 minutes; 95% confidence interval: 2.1-6.7).”
95%
From the paper · Abstract
“Surgical planning of flow-augmentation EC-IC bypass procedures with three-dimensional interactive holograms is feasible and relatively fast.”
From the paper · Abstract
Conclusions (3)
Artery delineation 4 to 5 minutes fasterAnswer: Yes
“Meantime to delineate the superficial temporal artery with MxR was significantly lower than that required manually (mean difference 5 minutes; 95% confidence interval: 0.3-10.3) and with Doppler (mean difference 4 minutes; 95% confidence interval: 2.1-6.7).”
5 min (95% CI 0.3-10.3) vs manual; 4 min (95% CI 2.1-6.7) vs Doppler
From the paper · Abstract
Hologram preparation took 36 minutesAnswer: Describes
“Mean holographic preparation time was 36 +/- 12 minutes.”
36 +/- 12 minutes
From the paper · Abstract
Hologram planning feasible and relatively fastAnswer: Yes
“Surgical planning of flow-augmentation EC-IC bypass procedures with three-dimensional interactive holograms is feasible and relatively fast.”
Two cases of direct aortic transcatheter aortic valve implantation via anterior right Mini-thoracotomy after preoperative virtual reality-based simulation: a case report#
Aichi C et al. · European heart journal. Case reports · 2025
Adult cardiac & structural heart · Case series · n: 2 patients
VR, platform not specified
Two case reports (an 81-year-old man and an 86-year-old woman) of direct aortic TAVI via anterior right mini-thoracotomy, in which preoperative VR simulation was used to choose the intercostal space for access based on distance and angle to the annulus (second space in one patient, third in the other). Both SAPIEN 3 implants were successful.
“In Patient 1, virtual reality simulation revealed that, according to the distance and angulation from the annulus, the ideal puncture site was the second intercostal space.”
From the paper · Abstract
“The use of preoperative virtual reality simulation enabled the safe and precise execution of direct aortic transcatheter aortic valve implantation via anterior right mini-thoracotomy.”
From the paper · Abstract
Conclusions (4)
VR identified second intercostal space in Patient 1Answer: Yes
“In Patient 1, virtual reality simulation revealed that, according to the distance and angulation from the annulus, the ideal puncture site was the second intercostal space.”
From the paper · Abstract
Authors credit VR with safe, precise implantationAnswer: Describes
“The use of preoperative virtual reality simulation enabled the safe and precise execution of direct aortic transcatheter aortic valve implantation via anterior right mini-thoracotomy.”
From the paper · Abstract
No aortic regurgitation after implant, Patient 1Answer: Describes
“Postoperative echocardiography showed no aortic regurgitation and a mean pressure gradient of 14 mmHg.”
mean pressure gradient 14 mmHg
From the paper · Full text
Annulus distance confirmed at surgery, Patient 2Answer: Describes
“The distance to the annulus was confirmed at 78 mm.”
Advancing precision, safety, and education in D3 lymph node dissection for right hemicolectomy using mixed reality technology#
Ryu S et al. · Scientific reports · 2025
General & GI surgery · Retrospective cohort · n: 192 patients
Microsoft HoloLens
Holoeyes MD
Retrospective propensity-matched comparison of right hemicolectomy with D3 lymph node dissection for colon cancer with (47) or without (145) mixed reality, in which SYNAPSE VINCENT reconstructions were viewed on HoloLens 2 via Holoeyes MD before and during surgery. In 44 matched pairs, the authors report lower blood loss, shorter hospital stay and more lymph nodes harvested around the middle colic vessels with MR, without longer operative time.
“Compared with the MR (-) group, intraoperative blood loss and hospital stay were decreased, and the number of lymph nodes harvested around the middle colic artery/vein were increased without prolonging the operative time in the MR (+) group.”
From the paper · Abstract
“MR in RHC offers surgical precision, safety, enhanced patient recovery, and educational value.”
From the paper · Abstract
“There was no difference in operation time.”
289 vs 298 min, p = 0.7072
From the paper · Fulltext
Conclusions (3)
Less blood loss and shorter stay with MRAnswer: Yes
“Compared with the MR (-) group, intraoperative blood loss and hospital stay were decreased, and the number of lymph nodes harvested around the middle colic artery/vein were increased without prolonging the operative time in the MR (+) group.”
blood loss 3 vs 10 ml, p < 0.0001; stay 8 vs 9 days, p = 0.003
From the paper · Abstract
No difference in operation timeAnswer: No significant difference
“There was no difference in operation time.”
289 vs 298 min, p = 0.7072
From the paper · Full text
Conversion rate difference not significantAnswer: No significant difference
“Although the difference was not statistically significant, there was a trend towards a lower conversion rate in the MR (+) group.”
Extended reality for mapping perforator-based flaps in breast reconstruction: a systematic review and meta-analysis#
Lacey H et al. · JPRAS open · 2025
Plastic & reconstructive · Systematic review
Multiple platforms
Systematic review and meta-analysis of 10 studies (229 flaps) on AR and VR for mapping perforators in breast reconstruction. The authors report mean localisation errors of 4 mm for AR and 14 mm for VR, shorter harvesting and operative times in some studies, and a non-significant reduction in complications, and conclude that the accuracy benefit is limited.
“Preoperative VR was associated with shorter operative times than conventional Doppler ultrasound (478±56.94 vs 606.29 ± 81.94 min, P<0.05).”
P<0.05
From the paper · Abstract
“Use of a simulated environment for mapping perforators appeared to reduce complications (wound breakdown, flap revision, flap loss, infection); however, this failed to reach statistical significance (odds ratio 0.6; 95% CI 0.3-1.3; P=0.20).”
P=0.20
From the paper · Abstract
“This study suggests that AR and VR offer limited benefit in improving accuracy of perforator identification; however, they may reduce flap harvesting and total operative time.”
From the paper · Abstract
Conclusions (4)
Limited benefit for perforator identification accuracyAnswer: No
“This study suggests that AR and VR offer limited benefit in improving accuracy of perforator identification”
4 mm (95% CI 3.2-4.9) for AR, 14 mm (95% CI 5.5-22.5) for VR
From the paper · Abstract
Preoperative VR gave shorter operative times than DopplerAnswer: Yes
“Preoperative VR was associated with shorter operative times than conventional Doppler ultrasound (478±56.94 vs 606.29 ± 81.94 min, P<0.05).”
478±56.94 vs 606.29 ± 81.94 min, P<0.05
From the paper · Abstract
Complication reduction not significantAnswer: No significant difference
“however, this failed to reach statistical significance (odds ratio 0.6; 95% CI 0.3-1.3; P=0.20)”
OR 0.6; 95% CI 0.3-1.3; P=0.20
From the paper · Abstract
Two studies reported shorter flap harvesting timeAnswer: Yes
“Two studies reported a significant reduction in harvesting time (88 min for VR and 19 min for AR).”
Virtual Reality for Preoperative Planning and Education in Pediatric Surgery: Preliminary Results for the Treatment of Congenital Malformations and Tumors#
Pelizzo G et al. · World journal of surgery · 2025
General & GI surgery · Retrospective case series · n: 50 patients
VR, platform not specified
Retrospective study of 50 patient-specific VR models from CT/MRI of children with congenital malformations (35) or tumours (15), reviewed in a VR head-mounted display before surgery at a children's hospital in Milan. The authors report that VR changed the surgical approach in 75% of cases and identified potential intraoperative complications in 92%, with limited usefulness for ureters and bladder.
“Compared to conventional imaging, preoperative VR simulations modified the surgical approach in 75.0% of cases”
75.0%
From the paper · Abstract
“Limitations in visualizing urological structures (e.g., ureters and bladder in complex urogenital malformations) limited the VR's utility in those cases”
From the paper · Abstract
“In 92% of cases (46 out of 50), VR provided superior anatomical resolution compared to CT/MRI imaging”
92% (46 out of 50)
From the paper · Fulltext
Conclusions (3)
Surgical approach changed in 75% of casesAnswer: Yes
“Compared to conventional imaging, preoperative VR simulations modified the surgical approach in 75.0% of cases”
75.0%
From the paper · Abstract
Anatomical resolution higher than CT/MRI in 46/50Answer: Yes
“In 92% of cases (46 out of 50), VR provided superior anatomical resolution compared to CT/MRI imaging”
92% (46 out of 50)
From the paper · Full text
Urological structures limited VR usefulnessAnswer: No
“Limitations in visualizing urological structures (e.g., ureters and bladder in complex urogenital malformations) limited the VR's utility in those cases”
Case report of a 17-year-old man with a previous hemimandibulectomy and failed fibula reconstruction, whose free fibula mandibular reconstruction and dental implant placement were planned by the surgeon in a VR application (ImmersiveRecon, ImmersiveTouch) with 3D-printed guides. The authors report a planning time of 5 minutes without engineer assistance, an uncomplicated operation with good outcomes, and close agreement between planned and postoperative CT measurements.
“VR planning was completed directly by the surgeon without engineer assistance, with a total planning time of 5 minutes.”
5 minutes
From the paper · Abstract
“VR surgical planning is feasible and provides several advantages over traditional surgical planning approaches, such as improved scan visualization, simplified user interface, and shorter planning sessions.”
From the paper · Abstract
Conclusions (3)
Surgeon planned alone in 5 minutesAnswer: Describes
“VR planning was completed directly by the surgeon without engineer assistance, with a total planning time of 5 minutes.”
5 minutes
From the paper · Abstract
Authors judge VR planning feasible, with advantagesAnswer: Yes
“VR surgical planning is feasible and provides several advantages over traditional surgical planning approaches, such as improved scan visualization, simplified user interface, and shorter planning sessions.”
From the paper · Abstract
High fidelity reported; deviations up to 14.1 degreesAnswer: Describes
“Comparison of measurements from the three-dimensionally planned models and postoperative models showed high fidelity and met the standards of the surgeon.”
deviation 14.1 degrees (VC_R–VC_L) and 13.5 mm (Me–VC_R), Table 1
Initial experience with augmented reality in planning renal access for PCNL#
Lasmanovich R et al. · Urolithiasis · 2025
Urology · Survey/user study
Microsoft HoloLens
D2P (3D Systems)
Study of AR planning of renal access for PCNL using 3D models built in DICOM-to-Print (D2P) software and viewed on a HoloLens headset, in patients with various stone types; 13 urologists completed 38 questionnaires comparing AR with CT. The authors report better understanding of stone location, anatomy and access route with AR.
“The orientation of adjacent organs was better understood using AR (5 vs. 4, p = 0.004).”
p = 0.004
From the paper · Abstract
“In 86.8% of cases, surgeons preferred using AR models both before and during surgery, with 69.2% suggesting that AR could enhance procedural safety.”
86.8%
From the paper · Abstract
“Further research is required to implement this innovative technique preoperatively and intra-operatively.”
From the paper · Abstract
Conclusions (4)
AR rated higher than CT for renal anatomyAnswer: Yes
“Estimating renal location, renal pelvis, and stone mass were better demonstrated by AR (5 vs. 4, p < 0.001).”
5 vs. 4, p < 0.001
From the paper · Abstract
AR rated higher than CT for adjacent organsAnswer: Yes
“The orientation of adjacent organs was better understood using AR (5 vs. 4, p = 0.004).”
5 vs. 4, p = 0.004
From the paper · Abstract
Surgeons preferred AR models before and during surgeryAnswer: Yes
“In 86.8% of cases, surgeons preferred using AR models both before and during surgery, with 69.2% suggesting that AR could enhance procedural safety.”
86.8%; 69.2%
From the paper · Abstract
Model exploration time fell with experienceAnswer: Yes
“The time frames for testing the models differed between senior and junior practitioners (p = 0.016) and were significantly reduced with model experience (p < 0.001).”
Three-dimensional volumetric rendering on augmented reality headsets for ovarian cancer cytoreduction planning: A Memorial Sloan Kettering Cancer Center Team Ovary study#
Kahn RM et al. · Gynecologic oncology · 2025
Gynecology · Validation study · n: 15 patients
AR/MR, platform not specified
Prospective single-institution study of 15 patients with suspected advanced ovarian cancer, in which investigators reviewed 3D volumetric renderings on Medivis AR headsets before cytoreductive surgery and predicted disease at each anatomical site, compared with pathology. The authors report accuracy of 80% to 100% across sites, including 100% for omentum and pelvic lymph nodes.
“Using pathology results as the gold standard for each anatomic site, the 3D headset demonstrated accuracy of 100 % for omentum and pelvic lymph nodes; 93 % for para-aortic lymph nodes, right diaphragm, rectum, and liver; 87 % for small mesentery”
100 %
From the paper · Abstract
“The use of preoperative 3D volumetric rendering on augmented reality headsets to predict the extent of ovarian cancer spread showed high agreement with pathology across all anatomic sites studied.”
From the paper · Abstract
“Additional research is needed to assess the potential role of this technology in improving surgical planning and patient outcomes.”
From the paper · Abstract
Conclusions (2)
Disease prediction accuracy 80% to 100% by siteAnswer: Yes
“the 3D headset demonstrated accuracy of 100% for omentum and pelvic lymph nodes; 93% for para-aortic lymph nodes, right diaphragm, rectum, and liver”
100% omentum and pelvic lymph nodes; 80% small bowel serosa, spleen, left diaphragm; P>0.05 for all
From the paper · Abstract
14 of 15 patients had complete gross resectionAnswer: Describes
“For procedure, 14 (93%) had complete gross resection and 1 (7%) suboptimal cytoreduction (>1 cm of residual disease).”
Virtual reality modelling based on computed tomography and three-dimensional angiography for planning of percutaneous and hybrid treatment in infants with pulmonary vein stenosis#
Szeliga J et al. · Postepy w kardiologii interwencyjnej · 2025
Congenital heart · Case series · n: 2 patients
VMersive (VR-Learning)
Brief report of two infants with congenital heart defects and pulmonary vein stenosis, in whom VR models from CT and 3D rotational angiography (Vmersive software) were used to plan percutaneous and hybrid treatment. The authors report that VR allowed spatial planning of catheterisation and precise localisation of stenoses.
“The CT-based VR model (Vmersive, VR-learning, Poland; Figure 1 D ) allowed precise spatial planning of the catheterization, including access from the SVC.”
From the paper · Full text: main text
“In 2 patients with severe multivessel PVS, CT and 3DRA-generated VR models proved valuable for procedural planning, enhancing the precision and effectiveness of percutaneous and hybrid treatment.”
From the paper · Full text: main text
Conclusions (3)
VR models aided planning in two infantsAnswer: Yes
“In 2 patients with severe multivessel PVS, CT and 3DRA-generated VR models proved valuable for procedural planning, enhancing the precision and effectiveness of percutaneous and hybrid treatment.”
From the paper · Full text
CT-based VR model allowed spatial catheter planningAnswer: Yes
“The CT-based VR model (Vmersive, VR-learning, Poland; Figure 1 D ) allowed precise spatial planning of the catheterization, including access from the SVC.”
From the paper · Full text
VR-seen stenoses confirmed during surgeryAnswer: Yes
“The stenotic sites observed in 3DRA VR were confirmed intraoperatively, with significant neointimal hyperplasia as described.”
Extended Reality Technologies for Visualization in DIEP Flap Breast Reconstruction: A Systematic Review#
Ozmen BB et al. · Surgical innovation · 2025
Plastic & reconstructive · Systematic review
Multiple platforms
Systematic review of 13 studies (265 patients) on extended reality in DIEP flap breast reconstruction, seven using AR and six VR. The authors report associations with more accurate perforator identification, shorter operating times and better planning, with limitations including soft-tissue deformation, headset ergonomics and processing constraints.
“XR technologies were associated with improved accuracy in perforator identification, reduced operating times, and enhanced surgical planning.”
From the paper · Abstract
“While preliminary results are promising, further large-scale studies are needed to establish efficacy, address limitations, and facilitate integration into clinical practice.”
“XR technologies were associated with improved accuracy in perforator identification, reduced operating times, and enhanced surgical planning.”
From the paper · Abstract
Large-scale studies still neededAnswer: Describes
“While preliminary results are promising, further large-scale studies are needed to establish efficacy, address limitations, and facilitate integration into clinical practice.”
Augmented reality in cranial surgery: Surgical planning and maximal safety in resection of brain tumors via head-mounted fiber tractography#
Gurses ME et al. · Clinical neurology and neurosurgery · 2025
Neurosurgery · Case report · n: 1 patient
Medivis SurgicalAR
AR/MR, platform not specified
Case report of an occipital tumour resection in which preoperative MRI and Quicktome DTI tractography were loaded into the Medivis AR system and viewed on a headset to plan the incision and approach and to visualize the visual pathways during surgery. The authors report preserved visual fields and maintained visual tract volumes after surgery.
“This technological setup was employed for pre-operative and intraoperative planning and further enhanced clinical decision-making for the actual tumor resection.”
From the paper · Abstract
Conclusions (2)
Visual tract volume maintained after resectionAnswer: Describes
“The volumes of the visual tracts were measured in preoperative and postoperative DTIs, showing that their volume was maintained.”
From the paper · Abstract
AR used for pre- and intraoperative planningAnswer: Yes
“This technological setup was employed for pre-operative and intraoperative planning and further enhanced clinical decision-making for the actual tumor resection.”
Preoperative evaluation of glottis and trachea using mixed reality technology in neurosurgical patients#
Vaithialingam B, Rudrappa S · Minerva anestesiologica · 2025
Anesthesia & pain · Short article (no abstract)
AR/MR, platform not specified
Short article in Minerva Anestesiologica on preoperative evaluation of the glottis and trachea with mixed-reality technology in neurosurgical patients. No abstract was available, so these details are from the title and venue and could not be confirmed.
The use of three-dimensional printing and virtual reality technologies in orthopaedics-with a focus on orthopaedic trauma#
Policicchio TJ et al. · Journal of clinical orthopaedics and trauma · 2025
Orthopedics · Narrative review
Multiple platforms
Narrative review of 3D printing and virtual reality in orthopaedics, focusing on orthopaedic trauma. The authors summarise reported benefits for preoperative planning, intraoperative precision, resident education and patient understanding, and discuss cost and time barriers.
Aye WMM et al. · Journal of cardiovascular development and disease · 2025
Adult cardiac & structural heart · Case series · n: 3 patients
Microsoft HoloLens
Feasibility report of three minimally invasive cardiac operations (AVR via right anterior thoracotomy, CABG and pulmonary valve replacement via left anterior thoracotomy), in which CT-based holograms on HoloLens 2 were superimposed on the patient using surface landmarks to choose the incision. The holographic marking differed by one intercostal space from conventional marking and was judged more appropriate.
“The incision site marking made using HoloLens® 2 differed by one intercostal space from the marking made using a conventional surgeon's mental reconstructed image from the patient's preoperative imaging and was found to be a more appropriate site of entry”
From the paper · Abstract
“The transparent visor of the HoloLens® 2 provided unobstructed views of the operating field.”
From the paper · Abstract
“The operative time in 3 MIS cardiac surgical procedures described, with the use of HoloLens 2, was reduced by a mean duration of 34.3 ± 3.2 min.”
34.3 ± 3.2 min
From the paper · Fulltext
Conclusions (3)
Incision site differed by one intercostal spaceAnswer: Yes
“In all three cases, the incision site marked with and without the HoloLens ® 2 differed by one intercostal space.”
From the paper · Full text
Operative time reduced by mean 34.3 minAnswer: Yes
“The operative time in 3 MIS cardiac surgical procedures described, with the use of HoloLens 2, was reduced by a mean duration of 34.3 ± 3.2 min.”
34.3 ± 3.2 min
From the paper · Full text
Hologram creation took about 3 hoursAnswer: Describes
“The entire process of hologram creation took approximately 3 h.”
Pilot diagnostic study in 24 patients undergoing ALT flap reconstruction comparing preoperative perforator localisation with AR plus a purpose-built device (AR-Finder) against colour Doppler ultrasound. The authors report higher sensitivity (97.5% vs 81.1%) and smaller location error (3.5 vs 9.6 mm) with AR-Finder.
“AR-Finder demonstrated a higher sensitivity of 97.5 % (95 % CI 85.3 %-99.9 %, p = 0.031) and an AUC of 0.90 (95 % CI 0.80-1.01, p = 0.035).”
97.5 %
From the paper · Abstract
Conclusions (3)
Perforator detection sensitivity higher than ultrasoundAnswer: Yes
“AR-Finder demonstrated a higher sensitivity of 97.5 % (95 % CI 85.3 %-99.9 %, p = 0.031)”
97.5 % vs 81.1 %, p = 0.031
From the paper · Abstract
Perforator location error smaller than ultrasoundAnswer: Yes
“The average distance difference from the actual perforator to virtually determined location was 3.54 ± 2.80 mm (95 % CI 2.58–4.50) for AR-Finder and 9.57 ± 5.84 mm (95 % CI 7.75–11.58) for UCD (p < 0.001).”
3.54 ± 2.80 vs 9.57 ± 5.84 mm, p < 0.001
From the paper · Abstract
All flaps survived except one partial necrosisAnswer: Describes
“24 patients underwent ALT flap reconstruction, with all flaps surviving except one case of partial necrosis”
Pre-surgical planning with extended reality in neurosurgery: a survey-based study describing a preliminary experience in Italy#
Iacoangeli A et al. · Journal of neurosurgical sciences · 2025
Neurosurgery · Survey/user study
VR, platform not specified
Survey study of Italian neurosurgery residents on extended reality for presurgical planning: 32 residents nationwide answered a 23-item survey, and 5 trainees at one children's hospital reported on 3 months of daily XR use. Most perceived XR as effective at simulating anatomy and trajectory, and the pilot group reported growing confidence in case management.
“These results also reflect the subjective perception of the five trainee-pilot group which report a progressive confidence on the surgical case management.”
From the paper · Abstract
“This preliminary study suggests XR as an effective tool which can positively influence trainees' education.”
From the paper · Abstract
“Further and larger studies are necessary in our country to better understand and standardize these results.”
“This preliminary study suggests XR as an effective tool which can positively influence trainees' education.”
From the paper · Abstract
Pilot trainees reported growing case confidenceAnswer: Yes
“These results also reflect the subjective perception of the five trainee-pilot group which report a progressive confidence on the surgical case management.”
How to Use Virtual Reality from Echocardiographic-Acquired Images#
Zablah JE et al. · Current cardiology reports · 2025
Congenital heart · Narrative review
Includes an author who is a Realize Medical advisor.
Multiple platforms
Narrative review of virtual reality built from echocardiographic images, covering diagnosis, procedural planning, education and possible intraprocedural guidance, including VR from 3D echocardiography and CT for pre-surgical rehearsal, device selection and landing-zone visualisation, and 3D transthoracic and paediatric transoesophageal probes.
A new technology for a novel clinical approach in a dog with a complex vascular anomaly: the "extended reality#
Cupido S et al. · Veterinary research communications · 2025
Veterinary · Case report · n: 1 dog
Microsoft HoloLens
Case report of a one-year-old French bulldog with a complex vascular anomaly resembling a patent ductus arteriosus, in whom VR in a head-mounted display was used to plan surgery and AR assisted closure of the abnormal vessel through a left thoracotomy. The authors report no complications, complete recovery and no residual flow at 18 months.
“No complications were reported during or after the surgery and the dog completely recovered.”
From the paper · Abstract
“In this case report the virtual model allowed a better understanding of the vascular anomaly with the head-mounted display worn before the surgery”
From the paper · Fulltext
Conclusions (3)
No complications and full recovery in one dogAnswer: Describes
“No complications were reported during or after the surgery and the dog completely recovered.”
From the paper · Abstract
No residual flow at 18 monthsAnswer: Describes
“Echocardiographic findings 3 days, 1 month and 18 months after the surgery demonstrated absence of residual flow and improving ventricular dimensions.”
From the paper · Abstract
Virtual model improved understanding of the anomalyAnswer: Yes
“In this case report the virtual model allowed a better understanding of the vascular anomaly with the head-mounted display worn before the surgery”
Mixed reality for preoperative planning and intraoperative assistance of surgical correction of complex congenital heart defects#
Ponzoni M et al. · The Journal of thoracic and cardiovascular surgery · 2025
Congenital heart · Case series · n: 5 patients
Microsoft HoloLens
Report of mixed reality (Microsoft HoloLens 2 holograms from CT/MRI) used for preoperative planning and intraoperative assistance in five complex congenital heart operations, including partial anomalous pulmonary venous connection repair, Fontan completion, arterial switch with abnormal coronaries, unifocalisation of collaterals and total artificial heart implantation. The authors report that preoperative use helped the surgeon understand the anatomy and plan the strategy, and that intraoperative use needs further hardware and software development.
“Preoperative MixR allowed a comprehensive understanding of complex anatomical relationships and spatial mapping, using immersive 3-dimensional navigation.”
From the paper · Abstract
“MixR represents a promising tool for preoperative planning and 3-dimensional visualization in patients with complex congenital heart defects; however, its systematic adoption in intraoperative settings requires further implementation of current hardware technology and software versatility.”
From the paper · Abstract
Conclusions (2)
Preoperative holograms gave anatomical understandingAnswer: Yes
“Preoperative MixR allowed a comprehensive understanding of complex anatomical relationships and spatial mapping, using immersive 3-dimensional navigation.”
From the paper · Abstract
Promising for planning; intraoperative use needs developmentAnswer: Describes
“MixR represents a promising tool for preoperative planning and 3-dimensional visualization in patients with complex congenital heart defects; however, its systematic adoption in intraoperative settings requires further implementation of current hardware technology and software versatility.”
Mixed reality infrastructure based on deep learning medical image segmentation and 3D visualization for bone tumors using DCU-Net#
Wang K et al. · Journal of bone oncology · 2025
Orthopedics · Technical development
Microsoft HoloLens
Technical paper describing DCU-Net, a deep-learning model for segmenting bone tumours on CT, and a mixed-reality system for viewing the resulting 3D models. The authors report segmentation scores above 90%, and that two surgeons who examined patients with the MR system reported better spatial awareness for preoperative planning than with 2D images.
“Furthermore, LS showed that clinicians in the DCU-Net-based MR group had better spatial awareness of tumor preoperative planning.”
From the paper · Abstract
Conclusions (4)
Network gave highest segmentation overlap (DSC)Answer: Yes
“The experimental results of this method are better than those of the other three comparison networks.”
DSC 92.23 ± 4.97 vs 76.41 ± 10.26 (U-Net)
From the paper · Full text
Network gave smallest 3D reconstruction errorAnswer: Yes
“The mean VDE of this method is reduced to 1.19, with the smallest standard deviation, which is better than the other three network methods.”
VDE 1.19 ± 0.08 vs 3.19 ± 2.83 (U-Net)
From the paper · Full text
Two surgeons rated spatial awareness higher with MRAnswer: Yes
“Compared with the screen 2D group, the MR 3D group achieved better results in all six indicators of tumor spatial awareness.”
Likert median spatial visualization 5 vs 2, no test
From the paper · Full text
MR evaluation limited to few surgeonsAnswer: Describes
“Only a few surgeons conducted preliminary evaluations on limited cases in the experiment, which limited the generalizability and reliability of the results.”
Crossover study in which 16 maxillofacial residents planned patient-specific orbital reconstruction plates for 10 fracture cases using either mixed reality or a conventional approach based on 3D printing and a 2D screen. The authors report a significantly shorter total workflow time and significantly more accurate planning with MR (p=0.028), and higher global satisfaction (80.6% versus 72.5%).
“The total workflow time for MR technology was significantly shorter compared to the conventional method.”
From the paper · Abstract
“Moreover, treatment planning using MR was significantly more accurate (p = .028), with participants reporting a higher mean global satisfaction score compared to the conventional group (80.6% vs. 72.5%).”
p = .028
From the paper · Abstract
Conclusions (4)
Step times equal; MR skips print timeAnswer: Mixed
“MR and 3D techniques require an equal amount of time for diagnosis, planning, and treatment evaluation, but 3D techniques require a significant additional time investment for model printing.”
From the paper · Full text
Self-overestimation of plan lower with MRAnswer: Yes
“the overestimation was significantly higher in 3D compared to MR”
p = 0.0280
From the paper · Full text
Diagnostic accuracy not significantly differentAnswer: No significant difference
“diagnosis scores did not differ between MR and 3D”
p = 0.93
From the paper · Full text
Global satisfaction higher with MRAnswer: Yes
“A significant difference was observed, indicating higher overall satisfaction with MR compared to 3D”
Feasibility study measuring the workload of liver resection planning with EEG (auditory oddball paradigm) and NASA-TLX in nine participants under three conditions: AR glasses, VR glasses and conventional planning software on a computer. The authors report the highest subjective mental demand, effort and frustration with AR, EEG findings suggesting higher workload with AR, and no notable EEG differences between VR and conventional planning.
“The AR condition had the highest scores for mental demand (median 75, IQR 70-85), effort (median 55, IQR 30-65), and frustration (median 40, IQR 15-75) compared with the VR and PC conditions.”
From the paper · Abstract
“The results suggest a lower stress level when using VR glasses compared with AR glasses, likely due to the 3D visualization of the liver model.”
From the paper · Abstract
Conclusions (4)
AR workload scores highest, not significantAnswer: No significant difference
“The AR condition had the highest scores for mental demand (median 75, IQR 70-85), effort (median 55, IQR 30-65), and frustration (median 40, IQR 15-75) compared with the VR and PC conditions.”
mental demand median 75, effort median 55, frustration median 40; P =.10
From the paper · Abstract
AR EEG workload trend not significantAnswer: No significant difference
“The analysis of the EEG revealed a trend toward a lower amplitude of the N1 component as well as for the P3 component at the central electrodes in the AR condition, suggesting a higher workload for participants when using AR glasses.”
conditions P =.71; P3 P =.26
From the paper · Abstract
VR EEG amplitudes similar to conventional planningAnswer: No significant difference
“EEG components in the VR condition did not reveal any noticeable differences compared with the EEG components in the conventional planning condition.”
From the paper · Abstract
VR gave earlier P1 latency than computerAnswer: Yes
“the VR condition elicited significantly earlier latencies at the Fz electrode (mean 75.3 ms, SD 25.8 ms) compared with the PC condition (mean 99.4 ms, SD 28.6 ms).”
[Augmented and virtual reality in surgery: fields of application and exploratory studies exemplified by VIVATOP : Perioperative surgical planning and intraoperative support]#
Weyhe D et al. · Chirurgie (Heidelberg, Germany) · 2025
German-language overview of AR and VR in surgery, with results from the BMBF-funded VIVATOP project, which developed a VR planning tool for partial liver resection, holograms for intraoperative AR support (HoloLens), an avatar telemedicine function and a 3D-printed training model. Outcomes of the intraoperative AR support (operation time, hospital and ICU stay, complications) are compared with a historical cohort.
“Schnitt-Naht-Zeit ( p = 0,665), die Krankenhausverweildauer ( p = 0,317) und die Dauer des Intensivaufenthalts ( p = 0,063) unterscheiden sich nicht zwischen Interventions- und Kontrollgruppe”
p = 0,665
From the paper · Fulltext
“Nach Clavien-Dindo eingeteilt fand sich kein Unterschied zwischen den beiden Gruppen, speziell auch bei höheren Komplikationsgraden”
From the paper · Fulltext
Conclusions (2)
No difference in cut-to-suture timeAnswer: No significant difference
“Schnitt-Naht-Zeit ( p = 0,665), die Krankenhausverweildauer ( p = 0,317) und die Dauer des Intensivaufenthalts ( p = 0,063) unterscheiden sich nicht zwischen Interventions- und Kontrollgruppe”
cut-to-suture p = 0,665; hospital stay p = 0,317; ICU stay p = 0,063
From the paper · Full text
No difference in Clavien-Dindo complicationsAnswer: No significant difference
“Nach Clavien-Dindo eingeteilt fand sich kein Unterschied zwischen den beiden Gruppen, speziell auch bei höheren Komplikationsgraden”
PreVISE: an efficient virtual reality system for SEEG surgical planning#
Spiegler P et al. · Virtual reality · 2025
Neurosurgery · Technical development
Meta Quest / Oculus
Technical development of PreVISE, a VR system on an Oculus Quest 3 for planning SEEG electrode trajectories, with real-time feedback on distance to vessels, insertion angle and an overall plan quality score. The authors report a 91% reduction in planning time compared with conventional 2D planning.
“The system reduces the surgical planning time by 91%.”
91%
From the paper · Abstract
Conclusions (3)
Planning time 91% lower than literature figureAnswer: Yes
“The system reduces the surgical planning time by 91%.”
91%
From the paper · Abstract
Planning took 72.6 and 80.2 s per trajectoryAnswer: Describes
“The average planning times per trajectory are 72.6 ± 20.9 s and 80.2 ± 23.9 s for clinicians and non-clinicians, respectively.”
German narrative review of virtual reality in liver surgery, covering 3D reconstruction for preoperative planning and communication, structured training in surgical anatomy and operation planning, VR-based examinations, and prototypes simulating patient-specific intraoperative ultrasound.
Application of extended reality in pediatric neurosurgery: A comprehensive review#
Chang YZ, Wu CT · Biomedical journal · 2025
Neurosurgery · Systematic review
Multiple platforms
PRISMA-based comprehensive review of XR (AR and VR) in paediatric neurosurgery, covering workflow, preoperative planning, intraoperative navigation, postoperative assessment, education and future prospects.
“Their research involving 47 patients demonstrated that VR-enhanced consultations resulted in 91% of patients reporting significantly improved understanding of their condition.”
91% of 47 patients
From the paper · Fulltext
“revealing initial implementation costs between $150,000 and $400,000 per institution, adjusted by the scale of adoption.”
“Their research involving 47 patients demonstrated that VR-enhanced consultations resulted in 91% of patients reporting significantly improved understanding of their condition.”
91% of 47 patients
From the paper · Full text
Review concludes XR offers benefits; no pooled dataAnswer: Describes
“Integrating XR into pediatric neurosurgical practice offers numerous benefits, including improved surgical precision, reduced operative times, enhanced patient outcomes, and more effective surgeon training methodologies”
Augmented reality for epilepsy surgery: Examining usability and efficacy in presurgical planning#
Chilappa R et al. · Epileptic disorders · 2025
Neurosurgery · Survey/user study · n: 5 patient datasets
Microsoft HoloLens
Usability study of the Duke Augmented Reality Epilepsy Planner, a HoloLens 2 app that displays 3D brain models with SEEG electrodes made from five patients' MRI, CT and electrode data for presurgical epilepsy planning. Eighteen faculty members completed a survey indicating it was user-friendly and potentially effective for planning.
“Survey results from 18 faculty members regarding seven questions indicated that AREP was user-friendly and can be effective in presurgical planning moving forward.”
“Survey results from 18 faculty members regarding seven questions indicated that AREP was user-friendly and can be effective in presurgical planning moving forward.”
Use of Three-Dimensional (3D) Airway Modeling and Virtual Reality for Diagnosis, Communication, and Surgical Planning of Complex Airway Stenosis#
Cho Y et al. · Head & neck · 2025
ENT / head & neck · Technical development · n: 3 patients
syGlass (IstoVisio)
Mimics
Technical study describing segmentation of one normal and two stenotic airways from CT in Mimics and their import into the syGlass VR software, with narrated VR case presentations created by a team of airway surgeons, engineers, educators and radiologists. The authors report better geometric and anatomical detail than 2D CT and see potential for describing and planning surgery for complex airway stenosis.
Pre-Procedural Virtual Reality Guiding Catheter Simulation Navigating Successful Percutaneous Coronary Intervention of a Chronic Total Occlusion of an Anomalous Origin of the Right Coronary Artery#
Yoshinaga M et al. · Catheterization and cardiovascular interventions · 2025
Adult cardiac & structural heart · Case series · n: 2 patients
VR, platform not specified
Two case reports of PCI for chronic total occlusion of an anomalous-origin right coronary artery, in which a 3D VR guiding catheter simulation system based on CT volume rendering was used beforehand to choose the guiding catheter and vascular access. Both procedures were successful.
Conclusions (2)
Two CTO cases ended in successful PCIAnswer: Describes
“We report two cases of successful percutaneous coronary intervention (PCI) of a chronic total occlusion (CTO) lesion”
From the paper · Abstract
Authors say simulation widens planning optionsAnswer: Describes
“The present case report highlights that VR simulation provides a greater possibility than usual of”
A Randomized Pilot Trial of Virtual Reality Surgical Planning for Head and Neck Oncologic Resection#
Nunes KL et al. · The Laryngoscope · 2025
ENT / head & neck · Randomized controlled trial · n: 34 patients
Medicalholodeck / Medical Imaging XR
Meta Quest / Oculus
3D Slicer / SlicerVR
Randomised pilot trial in 34 patients undergoing head and neck cancer resection, comparing a VR case-enhancement protocol (CT/MRI reviewed in Medical Holodeck on an Oculus Rift) with standard planning. The protocol was completed in 94.4% of eligible cases without raising surgeon task load. The authors report fewer 'margin events' with VR (margin event rate 11.6% vs. 35.6%) and fewer defect-driven margins; differences in positive frozen and final margins were not significant.
“VRCEP was associated with decreased defect-driven margins (10% vs. 53.3%, p = 0.032).”
p = 0.032
From the paper · Abstract
“Although not statistically significant, positive frozen and final margin rates were lower in VRCEP.”
From the paper · Abstract
“Completion of the VRCEP was feasible with no significant increase in surgeon TLB appreciated.”
From the paper · Abstract
Conclusions (4)
VR protocol completed in 17 of 18 casesAnswer: Yes
“94.4% of eligible VRCEP cases completed (17/18)”
94.4% (17/18)
From the paper · Abstract
Fewer margin events with VR planningAnswer: Yes
“Cases undergoing VRCEP were associated with a lower mean MES (0.27 vs. 0.94, p = 0.014) and MER (11.6% vs. 35.6%, p = 0.0041).”
MER 11.6% vs. 35.6%, p = 0.0041
From the paper · Abstract
Fewer defect-driven margins with VR planningAnswer: Yes
“VRCEP was associated with decreased defect-driven margins (10% vs. 53.3%, p = 0.032).”
10% vs. 53.3%, p = 0.032
From the paper · Abstract
Positive margin rates not significantly differentAnswer: No significant difference
“Although not statistically significant, positive frozen and final margin rates were lower in VRCEP.”
Surgeon perspectives on a virtual reality platform for preoperative planning in complex bone sarcomas#
Vucicevic RS et al. · Journal of orthopaedics · 2025
Orthopedics · Survey/user study · n: 4 cases
VR, platform not specified
Study in which six orthopaedic oncology surgeons and trainees reviewed four historical pelvic bone sarcoma cases with positive margins, first on 2D CT and then as 3D models in a VR headset using custom software. The authors report that tumour borders were judged clearly delineated in 66.6% of VR assessments versus none with 2D imaging, and that users would have changed the surgical approach or margins 44.4% of the time after VR.
“Users reported they would change the surgical approach or margins 44.4 % of the time after reviewing with VR technology.”
44.4 %
From the paper · Abstract
“Tumor borders were clearly delineated in 0 % and 66.6 % cases when evaluating with conventional 2D imaging and VR, respectively.”
66.6 %
From the paper · Abstract
Conclusions (3)
Tumour borders clear in 66.6% of VR reviewsAnswer: Yes
“Tumor borders were clearly delineated in 0 % and 66.6 % cases when evaluating with conventional 2D imaging and VR, respectively.”
0 % vs 66.6 %
From the paper · Abstract
Surgeons would change approach or margins 44.4%Answer: Yes
“Users reported they would change the surgical approach or margins 44.4 % of the time after reviewing with VR technology.”
44.4 %
From the paper · Abstract
Every case had a six-plane plan changeAnswer: Yes
“we found that for every case at least one change to the six-plane resection plan was made following use of VR technology.”
Application of Mixed Reality Technology in the Planning of PCNL for Special Types of Complex Upper Urinary Stones: A Pilot Study#
Liu Y et al. · Urology · 2025
Urology · Feasibility study · n: 15 patients
AR/MR, platform not specified
Pilot study of 15 patients with complex upper urinary tract stones (pelvic ectopic or horseshoe kidney, spinal deformity, transplant kidney) in whom CT-urography-based 3D reconstructions were projected into real space with mixed reality to plan ultrasound-guided PCNL. The authors report 87.6% agreement between planned and performed access, an 80% stone-free rate and no Clavien-Dindo grade II or higher complications.
“The consistency rate between preoperative planning and intraoperative completion was 87.6%.”
87.6%
From the paper · Abstract
“The average time for establishing the main tract was 2.3 ± 0.3 minutes, and the average total operative time was 61.5 ± 12.2 minutes.”
2.3 ± 0.3 minutes
From the paper · Abstract
“There were no occurrences of Clavien-Dindo grade≥II complications.”
From the paper · Abstract
Conclusions (3)
Plan matched completed access in 87.6%Answer: Yes
“The consistency rate between preoperative planning and intraoperative completion was 87.6%.”
87.6%
From the paper · Abstract
Main tract in 2.3 min; operation 61.5 minAnswer: Describes
“The average time for establishing the main tract was 2.3 ± 0.3 minutes, and the average total operative time was 61.5 ± 12.2 minutes.”
2.3 ± 0.3 min; 61.5 ± 12.2 min
From the paper · Abstract
No grade II or higher complicationsAnswer: Describes
“There were no occurrences of Clavien-Dindo grade≥II complications.”
Preoperative Immersive Virtual Reality Applied to Percutaneous Nephrolithotomy: A Prospective Randomized Clinical Study of Surgical Planning and Clinical Outcomes#
Cumpanas AD et al. · The Journal of urology · 2025
Randomised study of 175 patients undergoing percutaneous nephrolithotomy (2019-2023), comparing CT-only planning (89) with CT plus immersive VR models viewed on an Oculus Quest 2 (86). Viewing the VR model changed the planned calyx of entry in 30% of cases. The authors report a higher stone-free rate (33.7% vs. 20.2%) and fewer Clavien-Dindo II-IIIa complications (3.5% vs. 12.3%) in the VR group.
“Preoperative visualization of the iVR model resulted in a changed calyx of entry in 30% of cases.”
30%
From the paper · Abstract
“The CT+iVR group had a significant improvement in absolute stone-free rate (33.70% vs 20.22%, P = .043) and overall < 4 mm remnant rate (62.79% vs 48.20%, P = .044).”
P = .043
From the paper · Abstract
“Clavien-Dindo II+IIIa complications were less in the iVR group (3.48% vs 12.30%, P = .03).”
P = .03
From the paper · Abstract
“Mean operative time, min 152 (SD 60) 142 (SD 51) .24a”
152 (SD 60) vs 142 (SD 51) min, P = .24
From the paper · Fulltext
“A preoperative iVR experience enhanced each surgeon’s understanding of the perirenal anatomy, stone’s size, stone’s location, and optimal transcalyceal access”
From the paper · Fulltext
“iVR visualization resulted in an enhanced understanding of stone size, location, and shape as well as the rationale for PCNL recommendation”
From the paper · Fulltext
Conclusions (5)
Higher stone-free rate with added VR modelAnswer: Yes
“The CT+iVR group had a significant improvement in absolute stone-free rate (33.70% vs 20.22%, P = .043) and overall < 4 mm remnant rate (62.79% vs 48.20%, P = .044).”
Secondary Reconstruction of Panfacial Fractures With Virtual Reality Surgical Planning Using Both Pre and Postreconstruction Scans#
Bou Zeid N et al. · The Journal of craniofacial surgery · 2025
Oral & maxillofacial / craniofacial · Case series · n: 2 patients
VR, platform not specified
Report of two patients with malunited panfacial fractures in whom the original post-injury CT was used to reduce the fractures in a virtual-reality planning environment and recreate pre-injury anatomy, which was overlaid on current anatomy to design cutting guides and custom implants. The authors report that both patients were discharged home and all surgical and aesthetic goals were achieved.
“Both patients were discharged home, and all surgical goals and esthetic objectives were achieved.”
From the paper · Abstract
Conclusions (2)
Both patients met surgical and esthetic goalsAnswer: Describes
“Both patients were discharged home, and all surgical goals and esthetic objectives were achieved.”
From the paper · Abstract
Fracture reduction done in VR in 2 patientsAnswer: Describes
“Fracture reductions were completed in VR to recreate the preinjury anatomy.”
4-Dimensional Right Ventricular Outflow Tract Segmentation to Evaluate Candidacy for Transcatheter Pulmonary Valve Replacement#
Wilson HC et al. · Pediatric cardiology · 2025
Congenital heart · Case report · n: 1 patient
Funded in part by a charity grant supporting Elucis use.
Elucis
Case report in which the right ventricular outflow tract was segmented from cardiac CT in Elucis and viewed in VR with a virtual valve model, alongside industry fit analysis, to assess candidacy for transcatheter pulmonary valve replacement.
Pre-Operative Planning of a DCR Surgery Using Virtual Reality#
Priel A et al. · Seminars in ophthalmology · 2025
ENT / head & neck · Validation study · n: 10 patients
D2P (3D Systems)
Reader study in which six ENT and oculoplastic surgeons (consultants and residents) assessed preoperative orbital CT scans of 10 patients eligible for endoscopic DCR, using 3D models segmented in D2P and viewed in a VR headset. The authors report that ENT surgeons and consultants interpreted the anatomy more accurately than ophthalmologists and residents, but that the VR tool did not improve CT interpretation.
“Surprisingly, the VR system did not help them to interpret the CT better.”
From the paper · Abstract
Conclusions (3)
VR did not improve CT interpretationAnswer: No
“Surprisingly, the VR system did not help them to interpret the CT better.”
From the paper · Abstract
ENT more accurate than ophthalmology on pathology sideAnswer: Yes
“When evaluating the CT using the VR tool, in 73.3% of the cases ENT surgeons were right about the side of pathology, while only 43.3% ophthalmologists were right”
73.3% vs 43.3%, chi-square p = .018
From the paper · Abstract
Septum deviation: ENT vs ophthalmology not significantAnswer: No significant difference
“In 72.8% of the cases ENT surgeons were evaluated right that there is a septum deviation, while only in 47.2% of the cases the ophthalmologists were right”
814 Evaluation of Mixed Reality for Burn Margin Visualization and Surgical Planning#
Journal of burn care & research · 2025
Plastic & reconstructive · Conference abstract
AR/MR, platform not specified
Conference abstract (ABA 2025) evaluating mixed reality overlays of predefined deep burn margins that three burn surgeons traced on a printed burn image using a see-through and a pass-through headset, compared with a monitor. The authors present this as a first step towards MR to help interpret burn area and depth for surgical planning.
“When the traces were aligned with the ground truth using ICP, the pass-through headset had the highest IOU (0.797), followed by the see-through headset (0.770), with both outperforming the control condition (0.763) in trace precision.”
0.797
From the paper · Full text: main text
“MR allows surgeons to more precisely mark a pre-defined burn margin than a monitor alone.”
From the paper · Full text: main text
Conclusions (2)
Raw trace accuracy lower with headsets than monitorAnswer: No
“With the raw traces, average trace area IOU was highest for the control (0.718), then for the PTh headset (0.501), and lowest for the STh headset (0.187).”
IOU 0.718 control vs 0.501 PTh vs 0.187 STh
From the paper · Abstract
Trace precision after alignment slightly higher with headsetsAnswer: Yes
“When the traces were aligned with the ground truth using ICP, the pass-through headset had the highest IOU (0.797), followed by the see-through headset (0.770), with both outperforming the control condition (0.763) in trace precision.”
Advancing Surgical Practice With Mixed Reality: Current Innovations and Future Prospects#
Ke Y, Hu K · MedComm – Future Medicine · 2025
Multi-specialty · Narrative review
Multiple platforms
Narrative review of mixed reality across surgical specialties covering technical foundations (3D reconstruction, holographic visualisation, registration) and applications in preoperative planning, intraoperative navigation, training and rehabilitation. The authors conclude that evidence remains limited and call for multicentre randomised trials and standardised workflows.
“However, current limitations include insufficient computational and display capabilities of head‐mounted displays, inadequate accuracy in spatial registration, high costs, workflow complexity, and unresolved ethical concerns.”
Augmented Reality in Surgery for Recurrent Pelvic Tumors: Clinical Case#
Grebenkov VG et al. · Creative Surgery and Oncology · 2025
General & GI surgery · Case report · n: 1 patient
Microsoft HoloLens
Case report of a 58-year-old with locally advanced recurrent rectal cancer in whom a CT/MRI-based 3D tumour model viewed on Microsoft HoloLens 2 was used to plan the approach for an ultrasound-guided needle biopsy. The authors report precise localisation, shorter operating time and no damage to adjacent structures.
“The application of AR technology facilitated precise tumor localization, reduced the operation time, and prevented damage to vessels and adjacent anatomical structures.”
From the paper · Abstract
“This case demonstrates that AR improves diagnostic accuracy, enhances intervention planning, and minimizes surgical risks.”
From the paper · Abstract
Conclusions (1)
Authors credit AR with localisation and vessel protectionAnswer: Describes
“The application of AR technology facilitated precise tumor localization, reduced the operation time, and prevented damage to vessels and adjacent anatomical structures.”
Preprint describing an extended-reality segmentation tool for CT on Meta Quest 3 with the Logitech MX Ink stylus, offering stylus annotation with instant 3D rendering for planning and other uses. In a user study on a public craniofacial CT dataset, the authors report a SUS score of 66 and positive ratings for controls and hybrid 2D/3D navigation.
“A user study with a public craniofacial CT dataset demonstrated the tool's foundational viability, achieving a System Usability Scale (SUS) score of 66, within the expected range for medical applications.”
66
From the paper · Abstract
“Participants highlighted the system's intuitive controls (scoring 4.1/5 for self-descriptiveness on ISONORM metrics) and spatial interaction design, with qualitative feedback highlighting strengths in hybrid 2D/3D navigation and realistic stylus ergonomics.”
1/5
From the paper · Abstract
Conclusions (2)
Usability score of 66 in user studyAnswer: Describes
“achieving a System Usability Scale (SUS) score of 66, within the expected range for medical applications.”
SUS 66
From the paper · Abstract
Self-descriptiveness rated 4.1 of 5Answer: Describes
“scoring 4.1/5 for self-descriptiveness on ISONORM metrics”
Clinical Application of an Ergonomic Holographic Device to Optimize Port Placement in Robotic Mitral Valve Surgery: Proof-of-Concept Study#
Agnino A et al. · The Heart Surgery Forum · 2025
Adult cardiac & structural heart · Feasibility study
Microsoft HoloLens
3D Slicer / SlicerVR
Custom Unity app
Proof-of-concept study using HoloLens 2 holograms from preoperative CT (3D Slicer and Unity pipeline) overlaid on patients to optimise robotic port placement for mitral valve surgery, tested by a robotic team in October 2024. The authors report comfort, greater confidence and user-friendliness.
“Feedback highlighted its comfort, confidence enhancement, and user-friendliness.”
From the paper · Abstract
“This proof-of-concept study demonstrates the feasibility and user-friendliness of an ergonomic, AR-based holographic device to optimize port placement in robotic mitral valve surgery.”
From the paper · Abstract
Conclusions (2)
Feasible and user-friendly for port placementAnswer: Yes
“This proof-of-concept study demonstrates the feasibility and user-friendliness of an ergonomic, AR-based holographic device to optimize port placement in robotic mitral valve surgery.”
From the paper · Abstract
Team feedback cited comfort and confidenceAnswer: Yes
“Feedback highlighted its comfort, confidence enhancement, and user-friendliness.”
Comparison of seven segmentation methods available in DICOM to Print, at three smoothing levels, for building liver-vessel meshes from portal-venous CT in nine patients. Meshes were measured against a reference and rated by three raters in a head-mounted VR display. The authors found large differences between methods and conclude that automatic algorithms need manual adjustment to give usable surgical-planning meshes.
Conclusions (3)
Mesh agreement with reference peaked at ICC 0.79Answer: Describes
“The results for quantitative metrics reach intraclass correlation coefficients of up to 0.79.”
ICC up to 0.79
From the paper · Abstract
Automatic methods alone fall short of clinical meshesAnswer: No
“quantitative and qualitative analyses showed that, by themselves, they are not able to obtain meshes that are comparable to those created in clinical practice.”
From the paper · Full text
Each rater found large differences between methodsAnswer: Describes
“For both questions, all ICCs are below 0.145, independently of the amount of smoothing that is applied to the 3D meshes.”
Consistent Perspective Alignment in Multiuser Mixed Reality for Collaborative Surgical Pre-Planning#
Menon MM et al. · 2025 IEEE 6th India Council International Subsections Conference (INDISCON) · 2025
Multi-specialty · Technical development
Microsoft HoloLens
Custom Unity app
Conference paper on a multi-user Microsoft HoloLens 2 application (Unity, Vuforia, Mixed Reality Toolkit) that keeps a shared, consistent view of a 3D anatomical model for collaborative surgical pre-planning, using marker-based registration. The authors report negligible translation/rotation error and under 0.05 s latency for model placement.
Conclusions (2)
Model placement delay under 0.05 secondsAnswer: Describes
“A negligible delay of less than 0.05 seconds was observed for the model to achieve a state of zero translation and rotation error.”
less than 0.05 seconds
From the paper · Abstract
Marker tracking may keep model placement consistentAnswer: Describes
“The results reveal that marker-based tracking has the potential to ensure consistency in the deployment of models during surgical planning and decision-making workflows.”
Development and Implementation of a Mixed Reality-Based System for Planning, Simulation, and Real-World Clinical Performance of Laparoscopic Myomectomy#
Kong W et al. · Preprints.org · 2025
Gynecology · Preprint (study protocol)
AR/MR, platform not specified
Preprint outlining a planned mixed reality system for individualised laparoscopic myomectomy, combining automatic MRI segmentation, an interactive surgical simulation and planning prototype, and intraoperative MR visualisation, to be tested in a randomised trial. The authors aim to improve the precision and safety of myomectomy.
Mixed Reality as a tool for enhancing precision in surgery planning#
Gomez de Cadiz A et al. · AHFE international · 2025
Multi-specialty · Conference paper
Custom Unity app
Materialise Mimics
AR/MR, platform not specified
AHFE 2025 conference paper presenting a workflow for building mixed-reality scenarios for trauma and vascular surgery: anatomical models segmented in Mimics, scenes built in Unity, and display on tablets, smartphones and headsets, with 3D models and guidance elements superimposed in the surgeon's view.
Preprint of a prospective study of 32 patients with posterior urethral rupture after pelvic fracture, in whom mixed reality 3D models from CT urethrography were used for diagnosis and surgical planning, compared with 32 controls. The authors report a non-significant 12-minute reduction in operative time and residents' agreement that MR helped understanding.
“Compared with the control group, the mixed reality technology group showed an average operative time reduction of about 12 minutes, although this difference was not statistically significant (P > 0.05)”
12 minutes
From the paper · Abstract
“No statistically significant differences in the intraoperative blood loss volume or postoperative complication rates were observed (P > 0.05).”
P > 0.05
From the paper · Abstract
“Mixed reality 3D visualization technology is beneficial for accurately diagnosing and planning surgical treatment for PFUI.”
From the paper · Abstract
Conclusions (3)
Operative time 12 min shorter, not significantAnswer: No significant difference
“Compared with the control group, the mixed reality technology group showed an average operative time reduction of about 12 minutes, although this difference was not statistically significant (P > 0.05)”
about 12 minutes, P > 0.05
From the paper · Abstract
Blood loss and complications not significantly differentAnswer: No significant difference
“No statistically significant differences in the intraoperative blood loss volume or postoperative complication rates were observed (P > 0.05).”
“residents generally agreed that mixed reality 3D visualization technology was beneficial for not only observing the relationship between the urethra and its adjacent structures and therefore allowing a comprehensive assessment”
Offline Modeling and Mixed Reality Based Remote Diagnosis System for Patient-Specific Cardiovascular Diseases#
Wang J et al. · 2025 International Conference on Metaverse Computing, Networking and Applications (MetaCom) · 2025
Adult cardiac & structural heart · Technical development
AR/MR, platform not specified
Conference paper on a remotely connected mixed-reality platform combining offline multi-organ blood-flow simulation with head-mounted holographic collaboration for diagnosis and surgical planning of cardiovascular disease, demonstrated on stroke risk after coronary stenting.
Preliminary Study on the Accuracy Comparison Between 3D-Printed Bone Models and Naked-Eye Stereoscopy-Based Virtual Reality Models for Presurgical Molding in Orbital Floor Fracture Repair#
Tsuchiya M et al. · Applied Sciences · 2025
Oral & maxillofacial / craniofacial · Comparative study · n: 11 orbital fractures
Autostereoscopic/holographic display
Preliminary study in which two surgeons pre-shaped orbital floor implants for 11 unilateral fractures on both 3D-printed models and naked-eye stereoscopic display VR models from the same CT. The authors report comparable reproducibility and dimensional agreement (no significant differences in Hausdorff distance or RMSE), with depth the least reproducible measure.
“Between modalities, no significant differences were found; HD and RMSE were 2.95 ± 0.94 mm and 1.28 ± 0.49 mm.”
From the paper · Abstract
“These preliminary findings suggest that NED-based preshaping may be feasible; however, larger studies are required to confirm whether VR can achieve performance comparable to 3D-printed models.”
From the paper · Abstract
Conclusions (2)
No significant difference between modalitiesAnswer: No significant difference
“Between modalities, no significant differences were found; HD and RMSE were 2.95 ± 0.94 mm and 1.28 ± 0.49 mm.”
HD 2.95 ± 0.94 mm, RMSE 1.28 ± 0.49 mm
From the paper · Abstract
Preshaping may be feasible, larger studies neededAnswer: Describes
“These preliminary findings suggest that NED-based preshaping may be feasible; however, larger studies are required to confirm whether VR can achieve performance comparable to 3D-printed models.”
Revolutionizing Head and Neck Reconstruction: The Integration of Artificial Intelligence and Virtual Reality in Surgical Practice#
Ghasemi S et al. · Preprints.org · 2025
ENT / head & neck · Preprint (narrative review)
Multiple platforms
Preprint literature review of AI and VR in head and neck reconstruction, covering VR training, preoperative planning and intraoperative visualisation. The authors report that VR-based planning and AR guidance were associated with better margins and shorter operative time.
“AI algorithms increased the accuracy of tumor detection and treatment planning, while VR-based planning and augmented reality guidance improved surgical margins and reduced operative time.”
From the paper · Abstract
“VR training platforms shortened the learning curve for surgeons by providing risk-free, immersive simulation, and AI-driven analytics enabled real-time monitoring of reconstructive flaps and early complication detection.”
From the paper · Abstract
Conclusions (2)
Planning and AR guidance reduced operative timeAnswer: Yes
“AI algorithms increased the accuracy of tumor detection and treatment planning, while VR-based planning and augmented reality guidance improved surgical margins and reduced operative time.”
From the paper · Abstract
VR training shortened surgeons' learning curveAnswer: Yes
“VR training platforms shortened the learning curve for surgeons by providing risk-free, immersive simulation, and AI-driven analytics enabled real-time monitoring of reconstructive flaps and early complication detection.”
TCT 2025 abstract on CT angiography and holographic visualisation for planning minimally invasive coronary surgery. Title-only record: no abstract was openly available from the sources searched, so details could not be confirmed.
The importance of stereoscopic vision in virtual surgical planning#
Abramson ZR et al. · International Journal of Radiology & Radiation Therapy · 2025
Multi-specialty · Survey/user study
VR, platform not specified
Small pilot study among paediatric oncologic surgeons examining whether stereoscopic viewing in a commercial VR headset resolves size and distance ambiguity in 3D virtual models used for preoperative planning. The authors report that surgeons were often unaware of the ambiguity and that stereoscopy helped resolve it, especially with transparent rendering.
“Stereoscopic vision as provided by commercially available VR headset helps resolve ambiguity inherent to virtual scenes containing structures of unknown size and location.”
From the paper · Abstract
“The use of stereoscopic displays for 3D surgical planning may reduce unanticipated intra-operative findings.”
“Stereoscopic vision as provided by commercially available VR headset helps resolve ambiguity inherent to virtual scenes containing structures of unknown size and location.”
Virtual Reality in Orthopaedic Pre-Operative Trauma Planning: A Face and Content Validity Study#
Waugh D et al. · SVOA Orthopaedics · 2025
Orthopedics · Survey/user study · n: 24 surgeon responses
Medicalholodeck / Medical Imaging XR
Face and content validity study of a VR system built on Medicalholodeck software for orthopaedic trauma planning, in which surgeons reviewed CT on PACS and then in VR with implants. The authors report 24 responses, better understanding of fracture patterns in VR, agreement that VR matched PACS imaging, a change in operative plan for 87% and a Net Promoter Score of +71.
“All participants agreed that the VR representation matched PACS CT imaging, and 87% reported a change in operative plan.”
87%
From the paper · Abstract
“VR significantly improved surgeons’ understanding of fracture patterns (Wilcoxon signed-rank test: Z = –3.93, p<0.001, r = 0.59).”
p<0.001
From the paper · Abstract
“NPS was +71, with 75% promoters.”
+71
From the paper · Abstract
Conclusions (4)
Survey supports face and content validityAnswer: Yes
“This early evaluation demonstrates strong face and content validity for a low-cost VR trauma planning tool.”
Virtual reality planning in cardiothoracic surgery: From pilot to practice [Doctoral thesis]#
Bakhuis W. · Erasmus University Rotterdam (PhD thesis) · 2025
Thoracic · Thesis
Multiple platforms
Doctoral thesis (Erasmus University Rotterdam), 'Virtual reality planning in cardiothoracic surgery: from pilot to practice', compiling the author's studies on VR-based preoperative planning in cardiac and thoracic surgery.
Surgical Multidisciplinary Team Meetings Are Enhanced by Collaboration in the Metaverse#
Ghaderi R et al. · Journal of medical extended reality · 2024
Orthopedics · Feasibility study
Medicalholodeck / Medical Imaging XR
Feasibility study of an immersive VR metaverse platform (adapted Medicalholodeck) for orthopaedic trauma multidisciplinary team meetings, tested in four pilot meetings with 13 health professionals on 24 simulated cases. The authors report high ratings for data visualisation and clinical decision-making but mixed ratings for ease of communication.
“Participants found that "data visualization" and "clinical decision-making" were effective in IVR: median 5 (interquartile range [IQR], 4-5) and 5 (IQR, 4-5), respectively.”
From the paper · Abstract
“Ratings on "ease of communication" in the metaverse varied with a median of 3 (IQR, 2-4.5).”
From the paper · Abstract
“Health care professionals can feasibly conduct complex MDT-Ms using a novel metaverse platform on commercially available IVR headsets.”
From the paper · Abstract
Conclusions (3)
Data visualization and decisions rated effectiveAnswer: Yes
“Participants found that "data visualization" and "clinical decision-making" were effective in IVR: median 5 (interquartile range [IQR], 4-5) and 5 (IQR, 4-5), respectively.”
median 5 (IQR, 4-5) and 5 (IQR, 4-5)
From the paper · Abstract
Ease of communication ratings variedAnswer: Mixed
“Ratings on "ease of communication" in the metaverse varied with a median of 3 (IQR, 2-4.5).”
median 3 (IQR, 2-4.5)
From the paper · Abstract
Complex team meetings feasible on commercial headsetsAnswer: Yes
“Health care professionals can feasibly conduct complex MDT-Ms using a novel metaverse platform on commercially available IVR headsets.”
Advancing Pediatric Surgery: The Use of HoloLens 2 for 3D Anatomical Reconstructions in Preoperative Planning#
Di Mitri M et al. · Children (Basel, Switzerland) · 2024
General & GI surgery · Comparative study · n: 3 patients
Microsoft HoloLens
Prospective observational study in which ten paediatric surgeons planned surgery for three malformations (splenic cyst, cystic adenomatoid lung malformation and pelvi-ureteric junction stenosis) using 2D CT and 3D reconstructions on HoloLens 2, then completed questionnaires. The authors report that the 3D holograms were rated significantly clearer and more useful than 2D CT, with some ease-of-use issues.
“The results indicated significant improvements in anatomy understanding and surgical precision.”
From the paper · Abstract
“Furthermore, this technology facilitated collaborative decision-making and streamlined surgical workflows.”
From the paper · Abstract
“Despite some challenges in ease of use, HoloLens 2 showed promising results in reducing the learning curve for complex procedures.”
From the paper · Abstract
Conclusions (3)
Surgeons rated 3D clearer than 2D CTAnswer: Yes
“for questions 1 through 4, 3D visualization using HoloLens 2 significantly improves surgeons’ ability to view preoperative CT images”
From the paper · Full text
Large effect size for usability scoresAnswer: Describes
“The results revealed a large effect size (d = 1.15) for usability scores”
d = 1.15
From the paper · Full text
Ease of use received a lower ratingAnswer: Describes
“not all surgeons found the device to be easy to use, with this aspect receiving a lower average rating of 2.9”
Unifocalization of Major Aortopulmonary Collateral Arteries (MAPCAs) and Native Pulmonary Arteries in Infancy-Application of 3D Printing and Virtual Reality#
Kolcz J et al. · Journal of cardiovascular development and disease · 2024
Prospective cohort of nine infants undergoing unifocalisation of major aortopulmonary collateral arteries, five of whom were additionally planned with VR and 3D-printed models and four with conventional imaging. The authors report shorter operative and bypass times and no intraoperative complications in the VR/3D group, and better staff-reported anatomical understanding and parental satisfaction.
“The intervention group had shorter operative and cardiopulmonary bypass times compared to the control group.”
From the paper · Abstract
“Medical staff in the VR/3D group reported significantly improved understanding of anatomy, surgical preparedness, and team collaboration (p < 0.05).”
p < 0.05
From the paper · Abstract
“Parents also expressed higher satisfaction, with better comprehension of their child's anatomy and surgical plan.”
From the paper · Abstract
Conclusions (4)
Operative time shorter with VR and 3D modelsAnswer: Yes
“The intervention group demonstrated a shorter operative time (6.5 h versus 8.3 h)”
Virtual reality-based preoperative planning for optimized trocar placement in thoracic surgery: A preliminary study#
Harirpoush A et al. · Healthcare technology letters · 2024
Thoracic · Technical development
3D Slicer / SlicerVR
Meta Quest / Oculus
Technical development of a VR preoperative planning tool for trocar placement in video-assisted thoracoscopic surgery, with visualisation and interaction designed around established placement principles, demonstrated for right upper lobectomy. The authors report that a preliminary user study found the system efficient, robust and user-friendly.
“A preliminary user study of the system indicates it is efficient, robust, and user-friendly for planning optimal trocar placement, with a great promise for clinical application while offering potentially valuable insights for the development of other surgical VR systems.”
From the paper · Abstract
Conclusions (2)
Usability score above the usability thresholdAnswer: Yes
“significantly higher than the usability threshold of 68”
SUS 81.8 ± 10.5 vs threshold 68
From the paper · Full text
Most participants needed no adjustmentsAnswer: Describes
“The majority of participants (75%) completed both tasks without adjustments.”
BREAST+: An augmented reality interface that speeds up perforator marking for DIEAP flap reconstruction surgery#
Timóteo R et al. · Healthcare technology letters · 2024
Plastic & reconstructive · Technical development
Microsoft HoloLens
Technical development and user study of BREAST+, a HoloLens 2 AR interface for marking DIEP flap perforator locations on the patient's skin before surgery and accessing clinical data in the operating room, tested with 27 medical students and 2 breast surgeons in a controlled setting. The authors report a mean marking error of 6.8 mm, about six-fold faster marking than the conventional approach, and biases likely related to depth perception.
“The average time taken to mark each perforator is 7.7 ± 6.5 s, with an average absolute error of 6.8 ± 2.6 mm and an estimated average deviation of 3.6 ± 1.4 mm.”
7.7 ± 6.5 s
From the paper · Abstract
“The results revealed non-negligeable biases in user estimates likely attributed to depth perception inaccuracies.”
From the paper · Abstract
“Still, the study concluded that BREAST+ is both accurate and considerably more efficient (∼6 times faster) when compared to the conventional perforator marking approach.”
From the paper · Abstract
Conclusions (3)
Marking about six times faster than estimateAnswer: Yes
“Insights from domain experts indicate that marking a single perforator conventionally takes approximately 45 s. Thus, our system's performance reflects a substantial enhancement, yielding an estimated speed up of ∼6 times.”
7.7 ± 6.5 s per perforator vs approximately 45 s conventional (expert estimate, not measured)
From the paper · Full text
Error 6.8 mm, 3.6 mm minus systematic errorAnswer: Describes
“an average absolute error of 6.8 ± 2.6 mm and an estimated average deviation of 3.6 ± 1.4 mm”
6.8 ± 2.6 mm absolute error; 3.6 ± 1.4 mm deviation
From the paper · Abstract
Depth perception biases in user estimatesAnswer: No
“The results revealed non‐negligeable biases in user estimates likely attributed to depth perception inaccuracies.”
Metaverse surgical planning for robotic surgery: preliminary experience and users' perception#
Volpi G et al. · Therapeutic advances in urology · 2024
Urology · Survey/user study
Meta Quest / Oculus
User study at a urology meeting in which surgeons planned robotic prostatectomy and partial nephrectomy using 3D virtual models in a cloud metaverse platform viewed through VR headsets, and 66 attendees then rated the experience. The authors report high median scores for usefulness in preoperative planning (9/10) and for anatomical accuracy.
“As emerged from the Health-ITUES questionnaire, META_EXP covers an important role in the presurgical/surgical planning and decision-making process and appears to be useful for preoperative planning, with a median response of 4 and 5, respectively.”
From the paper · Abstract
“Such results were also confirmed at the Face & Content validity questionnaire, with a median rate of 9/10 regarding its usefulness for surgical planning.”
9/10
From the paper · Abstract
“Also, anatomical accuracy was positively rated regarding both organ's and disease's details, with a median response of 9.”
From the paper · Abstract
“Regarding specific questions, the median evaluation of Meta-EXP’s capability to improve patients’ counselling was rated 9/10 (QSa (IQR 8–10)).”
median 9/10 (IQR 8–10)
From the paper · Fulltext
Conclusions (4)
Usability scale rated it useful for planningAnswer: Yes
“META_EXP covers an important role in the presurgical/surgical planning and decision-making process and appears to be useful for preoperative planning, with a median response of 4 and 5, respectively.”
“Such results were also confirmed at the Face & Content validity questionnaire, with a median rate of 9/10 regarding its usefulness for surgical planning.”
median 9/10
From the paper · Abstract
Anatomical accuracy rated highly by attendeesAnswer: Yes
“Also, anatomical accuracy was positively rated regarding both organ’s and disease’s details, with a median response of 9.”
median 9
From the paper · Abstract
Counselling potential rated 9/10 by attendeesAnswer: Describes
“Regarding specific questions, the median evaluation of Meta-EXP’s capability to improve patients’ counselling was rated 9/10 (QSa (IQR 8–10)).”
Merging mixed reality and computational modeling for enhanced visualization of cardiac biomechanics#
Costagliola E et al. · Medical engineering & physics · 2024
Adult cardiac & structural heart · Technical development
AR/MR, platform not specified
Technical study proposing a framework that brings computational heart modelling results (the Living Heart Human Model) into mixed reality for immersive visualization of cardiac kinematics and electrical fields, and of simulated LVOT obstruction after transcatheter mitral valve replacement. The authors suggest this could help assess device-induced anatomical constraints.
“Findings demonstrated that augmented exploration of cardiac biomechanics can be used for a better understanding of the electrical field of the beating heart.”
From the paper · Abstract
Conclusions (1)
Augmented exploration used to study cardiac electrical fieldAnswer: Describes
“Findings demonstrated that augmented exploration of cardiac biomechanics can be used for a better understanding of the electrical field of the beating heart.”
Role of eXtended Reality use in medical imaging interpretation for pre-surgical planning and intraoperative augmentation#
Kantor T et al. · Journal of medical imaging (Bellingham, Wash.) · 2024
Multi-specialty · Narrative review
Multiple platforms
Narrative review of 155 papers on immersive extended reality using medical imaging for surgical planning and intraoperative augmentation, with ChatGPT used to assist the review. The authors report potential improvements in procedure time, errors and workflow, and identify cost, infrastructure and regulation as barriers.
“However, adoption faces challenges such as high costs, infrastructure needs, and regulatory hurdles.”
From the paper · Abstract
Conclusions (1)
Cost, infrastructure and regulation limit adoptionAnswer: Describes
“However, adoption faces challenges such as high costs, infrastructure needs, and regulatory hurdles.”
How I do it: preoperative simulation and augmented reality assisted surgical resection of Glioblastoma in Broca's area#
Guo J et al. · Acta neurochirurgica · 2024
Neurosurgery · Case report · n: 1 patient
Microsoft HoloLens
Medivis SurgicalAR
'How I do it' report of a glioblastoma in Broca's area, in which tumour resection was simulated preoperatively in VR with fibre tracts displayed, then AR (Medivis SurgicalAR on HoloLens 2) localized the ends of the dorsal language pathways during resection, following the preoperative plan. The authors report gross total resection and a favourable functional outcome.
“Gross total resection and favorable functional outcome were finally achieved.”
From the paper · Abstract
“Image registration error is less than 1 mm by using preoperatively acquired MRI”
< 1 mm
From the paper · Fulltext
Conclusions (2)
Gross total resection, favorable function reportedAnswer: Describes
“Gross total resection and favorable functional outcome were finally achieved.”
From the paper · Abstract
Registration error under 1 mmAnswer: Describes
“Image registration error is less than 1 mm by using preoperatively acquired MRI”
Exploring the Potential Use of Virtual Reality with a Supraorbital Keyhole Craniotomy for Anterior Skull Base Meningiomas: Two Case Reports#
Valerio J et al. · Journal of personalized medicine · 2024
Neurosurgery · Case series · n: 2 patients
Magic Leap
Brainlab Elements
Two case reports of patients with anterior skull base meningiomas (aged 37 and 84) in whom the Brainlab Magic Leap AR/VR platform was used for patient selection and preoperative planning of a supraorbital keyhole craniotomy. The authors report complete resection in both, with postoperative hyponatraemia in one and an intracranial haemorrhage in the other, both of whom recovered.
“We can utilize VR/AR technologies to identify patients that will benefit from an SOKC and expand the implementation of the approach beyond its current limitations.”
From the paper · Abstract
Conclusions (2)
Complete resection in both patientsAnswer: Describes
“Both patients had a complete tumor resection by a minimally invasive SOKC after preoperative planning with the AR/VR platform.”
From the paper · Abstract
One hyponatremia, one intracranial hemorrhageAnswer: Describes
“Postoperatively, hyponatremia complicated the first case, while the second case developed an intracranial hemorrhage.”
Short operative report in Operative Neurosurgery on virtual planning and augmented reality for the microsurgical resection of a pineal epidermoid cyst. No abstract was available, so these details are from the title and venue and could not be confirmed.
The clinical application value of mixed reality in robotic laparoscopic partial nephrectomy#
Zou XC et al. · Frontiers in oncology · 2024
Urology · Retrospective cohort · n: 68 patients
Microsoft HoloLens
Smartphone / tablet AR
Retrospective comparison of 68 patients undergoing robot-assisted partial nephrectomy: 28 whose CT-based 3D models were used via 3D tablets and HoloLens for preoperative discussion, planning and intraoperative guidance, and 40 with conventional imaging. The authors report shorter operation and warm ischaemia times with MR, most marked for R.E.N.A.L. scores of 7 or higher, with negative margins in all patients.
“All patients had negative resection margins, indicating equivalent therapeutic outcomes between the two groups.”
From the paper · Abstract
“In comparison to traditional RAPN, MR technology demonstrates the ability to decrease operation time and warm ischemia time all the while maintaining equivalent curative outcomes.”
From the paper · Abstract
Conclusions (4)
Operation time about 30 min shorterAnswer: Yes
“the MR group experienced a reduction in operation time by approximately 30 min [(135.89 ± 23.494) min vs. (165.00 ± 34.320) min, P< 0.001)]”
(135.89 ± 23.494) min vs. (165.00 ± 34.320) min, P< 0.001
From the paper · Abstract
Warm ischemia time about 2.5 min shorterAnswer: Yes
“a decrease in ischemia time by around 2.5 min [(20.36 ± 3.956) min vs. (23.80± 6.889) min, P = 0.02)]”
(20.36 ± 3.956) min vs. (23.80± 6.889) min, P = 0.02
From the paper · Abstract
Negative margins in all patients, both groupsAnswer: No significant difference
“All patients had negative resection margins, indicating equivalent therapeutic outcomes between the two groups.”
From the paper · Abstract
Shorter operation time in complex tumoursAnswer: Yes
“the MR group exhibited shorter operation time [(140.83 ± 25.183) min vs. (195.77 ± 23.080) min, P< 0.001]”
(140.83 ± 25.183) min vs. (195.77 ± 23.080) min, P< 0.001
Single national centre study (Oslo, 2020-2022) of 50 children with complex congenital heart defects (median age 15 months), whose anatomic digital twins were shown to the heart team in mixed reality (TruHeart app on up to six synchronized HoloLens 2 headsets) after initial decisions using standard imaging. The digital twins changed the surgical strategy in 68% of cases; AI-assisted segmentation always needed manual correction.
“Anatomic digital twins changed the initially decided upon surgical strategies for 68% of cases.”
68%
From the paper · Abstract
“While artificial intelligence facilitated the rapid creation of digital anatomic twins, manual corrections were always necessary.”
From the paper · Abstract
Conclusions (4)
Team strategy changed in 34 of 50 casesAnswer: Yes
“Following the three-dimensional meeting, the initial therapeutic team strategy changed in 34 cases, representing 68% (95% confidence interval 0.54–0.80) of all cases”
34 of 50 cases, 68% (95% CI 0.54–0.80)
From the paper · Full text
Fewer individual plans after mixed realityAnswer: Yes
“Thus, the number of plans before and after using mixed reality were significantly different ( P = 0.0062).”
P = 0.0062
From the paper · Full text
Complications lower in digital twin plan armAnswer: Yes
“We registered lower complication rates in the arm closely aligned with the anatomic digital twin plan ( P = 0.012)”
P = 0.012
From the paper · Full text
Meeting ran 10 min longerAnswer: Describes
“Introducing a new three-dimensional visualization extended the discussion by 10 min, in addition to the 17 min spent discussing flat-screen images.”
Computed tomography-based virtual reality-guided preoperative simulation for endoscopic full-thickness resection of a gastric submucosal tumor#
Uozumi T et al. · Endoscopy · 2024
General & GI surgery · Case report (video/image) · n: 1 patient
Meta Quest / Oculus
Short image/video report of a CT-based 3D model viewed in a Meta Quest 3 VR headset to check arterial routes before endoscopic full-thickness resection of a gastric submucosal tumour. The authors report finding no major extraluminal artery near the tumour on VR review.
“EFTR was safely completed without any intraoperative adverse events ( Video 1 ).”
From the paper · Full text: main text
“However, by immersing ourselves in virtual reality, we could comprehend the spatial relationships between the gastric wall, tumor, and surrounding arteries.”
From the paper · Full text: main text
Conclusions (3)
VR clarified tumor and artery spatial relationshipsAnswer: Yes
“by immersing ourselves in virtual reality, we could comprehend the spatial relationships between the gastric wall, tumor, and surrounding arteries.”
From the paper · Full text
No major extraluminal artery found on VR reviewAnswer: Describes
“found no major extraluminal artery around the SMT”
From the paper · Full text
Resection completed without intraoperative adverse eventsAnswer: Describes
“EFTR was safely completed without any intraoperative adverse events”
Najera E et al. · Advances in experimental medicine and biology · 2024
Neurosurgery · Book chapter
Multiple platforms
Book chapter on mixed reality (VR plus AR) in neurosurgery: VR for patient-specific preoperative rehearsal and AR overlays during surgery, with case studies in tumour, skull base and cerebrovascular surgery, and discussion of training, custom implants and barriers to adoption.
Extended Reality Applications in Otolaryngology Beyond the Operating Room: A Scoping Review#
Torborg SR et al. · Journal of clinical medicine · 2024
ENT / head & neck · Systematic review
Multiple platforms
Scoping review of 10 studies on extended reality in otolaryngology-head and neck surgery outside the operating room, including patient education, physician training and interdisciplinary preoperative planning. The authors report that XR may improve patient understanding and team communication and planning, but that the literature is small and underpowered.
“XR is a novel strategy for increasing patients' comprehension of their procedures and can facilitate improved communication and planning amongst a multidisciplinary surgical team during preoperative discussions.”
From the paper · Abstract
“More robust studies are required to determine the true value of implementing XR.”
From the paper · Abstract
Conclusions (3)
XR may aid patient comprehension and team planningAnswer: Yes
“XR is a novel strategy for increasing patients’ comprehension of their procedures and can facilitate improved communication and planning amongst a multidisciplinary surgical team during preoperative discussions.”
From the paper · Abstract
Literature small with low statistical powerAnswer: Describes
“However, the existing literature is small in scale and has low statistical power for demonstrating clinical benefits.”
10 studies included
From the paper · Abstract
Only one included study showed quantitative improvementAnswer: Describes
“Additionally, only one study demonstrates a quantitative improvement with XR.”
Mixed reality applications in upper extremity surgery: the future is now#
Calem DB et al. · EFORT open reviews · 2024
Orthopedics · Narrative review
Multiple platforms
Narrative review of mixed reality with head-mounted displays in upper extremity surgery, covering trauma, corrective surgery, arthroplasty, arthroscopy and oncology. The authors describe uses for preoperative 3D planning, sterile intraoperative access to 3D data and remote assistance.
Virtual Reality for Preprocedure Planning of Covered Stent Correction of Superior Sinus Venosus Atrial Septal Defects#
Stephenson N et al. · Circulation. Cardiovascular interventions · 2024
Congenital heart · Validation study · n: 15 patients
HP Reverb G2
Custom Unity app
Blinded study in which two interventionalists used Heart VR, an in-house VR system that renders CT data without segmentation (Unity with an HP Reverb G2 headset, per the full text), to judge whether 15 patients with superior sinus venosus atrial septal defect were suitable for covered stent correction. The authors report that all 12 cases both reviewers judged suitable were technically feasible, that the three unsuitable cases were rated uncertain or disputed, and that loading and review took about 82 seconds and 7 minutes.
“Using VR, when both interventionalists agreed that a case was suitable for CSC (n=12), all proved technically feasible.”
From the paper · Abstract
“The strategy for pulmonary vein protection was correctly identified by interventionalist 1 and 2 in 9/12 and 8/12 cases, respectively.”
9/12 and 8/12
From the paper · Abstract
“Heart VR is a rapid and effective tool for predicting suitability for CSC in patients with a superior sinus venosus atrial septal defect and could be a feasible alternative to segmented virtual or physical 3-dimensional models.”
From the paper · Abstract
Conclusions (4)
All 12 jointly suitable cases proved feasibleAnswer: Yes
“Using VR, when both interventionalists agreed that a case was suitable for CSC (n=12), all proved technically feasible.”
n=12
From the paper · Abstract
Vein protection strategy correct in 9/12, 8/12Answer: Mixed
“The strategy for pulmonary vein protection was correctly identified by interventionalist 1 and 2 in 9/12 and 8/12 cases, respectively.”
9/12 and 8/12
From the paper · Abstract
VR suitability correct in 13 of 15 casesAnswer: Mixed
“Both interventionalists were correct in their VR assessment of suitability in 13 of 15 cases, uncertain in 1 of 15, and incorrect in 1 of 15.”
“The median total review time for both interventionalists was 7 minutes. The median time for data loading in VR was 82 (interquartile range, 32.8) seconds.”
Does Preoperative Virtual Reality Experience Enhance Implant Positioning Accuracy in Total Hip Arthroplasty?#
Ueno M et al. · Cureus · 2024
Orthopedics · Prospective cohort · n: 34 patients
Meta Quest / Oculus
Holoeyes MD
Single-centre prospective case-control study of 34 patients having primary total hip arthroplasty by one experienced surgeon, comparing those whose 3D plan (ZedHip) was also reviewed as a VR simulation (Holoeyes MD on Meta Quest 2, per the full text) with those without. The authors report significantly better radiographic inclination of the acetabular cup in the VR group, with no significant differences in anteversion, operative time, blood loss or hospital stay.
“Other surgical parameters, such as radiographic anteversion, operation time, blood loss, and postoperative hospital stay, showed no significant differences between the groups.”
From the paper · Abstract
“VR application in preoperative planning improved the RI accuracy in acetabular cup placement for THA, demonstrating its potential to enhance surgical precision for experienced surgeons.”
From the paper · Abstract
“The operation time and intraoperative blood loss were also comparable between the two groups”
46.0 vs 46.0 min, p = 0.9747
From the paper · Fulltext
Conclusions (3)
Cup inclination closer to plan with VRAnswer: Yes
“A significant improvement in radiographic inclination (RI) was observed in the VR group as compared to controls.”
RI difference 10.5 vs 7.3, p = 0.041
From the paper · Abstract
No difference in other surgical parametersAnswer: No significant difference
“Other surgical parameters, such as radiographic anteversion, operation time, blood loss, and postoperative hospital stay, showed no significant differences between the groups.”
hospital stay 13.39 vs 13.38 days, p = 0.9908
From the paper · Abstract
Operation time the same in both groupsAnswer: No significant difference
“The operation time and intraoperative blood loss were also comparable between the two groups”
Assessment of Interrater Reliability and Accuracy of Cerebral Aneurysm Morphometry Using 3D Virtual Reality, 2D Digital Subtraction Angiography, and 3D Reconstruction: A Randomized Comparative Study#
Saemann A et al. · Brain sciences · 2024
Neurosurgery · Comparative study · n: 10 cases
SpectoVR
Comparative study in which five neurosurgeons each measured ten unruptured intracranial aneurysms three times in immersive 3D VR (SpectoVR), on 2D DSA and on 3D DSA reconstructions on screen. The authors report higher interrater reliability for VR than for 3D DSA, no significant difference from 2D DSA, and comparable absolute measurements.
“Interrater reliability for 3D VR measurements was significantly higher than for 3D DSA measurements (3D VR mean intraclass correlation coefficient [ICC]: 0.69 ± 0.22 vs. 3D DSA mean ICC: 0.36 ± 0.37, p = 0.042).”
p = 0.042
From the paper · Abstract
“No significant difference was observed between 3D VR and 2D DSA (3D VR mean ICC: 0.69 ± 0.22 vs. 2D DSA mean ICC: 0.43 ± 0.31, p = 0.12).”
p = 0.12
From the paper · Abstract
Conclusions (3)
Interrater reliability higher than 3D reconstructionAnswer: Yes
“Interrater reliability for 3D VR measurements was significantly higher than for 3D DSA measurements”
ICC 0.69 ± 0.22 vs 0.36 ± 0.37, p = 0.042
From the paper · Abstract
Reliability not significantly different from 2D angiographyAnswer: No significant difference
“No significant difference was observed between 3D VR and 2D DSA”
ICC 0.69 ± 0.22 vs 0.43 ± 0.31, p = 0.12
From the paper · Abstract
Absolute measurements did not differ by modalityAnswer: No significant difference
“A linear mixed-effects model showed no effect of 3D VR and 3D DSA”
HoloPatch: improving intracardiac patch fit through holographically modelled templates#
Lippert M et al. · European heart journal. Imaging methods and practice · 2024
Congenital heart · Comparative study · n: 10 patients
Microsoft HoloLens
Holocare TruHeart
Prospective study of 10 patients having surgical repair of intracardiac defects, comparing patch templates designed by five clinical experts in mixed reality (Holocare TruHeart on HoloLens 2, per the full text) and in a 3D Slicer desktop application against a digitised model of the patch actually implanted. The authors report that mixed-reality patches closely matched the surgical material, whereas desktop-designed patches were significantly smaller.
“Different evaluators showed varying preferences for the application of the residual shunt risk and area.”
From the paper · Abstract
“Digital patches created in mixed-reality closely matched the surgical material, whereas those created using desktop applications were significantly smaller.”
“Digital patches created in mixed-reality closely matched the surgical material, whereas those created using desktop applications were significantly smaller.”
From the paper · Abstract
Evaluators varied in residual shunt risk preferenceAnswer: Describes
“Different evaluators showed varying preferences for the application of the residual shunt risk and area.”
From the paper · Abstract
Mixed-reality patches larger than desktop patchesAnswer: Describes
“All participants created larger digital patches in HoloLens than in the desktop application”
[The use of augmented reality for preoperative preparation of perforated flaps: a pilot study]#
Shpitser IM et al. · Stomatologiia · 2024
Plastic & reconstructive · Feasibility study · n: 3 patients
Microsoft HoloLens
Pilot study in three patients with cancer scheduled for SCIP or peroneal-artery perforator propeller flaps, in which CT segmentations were superimposed on the donor site with HoloLens 2 and compared with high-frequency ultrasound marking. The authors report full agreement with ultrasound in the two inguinal regions and a 5 mm discrepancy for three peroneal perforators.
“AR for microsurgical planning was performed in two inguinal regions and was 100% correlated with the results of high-frequency ultrasound, in the case of perforant vessels of the peroneal artery”
100%
From the paper · Abstract
Conclusions (2)
Full agreement with ultrasound in both inguinal regionsAnswer: Yes
“AR for microsurgical planning was performed in two inguinal regions and was 100% correlated with the results of high-frequency ultrasound”
100%
From the paper · Abstract
5 mm discrepancy for three peroneal perforatorsAnswer: Describes
“a discrepancy of 5 mm was noted for the X and Y axes in three perforant vessels”
Development and three-stage validation of a multi-user, multi-device mixed reality application (AR and VR) for multidisciplinary planning of structural heart interventions. Technical testing showed a median absolute measurement error of 0.69 mm (VR faster than AR); in clinical validation on five patients, VR measurements did not differ significantly from standard CT, and questionnaires were uniformly positive.
“Technical validation, including 106 size measurements, demonstrated an absolute median error of 0.69 mm (0.25 to 1.18 mm) compared with ground truth.”
0.69 mm
From the paper · Abstract
“The time to complete the entire task was 892 ± 407 s on average, with VR measurements being faster than AR ( 804 ± 483 versus 957 ± 257 s , P = 0.045 ).”
P = 0.045
From the paper · Abstract
“Questionnaires showcased unanimous agreement on the user-friendly nature, effectiveness, and clinical value.”
From the paper · Abstract
“Moreover, unanimous agreement underscored the improvement in spatial understanding of patients’ anatomy and the optimal placement of the device (Q11).”
From the paper · Fulltext
Conclusions (3)
Median measurement error 0.69 mm on 106 measurementsAnswer: Yes
“Technical validation, including 106 size measurements, demonstrated an absolute median error of 0.69 mm (0.25 to 1.18 mm) compared with ground truth.”
0.69 mm (0.25 to 1.18 mm)
From the paper · Abstract
VR and CT measurements did not differ significantlyAnswer: No significant difference
“There was no statistically significant difference between paired CT and VR measurements”
P = 0.586
From the paper · Full text
Measuring in VR faster than in ARAnswer: Yes
“The time to complete the entire task was 892 ± 407 s on average, with VR measurements being faster than AR ( 804 ± 483 versus 957 ± 257 s , P = 0.045 ).”
Investigation of the Clinical Value of Four Visualization Modalities for Congenital Heart Disease#
Lee SY et al. · Journal of cardiovascular development and disease · 2024
Congenital heart · Survey/user study · n: 3 cases
Meta Quest / Oculus
Custom Unity app
User study in which 17 cardiac specialists compared DICOM images, 3D-printed heart models, virtual reality (Unity on Oculus Quest 2, per the full text) and 3D PDFs for three congenital heart disease cases. The authors report that 76.4% ranked VR best for understanding spatial relationships and presurgical planning, and 94.1% ranked 3D-printed models best for communicating with patients and families.
“Out of these modalities, 76.4% of the specialists ranked VR as the best for understanding the spatial associations between cardiac structures and for presurgical planning.”
76.4%
From the paper · Abstract
“Meanwhile, 94.1% ranked 3DPHM as the best modality for communicating with patients and their families.”
94.1%
From the paper · Abstract
“The 3DPHM models were the best tool for medical education as well as communication.”
From the paper · Abstract
“For presurgical planning, VR was rated as the most useful modality, with a mean score of 8.71 and an SD of 1.1.”
mean 8.71, SD 1.1
From the paper · Fulltext
Conclusions (4)
Most specialists ranked VR first for spatial planningAnswer: Yes
“Out of these modalities, 76.4% of the specialists ranked VR as the best for understanding the spatial associations between cardiac structures and for presurgical planning.”
76.4%
From the paper · Abstract
VR rated most useful for presurgical planningAnswer: Yes
“For presurgical planning, VR was rated as the most useful modality, with a mean score of 8.71 and an SD of 1.1.”
mean 8.71, SD 1.1
From the paper · Full text
3D-printed models ranked first for patient communicationAnswer: Describes
“Meanwhile, 94.1% ranked 3DPHM as the best modality for communicating with patients and their families.”
94.1%
From the paper · Abstract
3D-printed models ranked first for educationAnswer: Describes
“The 3DPHM models were the best tool for medical education as well as communication.”
Experimental comparative study of setting surgical occlusion for 30 orthognathic cases by three methods: a mixed-reality tool (Magic Leap with Brainlab Elements, per the full text), conventional manual alignment of physical dental models, and an established virtual occlusion method (IPS Case Designer). The authors report that MR-set occlusions were comparable to the conventional method, with differences within the gold standard's inter-observer variability, although both virtual methods placed the maxilla slightly more anteriorly with fewer occlusal contacts.
“The mixed reality environment provides an intuitive and flexible experience for setting surgical occlusion, eliminating the need for costly 3D-printed physical models or the automatic calculations required by other virtual occlusion methods, thereby offering maximum freedom.”
From the paper · Abstract
“However, virtual occlusion demonstrated clinical applicability, achieving an average of 11 occlusal contacts with a bilaterally symmetrical distribution along the dental arch.”
11
From the paper · Abstract
“There was no significant difference in the mean time taken for the experimental cases between the three methods ( p > 0.05).”
p > 0.05
From the paper · Fulltext
Conclusions (3)
Maxillary movement equivalent to conventional methodAnswer: Yes
“it can be assumed that the spread of the two investigated virtual methods M2 and M3 is equivalent to that of the gold standard M1, and thus they can be considered equivalent in terms of maxillary movement.”
From the paper · Full text
Fewer occlusal contacts than conventional methodAnswer: No
“While overall contacts were highest for M1 (14.5), both virtual methods M2 and M3 showed a comparable number (11.2). Differences between M1 and the two virtual methods were significant ( p < 0.01)”
14.5 vs 11.2 contacts, p < 0.01
From the paper · Full text
No time difference between the three methodsAnswer: No significant difference
“There was no significant difference in the mean time taken for the experimental cases between the three methods ( p > 0.05).”
Four-dimensional endocardial surface imaging with dynamic virtual reality rendering: a technical note#
Yoo SJ et al. · Translational pediatrics · 2024
Congenital heart · Technical note
Elucis
Meta Quest / Oculus
Technical note describing segmentation of the blood pool and endocardial surface from ECG-gated CT and MR angiography in Elucis, viewed on Meta Quest 2 glasses. The workflow (thresholding, editing, adding an even-thickness surface shell, and separate segmentation of valve leaflets and chordae) is illustrated with two cases: a newborn with a perimembranous ventricular septal defect and a 3-year-old with hypoplastic left heart syndrome and tricuspid regurgitation.
Three-dimensional virtual reality-assisted surgical planning for neuronavigated sacrectomy of a chordoma: a technical note#
Paun L et al. · International orthopaedics · 2024
Spine · Technical note · n: 1 patient
VR, platform not specified
Technical note of a 70-year-old patient having two-stage en bloc partial sacrectomy for chordoma, in which a 3D virtual model of the tumour, bone and neurovascular structures built from MRI/CT was used to plan the resection and approach and then for navigated, real-time margin control. The authors report preserved lower-limb function after an intentional S2-S5 root sacrifice.
“Three-dimensional virtual reality-assisted surgical planning for neuronavigated sacrectomy in chordoma is useful, feasible and safe.”
From the paper · Abstract
Conclusions (2)
No lower-limb motor deficit at follow-upAnswer: Describes
“At follow-up, the patient did not present any lower extremities motor deficit with an improvement of sensory function on S1 dermatome.”
From the paper · Abstract
Judged useful, feasible and safe in one patientAnswer: Yes
“Three-dimensional virtual reality-assisted surgical planning for neuronavigated sacrectomy in chordoma is useful, feasible and safe.”
Virtual reality: a game-changer in the diagnosis and surgical planning of astrocytoma grade III: a case report#
Alhamood M et al. · Journal of medical case reports · 2024
Neurosurgery · Case report · n: 1 patient
VR, platform not specified
Case report of a 30-year-old man with a right temporal lesion, later confirmed as grade III astrocytoma. VR technology was used to measure and localize the lesion and plan the surgery.
Conclusions (1)
Tumour measured and localised in VRAnswer: Describes
“which allowed for precise measurements (21.8 × 14.5 mm) and localization (right temporal lobe)”
Virtual Reality Head-Mounted Display (HMD) and Preoperative Patient-Specific Simulation: Impact on Decision-Making in Pediatric Urology: Preliminary Data#
Lanfranchi G et al. · Diagnostics (Basel, Switzerland) · 2024
Urology · Retrospective case series · n: 6 patients
Meta Quest / Oculus
3D Slicer / SlicerVR
Retrospective series of six children with complex urological conditions (adrenal lesions, Wilms tumour, nephroblastomatosis, vascular/renal malformation) in whom CT-based 3D models were reviewed preoperatively in a VR headset. The authors report better visualisation of segmental and deep vessels in all cases and changes to intraoperative decision-making in five patients, but no benefit for pelvicalyceal anatomy.
“The high depth perception and precision in the orientation of the arteries and veins to the parenchyma changed the intraoperative decision-making process in five patients.”
From the paper · Abstract
“Preoperative VR patient-specific simulation did not offer accuracy in studying the pelvic and calyceal anatomy.”
From the paper · Abstract
Conclusions (3)
Intraoperative decisions changed in five of sixAnswer: Yes
“The high depth perception and precision in the orientation of the arteries and veins to the parenchyma changed the intraoperative decision-making process in five patients.”
five patients
From the paper · Abstract
Pelvic and calyceal anatomy not accurateAnswer: No
“Preoperative VR patient-specific simulation did not offer accuracy in studying the pelvic and calyceal anatomy.”
From the paper · Abstract
Vessel visualization enhanced in all casesAnswer: Yes
“Key benefits included enhanced visualization of the segmental arteries and the deep vascularization of the kidney and adrenal glands in all cases.”
Development of a Machine Learning-Enabled Virtual Reality Tool for Preoperative Planning of Functional Endoscopic Sinus Surgery#
Gudapati V et al. · Journal of neurological surgery reports · 2024
ENT / head & neck · Technical development
Custom Unity app
AR/MR, platform not specified
Technical development of a patient-specific endoscopic VR simulator built in Unity for exploring sinus anatomy before functional endoscopic sinus surgery, with a Saak-transform machine-learning method to segment sinus CT automatically from minimal training data. The authors report accurate soft-tissue segmentation and models that captured key sinus structures and patient-specific variation.
“When explored with an endoscope in the VR simulator, the anatomical models generated by the algorithm accurately capture key sinus structures and showcase patient-specific variability in anatomy.”
From the paper · Abstract
Conclusions (3)
Accurate soft-tissue segmentation from minimal training dataAnswer: Yes
“Using minimal training data, the Saak transform–based machine learning method offers accurate soft-tissue segmentation.”
Models captured key sinus structures and variationAnswer: Yes
“When explored with an endoscope in the VR simulator, the anatomical models generated by the algorithm accurately capture key sinus structures and showcase patient-specific variability in anatomy.”
From the paper · Abstract
Bone segmentation less accurate than soft tissueAnswer: No
“Bone segmentation was less accurate, likely due to the limitations of generating manually labeled training data around difficult-to-visualize structures like the ethmoid air cell walls.”
Enhancing Surgical Vision: Augmented Reality in Otolaryngology-Head and Neck Surgery#
Aweeda M et al. · Journal of medical extended reality · 2024
ENT / head & neck · Narrative review
Multiple platforms
Review of augmented reality systems in otolaryngology-head and neck surgery, delivered through head-mounted displays, microscopes and endoscopes. It covers their use in preoperative planning, intraoperative guidance and decision-making, and describes how the systems work, their features and reported accuracy across subspecialties.
Conclusions (2)
Reviewed studies show AR feasible, millimetric accuracyAnswer: Describes
“Specifically, they have demonstrated feasibility in guiding tumor margin resections, identifying critical structures intraoperatively, and displaying patient-specific virtual models derived from preoperative imaging, with millimetric accuracy.”
From the paper · Abstract
AR used in planning, guidance and decisionsAnswer: Describes
“have demonstrated utility in preoperative planning, intraoperative guidance, and improvement of surgical decision-making”
Systematic review of 17 studies (2013 to 2023) on mixed reality in orthognathic surgery. The authors report that MR was associated with high accuracy and reduced time, used both for presurgical planning and as an intraoperative navigation tool, and for training; meta-analysis was not possible because of heterogeneity.
“The main results indicated that the use of MR technology in OGS led to high accuracy and time reduction as primary outcomes and cost-effectiveness and skill improvement as secondary outcomes.”
From the paper · Abstract
“MR technology significantly improves OGS planning efficiency by providing pre-surgical information and serving as an intraoperative navigation tool, reducing surgical time without compromising outcomes.”
From the paper · Abstract
Conclusions (3)
Review reports reduced surgical time, no pooled testAnswer: Yes
“reducing surgical time without compromising outcomes”
From the paper · Abstract
Review reports high accuracy across studiesAnswer: Yes
“the use of MR technology in OGS led to high accuracy and time reduction as primary outcomes”
From the paper · Abstract
Meta-analysis not possible, studies too variedAnswer: Describes
“due to the heterogeneity of the included studies, meta-analyses could not be performed”
Review of the past decade's case studies and research on AR and VR in cardiology, from education to preoperative planning and intraoperative guidance, summarizing advantages and disadvantages by application. It discusses cost-effectiveness, regulatory and technical barriers.
“Our review highlights the need for a robust assessment of the effectiveness of the methods and discusses the technical limitations that hinder the complete integration of AR and VR in cardiology, including cost-effectiveness and regulatory compliance.”
From the paper · Abstract
Conclusions (1)
Effectiveness assessment needed; cost and regulation limit useAnswer: Describes
“Our review highlights the need for a robust assessment of the effectiveness of the methods and discusses the technical limitations that hinder the complete integration of AR and VR in cardiology, including cost-effectiveness and regulatory compliance.”
Mixed reality in interventional radiology: a focus on first clinical use of XR90 augmented reality-based visualization and navigation platform#
Finos K et al. · Expert review of medical devices · 2024
Interventional radiology · Narrative review
Multiple platforms
Narrative review of AR and VR in interventional radiology, covering education, preprocedural planning and intraprocedural guidance, with a focus on the first clinical use of the XR90 AR visualisation and navigation platform. The authors report that preprocedural AR/VR use was associated with shorter procedure times, that intraprocedural tracking was accurate to within 5 mm in patients, and that most evidence comes from small studies.
“Challenges include cost, ergonomics, rapid segmentation, and organ motion.”
From the paper · Abstract
Conclusions (1)
Cost, ergonomics, segmentation and motion remain challengesAnswer: Describes
“Challenges include cost, ergonomics, rapid segmentation, and organ motion.”
TARDUS: A combined method for microsurgical easy planning with Thermography, Augmented Reality and Doppler Ultrasound#
Pereira N et al. · Journal of plastic, reconstructive & aesthetic surgery · 2024
Plastic & reconstructive · Letter (no abstract)
AR/MR, platform not specified
Letter in the Journal of Plastic, Reconstructive & Aesthetic Surgery describing TARDUS, a combined method for microsurgical planning with thermography, augmented reality and Doppler ultrasound. No abstract was available, so these details are from the title and venue and could not be confirmed.
Retrospective study of 60 consecutive TAVI patients whose preprocedural CT was used for aortic valve sizing both in 3mensio and in VR software. The authors report no significant differences and strong correlations between the methods, good to excellent intra- and interobserver reliability, and user-reported better anatomical understanding and depth perception in VR.
“There were no significant differences but strong correlations between the VR measurements compared with those performed with the 3mensio software.”
From the paper · Abstract
“In a structured questionnaire, users reported that VR simplified anatomical understanding, improved 3D comprehension of adjacent structures, and was associated with very good self-perceived depth perception.”
From the paper · Abstract
“The use of VR for preprocedural transcatheter aortic valve implantation sizing is feasible and has precise and reproducible measurements.”
From the paper · Abstract
Conclusions (4)
VR sizing measurements matched standard softwareAnswer: Yes
“There were no significant differences but strong correlations between the VR measurements compared with those performed with the 3mensio software.”
Annulus mean diameter 24.43 vs 24.58, P = 0.813
From the paper · Abstract
Good to excellent interobserver reliabilityAnswer: Yes
“The analysis showed excellent or good interobserver reliability for all values collected with ICCs between 0.818 and 0.980.”
Interobserver ICC 0.818 to 0.980; intraobserver ICC 0.832 to 0.988
From the paper · Full text
Physicians reported easier anatomical understanding with VRAnswer: Yes
“VR technology resulted in better anatomical understanding”
1.3±0.5 versus 1.9±0.4, P =0.046
From the paper · Full text
Physicians rated standard software more accurate for calciumAnswer: No
“3mensio was rated to be the more accurate method for the assessment of calcium load”
Virtual Reality for Preoperative Surgical Planning in Complex Pediatric Oncology#
Bramlet M et al. · Journal of laparoendoscopic & advanced surgical techniques. Part A · 2024
Multi-specialty · Survey/user study · n: 12 patients
VR, platform not specified
Prospective study of 12 children with complex tumours (including neuroblastoma, Wilms tumour and sarcomas) in whom surgeons recorded operative plans after 2D imaging and again after reviewing virtual reality models, with a blinded surgeon also assessing both. The authors report that VR increased the operating surgeon's confidence in 63% of assessments and changed the operative plan in 8.3%.
“VRM increased the operating surgeon's confidence 63% of the time.”
63%
From the paper · Abstract
“The operative plan changed 8.3% of the time after VRM.”
8.3%
From the paper · Abstract
Conclusions (2)
Operative plan changed 8.3% of the timeAnswer: Mixed
“The operative plan changed 8.3% of the time after VRM.”
8.3%
From the paper · Abstract
Surgeon confidence rose in 63% of assessmentsAnswer: Yes
“VRM increased the operating surgeon's confidence 63% of the time.”
Successful laparoscopic retroperitoneal tumor resection using mixed reality and guiding marker techniques#
Tohi Y et al. · IJU case reports · 2024
General & GI surgery · Case report · n: 1 patient
Microsoft HoloLens
Holoeyes MD
Case report of a 67-year-old woman with a 2 cm retroperitoneal metastasis of uterine cancer near the right diaphragm, whose surgery was planned with Holoeyes mixed-reality software on HoloLens 2, including port-site placement, combined with an ultrasound-guided marker. The authors report accurate tumour identification and laparoscopic resection with minimal blood loss and no complications.
“Novel techniques, including ultrasonography-guided placement of a guiding marker and strategic port-site placement facilitated by HoloLens2, ensured accurate tumor identification and laparoscopic resection with minimal blood loss and no intraoperative complications.”
From the paper · Abstract
“This process revealed that the conventional port site located directly below the costal arch for laparoscopic nephrectomy was near the tumor. Therefore, the port site was set 1.5 cm caudal to this location”
From the paper · Fulltext
Conclusions (2)
Resection with minimal blood loss, no complicationsAnswer: Describes
“ensured accurate tumor identification and laparoscopic resection with minimal blood loss and no intraoperative complications”
From the paper · Abstract
Port site moved 1.5 cm from usual positionAnswer: Yes
“This process revealed that the conventional port site located directly below the costal arch for laparoscopic nephrectomy was near the tumor. Therefore, the port site was set 1.5 cm caudal to this location”
Retrospective two-centre study of 100 patients with severe aortic stenosis, comparing aortic valve complex measurements from a holographic mixed reality software (ARTICOR, Artiness) with standard 3mensio CT analysis for TAVR planning. 98% of datasets converted to holograms. The authors report good agreement for linear diameters, lower agreement for area, perimeter and coronary-height measures (consistently smaller with MxR), and excellent interobserver reliability for most measures.
“Ninety-eight percent of the CCT datasets were successfully converted into holographic models.”
Ninety-eight percent
From the paper · Abstract
“A higher level of agreement between the two software systems was observed for linear metrics (short, long, and average diameter).”
From the paper · Abstract
“In comparison, agreement was lower for area, perimeter, and annulus-to-coronary ostia distance measurements.”
From the paper · Abstract
Conclusions (3)
Higher agreement for linear diameters than other metricsAnswer: Yes
“A higher level of agreement between the two software systems was observed for linear metrics (short, long, and average diameter).”
From the paper · Abstract
Lower agreement for area, perimeter, coronary distanceAnswer: No
“In comparison, agreement was lower for area, perimeter, and annulus-to-coronary ostia distance measurements.”
From the paper · Abstract
Nearly all scans converted to hologramsAnswer: Yes
“Ninety-eight percent of the CCT datasets were successfully converted into holographic models.”
A usability analysis of augmented reality and haptics for surgical planning#
Kazemipour N et al. · International journal of computer assisted radiology and surgery · 2024
Multi-specialty · Survey/user study
AR/MR, platform not specified
Two user studies (novices and experts) comparing surgical planning with monitor and mouse, a monitor with a haptic device, and a gesture-controlled AR head-mounted display, for heart valve repair, hip tumour resection and pedicle screw placement. Both groups preferred AR for pedicle screws and reported the best depth perception with AR, while preferences for the other tasks varied.
“Both novices and experts preferred the AR system for pedicle screw placement.”
From the paper · Abstract
“Novices preferred the haptic system for hip tumor planning, while experts preferred the mouse and keyboard.”
From the paper · Abstract
“In the case of heart valve planning, novices preferred the AR system but there was no clear preference for experts.”
From the paper · Abstract
Conclusions (4)
Both groups preferred AR for pedicle screwsAnswer: Yes
“Both novices and experts preferred the AR system for pedicle screw placement.”
From the paper · Abstract
Both groups ranked AR first for depth perceptionAnswer: Yes
“Both groups reported that AR provides the best spatial depth perception.”
Artificial intelligence and mixed reality for dental implant planning: A technical note#
Mangano FG et al. · Clinical implant dentistry and related research · 2024
Dental · Technical note · n: 1 patient
AR/MR, platform not specified
Technical note presenting a protocol in which AI-segmented CBCT and intraoral scan models are loaded into mixed-reality software to plan implants holographically, followed by guide design in open-source software, 3D-printed static guided surgery and digital prosthetic finishing. In a proof-of-principle case, the authors report clinically acceptable placement accuracy with minor deviations.
“The precision of implant placement seems clinically acceptable, with minor deviations.”
From the paper · Abstract
“Further clinical studies are needed to validate this protocol.”
From the paper · Abstract
Conclusions (3)
Implant placement deviations minor in one caseAnswer: Yes
“The precision of implant placement seems clinically acceptable, with minor deviations.”
From the paper · Abstract
Implants planned in 3D without guided-surgery softwareAnswer: Describes
“The clinician can plan the implants in an authentic 3D environment without using any radiology-guided surgery software.”
From the paper · Abstract
Authors call for further clinical validationAnswer: Describes
“Further clinical studies are needed to validate this protocol.”
Technical report of shared mixed-reality ('metaverse') planning sessions using HoloLens headsets and the Microsoft Mesh application, in which surgeons and trainees discussed perforator anatomy and selection on CTA-derived virtual models for four DIEP flaps. The authors present the workflow and a video from both viewpoints, and propose the approach for collaborative planning and education.
“In these sessions, surgeons discuss perforator anatomy and perforator selection strategies whilst comprehensively assessing the respective models.”
From the paper · Abstract
“We believe the Metaverse will provide novel opportunities to use the 3D-models that are already created in everyday plastic surgery practice in a more collaborative, immersive, accessible, and educational manner.”
From the paper · Abstract
“Thirdly, the senior surgeon felt that pedicle dissection was more expeditious due to 3D pre-planning.”
From the paper · Fulltext
“Lastly, the 3D visualization and interactivity were very appreciated by all team members when compared to conventional 2D greyscale slice display.”
From the paper · Fulltext
Conclusions (3)
Trainees felt more intuitive anatomical understandingAnswer: Yes
“Secondly, trainees felt more confident and comfortable during flap dissection due to having a more intuitive anatomical understanding by more naturally being familiarized with the patient-specific anatomy.”
From the paper · Full text
Senior surgeon felt dissection was quickerAnswer: Describes
“Thirdly, the senior surgeon felt that pedicle dissection was more expeditious due to 3D pre-planning.”
From the paper · Full text
Team valued 3D view over 2D slicesAnswer: Yes
“Lastly, the 3D visualization and interactivity were very appreciated by all team members when compared to conventional 2D greyscale slice display.”
3D-SARC: A Pilot Study Testing the Use of a 3D Augmented-Reality Model with Conventional Imaging as a Preoperative Assessment Tool for Surgical Resection of Retroperitoneal Sarcoma#
Mor E et al. · Annals of surgical oncology · 2024
General & GI surgery · Feasibility study · n: 13 patients
Microsoft HoloLens
D2P (3D Systems)
Pilot study of 13 patients who had resection of retroperitoneal sarcoma, whose CT-derived 3D models (created with D2P) were viewed as augmented-reality holograms on a HoloLens and compared with standard CT by three sarcoma surgeons. The authors report that 10 of 26 responses favoured AR for preparing for resection (5 favoured CT, 11 no difference; p=0.074) and that 57.6% of responses rated AR as adding value to preoperative planning.
“When the surgical team was asked to evaluate whether the 3DAR better prepared the surgeon for planned surgical resection, 10 responses favored the 3DAR, 5 favored the 2D CT scans and 11 showed no difference (p = 0.074).”
p = 0.074
From the paper · Abstract
“According to 15 (57.6 %) of the 26 responses, the 3DAR offered additional value over standard imaging in the preoperative planning (median score of 4; range, 1-5).”
57.6 %
From the paper · Abstract
Conclusions (2)
Preparation preference split, not significantAnswer: No significant difference
“10 responses favored the 3DAR, 5 favored the 2D CT scans and 11 showed no difference (p = 0.074).”
10 vs 5, 11 no difference, p = 0.074
From the paper · Abstract
Added planning value in 15 of 26 responsesAnswer: Mixed
“According to 15 (57.6 %) of the 26 responses, the 3DAR offered additional value over standard imaging in the preoperative planning (median score of 4; range, 1-5).”
Case report of a 73-year-old man with three-vessel coronary disease in whom an AI-generated 3D coronary model from CT angiography was loaded into a custom mixed reality platform (CoronaryXR on HoloLens 2) for preoperative CABG planning and intraoperative guidance. The authors report that it improved spatial orientation and stenosis localization.
“Both preoperatively and intraoperatively, the tool augmented spatial orientation and facilitated precise stenosis localization, thereby enhancing the surgeon's operative proficiency.”
From the paper · Abstract
Conclusions (3)
Spatial orientation and stenosis localization improvedAnswer: Yes
“Both preoperatively and intraoperatively, the tool augmented spatial orientation and facilitated precise stenosis localization, thereby enhancing the surgeon's operative proficiency.”
From the paper · Abstract
No complications, discharge on day 6Answer: Describes
“There were no complications in the postoperative setting and the patient was discharged 6 days after surgery.”
discharged 6 days after surgery
From the paper · Full text
Tool perceived as user-friendlyAnswer: Describes
“Notably, the tool was perceived as user-friendly, contributing to a positive user experience.”
A Pilot Clinical and Technical Validation of an Immersive Virtual Reality Platform for 3D Anatomical Modeling and Contouring in Support of Surgical and Radiation Oncology Treatment Planning#
Belec J et al. · Journal of imaging informatics in medicine · 2024
Radiation oncology · Validation study · n: 5 patients
Co-authored by Realize Medical founders. Includes authors who are Realize Medical advisors.
Elucis
Pilot technical and clinical validation study of the immersive VR platform later commercialised as Elucis. Eight image sets covering a range of scanners, modalities and voxel sizes (18 structures) were segmented both in VR and in reference commercial software, and the resulting models, contours and measurements (volume, cross-sectional area, length and angle) were assessed against each other. Image sets from five paediatric patients with resected standard-risk medulloblastoma were then used to contour craniospinal target volumes for radiotherapy planning on both platforms, with contouring time recorded.
Infections of cardiac implantable electronic devices and how to improve transvenous lead extraction by the virtual reality#
Carretero EG et al. · Indian journal of thoracic and cardiovascular surgery · 2024
Adult cardiac & structural heart · Case series · n: 10 patients
VR, platform not specified
Case series of 10 patients with cardiac device infections judged to need difficult transvenous lead extraction. Synchronized CT was processed and reviewed in a fully immersive VR room for planning, and also brought into the OR as mixed reality. The authors report that VR showed lead adherences that informed the technique, and all leads were extracted without complications.
“Processed images and virtual reality showed intense adherences of the leads to the veins, right ventricle, and right atrium endocardium and between them that preclude a difficult extraction and required a carefully planning and sometimes a different technical approach.”
From the paper · Abstract
“All leads were extracted and no complications were registered.”
From the paper · Abstract
“Virtual reality seems an estimable aid for operators in planning difficult cases and also an excellent tool for teaching.”
From the paper · Abstract
Conclusions (3)
Preoperative study changed extraction approach in some casesAnswer: Yes
“In certain instances, preoperative study altered the approach to TLE, making it necessary to extract two leads simultaneously through a dissection sheath due to strong adhesion between them.”
From the paper · Full text
All leads extracted, no complicationsAnswer: Describes
“All leads were extracted and no complications were registered.”
From the paper · Abstract
Actual difficulty matched preoperative assessmentAnswer: Describes
“The intra-operative difficulty was consistent with pre-operative assessments, and four of the patients experienced particularly challenging transvenous lead extractions, as anticipated and validated by higher fluoroscopy times (> 30 min).”
Virtual reality modelling for planning of percutaneous first step palliation in a newborn with heterotaxy syndrome#
Dziewulska A et al. · Cardiology in the young · 2024
Congenital heart · Case report · n: 1 patient
VR, platform not specified
Case report of a newborn with a rare heterotaxy syndrome variant in whom virtual reality imaging helped visualisation, decision-making and planning of first-stage percutaneous palliation. The authors report successful atrial septoplasty via the internal jugular vein and an anomalous pulmonary vein, followed by stenting of the ductus arteriosus.
“Virtual reality imaging aided visualisation, decision-making, and planning.”
From the paper · Abstract
“Successful atrial septoplasty performed via the internal jugular vein and anomalous pulmonary vein was followed by stenting of ductus arteriosus.”
From the paper · Abstract
Conclusions (2)
VR aided visualisation and planning in one newbornAnswer: Yes
“Virtual reality imaging aided visualisation, decision-making, and planning.”
From the paper · Abstract
Septoplasty and ductus stenting succeeded in one patientAnswer: Describes
“Successful atrial septoplasty performed via the internal jugular vein and anomalous pulmonary vein was followed by stenting of ductus arteriosus.”
Holography-guided procedural planning for modifying Venus P-valve implantation technique in patients with left pulmonary artery stents: a case-series#
d'Aiello AF et al. · Frontiers in cardiovascular medicine · 2024
Congenital heart · Case series · n: 17 patients
Artiness (ARTICOR)
AR/MR, platform not specified
Case series of 17 patients scheduled for Venus P-valve transcatheter pulmonary valve implantation in 2023, of whom three had previous left pulmonary artery stents. For these patients, CT-derived holographic heart models (Artiness), viewed through mixed-reality headsets, were used to plan a modified implantation technique. The authors report procedural success in all three with no complications.
“Procedural success rate was 100%.”
100%
From the paper · Abstract
“The use of holographic models facilitated procedural planning in these challenging anatomical scenarios.”
From the paper · Abstract
“which were useful to plan valve implantation with a modified technique”
From the paper · Abstract
Conclusions (3)
All three procedures succeeded, no comparatorAnswer: Describes
“Procedural success rate was 100%.”
100%
From the paper · Abstract
No procedural complications in three patientsAnswer: Describes
“No procedural complications occurred.”
From the paper · Abstract
Models useful to plan a modified techniqueAnswer: Yes
“which were useful to plan valve implantation with a modified technique”
Design and evaluation of an AR-based thermal imaging system for planning reconstructive surgeries#
Unger M et al. · International journal of computer assisted radiology and surgery · 2024
Plastic & reconstructive · Technical development · n: 21 participants
Microsoft HoloLens
Technical development of a planning aid for reconstructive surgery that combines RGB, depth and thermal cameras and superimposes thermal information (blood vessels of the skin) on the patient as a hologram on Microsoft HoloLens, registered with a Vuforia marker. In a laboratory evaluation with 21 participants the mean projection error was 10.3 ± 9.4 mm, and the authors conclude that HoloLens inside-out tracking with a Vuforia marker is not accurate enough for the intended clinical use.
“The mean projection error is 10.3 ± 9.4 mm.”
10.3 ± 9.4 mm
From the paper · Abstract
“The inside-out tracking of the HoloLens in combination with a Vuforia marker is not accurate enough for the intended clinical use.”
From the paper · Abstract
Conclusions (2)
Inside-out tracking not accurate enough clinicallyAnswer: No
“The inside-out tracking of the HoloLens in combination with a Vuforia marker is not accurate enough for the intended clinical use.”
Advanced Imaging Guidance for Ductus Venosus Stenting in Obstructed Total Anomalous Pulmonary Venous Return#
Mejia E et al. · World journal for pediatric & congenital heart surgery · 2024
Congenital heart · Case report · n: 1 patient
Includes an author who is a Realize Medical advisor.
VR, platform not specified
Case report of ductus venosus stenting as a temporising treatment in an infant with obstructed infracardiac total anomalous pulmonary venous return, in which virtual reality, 3D-printed models and fusion imaging were used to plan and guide the intervention.
Conclusions (1)
VR, 3D models and fusion can aid planningAnswer: Describes
“In challenging anatomic cases, virtual reality, 3D-printed models, and fusion image guidance can aid in procedural planning and provide support for successful intervention.”
Orthopaedic sport medicine surgeons and fellows value immersive virtual reality for improving surgical training, procedural planning, and distance learning#
Hiemstra LA et al. · Journal of ISAKOS · 2024
Orthopedics · Survey/user study
VR, platform not specified
Survey of 43 Canadian sports medicine orthopaedic surgeons and fellows after a live immersive VR demonstration at a meeting. The authors report favourable attitudes, with 78 to 98% agreement on value for teaching and learning, 66 to 97% for clinical practice including procedural planning, and 88 to 100% for distance education and mentoring.
“iVR was perceived to be valuable for the field of orthopaedic surgery providing face validity for the technology.”
From the paper · Abstract
“The potential for utilizing iVR technology for distance learning, mentorship and global education appears promising.”
From the paper · Abstract
Conclusions (2)
Surgeons rated immersive VR valuable for orthopaedicsAnswer: Yes
“iVR was perceived to be valuable for the field of orthopaedic surgery providing face validity for the technology.”
From the paper · Abstract
Distance learning and mentorship seen as promisingAnswer: Describes
“The potential for utilizing iVR technology for distance learning, mentorship and global education appears promising.”
Virtual reality modelling in a child after multiple interventions for hypoplastic aortic arch and coarctation#
Szeliga J et al. · Cardiology in the young · 2024
Congenital heart · Case report · n: 1 patient
VR, platform not specified
Case report of a child who developed aneurysms after multiple interventions for hypoplastic aortic arch and coarctation, in whom multimodality imaging and virtual reality modelling were used for diagnosis and treatment planning.
Assessment of pulmonary vascular anatomy: comparing augmented reality by holograms versus standard CT images/reconstructions using surgical findings as reference standard#
Petrella F et al. · European radiology experimental · 2024
Thoracic · Validation study · n: 52 patients
Microsoft HoloLens
Prospective comparative study of 52 patients scheduled for lobectomy, in which a radiologist and a thoracic surgeon counted lobar arteries on CT and on patient-specific AR holograms, with surgical findings as the reference standard. The authors report closer agreement with surgery for holograms, especially for the upper lobes, higher inter-reader agreement (kappa 0.99 vs 0.81), and that holograms were easier to evaluate.
“The mean difference between the number of artery branches detected by surgery and CT images was 0.31 ± 0.98, whereas it was 0.09 ± 0.37 between surgery and HGs (p = 0.433).”
p = 0.433
From the paper · Abstract
“Both radiologist and surgeon showed a higher agreement for holograms (κ = 0.99) than for CT (κ = 0.81) and found holograms easier to evaluate than CTs (p < 0.001).”
κ = 0.99
From the paper · Abstract
“found holograms easier to evaluate than CTs (p < 0.001)”
p < 0.001
From the paper · Abstract
Conclusions (4)
Artery count error versus CT not significantAnswer: No significant difference
“The mean difference between the number of artery branches detected by surgery and CT images was 0.31 ± 0.98, whereas it was 0.09 ± 0.37 between surgery and HGs (p = 0.433).”
0.31 ± 0.98 vs 0.09 ± 0.37, p = 0.433
From the paper · Abstract
Hologram advantage over CT larger in upper lobesAnswer: Yes
“the mean difference in the number of arteries detected in the upper lobes was 0.67 ± 1.08 between surgery and CT images and 0.17 ± 0.46 between surgery and holograms (p = 0.029)”
0.67 ± 1.08 vs 0.17 ± 0.46, p = 0.029
From the paper · Abstract
Both readers rated holograms easier to evaluateAnswer: Yes
“found holograms easier to evaluate than CTs (p < 0.001)”
p < 0.001
From the paper · Abstract
Inter-reader agreement kappa 0.99 versus 0.81Answer: Describes
“Both radiologist and surgeon showed a higher agreement for holograms (κ = 0.99) than for CT (κ = 0.81)”
Mixed reality-based technology to visualize and facilitate treatment planning of impacted teeth: Proof of concept#
Fudalej PS et al. · Orthodontics & craniofacial research · 2024
Dental · Technical development
Microsoft HoloLens
Proof-of-concept HoloLens 2 application, built in Unreal Engine from segmented CBCT, with adjustable pointers to plan attachment placement, traction direction and force application for aligning impacted canines, shown to 38 participants at a course who then completed a survey. The authors report that most respondents agreed or totally agreed with the potential benefits.
“However, the recommendation for widespread use awaits validation through clinical trials.”
From the paper · Abstract
Conclusions (3)
Attendees agreed with ten potential benefitsAnswer: Yes
“Median answers for six questions were ‘totally agree’ (25th percentile 1, 75th percentile 2) and for four questions ‘agree’ (25th percentile 1, 75th percentile 2).”
38 respondents
From the paper · Abstract
Widespread use awaits clinical trial validationAnswer: Describes
“However, the recommendation for widespread use awaits validation through clinical trials.”
From the paper · Abstract
Responses did not vary by age or professionAnswer: No significant difference
“No correlation was found between age, profession, and responses.”
Comparison of virtual reality and computed tomography in the preoperative planning of complex tibial plateau fractures#
Colcuc C et al. · Archives of orthopaedic and trauma surgery · 2024
Orthopedics · Comparative study · n: 30 cases
Meta Quest / Oculus
Study in which five orthopaedic surgeons planned surgery for 30 complex tibial plateau fractures using either CT slices or VR visualisation on an Oculus Quest 2 headset, in randomised order with three months between sessions. The authors report a significantly shorter planned operative time after VR planning (156 versus 172 minutes), a slightly longer planning time (3.48 versus 2.98 minutes), and that more surgeons felt well prepared after VR.
“The mean planned operative time of 156 (SD 47) minutes was significantly lower (p < 0.001) in the VR group than in the CT group (172 min; SD 44).”
156
From the paper · Abstract
“The mean planning time in the VR group was 3.48 min (SD 2.4), 17% longer than in the CT group (2.98 min, SD 1.9; p = 0.027).”
17%
From the paper · Abstract
Conclusions (4)
Planned operative time lower with VRAnswer: Yes
“The mean planned operative time of 156 (SD 47) minutes was significantly lower”
156 vs 172 min, p < 0.001
From the paper · Abstract
VR planning took longer than CTAnswer: No
“The mean planning time in the VR group was 3.48 min (SD 2.4), 17% longer than in the CT group (2.98 min, SD 1.9).”
3.48 vs 2.98 min, p = 0.027
From the paper · Full text
67% felt well prepared with VR, 54% CTAnswer: Describes
“Overall, 67% of the VR group and 54% of the CT group felt (very) well prepared.”
67% vs 54%
From the paper · Full text
Rater agreement 0.801 with VR, 0.605 with CTAnswer: Describes
“In terms of interrater reliability, a Krippendorff’s alpha of 0.801 for virtual reality planning showed very good agreement among the 5 raters for fracture classification.”
Current Applications of VR/AR (Virtual Reality/Augmented Reality) in Pediatric Neurosurgery#
Patel N et al. · Advances and technical standards in neurosurgery · 2024
Neurosurgery · Book chapter
Multiple platforms
Book chapter reviewing the history, current applications (navigation, planning, education, assessment) and future directions of VR and AR in paediatric neurosurgery.
Narrative review of virtual and augmented reality and 3D modelling in cardiology, covering interventional, congenital, structural-heart and electrophysiology uses such as septal defect closure, transcatheter valve procedures and left atrial appendage occlusion. The authors summarise benefits reported in the literature, including shorter procedures and less radiation, contrast and anaesthesia.
“The incorporation of 3D reconstruction modeling has significantly enhanced our understanding of patient anatomy and morphology, thereby improving diagnostic accuracy and patient outcomes.”
From the paper · Abstract
“The implementation of virtual reality has been shown to yield cost savings in healthcare, reduce procedure time, minimize radiation exposure, lower intravenous contrast usage, and decrease the extent of anesthesia required.”
From the paper · Abstract
Conclusions (2)
Review credits VR with cutting procedure timeAnswer: Describes
“The implementation of virtual reality has been shown to yield cost savings in healthcare, reduce procedure time, minimize radiation exposure, lower intravenous contrast usage, and decrease the extent of anesthesia required.”
From the paper · Abstract
Review links interactive models to understanding pathologyAnswer: Describes
“The interactive modeling of cardiac structure and function within the virtual realm plays a pivotal role in comprehending complex congenital, structural, and coronary pathology.”
Surgical planning in virtual reality: a systematic review#
Queisner M, Eisenträger K · Journal of medical imaging (Bellingham, Wash.) · 2024
Multi-specialty · Systematic review
Multiple platforms
Systematic review of studies published April 2021 to May 2023 on preoperative surgical planning with patient-specific images in head-mounted VR. The authors report generally positive effects on decision-making and anatomical understanding, more frequent plan changes, and shorter planning time. They also note many anecdotal or case-level reports, heterogeneous designs and weak statistics.
“Notably, surgical planning using VR led to more frequent changes in surgical plans compared to planning with other visualization methods when surgeons reassessed their initial plans.”
From the paper · Abstract
“Results show that the application of VR for surgical planning is still in an experimental stage but is gradually advancing toward clinical use.”
From the paper · Abstract
“Some findings lack statistical evidence and rely on subjective assumptions.”
From the paper · Abstract
“However, the mean procedure time was statistically significantly shorter for the VR group compared to the CT and DSA group by an average reduction of 80 min.”
80 min
From the paper · Fulltext
Conclusions (4)
VR planning led to more frequent plan changesAnswer: Yes
“Notably, surgical planning using VR led to more frequent changes in surgical plans compared to planning with other visualization methods when surgeons reassessed their initial plans.”
From the paper · Abstract
VR planning still experimental, moving toward clinical useAnswer: Describes
“Results show that the application of VR for surgical planning is still in an experimental stage but is gradually advancing toward clinical use.”
From the paper · Abstract
Some findings lack statistical evidenceAnswer: Describes
“Some findings lack statistical evidence and rely on subjective assumptions.”
From the paper · Abstract
Aneurysm clipping 80 min shorter in one studyAnswer: Yes
“However, the mean procedure time was statistically significantly shorter for the VR group compared to the CT and DSA group by an average reduction of 80 min.”
80 min shorter, one retrospective study (n = 11 vs n = 10)
Pioneering Patient-Specific Approaches for Precision Surgery Using Imaging and Virtual Reality#
Jockisch RD et al. · Journal of visualized experiments · 2024
Adult cardiac & structural heart · Technical note
VR, platform not specified
JoVE methods article describing how segmented patient-specific 3D models can be used before catheter-lab procedures to predict C-arm positions, take 2D measurements relevant to fluoroscopic projections and generate roadmap analogues for endovascular treatment of complex vascular anomalies.
Preoperative three-dimensional modelling and virtual reality planning aids nephron sparing surgery in a child with bilateral Wilms tumour#
Banerjee A et al. · BMJ case reports · 2024
Urology · Case report · n: 1 patient
VR, platform not specified
Case report of a child with bilateral Wilms tumour in whom VR planning and 3D printing from preoperative imaging were used to prepare for bilateral nephron-sparing surgery. The authors describe conventional imaging as often inadequate for tumour-organ-vascular relationships and suggest VR and 3D printing help plan such operations.
“Advances like VR and 3D printing help surgeons plan better for complex surgeries like bilateral NSS.”
From the paper · Abstract
Conclusions (3)
VR planning showed tumour depth near the hilumAnswer: Yes
“In our case, the VR surgical planning enabled us to know the depth of the tumour particularly on the right side where it was close to the hilum.”
From the paper · Full text
Resected tumour volumes close to VR estimatesAnswer: Yes
“The resected tumour volumes (right 40 mL; left 10 mL) correlated well with the estimated VR/3D measurements (right 43 mL; left 9.3 mL)”
right 40 vs 43 mL; left 10 vs 9.3 mL
From the paper · Full text
Margins involved with viable tumour on both sidesAnswer: Describes
“Further histopathology revealed that on both sides, margins were involved with viable tumour”
Mixed Reality as a Digital Visualisation Solution for the Head and Neck Tumour Board: Application Creation and Implementation Study#
Karnatz N et al. · Cancers · 2024
ENT / head & neck · Technical development
Magic Leap
Brainlab Elements
Application-development study of a mixed reality prototype for the head and neck tumour board, built with Brainlab and viewed on Magic Leap 1 headsets, to present radiological and clinical data for treatment decisions. The authors describe the development phases and workflows needed for a multidisciplinary MR tumour board.
“The preparation of the case discussions showed that the preparation of the clinical cases for the MR-HNTB took more time than for conventional HNTB.”
47 min (SD = 8.18) vs 13 min (SD = 2.45), not tested
From the paper · Fulltext
“Integration into everyday clinical practice is, therefore, likely to be difficult at present.”
From the paper · Fulltext
“Increased interdisciplinary understanding through 3D visualisation”
From the paper · Fulltext
Conclusions (3)
Case preparation took longer with mixed realityAnswer: No
“The preparation of the case discussions showed that the preparation of the clinical cases for the MR-HNTB took more time than for conventional HNTB.”
47 min (SD = 8.18) vs 13 min (SD = 2.45), not tested
From the paper · Full text
Authors expect difficult integration into daily practiceAnswer: Describes
“Integration into everyday clinical practice is, therefore, likely to be difficult at present.”
Utilisation of extended reality for preprocedural planning and education in anaesthesiology: a practical guide for spatial computing#
Rubin JE et al. · British journal of anaesthesia · 2024
Anesthesia & pain · Research letter
VR, platform not specified
Letter in the British Journal of Anaesthesia giving a practical guide to using extended reality and spatial computing for preprocedural planning and education in anaesthesiology. No abstract was available, so these details are from the title and venue and could not be confirmed.
Study in which ten cardiologists rated MSCT, TEE, patient-specific 3D prints and VR models (Mimics, Meta Quest 2) for planning percutaneous left atrial appendage closure in ten patients. The authors report that device sizing was rated best on MSCT, while VR and 3D printing added value through better depth perception.
“In particular, the superior perception of depth was seen as a strength of a 3D visualization.”
From the paper · Abstract
Conclusions (4)
Device sizing rated highest on MSCTAnswer: No
“Device sizing was rated highest in MSCT”
MSCT 1.9 ± 0.8 vs VR 2.5 ± 1.1, p < 0.01
From the paper · Abstract
Depth perception rated higher with VRAnswer: Yes
“The major strength of VR and 3D printing techniques was a superior depth perception”
VR 1.6 ± 0.5 vs MSCT 2.6 ± 0.8, p < 0.01
From the paper · Abstract
Fossa ovalis rated clearer in VR than MSCTAnswer: Yes
“TEE, VR, and 3D printing were superior in the visualization of the Fossa ovalis compared to MSCT”
VR 1.9 ± 1.3 vs MSCT 3.3 ± 1.4, p < 0.01
From the paper · Abstract
VR showed extracardiac structures poorlyAnswer: No
“3D printing and VR insufficiently visualized extracardiac structures in the present study.”
Feasibility of Augmented Reality for Pediatric Giant Supratentorial Tumors: A Report of Three Cases#
Wu Y et al. · Cureus · 2024
Neurosurgery · Case series · n: 3 patients
Magic Leap
Report of three paediatric giant supratentorial tumours in which an AR platform (the Magic Leap Mixed Reality Viewer) was trialled for preoperative case discussion and planning. The authors report good visuospatial insight, but substantial set-up time before each discussion.
“Overall, the AR platform offers our neurosurgical team excellent visuospatial insights for preoperative decision-making.”
From the paper · Abstract
“However, we observe that substantial time is required to set up the AR system prior to each clinical case discussion by the neurosurgical team.”
From the paper · Abstract
“In congruency with existing literature, our preliminary results report that there are still obstacles that need to be addressed before the technology can be seamlessly implemented into the clinical workflow for these time-sensitive childhood brain tumors.”
From the paper · Abstract
Conclusions (3)
Setup took 71.7 minutes per caseAnswer: No
“However, we observe that substantial time is required to set up the AR system prior to each clinical case discussion by the neurosurgical team.”
mean = 71.7 minutes
From the paper · Abstract
Team reported clearer spatial insightAnswer: Yes
“the AR platform offers our neurosurgical team excellent visuospatial insights for preoperative decision-making”
From the paper · Full text
Setup time rules out emergency useAnswer: No
“Specific to GSBT cases, the additional time required for setup does not make it feasible to be used for emergency cases at this stage.”
[Simulation and Navigation in the Neurosurgical Field Using Three-Dimensional Hholograms by Mixed Reality Devices]#
Motoyama Y · No shinkei geka. Neurological surgery · 2024
Neurosurgery · Narrative review
Multiple platforms
Japanese-language review of 3D holograms from mixed reality devices in neurosurgery, covering preoperative simulation and AR neuronavigation with patient-registered holograms. The author states that holograms are very useful for preoperative simulation and expects them to develop into new treatment approaches.
Virtual Reality and Mixed Reality-Assisted Endoscopic DCR in Extremely Complex Lacrimal Obstructions#
Nowak R et al. · The Laryngoscope · 2024
ENT / head & neck · Case series
VR, platform not specified
AR/MR, platform not specified
Prospective non-randomised proof-of-concept report of endoscopic dacryocystorhinostomy for extremely complex lacrimal obstructions (syndromic congenital cases such as Apert syndrome, and post-traumatic cases after Le Fort fractures), planned preoperatively with VR models and supported during surgery by mixed-reality models in the surgeon's view. The authors report that the VR models helped assess the altered anatomy and plan the approach, and that MR models could be manipulated during surgery without disturbing the endoscopic procedure.
“The VR models helped the surgeon to assess the details of the altered anatomy preoperatively to plan an appropriate approach.”
From the paper · Abstract
Conclusions (2)
Models helped assess altered anatomy before surgeryAnswer: Yes
“The VR models helped the surgeon to assess the details of the altered anatomy preoperatively to plan an appropriate approach.”
From the paper · Abstract
Mixed reality models did not disturb endoscopyAnswer: Describes
“Intraoperatively, MR models were present in the surgeon’s view without disturbing the endoscopic procedure.”
Case Report: Use of novel AR registration system for presurgical planning during vestibular schwannoma resection surgery#
Olexa J et al. · Frontiers in surgery · 2024
Neurosurgery · Case report · n: 1 patient
Microsoft HoloLens
Hoth Intelligence
Case report of a 47-year-old woman with a 3.3 cm vestibular schwannoma, in which a mixed reality system (a Hoth Intelligence app on HoloLens 2) registered her 3D anatomical model onto her head in the OR to plan the retrosigmoid approach. The authors present it as efficient and accurate registration for operative planning.
“This technology allows for efficient and accurate registration of a patient's 3D anatomical model onto their head while positioned in the operating room.”
From the paper · Abstract
“This allowed the surgeon to plan the craniotomy location and optimize proper head position.”
From the paper · Fulltext
Conclusions (2)
Registration called accurate, no accuracy dataAnswer: Describes
“This technology allows for efficient and accurate registration of a patient's 3D anatomical model onto their head while positioned in the operating room.”
From the paper · Abstract
AR view guided craniotomy and head positionAnswer: Yes
“This allowed the surgeon to plan the craniotomy location and optimize proper head position.”
The Apple Vision Pro as a Neurosurgical Planning Tool: A Case Report#
Olexa J et al. · Cureus · 2024
Neurosurgery · Case report · n: 1 patient
Apple Vision Pro
Case report of the Apple Vision Pro used in the OR to view and interact with a 3D model of a patient's anatomy to plan the approach and entry point for revision of a ventriculoperitoneal shunt. Clinicians and staff who used it rated the models realistic and the passthrough natural, and most would use it again.
“Overall, users felt the 3D models felt realistic (4.5/5), that the display of the user's real-world view felt natural (4.3/5), and that the headset did not cause eye strain or fatigue (4.5/5).”
4.5/5
From the paper · Abstract
“The majority of users responded that they would continue to use the headset for cases (4/5).”
4/5
From the paper · Abstract
Conclusions (3)
Users rated continued headset use 4/5Answer: Yes
“The majority of users responded that they would continue to use the headset for cases (4/5).”
4/5
From the paper · Abstract
Users rated 3D models realisticAnswer: Describes
“Overall, users felt the 3D models felt realistic (4.5/5)”
4.5/5 realism
From the paper · Abstract
Ventricle view helped plan approach and entryAnswer: Describes
“In particular, visualizing the size and location of the ventricles in relation to the brain and skull assisted in planning the approach and entry point”
Virtual Reality Planning of Microvascular Decompression in Trigeminal Neuralgia: Technique and Clinical Outcome#
Fabrig OD et al. · Journal of neurological surgery. Part A, Central European neurosurgery · 2024
Neurosurgery · Retrospective case series · n: 26 patients
VR, platform not specified
Retrospective single-surgeon study of 26 patients (from 30 consecutive cases) having microvascular decompression for trigeminal neuralgia. Fused MRI/MRA/MRV were reconstructed in a VR environment to visualize the neurovascular conflict and simulate retrosigmoid trajectories. The authors report that intraoperative anatomy matched the simulations in all cases, 92.3% were pain-free at follow-up, and there were no surgical complications.
“The VR planning was well integrated into the clinical workflow, and imaging processing time was 30 to 40 minutes.”
30 to 40 minutes
From the paper · Abstract
“The preoperative simulations provided a precise visualization of the anatomical relationships of the offending vessels and the trigeminal nerves as well as the surrounding structures.”
From the paper · Abstract
“The surgical complication rate was zero.”
From the paper · Abstract
“The NVC and the anatomy of the cerebellopontine angle as seen intraoperatively matched with the preoperative simulations in all cases”
From the paper · Abstract
Conclusions (4)
Intraoperative anatomy matched simulation in all casesAnswer: Yes
“The NVC and the anatomy of the cerebellopontine angle as seen intraoperatively matched with the preoperative simulations in all cases”
From the paper · Abstract
Most patients pain free at follow-upAnswer: Describes
“At follow-up, 92.3% (24/26) of patients were pain free”
92.3% (24/26)
From the paper · Abstract
No surgical complications in the seriesAnswer: Describes
“The surgical complication rate was zero.”
From the paper · Abstract
Imaging processing took 30 to 40 minutesAnswer: Describes
Retrospective study of 22 patients with severe bicuspid aortic valve stenosis who had transcatheter aortic valve replacement (TAVR) at the University of Minnesota between 2014 and 2018. Aortic-root models were built from pre-procedure CT and transcatheter valves were virtually implanted in Elucis, viewed on a Valve Index headset. The primary endpoint was the extent of valve malapposition around the circumference in VR, assessed against the severity of paravalvular leak on post-procedure echocardiography.
Using a novel three-dimensional holographic technology to perform open vascular surgery procedures#
Galyfos G et al. · Journal of vascular surgery cases and innovative techniques · 2024
Vascular · Case report · n: 1 patient
Microsoft HoloLens
Case report of a 72-year-old man with chronic limb-threatening ischaemia in whom CT angiography was converted into holograms with CarnaLife Holo and reviewed on HoloLens 2 for preoperative assessment, leading to a femoral-deep femoral artery bypass. The authors report improved distal perfusion and discharge after four days.
“Distal perfusion was significantly improved, and the patient had no rest pain”
From the paper · Fulltext
“Based on the preoperative assessment, it was decided to perform a femoral–deep femoral artery bypass. Due to coral reef aorta, aortic surgery was excluded”
From the paper · Fulltext
“Finally, although the cost of this software remains high, this could be overcome by the increasing clinical benefits associated with a wider application of this technology in different procedures in the future”
From the paper · Fulltext
Conclusions (3)
Distal perfusion improved, no rest painAnswer: Describes
“Distal perfusion was significantly improved, and the patient had no rest pain”
From the paper · Full text
Bypass chosen, aortic surgery excludedAnswer: Describes
“Based on the preoperative assessment, it was decided to perform a femoral–deep femoral artery bypass. Due to coral reef aorta, aortic surgery was excluded”
From the paper · Full text
Authors name software cost as a barrierAnswer: Describes
“Finally, although the cost of this software remains high, this could be overcome by the increasing clinical benefits associated with a wider application of this technology in different procedures in the future”
Includes an author who is a Realize Medical advisor.
Elucis
Meta Quest / Oculus
Retrospective study of 27 patients at Children's Hospital Colorado who were screened for a self-expanding transcatheter pulmonary valve (Harmony TPV or Alterra prestent) between September 2020 and January 2022. Two blinded congenital interventional cardiologists performed VR fit assessment in Elucis on an Oculus Quest 2 headset; the manufacturers' screening results and the valves implanted were also collected as reference data.
Novel Use of Virtual Reality and Augmented Reality in Temporomandibular Total Joint Replacement Using Stock Prosthesis#
Niloy I et al. · Journal of oral and maxillofacial surgery · 2024
Oral & maxillofacial / craniofacial · Case series · n: 2 patients
ImmersiveTouch
Technical innovation report of two patients with condylar degeneration who had total temporomandibular joint replacement with a stock prosthesis, planned in ImmersiveTouch virtual reality (resection, prosthesis selection and positioning) and performed with AR guidance. The authors report average plan-to-result differences of 1.25 mm for the condylar and 1.39 mm for the fossa component, and note a steep learning curve and added time and cost.
“The average differences in the positioning of the condylar and fossa prosthesis are 1.252 ± 0.269 mm and 1.393 ± 0.335 mm, respectively.”
1.252 ± 0.269 mm
From the paper · Abstract
“The main challenges include a steep learning curve, intraoperative technical difficulties, added surgical time, and additional costs.”
From the paper · Abstract
Conclusions (2)
Small mean prosthesis deviation from planAnswer: Yes
“The average differences in the positioning of the condylar and fossa prosthesis are 1.252 ± 0.269 mm and 1.393 ± 0.335 mm, respectively.”
1.252 ± 0.269 mm condylar, 1.393 ± 0.335 mm fossa
From the paper · Abstract
Steep learning curve, added time and costAnswer: Describes
“The main challenges include a steep learning curve, intraoperative technical difficulties, added surgical time, and additional costs.”
Spanish narrative review of digital imaging, virtual reality and augmented reality in surgery. The authors describe predictive surgical planning and intraoperative navigation as the main applications and discuss the convergence of VR and AR into mixed reality headsets.
Mixed Reality and Artificial Intelligence: A Holistic Approach to Multimodal Visualization and Extended Interaction in Knee Osteotomy#
Moglia A et al. · IEEE journal of translational engineering in health and medicine · 2024
Orthopedics · Survey/user study
Microsoft HoloLens
Preclinical usability study of Holoknee, a HoloLens 2 application combining AI-based segmentation and mixed reality for visualising multimodal data and planning knee osteotomy. Eleven participants (eight surgeons, two residents and one student) completed planning tasks in repeated sessions; the authors report faster task times in later sessions and that 10 of 11 strongly agreed MR could be used effectively for preoperative planning.
“All subjects strongly agreed that MR can be used effectively for surgical training, whereas 10 (90.9%) strongly agreed that it can be used effectively for preoperative planning.”
90.9%
From the paper · Abstract
“Six (54.5%) agreed and two of them (18.2%) strongly agreed that it can be used effectively for intraoperative guidance.”
54.5%
From the paper · Abstract
“for 10 (90.9%) the system can help the surgeon to perceive the anatomy of the patient in a better way”
10 (90.9%)
From the paper · Fulltext
Conclusions (5)
Task times fell from first to second trialAnswer: Yes
“During the second trial of the I session, the participants were faster in all tasks than in the first one with a statistically significant difference in all tasks with the exception of IN”
From the paper · Full text
10 of 11 users endorse MR for planningAnswer: Yes
“10 (90.9%) strongly agreed that it can be used effectively for preoperative planning”
10 (90.9%)
From the paper · Abstract
10 of 11 say system aids anatomy perceptionAnswer: Yes
“for 10 (90.9%) the system can help the surgeon to perceive the anatomy of the patient in a better way”
10 (90.9%)
From the paper · Full text
Intraoperative guidance rated less favourablyAnswer: Mixed
“Six (54.5%) agreed and two of them (18.2%) strongly agreed that it can be used effectively for intraoperative guidance.”
The Integration of 3D Virtual Reality and 3D Printing Technology as Innovative Approaches to Preoperative Planning in Neuro-Oncology#
González-López P et al. · Journal of personalized medicine · 2024
Neurosurgery · Technical note
3D Slicer / SlicerVR
Meta Quest / Oculus
Technical description of a workflow in which patient scans are segmented in 3D Slicer, exported as 3D models and viewed on a standalone Oculus/Meta Quest headset for preoperative rehearsal in neuro-oncology, with the same models 3D-printed for hands-on preparation.
Virtual Planning and Augmented Reality-Guided Microsurgical Resection of a Frontal Arteriovenous Malformation#
Halpin BS et al. · World neurosurgery · 2024
Neurosurgery · Case report (video) · n: 1 patient
AR/MR, platform not specified
Video case report of a 66-year-old man with a right frontal pole AVM. A virtual planning platform was used to prepare for surgery, and AR integrated with neuronavigation helped localize feeders and draining veins during microsurgical resection. The authors report complete resection and no complications at 4 months.
“The patient was discharged home on postoperative day 3 with no complications.”
From the paper · Abstract
Conclusions (2)
Complete AVM resection on postoperative angiographyAnswer: Describes
“Postoperative angiography showed complete resection of the AVM.”
From the paper · Abstract
Discharge on day 3, no complicationsAnswer: Describes
“The patient was discharged home on postoperative day 3 with no complications.”
Putting our heads together: The future of craniopagus twin separation#
Pontell ME et al. · Journal of cranio-maxillo-facial surgery · 2024
Neurosurgery · Narrative review
Multiple platforms
Review of six teams that separated craniopagus twins with CAD/CAM models, virtual surgical planning and/or AR/VR. The authors report increasing use of these tools and associate them with higher success rates than historical controls.
“Surgeons involved in separating craniopagus twins have increasingly utilized tools such as CAD/CAM models, VSP and AR/VR to plan and execute successful separation, and these tools are associated with higher success rates than historical controls.”
From the paper · Abstract
Conclusions (1)
Success link to historical controls not testedAnswer: Describes
“these tools are associated with higher success rates than historical controls.”
Anatomic Review in 3D Augmented Reality Alters Craniotomy Planning Among Residents#
Haider S et al. · World neurosurgery · 2024
Neurosurgery · Survey/user study · n: 6 cases
AR/MR, platform not specified
Study in which 11 neurosurgery residents planned skull positioning and craniotomies for six case vignettes from 2D imaging, then repeated the planning after reviewing the lesion in 3D AR. The authors report that skull position changed significantly in 5 of 6 cases, with no significant change in incision or craniotomy size overall, and positive resident ratings.
“Skull position significantly changed in 5 out of 6 cases after 3D-AR view (P < 0.05, 20° angular adjustment).”
5 out of 6 cases
From the paper · Abstract
“No significant change in incision length or craniotomy size.”
From the paper · Abstract
“Residents uniformly appreciated 3D-AR as a valuable tool for improving appreciation of critical anatomic structures and their relationship to lesional pathology.”
From the paper · Abstract
Conclusions (3)
Skull position changed in 5 of 6 casesAnswer: Yes
“Skull position significantly changed in 5 out of 6 cases after 3D-AR view”
5 out of 6 cases, P < 0.05, 20° angular adjustment
From the paper · Abstract
Incision length and craniotomy size unchangedAnswer: No significant difference
“No significant change in incision length or craniotomy size.”
From the paper · Abstract
Residents valued 3D AR for anatomy reviewAnswer: Yes
“Residents uniformly appreciated 3D-AR as a valuable tool for improving appreciation of critical anatomic structures and their relationship to lesional pathology.”
The use of mixed reality in the preoperative planning of colorectal surgery: Preliminary experience with a narrative review#
Bracale U et al. · Cirugia espanola · 2024
General & GI surgery · Case series · n: 10 patients
Microsoft HoloLens
Retrospective report of 10 colorectal cancer cases (2020 to 2022) in which holographic 3D reconstructions on HoloLens were used to identify vascular anomalies, locate tumours, assess infiltration and plan surgery, with a short narrative review of VR, AR and MR. The authors report successful use for preoperative planning and intraoperative application in all 10 cases.
“Successful implementation was observed in 10 colorectal cancer cases, showcasing the effectiveness of MR in improving preoperative planning and its intraoperative application.”
From the paper · Abstract
Conclusions (1)
Successful use in 10 colorectal cancer casesAnswer: Yes
“Successful implementation was observed in 10 colorectal cancer cases, showcasing the effectiveness of MR in improving preoperative planning and its intraoperative application.”
Developing a Virtual Reality Simulation System for Preoperative Planning of Robotic-Assisted Thoracic Surgery#
Ujiie H et al. · Journal of clinical medicine · 2024
Thoracic · Technical development
VR, platform not specified
Technical report of a VR system in which CT-based 3D reconstructions of pulmonary structures are viewed in head-mounted displays with Perspectus VR Education software for preoperative resection simulation, then shown on the robot's TilePro display during robotic thoracic surgery. The authors report precise visualisation of pulmonary structures and lesion relationships, and describe benefits for planning, safety and accuracy.
“The VR system enabled precise visualization of pulmonary structures and lesion relations, enhancing surgical safety and accuracy.”
From the paper · Abstract
“The preoperative preparation with the VR HMD was instrumental in identifying a variant in the PA vessel anatomy, specifically a mediastinal branch A5 (Med. A5)”
From the paper · Fulltext
Conclusions (2)
VR review identified an anatomical variantAnswer: Yes
“The preoperative preparation with the VR HMD was instrumental in identifying a variant in the PA vessel anatomy, specifically a mediastinal branch A5 (Med. A5)”
From the paper · Full text
Safety and accuracy claimed, none measuredAnswer: Describes
“The VR system enabled precise visualization of pulmonary structures and lesion relations, enhancing surgical safety and accuracy.”
Prospective study of 40 patients with trigeminal neuralgia, hemifacial spasm or intracranial tumours, whose holographic models were shared online and viewed on HoloLens or iOS devices in an interactive, multiuser mixed reality system for resident training and planning. Ten residents were trained. The authors report changed exploration strategy in 48.3% of neurovascular compression cases and changed surgical posture in 31.7% of tumour responses.
“The surgeons changed their exploration strategy in 48.3% of the NVC cases.”
48.3%
From the paper · Abstract
“For residents with limited experience in surgery, the exploration strategy for 75.0% of all patients with NVC was changed after the residents were trained with the mixed-reality NT system.”
75.0%
From the paper · Abstract
“Of the 60 responses for intracranial tumors, the trainee changed the surgical posture in 19 (31.7%) cases.”
31.7%
From the paper · Abstract
Conclusions (3)
Exploration strategy changed in 48.3% of casesAnswer: Yes
“The surgeons changed their exploration strategy in 48.3% of the NVC cases.”
48.3% of NVC cases
From the paper · Abstract
Residents changed strategy in 75.0% after trainingAnswer: Yes
“For residents with limited experience in surgery, the exploration strategy for 75.0% of all patients with NVC was changed after the residents were trained with the mixed-reality NT system.”
75.0% of NVC patients
From the paper · Abstract
Surgical posture changed in 19 tumour casesAnswer: Yes
“Of the 60 responses for intracranial tumors, the trainee changed the surgical posture in 19 (31.7%) cases.”
Mixed reality in neurosurgery: redefining the paradigm for arteriovenous malformation planning and navigation to improve patient outcomes#
Najera E et al. · Neurosurgical focus · 2024
Neurosurgery · Retrospective case series · n: 10 patients
VR, platform not specified
Retrospective review of 10 patients who had AVM resection (2021-2023), with preoperative planning on patient-specific 360-degree VR models and AR markers for intraoperative feeder disconnection. The authors report identification of 21 arterial feeders, a mean operative time of about 5 hours, mean blood loss of 507.5 ml, and worsened deficits in two patients.
“In 10 patients with cerebral AVMs, MxR significantly facilitated the identification of 21 arterial feeders, including challenging deep feeders.”
From the paper · Abstract
“The mean surgical duration was approximately 5 hours 11 minutes, with a mean intraoperative blood loss of 507.5 ml.”
From the paper · Abstract
Conclusions (2)
21 arterial feeders identified in 10 AVMsAnswer: Yes
“In 10 patients with cerebral AVMs, MxR significantly facilitated the identification of 21 arterial feeders, including challenging deep feeders.”
21 feeders in 10 patients
From the paper · Abstract
Mean surgical duration about 5 hours 11 minutesAnswer: Describes
“The mean surgical duration was approximately 5 hours 11 minutes, with a mean intraoperative blood loss of 507.5 ml.”
The role of extended reality in eloquent area lesions: a systematic review#
Marrone S et al. · Neurosurgical focus · 2024
Neurosurgery · Systematic review
Multiple platforms
Systematic review (2000-2023; 21 included papers) of VR, AR and mixed reality for lesions in eloquent brain areas, used both for preoperative planning and intraoperatively.
“The increasing use of such innovative technologies has completely changed the way to approach a lesion, using 3D visualization to foster a better understanding of its anatomical and vascular characteristics.”
From the paper · Abstract
Conclusions (1)
Review reports changed approach to lesionsAnswer: Describes
“The increasing use of such innovative technologies has completely changed the way to approach a lesion, using 3D visualization to foster a better understanding of its anatomical and vascular characteristics.”
Obstetric anesthesiology and extended reality: an introduction to future uses of spatial computing in obstetric anesthesiology#
Rubin JE et al. · International journal of obstetric anesthesia · 2024
Anesthesia & pain · Letter/editorial
Multiple platforms
Letter introducing possible uses of extended reality (spatial computing) in obstetric anaesthesiology, including VR/AR review of patient-specific anatomy to plan procedures. It is a perspective with no study data; one figure shows planning in Elucis.
From Vision to Reality: Virtual Reality's Impact on Baffle Planning in Congenital Heart Disease#
Priya S et al. · Pediatric cardiology · 2024
Congenital heart · Feasibility study
Co-authored by a Realize Medical founder and a staff member.
Elucis
Valve Index
Feasibility study of VR for intracardiac baffle planning in congenital heart disease. Patient-specific heart models were segmented from CT angiography in the FDA-cleared edition of Elucis (v1.7) and viewed on a Valve Index headset, and a VR interface was used to simulate baffle configurations collaboratively, illustrated with a case of double-outlet right ventricle with a subaortic ventricular septal defect. Model creation and the VR interface were assessed for feasibility, usability and clinical relevance.
Virtual Reality Planning in Reconstructive Surgery for Orbital Prosthetic Rehabilitation Using ImmersiveTouch Platform: Preliminary Report#
Arias-Amezquita E et al. · The Journal of craniofacial surgery · 2024
Oral & maxillofacial / craniofacial · Case series · n: 2 patients
ImmersiveTouch
Preliminary report of a VR planning workflow (ImmersiveView Surgical Plan, ImmersiveTouch) for placing craniofacial implants for orbital prosthetic rehabilitation in two patients, with the plan exported as 3D-printed surgical guides. The authors report about 10 minutes to place four implants virtually and an average deviation of 0.6 mm between plan and postoperative CT.
“It takes, on average, 10 minutes to place 4 implants in the virtual reality space.”
10 minutes
From the paper · Abstract
“Our user-friendly VRP workflow allows for an accurate simulation of surgical and nonsurgical procedures with an average displacement in XYZ of 0.6 mm and an SD of 0.3 mm.”
0.6 mm
From the paper · Abstract
“Patients allowed to interact with VR have been engaged, which would aid their treatment acceptance and patient education.”
From the paper · Abstract
Conclusions (2)
Implants averaged 0.6 mm from virtual planAnswer: Yes
“an accurate simulation of surgical and nonsurgical procedures with an average displacement in XYZ of 0.6 mm and an SD of 0.3 mm.”
0.6 mm average displacement, SD 0.3 mm
From the paper · Abstract
Virtual placement of four implants took 10 minutesAnswer: Describes
“It takes, on average, 10 minutes to place 4 implants in the virtual reality space.”
From Augmented to Virtual Reality in Plastic Surgery: Blazing the Trail to a New Frontier#
Sullivan J et al. · Journal of reconstructive microsurgery · 2024
Plastic & reconstructive · Narrative review
Multiple platforms
Narrative review of AR and VR in the operative setting across plastic, oral and maxillofacial, colorectal, neurosurgical, ENT and orthopaedic surgery. The authors describe wide use of mixed reality for planning complex craniomaxillofacial reconstruction and VR for DIEP flap planning from CTA, alongside uses in education and phantom limb pain.
“VR has been shown to increase surgical precision and decrease operative time.”
From the paper · Abstract
Conclusions (1)
Review states VR improves precision and timeAnswer: Yes
“VR has been shown to increase surgical precision and decrease operative time.”
The Inaugural "Century" of Mixed Reality in Cranial Surgery: Virtual Reality Rehearsal/Augmented Reality Guidance and Its Learning Curve in the First 100-Case, Single-Surgeon Series#
Jean WC et al. · Operative neurosurgery (Hagerstown, Md.) · 2024
Neurosurgery · Case series · n: 100 cases
VR, platform not specified
Single-surgeon series of the first 100 consecutive complex cranial cases intended to be planned with VR rehearsal and executed with AR guidance, analysing the learning curve. AR guidance was abandoned in 8 operations for technical reasons, and problem-free use increased between the 44th and 63rd cases. The authors report no significant differences in blood loss, length of stay or surgery duration in 17 cases matched to historical non-MxR controls.
“AR guidance was abandoned in eight operations because of technical problems, but problem-free application of MxR increased between the 44th and 63rd cases.”
From the paper · Abstract
“Comparing the 17 pairs of matched MxR and non-MxR cases, no statistically significant differences exist in the groups regarding blood loss, length of stay nor duration of surgery.”
From the paper · Abstract
Conclusions (2)
No significant difference in 17 matched pairsAnswer: No significant difference
“Comparing the 17 pairs of matched MxR and non-MxR cases, no statistically significant differences exist in the groups regarding blood loss, length of stay nor duration of surgery.”
surgery 218.4 vs 252.8 min, P = .4
From the paper · Abstract
AR abandoned in 8 cases; problem-free use roseAnswer: Mixed
“AR guidance was abandoned in eight operations because of technical problems, but problem-free application of MxR increased between the 44th and 63rd cases.”
Optimizing Surgical Efficiency in Complex Spine Surgery Using Virtual Reality as a Communication Technology to Promote a Shared Mental Model: A Case Series and Review#
Case series of three complex spine operations in which narrated walkthroughs of patient-specific 3D VR models were sent to team members the night before and reviewed in a VR huddle before surgery, with a review of the literature on preoperative VR in spine surgery. Most of the seven survey respondents rated the tool at least moderately useful for understanding the operative sequence, their role, and case safety or efficiency.
“Postoperative survey results demonstrate a positive experience among surgical team members after reviewing preoperative plans created with patient-specific 3D VR models.”
From the paper · Abstract
“Initial survey results demonstrate positive feedback among respondents.”
From the paper · Abstract
Conclusions (2)
Team survey positive on preoperative VR planningAnswer: Yes
“Postoperative survey results demonstrate a positive experience among surgical team members after reviewing preoperative plans created with patient-specific 3D VR models.”
From the paper · Abstract
Most respondents rated VR review moderately usefulAnswer: Yes
“Respondents felt that preoperative VR video review was “moderately useful” or more useful in improving their understanding of the operational sequence (71%, 5/7), in enhancing their ability to understand their role (86%, 6/7), and in improving the safety or efficiency of the case (86%, 6/7).”
Augmented Reality Visualization of 3D Rotational Angiography in Congenital Heart Disease: A Comparative Study to Standard Computer Visualization#
Salavitabar A et al. · Pediatric cardiology · 2024
Congenital heart · Comparative study · n: 30 patients
AR/MR, platform not specified
Single-centre study that converted 30 3D rotational angiography datasets from patients with congenital heart disease (median age 6.5 years) into augmented-reality models and compared them with standard on-screen computer models. The authors report that both were of similar quality, that structures were rated very easy to see in 81% of AR versus 68% of computer-model assessments, and that AR was considered helpful for identifying pathology and planning interventions in 94% of assessments.
“Fifty-nine (66%) grades 'Agreed' or 'Strongly Agreed' that AR models provided superior appreciation of 3D relationships; AR was found to be least beneficial in visualization of aortic arch obstruction.”
66%
From the paper · Abstract
“AR models were thought to be helpful in identifying pathology and assisting in interventional planning in 85 assessments (94.4%).”
94.4%
From the paper · Abstract
“It is feasible to convert 3D models of 3DRAs into AR models, which are of similar image quality as compared to CM.”
From the paper · Abstract
“There was significant potential seen in the opportunity for patient/family counseling”
85, 94.5% agree
From the paper · Abstract
Conclusions (4)
Ease of visualisation not significantly differentAnswer: No significant difference
“Visualization and identification of structures were graded as “very easy” in 81.1% (n=73) and 67.8% (n=61) of AR and CM, respectively.”
81.1% vs 67.8% very easy, P=0.09
From the paper · Abstract
AR and computer model quality similarAnswer: No significant difference
“It is feasible to convert 3D models of 3DRAs into AR models, which are of similar image quality as compared to CM.”
93.4% vs 94.4% Excellent/Good, P=0.09
From the paper · Abstract
66% agreed AR aided 3D relationship appreciationAnswer: Mixed
“Fifty-nine (66%) grades ‘Agreed’ or ‘Strongly Agreed’ that AR models provided superior appreciation of 3D relationships; AR was found to be least beneficial in visualization of aortic arch obstruction.”
59 (66%) agreed
From the paper · Abstract
AR rated helpful for pathology and planningAnswer: Yes
“AR models were thought to be helpful in identifying pathology and assisting in interventional planning in 85 assessments (94.4%).”
Narrative review of 38 articles on virtual and augmented reality in oral and maxillofacial surgery, covering education, surgical planning, hardware and software. The authors identify cost, the need for more research, educator unfamiliarity and technical limitations as barriers to adoption.
“Virtual reality/AR technology offers significant potential in various aspects, including student education, resident evaluation, surgical planning, and overall surgical implementation.”
From the paper · Abstract
“However, its widespread adoption in practice is hindered by factors such as the need for further research, cost concerns, unfamiliarity among current educators, and the necessity for technological improvement.”
From the paper · Abstract
Conclusions (2)
Review sees potential across oral surgery usesAnswer: Describes
“Virtual reality/AR technology offers significant potential in various aspects, including student education, resident evaluation, surgical planning, and overall surgical implementation.”
From the paper · Abstract
Cost, research gaps and unfamiliarity limit adoptionAnswer: Describes
“However, its widespread adoption in practice is hindered by factors such as the need for further research, cost concerns, unfamiliarity among current educators, and the necessity for technological improvement.”
Metaverse Surgical Planning with Three-dimensional Virtual Models for Minimally Invasive Partial Nephrectomy#
Checcucci E et al. · European urology · 2024
Urology · Case report · n: 1 patient
VR, platform not specified
Case report describing a preoperative case discussion held in a metaverse virtual room, where surgeons' avatars reviewed 3D virtual kidney models and agreed the surgical strategy and clamping approach before minimally invasive partial nephrectomy. The authors report that the procedure was carried out according to the simulated strategy and describe the immersive experience as overcoming distance barriers.
“We demonstrate how this immersive virtual reality experience overcomes the barriers of distance and how the quality of surgical planning is enriched by a great sense of "being there", even if virtually.”
From the paper · Abstract
Conclusions (1)
Virtual meeting overcame distance for surgical planningAnswer: Yes
“We demonstrate how this immersive virtual reality experience overcomes the barriers of distance and how the quality of surgical planning is enriched by a great sense of "being there", even if virtually.”
Usability of mixed reality in awake craniotomy planning#
Moon RDC, Barua NU · British journal of neurosurgery · 2024
Neurosurgery · Survey/user study · n: 10 procedures
Magic Leap
Brainlab Elements
Report of an institutional workflow in which Magic Leap mixed reality headsets, sharing a virtual space, displayed Brainlab Elements reconstructions (including DTI tracts) for multidisciplinary planning of awake craniotomy. It was used in 10 consecutive procedures over 5 months. Ten non-consultant team members (anaesthetists, trainees, speech therapists, a neuropsychologist) gave a mean System Usability Scale score of 71.5 and valued rehearsing positioning and mapping protocols.
“Ten participants (2 Anaesthetists, 5 Neurosurgical trainees, 2 Speech therapists, 1 Neuropsychologist) completed System Usability Scale assessments, reporting a mean score of 71.5.”
71.5
From the paper · Abstract
Conclusions (3)
Acceptable usability, mean SUS score 71.5Answer: Yes
“This study supports the use of mixed reality for multidisciplinary planning for awake craniotomy surgery, with an acceptable degree of usability of the interface.”
SUS mean 71.5
From the paper · Abstract
Staff valued rehearsing positioning and mapping stepsAnswer: Yes
“Feedback highlighted the benefit of being able to rehearse important steps in the procedure, including patient positioning and anaesthetic access and visualising the testing protocol for cortical and subcortical speech mapping.”
From the paper · Abstract
Non-neurosurgical team needs require attentionAnswer: Describes
“We highlight the need to consider the requirements of non-technical, non-neurosurgical team members when involving mixed reality activities.”
Systematic review of 15 studies (328 patients) of extended reality in mitral valve surgery, grouped into preoperative planning (annular assessment, approach, ring sizing, training) and prediction of postoperative outcomes. The authors call for randomized studies.
“Preoperatively, XR has been shown to evaluate mitral annular pathology more accurately than echocardiography, informing the surgeon about the optimal surgical technique, approach and plan for a particular patient's MV pathology.”
From the paper · Abstract
“XR demonstrated promising applications for assisting MV surgery, enhancing outcomes and patient-centred care, nevertheless, there remain the need for randomized studies to ascertain its feasibility, safety, and validity in clinical practice.”
From the paper · Abstract
Conclusions (2)
Review calls for randomized studiesAnswer: Describes
“XR demonstrated promising applications for assisting MV surgery, enhancing outcomes and patient-centred care, nevertheless, there remain the need for randomized studies to ascertain its feasibility, safety, and validity in clinical practice.”
A Collaborative Mixed Reality Platform for the Planning of Vascular Surgery#
Wang J et al. · 2024 IEEE International Conference on Metaverse Computing, Networking, and Applications (MetaCom) · 2024
Vascular · Technical development
AR/MR, platform not specified
Conference paper on a collaborative mixed-reality platform in which several users with holographic headsets view and edit 3D models from MRI and control supercomputer blood-flow simulations by hand gesture, demonstrated on stent placement planning for type B aortic dissection.
An innovative mixed reality approach for Robotics Surgery#
Rus G et al. · IOP Conference Series Materials Science and Engineering · 2024
Multi-specialty · Technical development
Microsoft HoloLens
Conference paper on a HoloLens 2 augmented-reality application for robot-assisted surgery that supports pre-planning (image viewing, 3D anatomy, robotic planning) and intraoperative steps. The authors report positive results in laboratory testing.
Breakthrough and Challenging Application: Mixed Reality-Assisted Intracardiac Surgery#
Marinozzi F et al. · Applied Sciences · 2024
Adult cardiac & structural heart · Technical development
AR/MR, platform not specified
Study segmenting the heart including the aortic valve and intracardiac structures with open-source and commercial software and building a mixed-reality app (exploded view, free sectioning) for preoperative planning of cardiac surgery. The authors report the app showed potential for diagnosis and planning, with limitations still to overcome.
“Furthermore, the mixed-reality app has confirmed the potential of this technology in diagnostic and preoperative planning, although some limitations should still be overcome.”
From the paper · Abstract
Conclusions (1)
Potential for planning, limitations remainAnswer: Describes
“Furthermore, the mixed-reality app has confirmed the potential of this technology in diagnostic and preoperative planning, although some limitations should still be overcome.”
Review of 3D printing and virtual reality in liver surgery and transplantation, covering preoperative planning, simulation and training, with augmented reality and AI discussed as future intraoperative aids. The authors note that randomised trials are needed to show effects on surgical efficiency and recovery.
“Though safely implemented, AR failed to improve outcomes over standard techniques in this initial experience”
From the paper · Full text: main text
“Early adopters have demonstrated enhanced anatomical appreciation, innovative educational opportunities, and improved outcomes from immersive preoperative simulation.”
From the paper · Full text: main text
Conclusions (3)
Early adopters report enhanced anatomical appreciationAnswer: Yes
“Early adopters have demonstrated enhanced anatomical appreciation, innovative educational opportunities, and improved outcomes from immersive preoperative simulation.”
From the paper · Full text
Few studies link tools to perioperative outcomesAnswer: Describes
“few studies have linked these technologies to improvements in concrete perioperative outcomes”
From the paper · Full text
More clinical evidence needed before adoptionAnswer: Describes
“However, despite technological maturation, continued quantitative clinical evidence is necessary before widespread adoption.”
EP09.03: Transposition of great arteries: three-dimensional virtual and physical models from obstetrical ultrasound data#
Bravo-Valenzuela NJ et al. · Ultrasound in Obstetrics & Gynecology (ISUOG 2024 abstract) · 2024
Fetal medicine · Conference abstract · n: 1 patient
Elucis
3D Slicer / SlicerVR
Conference abstract describing a fetus with transposition of the great arteries whose fetal echocardiography volume dataset was processed in 3D Slicer and segmented in Elucis in VR, producing virtual and 3D-printed heart models.
Holographic surgical planning of cerebrovascular cases: the benefits of 3D Mixed Reality over standard 2D imaging#
Colombo E et al. · Brain and Spine · 2024
Neurosurgery · Conference abstract
AR/MR, platform not specified
EANS 2024 abstract (Brain and Spine supplement) from the Zurich group on holographic mixed-reality surgical planning of cerebrovascular cases compared with standard 2D imaging. Title-only record: no abstract was openly available from the sources searched, so details could not be confirmed.
HPB 2024 abstract on mixed reality to improve size matching and graft reduction planning in paediatric living donor liver transplantation. Title-only record: no abstract was openly available from the sources searched, so details could not be confirmed.
Narrative review of VR and AR applications in cardiology and cardiac surgery, including pre-procedural planning.
“The evaluation of the anatomy in CHDs was not enhanced by stereoscopic VR (p = 0.11).”
p = 0.11
From the paper · Fulltext
“a research group of pediatric cardiac surgeons reported increased confidence when planning and performing surgeries in two-thirds of cases and improvements in the surgical strategy in 60% of cases [38].”
60% of cases
From the paper · Fulltext
“VR was more useful in medical training and preoperative planning than 3D-printed models; however, the differences were not statistically significant [42].”
From the paper · Fulltext
Conclusions (3)
Authors call VR a powerful planning toolAnswer: Describes
“VR becomes a powerful tool for both surgical planning and education.”
From the paper · Abstract
Authors say VR can improve accuracy and safetyAnswer: Describes
“This can significantly improve surgical accuracy and safety.”
From the paper · Full text
Large randomised trials still neededAnswer: Describes
“Reliable VR efficacy assessment in clinical practice requires large-scale studies and randomized clinical trials.”
SurgiColab: Collaborative Mixed Reality for Enhanced Pre-Surgical Planning with 3D Anatomical Models#
Prabhakaran S et al. · International Conference on Biomedical Engineering · 2024
Multi-specialty · Technical development
Microsoft HoloLens
Conference paper describing SurgiColab, a collaborative mixed-reality application on Microsoft HoloLens 2 in which several clinicians view and manipulate the same patient-specific 3D organ models (position, scale, rotation, clipping) for pre-surgical planning. The authors report that surgeons who tested it found it improved preoperative visualisation and teamwork and lowered cognitive workload.
HPB 2024 abstract on preoperative virtual reality simulation in liver surgery as an aid for a young trainee surgeon. Title-only record: no abstract was openly available from the sources searched, so details could not be confirmed.
The "Canopy Approach": Case Series Using Immersive Virtual Reality for Bottom-Up Target-Based Preoperative Planning in Pediatric Neurosurgery#
Lai GY et al. · Neurosurgery practice · 2023
Neurosurgery · Case series · n: 5 patients
Surgical Theater
Meta Quest / Oculus
Case series of 5 children (aged 7-14) with intraparenchymal lesions near vessels and fibre tracts. 3D models (Surgical Theater SRP) were reviewed on desktop and with immersive Oculus headsets for both 'top-down' and lesion-outward 'bottom-up' trajectory planning, and shown to families. Plans were modified after bottom-up review in all cases; the authors report no complications or permanent deficits, gross total resection in all lesional cases, and seizure freedom at 2 years in the epilepsy cases.
“Modifications to 2-dimensional and "top-down" VR trajectory plans were made after "bottom-up" navigation in all cases.”
From the paper · Abstract
“All families reported that the VR enhanced their understanding of the procedure.”
From the paper · Abstract
“There were no complications, and no patients suffered permanent neurological deficits postoperatively.”
From the paper · Abstract
Conclusions (5)
Trajectory plans modified after bottom-up reviewAnswer: Yes
“Modifications to 2-dimensional and “top-down” VR trajectory plans were made after “bottom-up” navigation in all cases.”
From the paper · Abstract
All families reported enhanced procedure understandingAnswer: Yes
“All families reported that the VR enhanced their understanding of the procedure.”
From the paper · Abstract
No complications or permanent neurological deficitsAnswer: Describes
“There were no complications, and no patients suffered permanent neurological deficits postoperatively.”
From the paper · Abstract
Gross total resection in all lesional casesAnswer: Describes
“Gross total resection was achieved in all lesional cases”
From the paper · Abstract
Seizures recurred in year 2 in one caseAnswer: Describes
“During the second postoperative year, seizures recurred, albeit with decreased frequency than before, with new posterior parietal foci noted on ictal single-photon emission computed tomography (SPECT).”
Virtual reality training and modeling to aid in pre-procedural practice for thoracic nerve root block in the setting of a schwannoma#
Wang EF et al. · Interventional pain medicine · 2023
Anesthesia & pain · Case report · n: 1 patient
Meta Quest / Oculus
3D Organon VR Anatomy
Case report of a 64-year-old woman with neuroforaminal compression from a thoracic schwannoma. Before a transforaminal epidural steroid injection, the mass was modelled in a VR anatomy application (3D Organon, sized manually from MRI) on an Oculus Quest 2 to rehearse the procedure and choose the fluoroscopic angle that would avoid the mass and nerve root.
“a fluoroscopic view with right-sided oblique angulation to 15° would provide the optimal approach to the neuroforamen with minimal risk to infiltrating the mass or nerve root”
From the paper · Fulltext
“At four weeks follow-up, the patient reported significant, near complete, ongoing relief of her symptoms”
From the paper · Fulltext
Conclusions (2)
VR modelling set the fluoroscopic angleAnswer: Yes
“a fluoroscopic view with right-sided oblique angulation to 15° would provide the optimal approach to the neuroforamen with minimal risk to infiltrating the mass or nerve root”
From the paper · Full text
Near complete symptom relief at four weeksAnswer: Describes
“At four weeks follow-up, the patient reported significant, near complete, ongoing relief of her symptoms”
Report of tertiary-centre experience using holograms (Artiness reconstructions viewed on HoloLens) for planning interventional and surgical procedures in several clinical scenarios, including congenital cases, and for university teaching.
“Basing on these analyses transcatheter treatment was preferred to open surgery.”
From the paper · Fulltext
Conclusions (3)
AR group higher on part two, no statisticsAnswer: Describes
“students in the AR performed better than students from the other groups in the second part of the test thus implying that holography helped students to understand better the complicated anatomical relationships of the congenital defect”
From the paper · Full text
Hologram review favoured transcatheter over open surgeryAnswer: Yes
“Basing on these analyses transcatheter treatment was preferred to open surgery.”
From the paper · Full text
Fibroma removed without entering LV cavityAnswer: Describes
“the tumour was removed without entering the LV cavity as predicted by the hologram”
Experience in the Application of Augmented Reality Technology in the Surgical Treatment of Patients Suffering Primary and Recurrent Pelvic Tumors#
Ivanov VM et al. · Journal of personalized medicine · 2023
Multi-specialty · Case series · n: 11 patients
AR/MR, platform not specified
Report of an augmented-reality workflow (3D Slicer models displayed on AR glasses) used in planning and surgery for 11 patients with primary and recurrent tumours of the pelvic organs. The authors report that eight patients had radical operations using intraoperative AR with favourable outcomes, one had palliative surgery and two were not operated on, and conclude that the workflow was technically feasible and reproducible.
“The testing of the algorithm for the application of AR technology in the surgical treatment of primary and recurrent pelvic tumors demonstrated both a technical possibility and reproducibility of this algorithm and the AR technology itself in clinical practice.”
From the paper · Abstract
Conclusions (3)
AR workflow technically feasible and reproducibleAnswer: Yes
“The testing of the algorithm for the application of AR technology in the surgical treatment of primary and recurrent pelvic tumors demonstrated both a technical possibility and reproducibility of this algorithm and the AR technology itself in clinical practice.”
From the paper · Abstract
Full workflow used in eight of eleven patientsAnswer: Describes
“In this study, we were able to fully implement the AlARUS algorithm in eight patients (72.72%).”
eight of 11 patients (72.72%)
From the paper · Full text
Negative resection margin in all eight operatedAnswer: Describes
“Postoperative specimen morphology indicated that a negative resection edge (R0—resection) was achieved in all eight patients.”
Mixed Reality for Cranial Neurosurgical Planning: A Single-Center Applicability Study With the First 107 Subsequent Holograms#
Colombo E et al. · Operative neurosurgery (Hagerstown, Md.) · 2023
Neurosurgery · Prospective cohort · n: 107 cases
Augmedit Lumi
Microsoft HoloLens
Prospective single-centre study of 107 neurosurgical cases (oncologic, cerebrovascular and carotid endarterectomy) in 2022, for which holograms were prepared in a certified MR application (Lumi, Augmedit) and viewed on HoloLens 2 during surgical preparation. The authors report mean segmentation time of 39 minutes, preparation time similar to a matched 2021 cohort, approach modifications in 3 cases, and good usability ratings from 57% of 7 neurosurgeons.
“Based on the 3D hologram, the surgical approach was modified in 3 cases.”
3 cases
From the paper · Abstract
“Good usability was found by 57% of the users.”
57%
From the paper · Abstract
“Mean hologram segmentation time was 39.4 ± 20.4 minutes.”
39.4 ± 20.4 minutes
From the paper · Abstract
Conclusions (4)
Mean hologram segmentation took 39 minutesAnswer: Describes
“Mean hologram segmentation time was 39.4 ± 20.4 minutes.”
39.4 ± 20.4 min
From the paper · Abstract
Preparation time not longer than 2021 cohortAnswer: No significant difference
“Average surgical preparation time was 48.0 ± 17.3 minutes for MxR cases vs 52 ± 17 minutes in the matched 2021 cohort without MxR (mean difference 4, 95% CI 1.7527-9.7527).”
48.0 ± 17.3 vs 52 ± 17 min
From the paper · Abstract
Approach changed in 3 of 107 casesAnswer: Mixed
“Based on the 3D hologram, the surgical approach was modified in 3 cases.”
Evaluation Metrics for Augmented Reality in Neurosurgical Preoperative Planning, Surgical Navigation, and Surgical Treatment Guidance: A Systematic Review#
PRISMA systematic review of 80 studies of AR in cranial neurosurgery, cataloguing the evaluation metrics used. Only 5% addressed preoperative visualization (mostly user-perception metrics); 75% addressed navigation and 20% intraoperative guidance. The authors recommend metrics by application and innovation phase.
Conclusions (3)
Most studies tested AR for navigationAnswer: Describes
“The majority (75%) researched AR technology for surgical navigation, with registration accuracy, clinical outcome, and time measurements as the most frequently reported metrics.”
75% of 80 studies
From the paper · Abstract
Few studies tested preoperative visualizationAnswer: Describes
“Among the included studies, 5% dealt with preoperative visualization using AR, with user perception as the most frequently reported metric.”
5% of 80 studies
From the paper · Abstract
Evaluation metrics varied widely between studiesAnswer: Describes
“The results from this review revealed a large variability and low consistency in evaluation metrics used.”
Technical note presenting a prototype mixed-reality tool (Magic Leap) for setting virtual occlusion during orthognathic surgery planning, with a walkthrough of the workflow and a review of other virtual occlusion methods. The authors discuss its advantages and limitations.
“The overall time for this procedure takes less than 10 minutes.”
less than 10 min
From the paper · Fulltext
Conclusions (3)
Occlusion setting takes under 10 minutesAnswer: Describes
“The overall time for this procedure takes less than 10 minutes.”
less than 10 min
From the paper · Full text
Virtual workflow 30 min versus 90 minAnswer: Describes
“Compared to this, a full virtual workflow takes a third of the time with only 30 minutes.”
90 vs 30 min
From the paper · Full text
Reproducible planning after five to ten casesAnswer: Describes
“After five to ten cases (depending on prior experiences with mixed reality environments), case planning yields reproducible results within a reasonable timeframe.”
Stereo-EEG-guided network modulation for psychiatric disorders: Interactive holographic planning#
Noecker AM et al. · Brain stimulation · 2023
Neurosurgery · Technical development
Microsoft HoloLens
Technical report of HoloSNS, a holographic stereotactic neurosurgery research tool on HoloLens 2 with remote multi-headset networking. Patient-specific and atlas-based brain models were combined with connectomic hypotheses to plan stereo-EEG and DBS electrode placements for each patient in a depression trial (NCT03437928). The authors report that it allowed integration and group discussion of data beyond what conventional planning workstations support.
“The 3D nature of the surgical procedure, brain imaging data, and connectomic modeling results all highlighted the utility of employing holographic visualization to support the design of unique clinical experiments to explore brain network modulation with DBS.”
From the paper · Abstract
Models exceeded workstation data integrationAnswer: Describes
“which far exceed the data integration capabilities of traditional neurosurgical planning workstations”
From the paper · Abstract
Remote group planning reported easier, more convenientAnswer: Describes
“faster, easier, and more convenient (i.e. no travel, excellent group-based interactivity, and easier to schedule team meetings)”
Collaborative Virtual Reality Real-Time 3D Image Editing for Chest Wall Resections and Reconstruction Planning#
Feodorovici P et al. · Innovations (Philadelphia, Pa.) · 2023
Thoracic · Technical note · n: 2 patients
VR, platform not specified
Technique article on an immersive, real-time volume-rendered collaborative VR tool for planning chest wall resection and reconstruction, in which teams in separate locations can edit 3D images together, illustrated with two clinical cases. The authors suggest it may support more refined preoperative strategies and note that its advantage over conventional methods needs validation.
“Leveraging the capabilities of 3-dimensional (3D) imaging, real-time visualization, and collaborative VR environments, surgeons gain enhanced anatomical insights and can develop predictive surgical strategies.”
From the paper · Abstract
“However, its comparative advantage over traditional methods needs further empirical validation.”
Magnetic resonance imaging based neurosurgical planning on hololens 2: A feasibility study in a paediatric hospital#
Antonelli M et al. · Digital health · 2023
Neurosurgery · Feasibility study · n: 1 patient
Microsoft HoloLens
Custom Unity app
Feasibility study describing a workflow to load morphological, functional and diffusion MRI data from a paediatric patient into a HoloLens 2 mixed reality app built in Unity for neurosurgical planning. Four neurosurgeons rated the app by questionnaire, and the authors report high scores for its interactive features.
“We have successfully created a valuable and easy-to-use neuroimaging data mixed reality app, laying the foundation for more future clinical uses, as more models and data derived from various biomedical images can be imported.”
From the paper · Abstract
Conclusions (3)
Four surgeons rated the app positivelyAnswer: Yes
“Since all scores were greater than or equal to 4.75, it can be concluded that the neurosurgeons’ overall experiences of using HoloLens 2 were positive.”
all scores ≥ 4.75
From the paper · Full text
App response time averaged 129 msAnswer: Describes
“the app takes an average time of 129 ms to produce the output”
129 ms
From the paper · Full text
Frame rate fell below 15 FPSAnswer: Describes
“When the CPU exceeds 66 ms, the app goes under 15 frames per second (FPS).”
Virtual Reality Visualization of an Epidermoid Cyst Causing Intracranial Hypertension#
Reda AS et al. · The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques · 2023
Neurosurgery · Case report (image) · n: 1 patient
Co-authored by a Realize Medical founder.
Elucis
Image-based case report of an occipital intradiploic epidermoid cyst compressing the superior sagittal sinus and torcula in a patient with intracranial hypertension. 3D models were segmented in Elucis from a CT venogram and T1-weighted MRI to localise the cyst and map the surrounding neurovascular structures.
Narrative review of artificial intelligence, computational simulation and extended reality ('AISER') in cardiovascular interventions, covering preprocedural planning and decision-making, virtual clinical trials and device development, and education. The authors also discuss obstacles to adoption and possible solutions.
Preoperative planning using virtual reality and computed tomography angiogram in deep inferior epigastric perforator flap breast reconstruction#
Di Via Ioschpe A et al. · Journal of plastic, reconstructive & aesthetic surgery · 2023
Plastic & reconstructive · Validation study · n: 44 patients
VR, platform not specified
Retrospective study of 44 patients who had DIEP flap breast reconstruction, comparing perforators identified on conventional CTA with those identified in an immersive, interactive VR reconstruction of the same scans. The authors report strong correlation between the two methods for perforator location relative to the umbilicus, describe associations between perforator characteristics, and found VR planning easy to use and time-efficient.
“A correlation was found between the imaging modalities for unilateral (R = 0.96 (CI = 0.92, 0.98)) and bilateral (R = 0.93, (CI = 0.83, 0.97)) DIEP flap surgeries when comparing perforator location related to the umbilicus.”
R = 0.96
From the paper · Abstract
“Overall, preoperative planning using VR was easy to use, safe, more intuitive, and provided in a time-efficient manner, more information about perforant characteristics.”
From the paper · Abstract
Conclusions (2)
Perforator location correlated between VR and CTAAnswer: Yes
“A correlation was found between the imaging modalities for unilateral (R = 0.96 (CI = 0.92, 0.98)) and bilateral (R = 0.93, (CI = 0.83, 0.97)) DIEP flap surgeries when comparing perforator location related to the umbilicus.”
R = 0.96 unilateral, R = 0.93 bilateral
From the paper · Abstract
Authors found VR planning easy and intuitiveAnswer: Yes
“Overall, preoperative planning using VR was easy to use, safe, more intuitive, and provided in a time-efficient manner, more information about perforant characteristics.”
Preliminary Results of Preoperative Planning Using 3D Printing and Augmented Reality in Cryotherapy Treatment of Giant Cell Tumor of Bone-CRIO2AR Project#
D'Arienzo A et al. · Healthcare (Basel, Switzerland) · 2023
Orthopedics · Feasibility study · n: 1 patient
AR/MR, platform not specified
Preliminary report from CRIO2AR, an ongoing randomised prospective study of preoperative planning of cryotherapy probe placement with augmented reality and 3D printing for giant cell tumour of bone. Based on a single clinical case, the authors report that planning was reliable, replicable and useful to the surgeon.
“Secondly, preoperative planning is proving to be reliable, easily replicable, and useful for the surgeon.”
From the paper · Abstract
“The first results are confirming that these technologies are applicable in clinical practice.”
From the paper · Abstract
Conclusions (4)
Early results show clinical applicabilityAnswer: Yes
“The first results are confirming that these technologies are applicable in clinical practice.”
From the paper · Abstract
Planning judged useful to the surgeonAnswer: Yes
“Secondly, preoperative planning is proving to be reliable, easily replicable, and useful for the surgeon.”
From the paper · Abstract
Surgeon gave top score on listed itemsAnswer: Yes
“the surgeon expressed a score of 5 (extremely agree) to ITEMs 2-4-9-10-12-14-17-18 in all three clinical cases in which the preoperative planning was used.”
score of 5 (extremely agree), ITEMs 2-4-9-10-12-14-17-18
From the paper · Full text
Probe placement plan confirmed in theatreAnswer: Describes
“The placement planning was always confirmed in the operating room.”
Application of virtual and mixed reality for 3D visualization in intracranial aneurysm surgery planning: a systematic review#
Colombo E et al. · Frontiers in surgery · 2023
Neurosurgery · Systematic review
Multiple platforms
PRISMA systematic review of 28 studies using VR (18) or MR (10) for 3D visualization in intracranial aneurysm surgery. The authors report that 19 studies documented a positive impact on surgical planning (mostly tailoring of the approach), and that all reported better anatomical understanding.
“A positive impact on surgical planning was documented by 19 studies (67.9%)…”
67.9%
From the paper · Abstract
“A more precise anatomical visualization and understanding with VR and MR was endorsed by all included studies (100%).”
100%
From the paper · Abstract
Conclusions (3)
Positive planning impact in 19 of 28 studiesAnswer: Yes
“A positive impact on surgical planning was documented by 19 studies (67.9%): 17 studies (60.7%) chose the tailoring of the surgical approach as primary outcome of the analysis.”
19 studies (67.9%)
From the paper · Abstract
All included studies endorsed improved anatomical understandingAnswer: Yes
“A more precise anatomical visualization and understanding with VR and MR was endorsed by all included studies (100%).”
100%
From the paper · Abstract
No quantitative measures of added valueAnswer: Describes
“A relevant aspect emerging from the present analysis is the lack of measurable hardcore values to quantitatively examine the real added value of VR and MR applied to open IA surgery.”
Mixed reality in primary retroperitoneal tumour surgery: Evaluation of preoperative and intraoperative application value#
Shi X et al. · The international journal of medical robotics + computer assisted surgery · 2023
General & GI surgery · Comparative study · n: 92 patients
AR/MR, platform not specified
Comparative study of 46 patients who had mixed-reality-assisted primary retroperitoneal tumour resection (preoperative and intraoperative use) and 46 who had resection without MR. The authors report lower intraoperative blood loss in the MR group and higher Likert-scale ratings.
“The results of the Likert scale showed higher scores in the MR group than non-MR group.”
From the paper · Abstract
“There was a significant difference in the mean intraoperative bleeding volume between the two groups, but it was reduced in the MR group.”
From the paper · Abstract
Conclusions (1)
Intraoperative blood loss lower with MRAnswer: Yes
“There was a significant difference in the mean intraoperative bleeding volume between the two groups, but it was reduced in the MR group.”
Improving Visualization of Intramuscular Perforator Course: Augmented Reality Headsets for DIEP Flap Breast Reconstruction#
Seth I et al. · Plastic and reconstructive surgery. Global open · 2023
Plastic & reconstructive · Case series · n: 5 patients
Microsoft HoloLens
Case series of five patients undergoing DIEP flap breast reconstruction in whom a HoloLens 2 was used to identify perforators and map their extramuscular and intramuscular routes before surgery, with Doppler confirmation. The authors report successful identification of the perforators and their routes in all five cases.
“AR technology shows promise in enhancing perforator identification efficiency and deepening understanding of perforator trajectories during preoperative planning.”
From the paper · Abstract
“Nonetheless, additional research is needed to establish whether the advantages of AR technology warrant its widespread adoption for perforator identification.”
From the paper · Abstract
“In four cases, the piercing of the anterior fascia was perfectly aligned, as confirmed by sound Doppler.”
From the paper · Fulltext
Conclusions (4)
Perforators and routes identified in all five casesAnswer: Yes
“In all five cases, the AR device successfully identified preoperative perforators and delineated their extra- and intramuscular routes.”
From the paper · Abstract
Fascia piercing matched Doppler in four of fiveAnswer: Mixed
“In four cases, the piercing of the anterior fascia was perfectly aligned, as confirmed by sound Doppler.”
From the paper · Full text
Headset used in all five casesAnswer: Yes
“The AR headset was used in all five cases.”
From the paper · Full text
About 60 minutes to convert the CTAAnswer: Describes
“Engineers took approximately 60 minutes to convert the CTA for use with the AR headset.”
Feasibility study in 21 patients who underwent LAA closure, comparing LAA measurements made in VR (VMersive software on a Meta Quest 2) with conventional CT software. The authors report strong correlations for ostium and landing-zone diameters (r 0.80-0.93), and physicians rated 3D orientation better in VR.
“Three-dimensional orientation was judged superior by physicians in VR compared to MSCT (p < 0.05).”
p < 0.05
From the paper · Abstract
“Virtual reality visualization of the left atrium and appendage based on MSCT data is feasible and allows precise and reproducible measurements in planning of LAA occlusion procedures with enhanced 3D orientation.”
From the paper · Abstract
Conclusions (4)
VR and CT diameters strongly correlatedAnswer: Yes
“MSCT and VR ostium min. ( r = 0.93), max. ( r = 0.80) and mean ( r = 0.88, all p < 0.001) diameters as well as landing zone (LZ) min. ( r = 0.84), max. ( r = 0.86) and mean diameters ( r = 0.90, all p < 0.001) showed strong correlations.”
ostium r = 0.93, 0.80, 0.88; LZ r = 0.84, 0.86, 0.90; all p < 0.001
From the paper · Abstract
3D orientation rated higher in VR than CTAnswer: Yes
“Three-dimensional orientation was judged superior by physicians in VR compared to MSCT (p < 0.05).”
p < 0.05
From the paper · Abstract
VR measurements precise and reproducibleAnswer: Yes
“Virtual reality visualization of the left atrium and appendage based on MSCT data is feasible and allows precise and reproducible measurements in planning of LAA occlusion procedures with enhanced 3D orientation.”
From the paper · Abstract
Good to excellent intraobserver agreement in VRAnswer: Yes
“Measurements of LAA dimensions showed a good to excellent intraobserver agreement for all measurements with ICCs ranging from 0.88 to 0.97.”
How I do it? Preoperative Microsoft HoloLens 2 planning-assisted surgical clipping of a fetal posterior cerebral artery aneurysm#
Yan X et al. · Acta neurochirurgica · 2023
Neurosurgery · Case report · n: 1 patient
Microsoft HoloLens
'How I do it' report of a 72-year-old woman with an irregular fetal posterior cerebral artery aneurysm, in whom HoloLens 2 mixed reality was used for preoperative simulation and anatomical study before clipping. The authors report that the planned aneurysm-PCA relationship was identified during surgery and the patient recovered without complications.
“During the operation, we successfully identified the planned relationship between the aneurysm and the fetal PCA.”
From the paper · Abstract
“The patient was cured without any complications.”
From the paper · Abstract
Conclusions (2)
Planned aneurysm relationship found during surgeryAnswer: Yes
“During the operation, we successfully identified the planned relationship between the aneurysm and the fetal PCA.”
From the paper · Abstract
Patient recovered without complicationsAnswer: Describes
“The patient was cured without any complications.”
Applications of Extended Reality in Orthopaedic Surgery#
Nazzal EM et al. · The Journal of bone and joint surgery. American volume · 2023
Orthopedics · Narrative review
Multiple platforms
Narrative review in JBJS of extended reality (VR, AR and MR) in orthopaedic surgery. The authors state that immersive VR mainly benefits skills training, while AR and MR are better suited to preoperative planning and intraoperative use, and that evidence for these uses is still at an early stage.
Case report: Impact of mixed reality on anatomical understanding and surgical planning in a complex fourth ventricular tumor extending to the lamina quadrigemina#
Colombo E et al. · Frontiers in surgery · 2023
Neurosurgery · Case report · n: 1 patient
Augmedit Lumi
AR/MR, platform not specified
Case report of a 31-year-old woman with a tumour extending from the fourth ventricle to the lamina quadrigemina. An interactive mixed reality model (Lumi, Augmedit) was used with 2D images to choose an interhemispheric transtentorial approach, and 98% of the lesion was removed with good functional outcome.
“Through the combined use of routine 2D images and an interactive 3D anatomical model, an interhemispheric transtentorial approach was used to remove 98% of the lesion with successful functional outcomes.”
98%
From the paper · Abstract
“The application of advanced 3D visualization with a novel MxR system to the surgical planning of a complex fourth ventricular lesion proved relevant in designing the best surgical approach and trajectory to better identify potential intraoperative challenges and rehearse the patient-specific anatomy.”
From the paper · Abstract
Conclusions (3)
3D model helped design approach and trajectoryAnswer: Yes
“The application of advanced 3D visualization with a novel MxR system to the surgical planning of a complex fourth ventricular lesion proved relevant in designing the best surgical approach and trajectory to better identify potential intraoperative challenges and rehearse the patient-specific anatomy.”
From the paper · Abstract
98% of lesion removed, good functional outcomeAnswer: Describes
“Through the combined use of routine 2D images and an interactive 3D anatomical model, an interhemispheric transtentorial approach was used to remove 98% of the lesion with successful functional outcomes.”
98%
From the paper · Abstract
Hologram helped plan trajectory avoiding basal veinsAnswer: Yes
“The 3D holographic visualization greatly helped in planning and rehearsing a surgical trajectory that could avoid the risk of injury of the basal cerebral veins.”
3D Virtual modelling, 3D printing and extended reality for planning of implant procedure of short-term and long-term mechanical circulatory support devices and heart transplantation#
Stepanenko A et al. · Frontiers in cardiovascular medicine · 2023
Adult cardiac & structural heart · Case series · n: 6 patients (53 biomodels)
Microsoft HoloLens
VR, platform not specified
Single-centre experience (2019-2022) of 53 3D virtual biomodels made for planning interventions in advanced heart failure, viewed in VR/AR headsets (including HoloLens) and/or as 3D prints. Six complex cases are described: four had mechanical circulatory support implanted after this planning, and in two very high-risk cases heart transplantation was chosen instead.
“From November 2019 until February 2022, 53 3D virtual biomodels were produced for intervention planning (using Virtual/Augmented Reality and/or 3D printing), following a specific segmentation and preprocessing workflow for biomodelling, in patients with advanced heart failure due to structural heart disease or cardiomyopathies.”
From the paper · Abstract
“One short-term and three long-term ventricular assist device system were successfully clinically implanted after application of this technique.”
From the paper · Abstract
“In the cases presented, the final approach decided for each patient after 3D-based planning was improved when compared to the intention to treat recorded before 3D-based planning.”
From the paper · Fulltext
Conclusions (3)
Four support devices implanted after 3D planningAnswer: Describes
“One short-term and three long-term ventricular assist device system were successfully clinically implanted after application of this technique.”
From the paper · Abstract
Transplantation chosen in two very high-risk casesAnswer: Describes
“In other two cases with extremely high procedural risk, visualized after application of this multimodality imaging, heart transplantation was elected.”
From the paper · Abstract
Treatment plans revised after 3D-based planningAnswer: Yes
“In the cases presented, the final approach decided for each patient after 3D-based planning was improved when compared to the intention to treat recorded before 3D-based planning.”
Application of virtual reality in dental implants: a systematic review#
Monaghesh E et al. · BMC oral health · 2023
Dental · Systematic review
Multiple platforms
Systematic review of nine studies on virtual reality in dental implantology, seven on teaching and learning and two on implant planning. The authors report that head-mounted displays and Unity3D were most often used and that VR systems generally improved the skills of students and specialists.
“In almost all studies, the results showed that the use of virtual reality-based systems improves and enhances the skills of users, including dental students and specialists.”
From the paper · Abstract
“Although the use of VR technology is limited for various reasons such as cost, it can increase the skills of dental professionals in performing dental implants.”
From the paper · Abstract
Conclusions (2)
Most included studies reported improved user skillsAnswer: Yes
“In almost all studies, the results showed that the use of virtual reality-based systems improves and enhances the skills of users, including dental students and specialists.”
From the paper · Abstract
Experts accepted VR for planning several implantsAnswer: Yes
“The results of two studies that were conducted with the aim of implant planning procedure showed that virtual reality was accepted by experts and they were able to plan several implants satisfactorily.”
Systematic review of extended reality for preoperative planning of orbital fractures. Of 6,381 records, the authors identified four studies on educational use of VR and one prospective clinical study of AR, and report that AR improved incision accuracy and plate positioning, with a technical accuracy of 2 to 3 mm, while VR tools improved understanding of craniofacial trauma for education.
“AR was demonstrated to ameliorate the accuracy and precision of the incision and enable the better identification of deep anatomical tissues in real time.”
From the paper · Abstract
“However, the technical accuracy of 2-3 mm should be considered.”
2-3 mm
From the paper · Abstract
“VR-based educational tools provided better visualization and understanding of craniofacial trauma compared to conventional 2- or 3-dimensional images.”
From the paper · Abstract
“Preoperative planning time was longer compared to the conventional planning method.”
From the paper · Fulltext
Conclusions (4)
Planning time longer than conventional methodAnswer: No
“Preoperative planning time was longer compared to the conventional planning method.”
From the paper · Full text
Implant 0.432 mm from planned positionAnswer: Describes
“The average distance between the postoperative implant position and the virtually planned position was 0.432 mm.”
0.432 mm
From the paper · Full text
Technical accuracy of 2–3 mmAnswer: Describes
“However, the technical accuracy of 2–3 mm should be considered.”
2–3 mm
From the paper · Abstract
VR teaching aided trauma understanding over conventional imagesAnswer: Yes
“VR-based educational tools provided better visualization and understanding of craniofacial trauma compared to conventional 2- or 3-dimensional images.”
[Extended Reality (XR) - Applications in Thoracic Surgery]#
Feodorovici P et al. · Zentralblatt fur Chirurgie · 2023
Thoracic · Narrative review
Multiple platforms
German-language narrative overview of extended reality (VR, AR and MR) in thoracic surgery, covering treatment planning, navigation, training and patient information, current technical development and AI integration.
Mixed Reality Improves 3D Visualization and Spatial Awareness of Bone Tumors for Surgical Planning in Orthopaedic Oncology: A Proof of Concept Study#
Wong KC et al. · Orthopedic research and reviews · 2023
Orthopedics · Feasibility study · n: 9 patients
Microsoft HoloLens
Custom Unity app
Proof-of-concept study of nine patients with bone tumours, in whom the surgeon assessed each patient preoperatively both with conventional 2D images and with patient-specific holograms on a HoloLens 2 head-mounted display overlaid on the patient. The authors report better spatial awareness of the tumours, higher rated effectiveness for planning and lower NASA-TLX workload with MR, and no discomfort.
“The qualitative survey of the LS questionnaire suggested that the MR group had superior spatial awareness of tumors and was considered more effective as a preoperative planning tool than the conventional group.”
From the paper · Abstract
“For NASA-TLX scores, the overall cognitive workload was lower in MR 3D hologram group than in the 2D Group for preoperative clinical assessment.”
From the paper · Abstract
“When using MR technology with HMDs, the surgeon reported no discomfort.”
From the paper · Abstract
Conclusions (3)
MR rated higher for spatial awarenessAnswer: Yes
“The qualitative survey of the LS questionnaire suggested that the MR group had superior spatial awareness of tumors and was considered more effective as a preoperative planning tool than the conventional group.”
From the paper · Abstract
Cognitive workload lower with MRAnswer: Yes
“For NASA-TLX scores, the overall cognitive workload was lower in MR 3D hologram group than in the 2D Group for preoperative clinical assessment.”
From the paper · Abstract
Surgeon reported no discomfort with headsetAnswer: Describes
“When using MR technology with HMDs, the surgeon reported no discomfort.”
Virtual Reality for Preoperative Planning in Complex Surgical Oncology: A Single-Center Experience#
Lyuksemburg V et al. · The Journal of surgical research · 2023
General & GI surgery · Cohort study (retrospective + prospective) · n: 20 patients
Enduvo
HTC Vive
Single-centre study of 20 patients (7 retrospective, 13 prospective, 2018-2021) undergoing complex oncologic resections of the liver, pancreas, retroperitoneum, stomach or soft tissue. Plans made from 2D imaging and from VR models (Enduvo on an HTC Vive) were compared with the operation actually performed. In the prospective cases, plans made with VR matched the final operation more often than 2D plans (92% vs. 54% for the operating surgeon, 69% vs. 23% for a consulting surgeon), and surgeon confidence increased.
“Retrospectively, VRM were unable to be created in one patient due to a poor quality 2D image; the remainder (86%) were successfully able to be created and examined.”
86%
From the paper · Abstract
“The concordance of the operative plan with VRM was higher than with 2D imaging (92% versus 54% for the operating surgeon and 69% versus 23% for the consulting surgeon).”
92% versus 54%
From the paper · Abstract
“Confidence in the operative plan after VRM compared to 2D imaging also increased for both surgeons (by 15% and 8% for the operating and consulting surgeons, respectively).”
15%
From the paper · Abstract
Conclusions (3)
Plans matched the operation more often with VRAnswer: Yes
“The concordance of the operative plan with VRM was higher than with 2D imaging (92% versus 54% for the operating surgeon and 69% versus 23% for the consulting surgeon).”
92% versus 54% (operating surgeon), 69% versus 23% (consulting surgeon)
From the paper · Abstract
Surgeon confidence in the plan increasedAnswer: Yes
“Confidence in the operative plan after VRM compared to 2D imaging also increased for both surgeons (by 15% and 8% for the operating and consulting surgeons, respectively).”
15% and 8%
From the paper · Abstract
86% of retrospective VR models createdAnswer: Yes
“Retrospectively, VRM were unable to be created in one patient due to a poor quality 2D image; the remainder (86%) were successfully able to be created and examined.”
Virtual reality for transcatheter procedure planning in congenital heart disease#
Galeczka M et al. · Kardiologia polska · 2023
Congenital heart · Case report (image)
VR, platform not specified
Short article in Kardiologia Polska on the use of virtual reality to plan transcatheter procedures in congenital heart disease. No abstract was available, so these details are from the title and venue and could not be confirmed.
Conclusions (2)
Implanted stent matched the simulationAnswer: Yes
“corresponded well to the simulation.”
implanted 13.2 mm x 28 mm; simulated 13 mm x 27 mm
From the paper · Full text
Pressure gradient fell after stentingAnswer: Describes
Virtual reality and 3D printing in clinical anesthesia: a case series of two years' experience in a single tertiary medical centre#
Shaylor R et al. · Canadian journal of anaesthesia · 2023
Anesthesia & pain · Retrospective case series · n: 5 patients
VR, platform not specified
Retrospective case series of 20 patients referred over two years for 3D modelling to plan airway management at an anaesthesia department, 15 with 3D-printed models and 5 with VR reconstructions (three with mediastinal masses). The authors report that the model-based airway plan matched the final plan in 17 cases, with no anaesthetic complications.
“There were two cases (10%) where the model plan did not correlate with the final airway plan and one case where a model could not be created because of poor underlying imaging.”
10%
From the paper · Abstract
“Its routine use for patients with challenging airway anatomy correlated well with the final clinical outcome in most cases.”
From the paper · Abstract
“Three-dimensional modelling and subsequent printing or VR reconstruction are feasible in clinical anesthesia.”
From the paper · Abstract
Conclusions (3)
Model and final plans differed in two casesAnswer: Mixed
“There were two cases (10%) where the model plan did not correlate with the final airway plan and one case where a model could not be created because of poor underlying imaging.”
10%
From the paper · Abstract
No anesthetic complications in the seriesAnswer: Describes
“There were no anesthetic complications.”
From the paper · Abstract
3D modelling feasible in clinical anesthesiaAnswer: Yes
“Three-dimensional modelling and subsequent printing or VR reconstruction are feasible in clinical anesthesia.”
Virtual reality-based training and pre-operative planning for head and neck sentinel lymph node biopsy#
Feinmesser G et al. · American journal of otolaryngology · 2023
ENT / head & neck · Feasibility study · n: 21 patients
VR, platform not specified
Prospective pilot in which surgeons and residents used patient-specific VR models built from preoperative SPECT scans to examine anatomy before 21 sentinel lymph node biopsies for head and neck skin cancer, and then rated the models. Attending surgeons rated model accuracy 8.3/10, and 76% of residents reported increased confidence.
“The attending surgeons rated the VR model's accuracy at 8.3 ± 1.6 out of 10.”
8.3 ± 1.6
From the paper · Abstract
“Three-quarters (76%) of residents reported increased confidence after using VR.”
76%
From the paper · Abstract
“The physicians rated the platform's contribution to residents' training at 7.4 ± 2.1 to 8.9 ± 1.3 out of 10.”
From the paper · Abstract
Conclusions (3)
Attendings rated model accuracy 8.3 of 10Answer: Yes
“The attending surgeons rated the VR model's accuracy at 8.3 ± 1.6 out of 10.”
8.3 ± 1.6 out of 10
From the paper · Abstract
Most residents reported more confidenceAnswer: Describes
“Three-quarters (76%) of residents reported increased confidence after using VR.”
76%
From the paper · Abstract
Training contribution rated highly by physiciansAnswer: Yes
“The physicians rated the platform's contribution to residents' training at 7.4 ± 2.1 to 8.9 ± 1.3 out of 10.”
Spatial Computing for preoperative planning and postoperative evaluation of single-position lateral approaches in spinal revision surgery#
Elsayed GA et al. · Journal of craniovertebral junction & spine · 2023
Spine · Case report · n: 1 patient
VR, platform not specified
Case report of a 79-year-old man with thoracic myelopathy, pseudoarthrosis and malalignment after previous lumbar fusion, in whom a spatial computing platform with interactive reconstructed imaging was used to plan and evaluate a two-stage single-position lateral revision. The authors describe its use to assess pseudoarthrosis, the psoas and neurovascular structures, and graft sizing and trajectory.
“SC increases the familiarity of the patient's specific anatomy and enhances perioperative assessment.”
From the paper · Abstract
Conclusions (3)
Authors report increased familiarity with patient anatomyAnswer: Yes
“SC increases the familiarity of the patient's specific anatomy and enhances perioperative assessment.”
From the paper · Abstract
Used to plan a two-stage revisionAnswer: Yes
“In this case, SC was successfully used to plan for a two staged spinal revision surgery”
From the paper · Full text
Uneventful postoperative courseAnswer: Describes
“The patient had an uneventful postoperative course.”
Technical note describing the use of surface and volume object matching to compare prefabricated titanium meshes with patient-specific implants for an orbital floor fracture, with the results shown to the surgeon and patient preoperatively on mixed-reality devices. The authors discuss benefits for surgical decision-making, patient education and informed consent.
“The results could be visualized by mixed reality devices to further enhance surgical decision-making.”
From the paper · Abstract
“The data sets were demonstrated to the patient in mixed reality for immersive patient education and enhanced shared decision making.”
From the paper · Abstract
“Postoperatively, the patient showed no enophthalmos, double vision, or impairment of orbital mobility.”
From the paper · Fulltext
Conclusions (3)
Prefabricated mesh mismatch 1.5 mm on virtual fitAnswer: Describes
“The demonstration of the data sets revealed a mismatch of the pre-fabricated titanium mesh with a distance of 1.5 mm to the mirrored floor and a gap of 1.5 mm to the posterior ledge.”
1.5 mm to mirrored floor; 1.5 mm gap to posterior ledge
From the paper · Full text
Patient shown the plan in mixed realityAnswer: Describes
“The data sets were demonstrated to the patient in mixed reality for immersive patient education and enhanced shared decision making.”
From the paper · Abstract
No enophthalmos or double vision after surgeryAnswer: Describes
“Postoperatively, the patient showed no enophthalmos, double vision, or impairment of orbital mobility.”
Three-dimensional virtual reality in surgical planning for breast cancer with reconstruction#
De la Cruz-Ku G et al. · SAGE open medical case reports · 2023
Plastic & reconstructive · Case report · n: 1 patient
VR, platform not specified
Case report of a 36-year-old woman with breast cancer whose MRI was reconstructed in a virtual reality software platform (AVATAR MEDICAL) to assess tumour size and location, lymph nodes and vessels before nipple-sparing mastectomy with tissue expander reconstruction. The authors describe the 3D view as adding information about tumour distance from the skin and blood supply to standard imaging.
“The use of 3D-VR allowed us to rotate the MRI image and see it in three dimensions, which gave us an improved preoperative mental picture of the perforators and the tumors.”
From the paper · Fulltext
Conclusions (4)
Authors report clearer view of perforators and tumorsAnswer: Yes
“The use of 3D-VR allowed us to rotate the MRI image and see it in three dimensions, which gave us an improved preoperative mental picture of the perforators and the tumors.”
From the paper · Full text
Authors say VR may enhance planningAnswer: Describes
“the use of 3D virtual reality may enhance surgical planning and execution in the treatment of breast cancer and its reconstruction.”
From the paper · Full text
Negative margins on both tumorsAnswer: Describes
“Pathology confirmed negative margins for both tumors”
From the paper · Full text
No postoperative complicationsAnswer: Describes
“Post-operatively, the patient experienced no complications and progressed without incident.”
Fast-track virtual reality software to facilitate 3-dimensional reconstruction in congenital heart disease#
Bertelli F et al. · Interdisciplinary cardiovascular and thoracic surgery · 2023
Congenital heart · Validation study · n: 5 patients
Custom Unity app
Validation study of DIVA, a Unity-based software package with desktop and VR-headset modes, for quick 3D reconstruction in congenital heart disease. Five volunteers with no reconstruction experience used it to build heart models from MRI scans of five patients with partial anomalous pulmonary venous return, and the results were compared with an expert's reconstructions. The authors report good overall quality and improving speed and quality from the first case to the fifth.
“All our participants recreated 3D models in a relatively short time, maintaining a good overall quality (average quality score ≥ 3 on a scale of 1-5).”
From the paper · Abstract
“In this study, we demonstrated the potential use of DIVA by inexperienced users, with a significant improvement in quality and time after a few cases were performed.”
From the paper · Abstract
“Further studies are needed to confirm the potential application of this technology on a larger scale.”
From the paper · Abstract
Conclusions (3)
All novices built models in relatively short timeAnswer: Yes
“All our participants recreated 3D models in a relatively short time, maintaining a good overall quality (average quality score ≥ 3 on a scale of 1–5).”
From the paper · Abstract
Novice scores improved across five casesAnswer: Yes
“The variation of the scores over time was significant for all the parameters analysed: quality score ( P = 0.028), time ( P < 0.001), time score ( P < 0.001), adjusted score ( P < 0.001).”
quality P = 0.028; time P < 0.001
From the paper · Full text
Novice reconstruction time fell to 382 sAnswer: Describes
“The total scores obtained by the participants in case 5 were: quality score 4.2 ± 0.4; time 382 ± 62 s; time score 3.3 ± 0.5; adjusted score 3.8 ± 0.1.”
Real-time integration between Microsoft HoloLens 2 and 3D Slicer with demonstration in pedicle screw placement planning#
Pose-Díez-de-la-Lastra A et al. · International journal of computer assisted radiology and surgery · 2023
Spine · Technical development
Microsoft HoloLens
3D Slicer / SlicerVR
Custom Unity app
Technical development of a real-time link between 3D Slicer and a Unity AR application on Microsoft HoloLens 2 via OpenIGTLink, demonstrated for planning pedicle screw placement. Six volunteers planned screws with the AR system and a 2D desktop planner; the authors report low latency, non-inferior accuracy for AR (mean error 2.1 mm), 98% successful placements and a mean questionnaire score of 4.5/5.
“The AR method was non-inferior to the 2D desktop planner, with a mean error of 2.1 ± 1.4 mm.”
2.1 ± 1.4 mm
From the paper · Abstract
“Moreover, 98% of the screw placements performed with the AR system were successful, according to the Gertzbein-Robbins scale.”
98%
From the paper · Abstract
“Real-time communication between Microsoft HoloLens 2 and 3D Slicer is feasible and supports accurate planning for pedicle screw placement.”
From the paper · Abstract
Conclusions (3)
AR planning non-inferior to desktop plannerAnswer: Yes
“The AR method was non-inferior to the 2D desktop planner, with a mean error of 2.1 ± 1.4 mm.”
2.1 ± 1.4 mm
From the paper · Abstract
98% of AR screw placements successfulAnswer: Yes
“Moreover, 98% of the screw placements performed with the AR system were successful, according to the Gertzbein-Robbins scale.”
98%
From the paper · Abstract
Message latency low enough for real timeAnswer: Yes
“The latency in message exchange is sufficiently low to enable real-time communication between the platforms.”
Virtual Reality in Preoperative Planning of Complex Cranial Surgery#
Ruparelia J et al. · World neurosurgery · 2023
Neurosurgery · Survey/user study · n: 5 cases
ImmersiveTouch
Study in which 16 senior residents and fellows answered case questions on five complex cranial cases, first after viewing routine imaging and then after using the ImmersiveTouch VR system. The authors report improved scores after VR, particularly for vascular cases and for questions on surgical anatomy and approach, with positive feedback.
“There was overall positive feedback from participants regarding VR use, and most participants wanted VR to become a routine part of operative planning.”
From the paper · Abstract
“Our study shows that there is improvement in understanding of surgical aspects after use of this VR system.”
From the paper · Abstract
Conclusions (3)
Test scores improved after VR useAnswer: Yes
“There was an overall improvement in scores from pretest to posttest”
16.25 ± 2.70 vs 18.06 ± 3.51, P = 0.026
From the paper · Abstract
Larger gain for vascular than tumor casesAnswer: Describes
“This improvement was noted to be more for the vascular cases (15.89%) compared with the tumor cases (7.84%).”
15.89% vs 7.84%
From the paper · Abstract
Most participants wanted VR in routine planningAnswer: Yes
“most participants wanted VR to become a routine part of operative planning”
Exploring the Potential of Three-Dimensional Imaging, Printing, and Modeling in Pediatric Surgical Oncology: A New Era of Precision Surgery#
Valls-Esteve A et al. · Children (Basel, Switzerland) · 2023
General & GI surgery · Case series · n: 3 patients
Meta Quest / Oculus
Smartphone / tablet AR
Article examining 3D reconstruction (cinematic and volume rendering), CAD modelling, VR, AR and 3D printing for planning paediatric oncological surgery, illustrated with three cases: abdominal neuroblastoma, thoracic inlet neuroblastoma and bilateral Wilms tumour for nephron-sparing surgery. The authors compare the advantages and limitations of each technique.
“The results demonstrate that these new imaging and modeling techniques offer a promising alternative for planning complex pediatric oncological cases.”
From the paper · Abstract
Conclusions (4)
Authors call 3D techniques a promising planning alternativeAnswer: Describes
“The results demonstrate that these new imaging and modeling techniques offer a promising alternative for planning complex pediatric oncological cases.”
From the paper · Abstract
Authors call for structured validation before adoptionAnswer: Describes
“However, for the full adoption of these new technologies, structured validation is needed.”
From the paper · Full text
3D printed model cost by tumour typeAnswer: Describes
“For an NB, the average cost is EUR 461, while for a Wilms tumor case the cost is approximately EUR 130.”
EUR 461 (NB) and EUR 130 (Wilms tumor)
From the paper · Full text
VR described as cheaper than 3D printingAnswer: Describes
“VR constitutes a cheaper alternative when a 3D visualization and anatomy interaction can be of help.”
Optimizing Surgical Performance Using Preoperative Virtual Reality Planning: A Systematic Review#
Laskay NMB et al. · World journal of surgery · 2023
Multi-specialty · Systematic review
Multiple platforms
Systematic review (MEDLINE, Scopus and CINAHL to July 2022) of VR used for preoperative surgical-team planning and interdisciplinary communication across specialties. Thirteen studies of low-to-medium quality were included (mean MERSQI 10/18). The authors conclude that rehearsing patient-specific anatomy in VR may improve operative efficiency and communication.
“This review demonstrates that time spent rehearsing and visualizing patient-specific anatomical relationships in VR may improve operative efficiency and communication across multiple surgical specialties.”
From the paper · Abstract
Conclusions (2)
Review: VR rehearsal may improve operative efficiencyAnswer: Yes
“This review demonstrates that time spent rehearsing and visualizing patient-specific anatomical relationships in VR may improve operative efficiency and communication across multiple surgical specialties.”
From the paper · Abstract
Included studies of low-to-medium qualityAnswer: Describes
“These studies had a low-to-medium methodological quality with a MERSQI mean score of 10.04 out of 18 (standard deviation 3.61).”
Optimized preoperative planning of double outlet right ventricle patients by 3D printing and virtual reality: a pilot study#
Peek JJ et al. · Interdisciplinary cardiovascular and thoracic surgery · 2023
Congenital heart · Comparative study · n: 5 patients
CardioVR/MedicalVR
Retrospective pilot study of five patients with different subtypes of double-outlet right ventricle, whose CT data were shown to 12 congenital cardiac surgeons and paediatric cardiologists as 2D CT, 3D prints and 3D virtual reality models. The authors report that 3D methods showed spatial relationships better, that feasibility of VSD patch closure was judged best with VR (92% versus 66% for prints and 46% for ultrasound/CT), and that proposed plans matched the actual operation in 66%, 78% and 80% of assessments with 2D, 3D printing and VR respectively.
“Spatial relationships were generally better visualized using 3D methods (3D printing/3D-VR) than in 2D.”
From the paper · Abstract
“The feasibility of ventricular septum defect patch closure could be determined best using 3D-VR reconstructions (3D-VR 92%, 3D print 66% and US/CT 46%, P < 0.01).”
92%
From the paper · Abstract
Conclusions (3)
VSD patch feasibility assessable most often with VRAnswer: Yes
“The feasibility of ventricular septum defect patch closure could be determined best using 3D-VR reconstructions (3D-VR 92%, 3D print 66% and US/CT 46%, P < 0.01).”
3D-VR 92%, 3D print 66% and US/CT 46%, P < 0.01
From the paper · Abstract
Spatial relationships more visible in 3D than 2DAnswer: Yes
“Spatial relationships were generally better visualized using 3D methods (3D printing/3D-VR) than in 2D.”
From the paper · Abstract
Plans matched performed surgery in 66 to 80%Answer: Describes
“The percentage of proposed surgical plans corresponding to the performed surgical approach was 66% for plans based on US/CT, 78% for plans based on 3D printing and 80% for plans based on 3D-VR visualization.”
Echo-Endoscopy Combined with Virtual Reality: A Whole Perspective of Laparoscopic Common Bile Duct Exploration in Children#
Destro F et al. · Children (Basel, Switzerland) · 2023
General & GI surgery · Case series · n: 4 patients
3D Slicer / SlicerVR
Meta Quest / Oculus
Case series of 12 children with congenital biliary and pancreatic malformations managed with endoscopic ultrasound, ERCP and minimally invasive surgery, in four of whom the anatomy was studied and surgery simulated and shared with the team in a VR head-mounted display. The authors suggest preoperative VR allows better assessment of the malformation and tailored treatment.
“The introduction in the clinical practice of a preoperative study with Virtual Reality allows a better survey of the malformation and a tailored treatment.”
From the paper · Abstract
Conclusions (3)
Preoperative VR aids malformation survey and tailored treatmentAnswer: Yes
“The introduction in the clinical practice of a preoperative study with Virtual Reality allows a better survey of the malformation and a tailored treatment.”
From the paper · Abstract
VR showed accessory biliary branch missed on imagingAnswer: Yes
“In case 5, VR HMD permitted a faithful reproduction of the biliary tree by identifying an accessory branch unidentified with traditional imaging modalities.”
From the paper · Full text
VR model stimulated team discussionAnswer: Yes
“The accurate anatomical definition, specifically the biliary tree structure, stimulated the team discussion and favored decision-making.”
Workflow assessment of an augmented reality application for planning of perforator flaps in plastic reconstructive surgery: Game or game changer?#
Berger MF et al. · Digital health · 2023
Plastic & reconstructive · Feasibility study
Magic Leap
Grant-funded pilot of a hands-free AR goggle setup that superimposed trunk MR angiography onto patients to map perforator vessels before elective autologous breast reconstruction, with assessment of usability and development effort. The authors report intraoperative confirmation of all perforator locations, strong correlation with Doppler-based measurements, moderate-to-good usability (SUS 67) and 173 minutes per patient to make the AR projections ready.
“The overall usability (SUS) was 67 ± 10 (=moderate to good).”
67 ± 10
From the paper · Abstract
“The use of AR systems can provide new opportunities for future surgical planning, but has more potential for educational (e.g., patient information) or training purposes of medical under- and postgraduates (spatial recognition of imaging data associated with anatomical structures and operative planning).”
From the paper · Abstract
“The presented setup involved human interaction (no automation, no application programming interface used for data exchange among collaborators) in four different locations with a net workload of 173 min until clinical readiness on the AR system, and the evaluation considers therefore a pre-automation/implementation scenario.”
173 min
From the paper · Full text: Limitations
“We found a strong correlation between the MR-A projection and the 3D distance measurements (Spearman r = 0.894)”
Spearman r = 0.894
From the paper · Fulltext
Conclusions (4)
Usability moderate to good in seven evaluated patientsAnswer: Yes
“The overall usability (SUS) was 67 ± 10 (=moderate to good).”
SUS 67 ± 10
From the paper · Abstract
Strong correlation with Doppler-based distanceAnswer: Yes
“We found a strong correlation between the MR-A projection and the 3D distance measurements (Spearman r = 0.894)”
Spearman r = 0.894
From the paper · Full text
173 minutes per patient to clinical readinessAnswer: Describes
“The total implementation time was 173 min.”
173 min
From the paper · Full text
Not a candidate to replace conventional methodsAnswer: No
“Overall, the presented AR setup was assessed in a pilot study and was from a usability point of view at this stage no candidate to surrogate conventional methods for the experienced surgeons.”
Video-assisted thoracic surgery S7 segmentectomy: use of virtual reality surgical planning and simulated reality intraoperative modelling#
Bakhuis W et al. · Multimedia manual of cardiothoracic surgery · 2023
Thoracic · Case report (video/image) · n: 1 patient
VR, platform not specified
Surgical video article presenting a right video-assisted thoracoscopic segment 7 resection planned with preoperative virtual reality visualisation of the CT scan and guided during surgery by a soft-tissue dynamic lung model ('simulated reality').
Scoping review of 10 studies (2018 to 2021) on patient-specific, clinician-used VR and AR in plastic and craniomaxillofacial surgery, covering applications such as perforator flaps, breast reconstruction, craniosynostosis, auricular reconstruction and facial transplantation. The authors report that 60% of studies used VR/AR intraoperatively and 40% preoperatively, mostly with HoloLens or smartphones, and call for outcome-focused research.
“This review found consensus that VR/AR in plastic and craniomaxillofacial surgery has been used to enhance surgeons' knowledge of patient-specific anatomy and potentially facilitated decreased intraoperative time via preoperative planning.”
From the paper · Abstract
“However, further outcome-focused research is required to better establish the usability of this technology in everyday practice.”
From the paper · Abstract
Conclusions (3)
Review reports consensus on anatomy knowledgeAnswer: Yes
“This review found consensus that VR/AR in plastic and craniomaxillofacial surgery has been used to enhance surgeons' knowledge of patient-specific anatomy and potentially facilitated decreased intraoperative time via preoperative planning.”
From the paper · Abstract
60% of studies used VR/AR intraoperativelyAnswer: Describes
“More than half (60%) involved VR/AR use intraoperatively with the remainder (40%) examining preoperative use.”
60% intraoperative, 40% preoperative
From the paper · Abstract
Included studies lack quantitative comparisonsAnswer: Describes
“A common limitation of many of the studies included in this review is a lack of quantitative comparative analysis between VR/AR methods and gold standard techniques and a lack of prospective controlled studies.”
Systematic review of extended reality for planning and guiding procedures in structural and congenital heart disease. It identified at least 33 XR systems, many at proof-of-concept stage and few with stated regulatory approval, and notes that validation is limited and clinical benefit is hard to measure.
“At least 33 XR systems have been described, with many demonstrating proof of concept, but with no specific mention of regulatory approval including some prospective studies.”
From the paper · Abstract
Conclusions (2)
33 XR systems described, many proof of conceptAnswer: Describes
“At least 33 XR systems have been described, with many demonstrating proof of concept, but with no specific mention of regulatory approval including some prospective studies.”
From the paper · Abstract
Validation limited, clinical benefit hard to measureAnswer: Describes
“Validation remains limited, and true clinical benefit difficult to measure.”
Retrospective study of 20 patients who underwent left atrial appendage occlusion, comparing LAA orifice measurements from CCTA, VR derived from CCTA and TEE with the implanted device size. The authors report that the VR maximal-diameter measurement correlated best with device size (concordance 0.78).
“A VR visualization of the LAA ostium in different perspectives allows for a better understanding of its funnel-shaped structure.”
From the paper · Abstract
“VR measurement of the maximal ostium diameter had the strongest correlation with the diameter of the inserted device.”
From the paper · Abstract
Conclusions (3)
VR maximal diameter correlated most with device sizeAnswer: Yes
“VR measurement of the maximal ostium diameter had the strongest correlation with the diameter of the inserted device.”
CCTA 0.52, VR 0.78, TEE 0.60 (maximal diameter ρc)
From the paper · Abstract
VR aided understanding of funnel-shaped ostiumAnswer: Yes
“A VR visualization of the LAA ostium in different perspectives allows for a better understanding of its funnel-shaped structure.”
From the paper · Abstract
Maximal diameter mean differences from device sizeAnswer: Describes
“with mean differences of +0.92 ± 4.0 mm, −1.12 ± 2.3 mm, and −3.45 ± 2.69 mm, respectively.”
CCTA +0.92 ± 4.0 mm, VR −1.12 ± 2.3 mm, TEE −3.45 ± 2.69 mm
Use of Virtual Reality and Three-Dimensional Printing in the Surgical Planning of Slide Tracheoplasty#
Romero Lara DP et al. · World journal for pediatric & congenital heart surgery · 2023
Thoracic · Case series · n: 3 patients
VR, platform not specified
Experience report of three girls under five years of age with congenital tracheal stenosis in whom virtual reality and 3D-printed models were used to plan slide tracheoplasty. The authors report that the VR environment helped the surgical team agree the plan and improved radiologist-surgeon communication, and that rehearsal on 3D-printed models helped refine technique.
“The interaction within the VR environment allowed for collaboration of the surgical plan between surgical staff and enhancement of the radiologist-surgeon communication, while procedural simulation with 3D printing prototypes allowed for refining technical abilities for the surgical interventions.”
From the paper · Abstract
“Based on our experience, the application of these technologies have added value to the surgical planning of ST and its outcomes in the treatment of CTS.”
From the paper · Abstract
Conclusions (3)
VR aided surgical plan collaboration and radiologist communicationAnswer: Yes
“The interaction within the VR environment allowed for collaboration of the surgical plan between surgical staff and enhancement of the radiologist–surgeon communication”
“procedural simulation with 3D printing prototypes allowed for refining technical abilities for the surgical interventions”
From the paper · Abstract
Authors report added planning value, no comparatorAnswer: Describes
“Based on our experience, the application of these technologies have added value to the surgical planning of ST and its outcomes in the treatment of CTS.”
Study of an AR workflow on HoloLens 2, using its built-in infrared camera for tracking, to mark intracranial tumour outlines on the skin before resection, first in a phantom and then in a prospective clinical study with 12 surgeons and trainees, compared with conventional neuronavigation (Brainlab). The authors report registration errors under 2 mm and 2 degrees, and AR planning that was accurate, quicker and more intuitive.
“During phantom testing, registration errors remained below 2.0 mm and 2.0° for both AR-based navigation and conventional neuronavigation, with no significant difference between both systems.”
From the paper · Abstract
“AR-guided tumor delineation was deemed superior in 65% of cases, equally good in 30% of cases, and inferior in 5% of cases when compared to the conventional navigation system.”
65%
From the paper · Abstract
“The overall planning time (AR = 119 ± 44 s, conventional = 187 ± 56 s) was significantly reduced through the adoption of the AR workflow”
AR = 119 ± 44 s, conventional = 187 ± 56 s
From the paper · Abstract
Conclusions (3)
Planning time shorter with AR workflowAnswer: Yes
“The overall planning time (AR = 119 ± 44 s, conventional = 187 ± 56 s) was significantly reduced through the adoption of the AR workflow”
AR = 119 ± 44 s, conventional = 187 ± 56 s, p < 0.001
From the paper · Abstract
Delineation accuracy judged higher in 65% of casesAnswer: Yes
“AR-guided tumor delineation was deemed superior in 65% of cases, equally good in 30% of cases, and inferior in 5% of cases when compared to the conventional navigation system.”
65% superior, 30% equal, 5% inferior
From the paper · Abstract
Phantom registration errors not significantly differentAnswer: No significant difference
“During phantom testing, registration errors remained below 2.0 mm and 2.0° for both AR-based navigation and conventional neuronavigation, with no significant difference between both systems.”
Artificial intelligence and augmented reality for guided implant surgery planning: A proof of concept#
Mangano FG et al. · Journal of dentistry · 2023
Dental · Technical note
AR/MR, platform not specified
Proof-of-concept protocol for dental implant planning in which AI segments CBCT and aligns it with intraoral scans, the models are loaded into an AR system to plan implants with holograms, and a surgical guide is designed in open-source CAD software. The authors report that the protocol was effective and time-efficient for simple partially edentulous cases, with clinically acceptable placement precision.
“The precision of implant placement looks clinically acceptable, with minor deviations.”
From the paper · Abstract
“However, further clinical studies are needed to validate this protocol.”
From the paper · Abstract
Conclusions (3)
Protocol effective for simple partially edentulous casesAnswer: Yes
“This novel protocol is effective and time-efficient when used for planning simple cases of static guided implant surgery in the partially edentulous patient.”
[Study of virtual reality technology combined with reduction plasty of femoral head in treatment of coxa plana]#
Qiu Y et al. · Zhongguo xiu fu chong jian wai ke za zhi · 2023
Orthopedics · Case series · n: 3 patients
VR, platform not specified
Chinese study of three young men with coxa plana in whom CT-based virtual reality software was used to simulate the operation and plan femoral head reduction plasty with surgical dislocation and periacetabular osteotomy. The authors report that all operations were completed without complications and that pain, Harris hip scores and radiographic measures improved at 12 months.
“VR technology combined with reduction plasty of the femoral head can achieve satisfactory short-term effectiveness in the treatment of coxa plana.”
From the paper · Abstract
Conclusions (3)
Satisfactory short-term results in three patientsAnswer: Describes
“VR technology combined with reduction plasty of the femoral head can achieve satisfactory short-term effectiveness in the treatment of coxa plana.”
From the paper · Abstract
Actual osteotomy differed from plan by 1.53–3.02 mmAnswer: Describes
Pain and hip scores improved after surgeryAnswer: Describes
“The VAS score and Harris score at 12 months after operation and at last follow-up, as well as the femoral head rounding index, hip CE angle, and femoral head coverage at 12 months after operation significantly improved when compared with those before operation”
Harris 56, 52, 62 before vs 82, 86, 88 at 12 months
Virtual Resection Specimen Interaction Using Augmented Reality Holograms to Guide Margin Communication and Flap Sizing#
Necker FN et al. · Otolaryngology--head and neck surgery · 2023
ENT / head & neck · Cadaveric study
Microsoft HoloLens
Smartphone / tablet AR
Technical report of a method in which head and neck resection specimens are 3D-scanned with a smartphone, annotated and viewed on AR glasses, so the virtual specimen can be overlaid on the resection bed or flap donor site. In a cadaver workshop the authors projected annotated specimens into the resection bed within about 10 minutes and overlaid one on a flap harvest site to aid reconstructive planning.
“The 3D virtual specimen can be accurately superimposed onto surgical sites for orientation and sizing applications.”
From the paper · Abstract
“During an operative workshop, a surgeon using AR glasses projected virtual, annotated specimen models back into the resection bed onto a cadaver within approximately 10 minutes.”
10 minutes
From the paper · Abstract
Conclusions (3)
Scan to hologram took under 10 minutesAnswer: Describes
“The entire processing time from the 3D scan to the final 3D visualization on the HoloLens was under 10 minutes.”
Comparison of 17 patients whose STA-MCA bypass (mostly for moyamoya disease) was planned with VR models from CT angiography (donor, recipient, anastomosis site and craniotomy) and 13 controls planned conventionally. Planned branches were found intraoperatively in all 30 patients. The authors report no significant difference in procedure time or craniotomy size, and bypass patency of 94.1% vs. 84.6%.
“No significant difference were found in the procedure time or craniotomy size between the 2 groups.”
From the paper · Abstract
“Bypass patency was 94.1% for the VR group (16 of 17) and 84.6% for the control group (11 of 13).”
94.1% (16 of 17) vs 84.6% (11 of 13), P = 0.5575
From the paper · Abstract
Conclusions (3)
No significant difference in procedure timeAnswer: No significant difference
“No significant difference were found in the procedure time or craniotomy size between the 2 groups.”
From the paper · Abstract
Planned vessels found intraoperatively in all patientsAnswer: Yes
“For all 30 patients, the preoperatively planned donor and recipient branches were effectively translated intraoperatively.”
From the paper · Abstract
Bypass patency did not differ significantlyAnswer: No significant difference
“Bypass patency was 94.1% for the VR group (16 of 17) and 84.6% for the control group (11 of 13).”
Preoperative Mixed-Reality Visualization of Complex Tibial Plateau Fractures and Its Benefit Compared to CT and 3D Printing#
Bitschi D et al. · Journal of clinical medicine · 2023
Orthopedics · Survey/user study · n: 3 cases
Microsoft HoloLens
mediCAD Mixed Reality
Study in which 23 trauma surgeons from seven hospitals assessed three complex tibial plateau fractures using CT (with 3D reconstruction), mixed-reality visualisation (mediCAD Mixed Reality on HoloLens 2) and 3D prints, completing a questionnaire after each. The authors report that after MR viewing the ten-segment classification was adjusted in 78.6% of assessments and the planned approach in 33.9%, and that 82.1% rated MR as more beneficial than CT for understanding and planning.
“In addition, the intended patient positioning changed in 16.1% of the cases, the surgical approach in 33.9% and osteosynthesis in 39.3%.”
33.9%
From the paper · Abstract
“A total of 82.1% of the participants rated MRV as beneficial compared to CT regarding fracture morphology and treatment planning.”
82.1%
From the paper · Abstract
“Preoperative MRV of complex TPFs leads to improved fracture understanding, better treatment strategies and a higher detection rate of fractures in posterior segments, and it thus has the potential to improve patient care and outcomes.”
From the paper · Abstract
Conclusions (4)
Self-rated certainty in fracture morphology increasedAnswer: Yes
“Perceived certainty in the understanding of fracture morphology increased significantly after MRV compared to CT ( p < 0.001).”
p < 0.001
From the paper · Full text
Planned approach changed in a third of casesAnswer: Yes
“In addition, the intended patient positioning changed in 16.1% of the cases, the surgical approach in 33.9% and osteosynthesis in 39.3%.”
Virtual and Augmented Reality in Spine Surgery: A Systematic Review#
McCloskey K et al. · World neurosurgery · 2023
Spine · Systematic review
Multiple platforms
Systematic review of 48 studies on AR and VR in spine surgery, grouped into training (12), preoperative planning (5), intraoperative use (24) and radiation exposure (10). The authors report that preoperative VR planning influenced surgical recommendations and was associated with lower radiation exposure, operative time and blood loss, and that head-mounted displays were the most common intraoperative interface.
Three-dimensional technologies in presurgical planning of bone surgeries: current evidence and future perspectives#
Portnoy Y et al. · International journal of surgery (London, England) · 2023
Orthopedics · Narrative review
Multiple platforms
Narrative review of 61 studies (2014-2022) across five surgical disciplines on 3D printing, virtual reality and augmented reality for presurgical planning in bone surgery. The authors find 3D printing the most clinically advanced. VR lets surgeons set a plan and simulate the procedure on a screen or head-mounted display, and AR is mainly used for simulation on printed or virtual models.
“Overall, 3D technologies are gradually becoming an integral part of a surgeon's preoperative toolbox, allowing for increased surgical accuracy and reduction of operation time, mainly in complex and unique surgical cases.”
From the paper · Abstract
Conclusions (2)
Review concludes 3D tools reduce operation timeAnswer: Yes
“Overall, 3D technologies are gradually becoming an integral part of a surgeon’s preoperative toolbox, allowing for increased surgical accuracy and reduction of operation time, mainly in complex and unique surgical cases.”
From the paper · Abstract
3D printing most advanced in clinical useAnswer: Describes
“Among the mentioned technologies, 3D printing is currently the most advanced in terms of clinical use, predominantly creating anatomical models and patient-specific instruments that provide high-quality operative preparation.”
Virtual reality digital surgical planning for jaw reconstruction: a usability study#
Manzie T et al. · ANZ journal of surgery · 2023
ENT / head & neck · Survey/user study
VR, platform not specified
Pilot usability study in which 13 consultant reconstructive surgeons carried out a simulated planning session for jaw ablation and reconstruction on a new VR digital surgical planning platform, with questionnaires and qualitative interviews. The authors report above-average system usability and mostly positive experiences, with some perceived barriers to implementation.
“Based on the system usability score, the VR-DSP platform was found to have above average usability.”
From the paper · Abstract
“Participants identified some perceived barriers to implementing the VR-DSP platform.”
From the paper · Abstract
“Surgeons were able to perform the steps in an efficient time despite limited experience.”
From the paper · Abstract
Conclusions (3)
Usability rated above averageAnswer: Yes
“Based on the system usability score, the VR-DSP platform was found to have above average usability.”
From the paper · Abstract
Planning steps done in efficient timeAnswer: Yes
“Surgeons were able to perform the steps in an efficient time despite limited experience.”
From the paper · Abstract
Participants named barriers to implementationAnswer: Describes
“Participants identified some perceived barriers to implementing the VR-DSP platform.”
Experience report from a Spanish hepatobiliary-pancreatic surgery unit using augmented reality (HoloLens 2 with apoQlar HoloMedicine) since 2021. They used it to review 3D CT/MRI reconstructions for preoperative planning of complex cases, for remote holographic consultation and virtual guides during surgery, and for teaching. The authors report satisfactory experience but give no comparative data.
“For surgical planning, we have used 3D CT and MRI reconstructions to evaluate complex cases, which has made the interpretation of the anatomy more precise and the planning of the technique simpler.”
From the paper · Abstract
“As the experience has been satisfactory, augmented reality could be applied in the future to improve the results of hepatobiliary-pancreatic surgery.”
From the paper · Abstract
Conclusions (2)
Authors report clearer anatomy and simpler planningAnswer: Yes
“For surgical planning, we have used 3D CT and MRI reconstructions to evaluate complex cases, which has made the interpretation of the anatomy more precise and the planning of the technique simpler.”
From the paper · Abstract
Experience satisfactory, future benefit not measuredAnswer: Describes
“As the experience has been satisfactory, augmented reality could be applied in the future to improve the results of hepatobiliary-pancreatic surgery.”
[Digital Innovation for Lung Segmentectomy for Early-stage Small Lung Cancer]#
Omori T et al. · Kyobu geka. The Japanese journal of thoracic surgery · 2023
Thoracic · Experience report
VR, platform not specified
AR/MR, platform not specified
Japanese-language article describing one institution's approach to segmentectomy for small early-stage lung cancer, using 3D lung models made with SYNAPSE VINCENT, preoperative simulation with VR goggles, and mixed-reality goggles with ICG during surgery to identify the tumour and intersegmental planes. The authors describe current practice and future prospects.
HoloLens in Breast Reconstruction: What Is the Future?#
Masterton G et al. · Plastic and reconstructive surgery · 2023
Plastic & reconstructive · Technical note
Microsoft HoloLens
Technique article describing use of HoloLens AR to superimpose CTA images of the epigastric arteries and perforators onto the patient before incision for DIEP flap planning. The authors state that they did not use HoloLens for clinical decisions, and present it as a proof of concept of accuracy and ease of use.
“Although the authors did not use the HoloLens technology to make clinical decisions, they provide evidence of its accuracy and ease of use, offering a proof of concept.”
From the paper · Abstract
Conclusions (2)
Authors claim proof of concept, no outcomes measuredAnswer: Describes
“Although the authors did not use the HoloLens technology to make clinical decisions, they provide evidence of its accuracy and ease of use, offering a proof of concept.”
From the paper · Abstract
Describes CTA overlay for real-time planningAnswer: Describes
“This allows real-time surgical planning, increasing the value and tangibility of preoperative computed tomography angiography”
Using Virtual Reality for Deep Inferior Epigastric Perforator Flap Preoperative Planning#
Freidin D et al. · Plastic and reconstructive surgery. Global open · 2023
Plastic & reconstructive · Case series · n: 30 patients
HTC Vive
Prospective two-centre feasibility case series of 30 women having abdominal free-flap breast reconstruction, in which surgeons reviewed CTA and then a stereoscopic 3D VR model in a headset before surgery and compared the two by questionnaire. The authors report that surgeons ranked VR higher for anatomical understanding, that VR contributed to the surgical approach in over 70% of cases, and that it changed the strategy in four cases.
“In four cases, VR imaging modified the surgical strategy…”
From the paper · Abstract
“In 72.4% of cases, VR models were rated having maximum similarity to reality”
72.4%
From the paper · Abstract
“The surgeons ranked VR higher than CTA in terms of better anatomical understanding and operative anatomical findings.”
From the paper · Abstract
“According to the surgical records, the use of VR did not shorten the duration of the abdominal flap harvest, and the surgical procedure did not change”
From the paper · Fulltext
“In 86.21% of the cases, the surgeons rated VR as 5, thus indicating they would use the VR model as part of preoperative planning for their next procedure”
86.21%
From the paper · Fulltext
Conclusions (4)
Surgeons ranked VR easier to interpret than CTAAnswer: Yes
“there was a significant difference of 1.242 and a median difference of 2 between the preferred VR and CTA ranking (V = 19.5, P < 0.00001)”
V = 19.5, P < 0.00001
From the paper · Full text
VR mostly confirmed CTA-based plansAnswer: Mixed
“The VR served in most cases to confirm decisions that had already been made based on the CTA, and only supported a different clinical decision than the one based on the CTA in a few specific cases”
From the paper · Full text
VR did not shorten flap harvestAnswer: No
“According to the surgical records, the use of VR did not shorten the duration of the abdominal flap harvest, and the surgical procedure did not change”
From the paper · Full text
Surgeons would use VR for next caseAnswer: Yes
“In 86.21% of the cases, the surgeons rated VR as 5, thus indicating they would use the VR model as part of preoperative planning for their next procedure”
Advantages of a Training Course for Surgical Planning in Virtual Reality for Oral and Maxillofacial Surgery: Crossover Study#
Ulbrich M et al. · JMIR serious games · 2023
Oral & maxillofacial / craniofacial · Crossover study · n: 6 novices; 13 fibulae + 13 os coxae each (312 models)
Realize Medical is acknowledged in this paper for providing a free Elucis licence.
Elucis
HTC Vive
3D Slicer / SlicerVR
Crossover training study in which six novices learned to segment the fibula and hip bone (os coxae) from planning CT scans both in VR (Elucis v1.4 with an HTC Vive Pro) and on a desktop screen (3D Slicer). Each participant segmented 13 fibulae and 13 hip bones with each method (312 models in total). Learning curves, segmentation time and model quality (Hausdorff distance, Dice coefficient and blinded review by two radiologists) were assessed, together with participant questionnaires.
Qualitative evaluation in which six cardiologists tested web-based 3D visualization, VR (the VRIDAA platform on an HTC Vive Pro), computational fluid simulations and 3D printing on preoperative data from five patients, for planning left atrial appendage occluder implantation. The study reports the usability, limitations and requirements of each technology and the need to integrate them into one workflow.
“The obtained results demonstrate the potential impact of advanced visual computing solutions and 3D printing to improve the planning of LAAO interventions as well as the need for their integration into a single workflow to be used in a clinical environment.”
From the paper · Abstract
Conclusions (4)
Only 2/6 clinicians included VR in workflowAnswer: No
“The VR platform, VRIDAA, was included in the workflow by only 2/6 clinicians; both used it for regular and complex planning, while half of the participants would use 3D printing.”
2/6 clinicians
From the paper · Full text
VR setup unsuitable for most hospitalsAnswer: No
“The evaluated VR setup that requires a certain allocated physical space is not adequate for use in most hospitals.”
From the paper · Full text
Selected device often differed from implanted deviceAnswer: Describes
“generally (63% of the times) not matching the implanted one”
63%
From the paper · Full text
Web platform scored highest usabilityAnswer: Describes
“The web-based VIDAA platform was the best technology, according to the participants, with an average score of 78.13”
The Minimally Invasive Lateral Occipital Infracortical Supra-/Transtentorial Approach in Surgery of Lesions of the Pineal Region: A Possible Alternative to the Standard Approaches#
Feigl GC et al. · World neurosurgery · 2023
Neurosurgery · Case series · n: 7 patients
VR, platform not specified
Surgical technique report of 7 consecutive pineal-region lesions removed via a minimally invasive lateral occipital infracortical supra-/transtentorial approach. The authors state that preoperative 3D and VR modelling, together with a special retractor, helped reduce the size of the approach, and report complete removal without new permanent deficits.
Conclusions (4)
No new permanent deficits in 7 patientsAnswer: Describes
“All patients underwent surgery for removal of a lesion in the pineal region and suffered from no new and permanent neurological deficits postoperatively.”
From the paper · Abstract
Mean craniotomy size 2.3 × 1.85 cmAnswer: Describes
“The mean size of the craniotomies was 2.3 × 1.85 cm.”
2.3 × 1.85 cm
From the paper · Abstract
Approach usable for pineal tumour removalAnswer: Yes
“The minimally invasive lateral OICST approach described by us can be successfully used in the surgery of pineal neoplasms.”
“Preoperative 3-dimensional and virtual reality-modeling and the use of a special retractor also contributed to reducing the size of the surgical approach.”
Mixed Reality in Modern Surgical and Interventional Practice: Narrative Review of the Literature#
Vervoorn MT et al. · JMIR serious games · 2023
Multi-specialty · Narrative review
Multiple platforms
Narrative review of 57 studies (technology readiness level 5 or higher) on mixed reality in surgery and interventional practice, grouped into preoperative/interventional planning, intraoperative guidance, and training. The authors describe experience as generally positive, mainly through efficiency gains, with limitations due to head-mounted display hardware.
“Limitations primarily seem to be related to constraints associated with head-mounted display.”
From the paper · Abstract
Conclusions (3)
Overall experience with mixed reality positiveAnswer: Yes
“The overall experience with MR is positive.”
From the paper · Abstract
Benefits seem tied to improved efficiencyAnswer: Yes
“The main benefits of MR seem to be related to improved efficiency.”
From the paper · Abstract
Head-mounted display constraints are the main limitationAnswer: Describes
“Limitations primarily seem to be related to constraints associated with head-mounted display.”
Immersive Virtual Reality for Patient-Specific Preoperative Planning: A Systematic Review#
Lan L et al. · Surgical innovation · 2023
Multi-specialty · Systematic review
Multiple platforms
Systematic review (2000 to March 2021) of immersive VR for patient-specific preoperative planning. It includes 24 studies covering 264 clinicians and 460 patients, with neurosurgery the most common discipline. The authors found no significant effect on operative time, blood loss, complications or length of stay, but improvements in surgeons' strategy, anatomical understanding and confidence. Study quality was low (mean QATSDD 32.9%).
“Preoperative iVR did not significantly improve patient-specific outcomes of operative time, blood loss, complications, and length of stay, but may decrease fluoroscopy time.”
From the paper · Abstract
“In contrast, iVR improved surgeon-specific outcomes of surgical strategy, anatomy visualization, and confidence.”
From the paper · Abstract
Conclusions (3)
Patient outcomes not improved; fluoroscopy time may fallAnswer: Mixed
“Preoperative iVR did not significantly improve patient-specific outcomes of operative time, blood loss, complications, and length of stay, but may decrease fluoroscopy time.”
From the paper · Abstract
Surgeon strategy, anatomy view and confidence improvedAnswer: Yes
“In contrast, iVR improved surgeon-specific outcomes of surgical strategy, anatomy visualization, and confidence.”
From the paper · Abstract
Included studies were of low qualityAnswer: Describes
“The mean QATSDD score of included studies was 32.9%.”
Feasibility and clinical value of virtual reality for deep infiltrating pelvic endometriosis: A case report#
Martel C et al. · Journal of gynecology obstetrics and human reproduction · 2023
Gynecology · Case report · n: 1 patient
VR, platform not specified
Case report of a 42-year-old woman with deep infiltrating pelvic endometriosis in whom an MRI-derived 3D surface-rendered model was created for preoperative planning and compared retrospectively with the operative findings. The authors report that the model clearly defined the nodule's relationship to the uterus and rectum and matched the surgical findings, and suggest that VR based on such models could help plan complex surgery.
“The nodule's location and relationship to the uterus and the rectum was clearly defined by the 3D model and correlated with surgical findings.”
From the paper · Abstract
Conclusions (1)
3D model matched surgical findings in one caseAnswer: Yes
“The nodule's location and relationship to the uterus and the rectum was clearly defined by the 3D model and correlated with surgical findings.”
Essential Surgical Plan Modifications After Virtual Reality Planning in 50 Consecutive Segmentectomies#
Bakhuis W et al. · The Annals of thoracic surgery · 2023
Thoracic · Prospective cohort · n: 50 patients
PulmoVR
Prospective study of 50 consecutive patients scheduled for pulmonary segmentectomy, in which three surgeons made a plan from CT and then reviewed a 3D VR visualisation of segments and bronchovascular structures in PulmoVR. The authors report that the surgical plan was changed in 52% of patients (different tumour segment in 14%, more lung-sparing resection in 10%, extended resection in 28%) and that resection was radical in 98%.
“After supplemental VR visualization, the surgical plan was adjusted in 52%”
52%
From the paper · Abstract
“Pathologic examination confirmed radical resection in 49 patients (98%).”
49 patients (98%)
From the paper · Abstract
Conclusions (3)
Surgical plan changed in 52% of patientsAnswer: Yes
“After supplemental VR visualization, the surgical plan was adjusted in 52%”
52%
From the paper · Abstract
Types of plan change after VRAnswer: Describes
“the tumor was localized in a different segment in 14%, more lung-sparing resection was planned in 10%, and extended segmentectomy, including 1 lobectomy, was planned in 28%”
14%, 10%, 28%
From the paper · Abstract
Radical resection confirmed in 49 of 50Answer: Describes
“Pathologic examination confirmed radical resection in 49 patients (98%).”
Mixed reality for the assessment of aortoiliac anatomy in patients with abdominal aortic aneurysm prior to open and endovascular repair: Feasibility and interobserver agreement#
Hatzl J et al. · Vascular · 2023
Vascular · Validation study · n: 50 patients
Brainlab Elements
Feasibility study in which two experienced observers assessed 50 preoperative CT angiograms of patients with abdominal aortic aneurysm in the Brainlab Mixed Reality Viewer and on a conventional 2D DICOM viewer using a standard protocol. The authors report that all scans could be displayed, with equal or better interobserver agreement in MR for calcification, tortuosity and dilatation, but better agreement for patency and detection of more lumbar arteries with the conventional viewer.
“All CTAs could successfully be displayed in the MRV (100%).”
100%
From the paper · Abstract
“The MRV demonstrated equal or better IA in the assessment of anterior and posterior calcification (κMRV: 0.68 and 0.61, κCV: 0.33 and 0.45, respectively) as well as tortuosity (κMRV: 0.60, κCV: 0.48) and dilatation (κMRV: 0.68, κCV: 0.67).”
From the paper · Abstract
“The CV also identified significantly more lumbar arteries (CV: 379, MRV: 239, p < 0.01).”
p < 0.01
From the paper · Abstract
Conclusions (3)
All CT angiograms displayed in mixed realityAnswer: Yes
“All CTAs could successfully be displayed in the MRV (100%).”
100%
From the paper · Abstract
Interobserver agreement equal or higher in MRAnswer: Yes
“The MRV demonstrated equal or better IA in the assessment of anterior and posterior calcification (κMRV: 0.68 and 0.61, κCV: 0.33 and 0.45, respectively) as well as tortuosity (κMRV: 0.60, κCV: 0.48) and dilatation (κMRV: 0.68, κCV: 0.67).”
From the paper · Abstract
Conventional viewer found more lumbar arteriesAnswer: No
“The CV also identified significantly more lumbar arteries (CV: 379, MRV: 239, p < 0.01).”
The use of mixed reality for the treatment planning of unruptured intracranial aneurysms#
Stifano V et al. · Journal of neurosurgical sciences · 2023
Neurosurgery · Case series · n: 5 patients
Microsoft HoloLens
Prospective series of 5 patients with 8 unruptured intracranial aneurysms, in which HoloLens holographic models were used to plan surgical clipping. Ten surgeons and residents rated the platform by questionnaire; they valued it for education, positioning and craniotomy planning, but found the device not easy to use and uncomfortable over long periods.
“The graphic performance was also deemed very satisfactory.”
From the paper · Abstract
“On the other hand, the device was evaluated as not easy to use and pretty uncomfortable when worn for a long time.”
From the paper · Abstract
Conclusions (2)
Graphic performance rated very satisfactoryAnswer: Yes
“The graphic performance was also deemed very satisfactory.”
From the paper · Abstract
Device not easy to use, uncomfortableAnswer: No
“On the other hand, the device was evaluated as not easy to use and pretty uncomfortable when worn for a long time.”
Transcortical endoportal subchoroidal endoscope-assisted approach to the third ventricle: from virtual reality to anatomical laboratory#
Donofrio CA et al. · Journal of neurosurgical sciences · 2023
Neurosurgery · Technical development (cadaveric)
Surgical Theater
Anatomical study in which a new transcortical endoportal subchoroidal endoscope-assisted approach to the third ventricle was planned and measured in VR (Surgical Theater), then carried out on cadaver specimens with a portal system. The authors report surgical depths, portal working area and endoscopic reach, and support step-by-step VR planning followed by dissection.
CSANZ 2023 abstract on 3D holographic virtual reality imaging to evaluate aortic valve leaflet reconstruction with three same-sized autologous pericardial leaflets. Title-only record: no abstract was openly available from the sources searched, so details could not be confirmed.
Applications of 3-dimensional virtual reality models (Ceevra®) for surgical planning of robotic surgery#
Emmerling M et al. · Urology Video Journal · 2023
Urology · Case report (video)
Ceevra Reveal
Urology Video Journal article showing applications of 3D virtual reality models (Ceevra) for planning robotic surgery. Title-only record: no abstract was openly available from the sources searched, so details could not be confirmed.
Comparison of a VR Stylus with a Controller, Hand Tracking, and a Mouse for Object Manipulation and Medical Marking Tasks in Virtual Reality#
Rantamaa HR et al. · Applied Sciences · 2023
Dental · Survey/user study
VR, platform not specified
Experiment comparing a mouse, hand tracking and a VR stylus combined with a grab-enabled controller for object manipulation and landmark marking tasks in VR surgery planning. The authors report the stylus-controller combination was preferred and the mouse was most accurate.
“The combination of stylus and controller was the most preferred interaction method.”
From the paper · Abstract
“In the objective results, the mouse interaction method was the most accurate.”
From the paper · Abstract
Conclusions (2)
Stylus plus controller most preferred methodAnswer: Yes
“The combination of stylus and controller was the most preferred interaction method.”
From the paper · Abstract
Mouse most accurate interaction methodAnswer: No
“In the objective results, the mouse interaction method was the most accurate.”
Development of a mixed reality application to simulate neurosurgical procedures#
Hari K et al. · Medical Imaging · 2023
Neurosurgery · Technical development
Microsoft HoloLens
SPIE Medical Imaging paper on a Microsoft HoloLens application for neurosurgical planning and teaching in which surgeons view head, brain and tumour holograms, register them to the head and mark a craniotomy plan with a virtual or optically tracked stylus. Practising neurosurgeons were interviewed after a demonstration to assess design and usefulness.
“Initial responses indicated that the prototype could be an effective surgical teaching and planning tool for less-experienced neurosurgeons because it could allow neurosurgeons to view physical and image space simultaneously.”
From the paper · Abstract
Conclusions (1)
Surgeons rated prototype useful for teaching and planningAnswer: Yes
“Initial responses indicated that the prototype could be an effective surgical teaching and planning tool for less-experienced neurosurgeons because it could allow neurosurgeons to view physical and image space simultaneously.”
Development of Holoeyes Holographic Image-Guided Surgery and Telemedicine System: Clinical Benefits of Extended Reality (Virtual Reality, Augmented Reality, Mixed Reality), The Metaverse, and Artificial Intelligence in Surgery with a Systematic Review#
Sugimoto M, Sueyoshi T · Medical Research Archives · 2023
Multi-specialty · Narrative review
Holoeyes MD
Article by the Holoeyes developers describing the Holoeyes web-based XR system and the Holoeyes MD medical device for surgical planning, navigation and metaverse conferencing, with a literature review of its use. The authors state that it has been used in many institutions for conferences and surgical planning.
Evaluation Of Mixed Reality Technology In Shoulder Arthroplasty: From Preoperative Planning To Surgical Execution#
Launay MM et al. · Journal of Shoulder and Elbow Surgery (meeting abstract) · 2023
Orthopedics · Conference abstract
AR/MR, platform not specified
Meeting abstract (Journal of Shoulder and Elbow Surgery) evaluating mixed-reality technology in shoulder arthroplasty from preoperative planning to surgical execution. Title-only record: no abstract was openly available from the sources searched, so details could not be confirmed.
Preprint presenting automated reconstruction and segmentation of a patient's heart from DICOM data, flow simulation and a 3D-printed model, combined in a VR environment for developing preoperative strategies, demonstrated on a coarctation of the aorta case. The authors report that the VR environment improved procedural understanding before the operation.
Conclusions (3)
Flow simulation and heart model shown in VRAnswer: Describes
“The outcomes of the computation analysis coupled with the automatically reconstructed and segmented patient-specific 3D model are inserted in a Virtual Reality (VR) environment, where the clinicians can visualize the blood flow at the vessel walls and train on real-life medical scenarios”
From the paper · Abstract
3D-printed heart replicated mechanics and geometryAnswer: Describes
“the 3D printed heart possesses an adequate mechanical response replicating the mechanical properties as well as the geometrical characteristics of the investigated human heart”
From the paper · Abstract
Software module built from DICOM data aloneAnswer: Describes
“The present study introduced a robust software module for inspecting human hearts, aiding that way the medical doctors on the optimal preoperative assessment of patients with heart diseases using as input only the DICOM data of the examined patient.”
Study of 58 patients having breast lumpectomy, randomly allocated to mixed-reality 3D reconstruction (whole-breast ultrasound fused with MRI) or CT, assessing doctor-patient communication, preoperative planning and intraoperative localisation. The authors report higher patient knowledge and satisfaction and greater surgeon satisfaction with planning and localisation in the mixed-reality group.
“In addition, doctors were significantly more satisfied with surgical planning and intraoperative localization when the MR technique was used (T = 8.273; P < 0.01 ).”
T = 8.273
From the paper · Abstract
“The use of MR technology in lumpectomy has improved patients’ understanding of surgical procedures and surgical results and has achieved positive results.”
From the paper · Abstract
Conclusions (2)
Surgeons more satisfied with planning and localizationAnswer: Yes
“In addition, doctors were significantly more satisfied with surgical planning and intraoperative localization when the MR technique was used (T = 8.273; P < 0.01 ).”
T = 8.273, P < 0.01
From the paper · Abstract
Authors report improved patient understanding of surgeryAnswer: Yes
“The use of MR technology in lumpectomy has improved patients’ understanding of surgical procedures and surgical results and has achieved positive results.”
PRISMA systematic review of head-mounted mixed-reality displays for surgical training and planning, which found only 12 eligible comparative studies (nine RCTs). The authors report some learning benefit for training and little to no evidence that MR headsets improve planning over traditional methods.
“Regarding training, even if there is evidence demonstrating learning benefits, these do not seem to transpose to real environments.”
From the paper · Abstract
“Regarding planning, we see little-to-no evidence supporting MR-HMDs compared with traditional methods.”
From the paper · Abstract
Conclusions (2)
Little evidence headsets help planningAnswer: No
“Regarding planning, we see little-to-no evidence supporting MR-HMDs compared with traditional methods.”
From the paper · Abstract
Learning benefits seem not to reach real settingsAnswer: Mixed
“Regarding training, even if there is evidence demonstrating learning benefits, these do not seem to transpose to real environments.”
Interaction models for surgical planning in eXtended Reality. Challenges in radiologist-surgeon communication#
Latorre-Rojas et al. et al. · 2023 IEEE Conference on Virtual Reality and 3D User Interfaces Abstracts and Workshops (VRW) · 2023
Multi-specialty · Conference paper (qualitative)
Realize Medical is acknowledged in this paper for providing a trial version of Elucis.
Multiple platforms
Preliminary conference paper based on observations of and interviews with one surgeon and one radiologist who had used immersive XR for surgical planning, on interaction models for radiologist-surgeon communication in XR, with a review of existing medical imaging XR software against these needs.
Preparing for the future of cardiothoracic surgery with virtual reality simulation and surgical planning: a narrative review#
Bakhuis W et al. · Shanghai Chest · 2023
Thoracic · Narrative review
Multiple platforms
Non-systematic narrative review (MEDLINE, November 2022) of head-mounted VR for training, simulation and preoperative planning in cardiac and thoracic surgery; screen-based VR, AR and 3D printing were excluded. It presents the state of the art and a future outlook.
“There are many areas where VR planning is having an impact on daily clinical practice, especially in the congenital cardiac surgery and sub-lobar lung resections, where surgeons have touted VR planning as the biggest advancement since the advent of CT scans in the 1970s (67).”
From the paper · Full text: main text
“In the last years a lot of improvements have been made of the HMDs, however, they can still be uncomfortable, causing dizziness, headaches, or forms of motion sickness (73-75).”
From the paper · Full text: main text
Conclusions (2)
No large-scale efficacy trials yetAnswer: Describes
“The path to validate these simulators is well described, but large-scale trials producing high-level evidence for their efficacy are absent as of yet.”
From the paper · Abstract
Planning evidence is small tools and pilot studiesAnswer: Describes
“there are many small-scale tools available, and many case/pilot studies have been published”
The Expanding Uses of Medical Extended Reality in the Cardiac Catheterization Laboratory: Pre-procedural Planning, Intraprocedural Guidance, and Intraprocedural Navigation#
Review of medical extended reality in the cardiac catheterization lab, covering pre-procedural planning, intraprocedural planning and guidance in diagnostic catheterization, valve and coronary interventions, electrophysiology and device implants.
Virtual simulations in planning intravascular treatment of aortic coarctation - a retrospective analysis#
Topuzov N et al. · Postepy w kardiologii interwencyjnej · 2022
Congenital heart · Retrospective case series · n: 20 patients
Meta Quest / Oculus
Retrospective blinded analysis of CT scans from 20 patients treated with stents for aortic coarctation, in which virtual stent simulations were assessed in Materialise Mimics Viewer on a virtual reality headset (Oculus Quest, per the full text) and compared with the stents actually implanted. The authors report identical or very similar stent choices in 5 cases, slight misestimations in 12 and larger differences in 3, with stent location concordant in 14 cases.
“Overall, in 14 cases the location of the stent was concordant between the simulation and reality and in the remaining 6 cases the simulated stent was located lower than the actual one.”
From the paper · Abstract
“The method of computer modelling provided a satisfactory success rate of predicting the possible stents to use during the procedure.”
From the paper · Abstract
Conclusions (4)
Stent choice optimal in 5 of 20 casesAnswer: Mixed
“In 5 cases identical or very similar stents were proposed, in 12 cases simulations had slight, potentially avoidable misestimations either in stent length or diameter, and in 3 cases differences were more considerable.”
5 identical or very similar, 12 slight misestimations, 3 considerable differences
From the paper · Abstract
Stent location matched in 14 of 20Answer: Mixed
“Overall, in 14 cases the location of the stent was concordant between the simulation and reality and in the remaining 6 cases the simulated stent was located lower than the actual one.”
14 concordant, 6 lower
From the paper · Abstract
Identical stent diameter in just over halfAnswer: Mixed
“A stent with identical diameter was chosen in 11 (55%) cases”
11 (55%)
From the paper · Full text
Identical stent length in one fifthAnswer: Mixed
“only in 4 (20%) cases was a stent with exactly the same length proposed.”
Case report of thoracoscopic ablation in a patient with atrial fibrillation and a persistent left superior vena cava, in which preprocedural VR simulation confirmed the feasibility of the thoracoscopic approach. The authors report successful box-lesion, SVC-IVC line, appendage excision and PLSVC ablation.
“After preprocedural simulation using virtual reality, we successfully completed box-lesion, ablation line from superior vena cava to inferior vena cava, left atrial appendage (LAA) excision, and PLSVC ablation.”
From the paper · Abstract
Conclusions (3)
Planned ablation lesion set completed after VR simulationAnswer: Describes
“After preprocedural simulation using virtual reality, we successfully completed box-lesion, ablation line from superior vena cava to inferior vena cava, left atrial appendage (LAA) excision, and PLSVC ablation.”
From the paper · Abstract
VR simulation confirmed thoracoscopic approach was feasibleAnswer: Yes
“a preprocedural simulation of thoracoscopic ablation using virtual reality was performed and it verified the feasibility of the thoracoscopic approach”
From the paper · Full text
Sinus rhythm at 12-month follow-upAnswer: Describes
“At the 12-month follow-up, the electrocardiogram showed sinus and rhythmic rhythm.”
Preoperative visualization of congenital lung abnormalities: hybridizing artificial intelligence and virtual reality#
Bakhuis W et al. · European journal of cardio-thoracic surgery · 2022
Thoracic · Feasibility study · n: 5 patients
CardioVR/MedicalVR
PulmoVR
Feasibility study of combined AI segmentation and VR visualisation of segment-level lung anatomy in five children with asymptomatic congenital lung abnormalities, in which two specialists compared CT with 3D VR images. The authors report that the specialists agreed on lesion segment in 1 of 5 cases with CT and 3 of 5 with VR, and that VR would have changed the strategy (lobectomy versus segmentectomy) in four cases.
“If the patients would have been operated, adding the 3D VR tool to the preoperative workup would have resulted in changing the surgical strategy (i.e. lobectomy versus segmentectomy) in 4 cases.”
4 cases
From the paper · Abstract
Conclusions (4)
Segmentation and VR visualization successful in all casesAnswer: Yes
“Bronchovascular segmentation, volume calculation and image visualization in the VR environment were successful in all cases.”
From the paper · Abstract
Preferred strategy changed in 4 of 5 casesAnswer: Yes
“If the patients would have been operated, adding the 3D VR tool to the preoperative workup would have resulted in changing the surgical strategy (i.e. lobectomy versus segmentectomy) in 4 cases.”
4 cases
From the paper · Abstract
Reader segment agreement kappa 0.17 vs 0.55Answer: Describes
“segment localization based on 2D-CT differed between the surgeon and radiologist in 4 out of 5 cases (kappa = 0.17), while the localization matched in 3 out of 5 cases after 3D-VR analysis (kappa = 0.55).”
kappa 0.17 vs 0.55
From the paper · Full text
No VR-guided resection done; results hypotheticalAnswer: Describes
“We stress that these preliminary results remain hypothetical, since no paediatric VR-guided lung resection was performed (yet).”
Extended reality platform for minimally invasive endoscopic evacuation of deep-seated intracerebral hemorrhage: illustrative case#
Steineke TC, Barbery D · Journal of neurosurgery. Case lessons · 2022
Neurosurgery · Case report · n: 1 patient
Surgical Theater
Illustrative case of a deep thalamic intracerebral haemorrhage compressing the midbrain. A patient-specific 360-degree XR model (Surgical Theater) with tractography was used to plan the endoscopic evacuation trajectory, and was then integrated with neuronavigation during the procedure. The authors report that the patient was doing well at 11 months.
“Because of the deep-seated location of this ICH, a patient-specific 360XR model rendered using Surgical Theater was used for preoperative planning and intraoperative navigation to allow for enhanced visualization and understanding of the pathology and surrounding anatomy.”
From the paper · Abstract
“We then revised the approach using the 360VR model, allowing us to fly through the plan and ensure that no vital structures were compromised”
From the paper · Fulltext
Conclusions (4)
Trajectory revised after 3D model reviewAnswer: Yes
“We then revised the approach using the 360VR model, allowing us to fly through the plan and ensure that no vital structures were compromised”
“The XR platform enabled visualization of critical structures near the ICH by extracting and highlighting the white matter tracts from magnetic resonance imaging (MRI) with tractography, which improved preoperative planning beyond using state-of-the-art neuronavigation techniques alone.”
From the paper · Abstract
Model aided understanding of deep hemorrhage anatomyAnswer: Yes
“a patient-specific 360XR model rendered using Surgical Theater was used for preoperative planning and intraoperative navigation to allow for enhanced visualization and understanding of the pathology and surrounding anatomy”
From the paper · Abstract
Model rendering took about 25 minutesAnswer: Describes
“The rendering of the VR model took approximately 25 minutes.”
Use of virtual reality in complex double outlet right ventricle cases#
Belitsis G et al. · Multimedia manual of cardiothoracic surgery · 2022
Congenital heart · Case report (video) · n: 2 patients
VR, platform not specified
Video article from Great Ormond Street Hospital showing the virtual reality environment used to review two complex cases of double-outlet right ventricle. The authors present VR, alongside 3D-printed models and 3D PDFs, as a tool to aid anatomical understanding and surgical planning of complex intracardiac repairs.
Clinical Applications of Mixed Reality and 3D Printing in Congenital Heart Disease#
Lau I et al. · Biomolecules · 2022
Congenital heart · Survey/user study · n: 2 cases
Microsoft HoloLens
Custom Unity app
User study in which 34 cardiac specialists and physicians compared standard DICOM images, 3D-printed heart models and mixed-reality models (HoloLens 2, Unity, per the full text) for two congenital heart disease CT cases (atrial septal defect and double-outlet right ventricle). The authors report that mixed-reality models were rated best overall and significantly better than DICOM images for showing complex lesions, depth perception, spatial relationships, learning and preoperative planning, while 3D-printed models were rated best for communicating with patients.
“The results showed that the MR models were ranked as the best modality amongst the three, and were significantly better than DICOM images in demonstrating complex CHD lesions (mean difference (MD) = 0.76, p = 0.01)”
p = 0.01
From the paper · Abstract
“The 3DPHM were ranked as the best modality and significantly better than DICOM images in facilitating communication with patients (MD = 0.99, p = 0.00).”
MD = 0.99, p = 0.00
From the paper · Abstract
Conclusions (4)
Mixed reality outranked DICOM for complex lesionsAnswer: Yes
“The results showed that the MR models were ranked as the best modality amongst the three, and were significantly better than DICOM images in demonstrating complex CHD lesions (mean difference (MD) = 0.76, p = 0.01)”
MD = 0.76, p = 0.01
From the paper · Abstract
Mixed reality rated higher for depth perceptionAnswer: Yes
“in enhancing depth perception (MD = 1.09, p = 0.00), in portraying spatial relationship between cardiac structures (MD = 1.15, p = 0.00)”
depth MD = 1.09, p = 0.00; spatial MD = 1.15, p = 0.00
From the paper · Abstract
Mixed reality rated higher for preoperative planningAnswer: Yes
“and in facilitating pre-operative planning (MD = 0.87, p = 0.02)”
MD = 0.87, p = 0.02
From the paper · Abstract
3D-printed models rated higher for patient communicationAnswer: Describes
“The 3DPHM were ranked as the best modality and significantly better than DICOM images in facilitating communication with patients (MD = 0.99, p = 0.00).”
Case report: Resection of a massive primary sacrococcygeal mature teratoma in an adult using 3-dimensional reconstruction and mixed reality technology#
Zhang H et al. · Frontiers in surgery · 2022
Spine · Case report · n: 1 patient
AR/MR, platform not specified
Case report of a 49-year-old woman with a massive sacrococcygeal mature teratoma containing two bones forming a pseudoarthrosis, in whom CT-based 3D reconstruction and mixed reality were used to examine the tumour preoperatively before complete excision. The authors report no notable complications or recurrence.
“The 3-dimensional reconstruction and mixed reality (MR) technology based on computed tomography can provide spatial visualization, which allows surgeons to examine the teratoma at different angles preoperatively.”
From the paper · Abstract
“visualization aided us in explaining the planned procedure to the patient, who was thus able to understand both the surgical process and associated risks”
From the paper · Fulltext
Conclusions (3)
MR gave multi-angle view of the teratomaAnswer: Yes
“can provide spatial visualization, which allows surgeons to examine the teratoma at different angles preoperatively.”
From the paper · Abstract
Surgery completed with no complicationsAnswer: Describes
“Surgery was completed with no complications.”
From the paper · Full text
Visualization helped explain plan to patientAnswer: Yes
“visualization aided us in explaining the planned procedure to the patient, who was thus able to understand both the surgical process and associated risks”
Virtual Reality Simulation for Minimally Invasive Coronary Artery Bypass Grafting With Aortic No-Touch Total Arterial Grafting Technique#
Tachibana K et al. · Innovations (Philadelphia, Pa.) · 2022
Adult cardiac & structural heart · Case series · n: 17 patients
VR, platform not specified
Study of VR simulation for planning minimally invasive aortic no-touch total arterial CABG. CT-derived models of 35 in situ arterial grafts were reviewed with VR glasses on an immersive platform to estimate the lengths needed and plan graft design. Surgery was completed in 17 patients, with strategy adjusted in 11.8% based on VR; the authors report no early mortality or morbidity and 100% graft patency.
“The surgical strategy was adjusted in 11.8% of the cases due to the 3-dimensional virtual reality-based anatomy evaluation.”
11.8%
From the paper · Abstract
“The early mortality and morbidity were 0%, and the patency of the graft was 100%.”
0%
From the paper · Abstract
“Virtual reality simulation can allow the accurate preoperative understanding of anatomy and appropriate planning of the graft design with acceptable postoperative outcomes.”
From the paper · Abstract
Conclusions (3)
Strategy adjusted in 11.8% of casesAnswer: Yes
“The surgical strategy was adjusted in 11.8% of the cases due to the 3-dimensional virtual reality–based anatomy evaluation.”
11.8%
From the paper · Abstract
No early mortality, 100% graft patencyAnswer: Describes
“The early mortality and morbidity were 0%, and the patency of the graft was 100%.”
0% early mortality and morbidity, 100% patency
From the paper · Abstract
Bypass completed in 17 patients after VR planningAnswer: Describes
“Minimally invasive CABG using virtual reality simulation was completed in 17 patients, of whom 16 patients underwent aortic no-touch total arterial CABG.”
Case report of an 85-year-old man with a degenerated mitral bioprosthesis who was planned for transseptal valve-in-valve TMVR. A 360-degree VR model (Surgical Theater SRP, viewed on an Oculus Rift S) was used to place a virtual 29 mm SAPIEN 3 valve and assess the neo-LVOT, measured at 3.02 cm² in VR. The procedure was well tolerated.
“Preoperative planning in VR alleviated concerns regarding obstruction of the neo-LVOT and helped confirm safe implantation by clearly showing the three-dimensional spatial relationship between the implants and surrounding patient anatomy.”
From the paper · Abstract
Conclusions (3)
VR showed spatial relationship of implant and anatomyAnswer: Yes
“Preoperative planning in VR alleviated concerns regarding obstruction of the neo-LVOT and helped confirm safe implantation by clearly showing the three-dimensional spatial relationship between the implants and surrounding patient anatomy.”
From the paper · Abstract
VR neo-LVOT area judged sufficient for flowAnswer: Describes
“The neo-LVOT measured in VR was 3.02 cm 2 , which would allow for sufficient blood flow without significant obstruction from the new SAPIEN three bioprosthetic valve.”
Technique report on virtual planning of thin anterolateral thigh perforator flaps from CT angiography (Horos and Brainlab Elements), superimposed on the patient with a Magic Leap mixed reality headset to map perforators. The authors report 100% success in perforator mapping in six consecutive ALT flaps.
“The combination of Horos and Elements allows a better understanding of the ALT-free flap anatomy to virtually plan the surgery and to transfer the digital data to the Magic Leap Headset.”
From the paper · Full text: main text
“MR is a valuable tool to design thin perforator flaps safely.”
From the paper · Full text: main text
Conclusions (3)
Perforators mapped in all six consecutive flapsAnswer: Yes
“We have applied this method with a 100% success rate of perforator mapping in six consecutive ALT flaps.”
100% success rate, six consecutive ALT flaps
From the paper · Full text
Authors report clearer flap anatomy for planningAnswer: Yes
“The combination of Horos and Elements allows a better understanding of the ALT-free flap anatomy to virtually plan the surgery and to transfer the digital data to the Magic Leap Headset.”
From the paper · Full text
Planning takes 15 to 30 minutesAnswer: Describes
“The time consumed ranges between 15 and 30 minutes and needs to be done by the surgeon.”
Prospective study of 11 patients referred for TAVR, whose CT-segmented access routes and landing zones were reviewed by the heart team in immersive VR (VisuaMed platform) after initial decisions based on routine imaging. Decisions before and after VR were compared with each other and with intraprocedural findings, and the team rated VR's usefulness by questionnaire.
“VR models modified the implant strategy in 5 cases (45.4% of the cases).”
5 cases (45.4%)
From the paper · Fulltext
Conclusions (3)
Implant strategy changed in 5 of 11 patientsAnswer: Yes
“VR models modified the implant strategy in 5 cases (45.4% of the cases).”
5 cases (45.4%)
From the paper · Full text
Heart team confidence rose in all proceduresAnswer: Yes
“In all procedures, this additional information increased the confidence of the Heart Team during implantation.”
From the paper · Full text
All patients survived, no major complicationsAnswer: Describes
“All cases survived with good clinical outcome and no major complications.”
Uses of a dedicated 3D reconstruction software with augmented and mixed reality in planning and performing advanced liver surgery and living donor liver transplantation (with videos)#
Balci D et al. · Hepatobiliary & pancreatic diseases international · 2022
Review and experience report on the development of a dedicated 3D visualisation and reconstruction software for advanced liver surgery and living donor liver transplantation, and its extension from virtual reality to augmented and mixed reality for virtual surgical simulation and use during surgery.
Case Report: Application of Mixed Reality Combined With A Surgical Template for Precise Periapical Surgery#
Jia T et al. · Frontiers in surgery · 2022
Dental · Case report · n: 1 patient
Microsoft HoloLens
Case report of periapical (apical) surgery in which 3D files viewed on a HoloLens mixed-reality headset were used to explain the plan to the patient and matched to the operative area to choose the surgical approach, combined with a 3D-printed surgical template. The authors report that a buccal approach was confirmed and the apical lesion fully exposed and removed.
“We integrated the MR technique with a 3D surgical template to successfully accomplish the surgery.”
From the paper · Abstract
“The patient expressed full understanding of the information based on the holographic 3D images.”
From the paper · Fulltext
Conclusions (3)
Surgery completed in one caseAnswer: Describes
“We integrated the MR technique with a 3D surgical template to successfully accomplish the surgery.”
From the paper · Abstract
Patient reported full understanding of planAnswer: Yes
“The patient expressed full understanding of the information based on the holographic 3D images.”
From the paper · Full text
No lip numbness after surgeryAnswer: Describes
“The patient had no numbness in the lower lip and oral mucosa”
Advances and Innovations in Ablative Head and Neck Oncologic Surgery Using Mixed Reality Technologies in Personalized Medicine#
Karnatz N et al. · Journal of clinical medicine · 2022
ENT / head & neck · Technical development
Magic Leap
Technical paper presenting a 3D planning and mixed-reality software for ablative and reconstructive head and neck surgery, with planned models sent wirelessly to a head-mounted MR device for preoperative planning, tumour board discussion and education. The authors describe the software and its potential applications and note that integration into clinical routine remains experimental.
3D Approaches in Complex CHD: Where Are We? Funny Printing and Beautiful Images, or a Useful Tool?#
Spanaki A et al. · Journal of cardiovascular development and disease · 2022
Congenital heart · Narrative review
Multiple platforms
Narrative review of 3D approaches in complex congenital heart disease, covering 3D echocardiography, CT and MRI, 3D printing and extended reality. The authors state that XR imaging with dynamic cardiac motion has potential for planning surgical and catheter procedures, and that 3D imaging improves understanding of anatomy in complex cases.
“Overall, the use of 3D imaging has resulted in a better understanding of anatomy, with a direct impact on the surgical and catheter approach, particularly in more complex cases.”
From the paper · Abstract
Conclusions (2)
3D imaging improved anatomy understandingAnswer: Yes
“Overall, the use of 3D imaging has resulted in a better understanding of anatomy, with a direct impact on the surgical and catheter approach, particularly in more complex cases.”
From the paper · Abstract
Patient outcome benefit still unansweredAnswer: Describes
“What still remains to be answered is whether the introduction of this additional dimension is consistently leading to better patient outcomes.”
Immersive Three-dimensional Computed Tomography to Plan Chest Wall Resection for Lung Cancer#
Thumerel M et al. · The Annals of thoracic surgery · 2022
Thoracic · Comparative study
VR, platform not specified
Study comparing chest wall resection planning for lung cancer by senior and resident surgeons using an immersive VR headset versus 2D CT. The authors report more accurate resection planning with VR (28.6% vs 18.3%), particularly among residents, and more accurate prediction of the need for chest wall substitutes (96% vs 68.5%).
“Chest wall resection planning was more accurate when surgeons used virtual reality vs computed tomography analysis (28.6% vs 18.3%, P = .018), and this was particularly true in the resident surgeon group (27.4% vs 8.3%, P = .0025).”
P = .018
From the paper · Abstract
“Predictions regarding the need for chest wall substitutes were also more accurate when they were made using virtual reality vs computed tomography analysis in all groups (96% vs 68.5%, P < .0001).”
P < .0001
From the paper · Abstract
Conclusions (2)
Chest wall resection planning more accurateAnswer: Yes
“Chest wall resection planning was more accurate when surgeons used virtual reality vs computed tomography analysis (28.6% vs 18.3%, P = .018), and this was particularly true in the resident surgeon group (27.4% vs 8.3%, P = .0025).”
28.6% vs 18.3%, P = .018
From the paper · Abstract
Substitute need predicted more accuratelyAnswer: Yes
“Predictions regarding the need for chest wall substitutes were also more accurate when they were made using virtual reality vs computed tomography analysis in all groups (96% vs 68.5%, P < .0001).”
Retrospective analysis of 15 patients who had thoracoscopic left atrial appendage clipping, comparing LAA base size measured on CT and in immersive VR with the placed clip size. The authors report that VR measurement was feasible, that surgeon's-view VR measurements were larger than CT, and that all imaging measurements differed from the clip sizes used.
“The median LAA base size measured in CT (23.8 mm, interquartile range [IQR] 22.3 to 26.4 mm) and intracardial virtual reality (23.4 mm, IQR 21.6 to 25.5 mm) did not differ significantly ( P = 0.416).”
P = 0.416
From the paper · Abstract
“VR measurements of the LAA base in surgeon's view (25.7 mm, IQR 24.2 to 29.2) were significantly higher than those of 2-dimensional CT ( P = 0.037) and intracardial 3-dimensional (3D) VR ( P < 0.05) measurements.”
P = 0.037
From the paper · Abstract
“Immersive VR is a feasible method for obtaining anatomical information on LAA base size.”
From the paper · Abstract
Conclusions (3)
Intracardial VR size did not differ from CTAnswer: Yes
“The median LAA base size measured in CT (23.8 mm, interquartile range [IQR] 22.3 to 26.4 mm) and intracardial virtual reality (23.4 mm, IQR 21.6 to 25.5 mm) did not differ significantly ( P = 0.416).”
CT 23.8 mm vs VR 23.4 mm, P = 0.416
From the paper · Abstract
Surgeon's-view VR measured larger than CTAnswer: Describes
“VR measurements of the LAA base in surgeon's view (25.7 mm, IQR 24.2 to 29.2) were significantly higher than those of 2-dimensional CT ( P = 0.037) and intracardial 3-dimensional (3D) VR ( P < 0.05) measurements.”
25.7 mm, P = 0.037 vs CT
From the paper · Abstract
All imaging sizes differed from placed clipAnswer: Describes
“All measurements differed significantly with placed clip sizes ( P < 0.05).”
Practical Application of Augmented/Mixed Reality Technologies in Surgery of Abdominal Cancer Patients#
Ivanov VM et al. · Journal of imaging · 2022
General & GI surgery · Case series · n: 8 patients
3D Slicer / SlicerVR
Microsoft HoloLens
Report of experience using AR/MR for preoperative planning and intraoperative navigation in eight patients with abdominal cancer, describing practical obstacles and solutions, including an orthopaedic pin fixed to the pelvis as a combined X-ray and AR marker and a non-invasive skin-based marking method. The authors report that the techniques helped verify radicality, visualise nearby structures and shorten surgery, with one case described in detail.
“Both techniques were used (8 clinical cases) for preoperative planning and intraoperative navigation, which allowed surgeons to verify the radicality of the operation, to have visual control of all anatomical structures near the zone of interest”
From the paper · Abstract
“As a result, the average deviation within a radius of 250 mm from the marker was 2–3 mm”
2–3 mm
From the paper · Fulltext
Conclusions (3)
Bench hologram deviation 2-3 mmAnswer: Describes
“As a result, the average deviation within a radius of 250 mm from the marker was 2–3 mm”
“In the first case, using an implanted pin, the error was 1–4 mm. Thus, the average accuracy level was 3–5 mm.”
1–4 mm error, average accuracy 3–5 mm
From the paper · Full text
Skin marker error up to 10 mmAnswer: Describes
“in the case of skin displacement as a result of the use of wound dilators, the total error could reach up to 5 mm. If the marker was placed on the chest, the overall accuracy was up to 10 mm”
Multicentre, single-blind randomized trial of 92 patients undergoing robotic prostatectomy, in which surgeons in the intervention group also reviewed patient-specific 3D VR models from MRI, via a smartphone app or a VR headset. The authors report a non-significant trend to fewer positive margins and significantly fewer cases with detectable postoperative PSA in the intervention group (31% vs 9%), no difference in functional outcomes, and plan changes based on the model in 32% of intervention cases.
“In 32% of intervention cases, the surgeons modified their operative plan based on the model.”
32%
From the paper · Abstract
“trends toward lower positive margin rates (33% vs 25%) in the intervention group, no significant difference in functional outcomes and no difference in traditional operative metrics (p >0.05).”
p >0.05
From the paper · Abstract
Conclusions (4)
Positive margin rate not significantly differentAnswer: No significant difference
“trends toward lower positive margin rates (33% vs 25%) in the intervention group”
33% vs 25%, p = 0.4
From the paper · Abstract
Detectable postoperative PSA lower in model groupAnswer: Yes
“Detectable postoperative prostate specific antigen was significantly lower in the intervention group (31% vs 9%, p=0.036).”
31% vs 9%, p = 0.036
From the paper · Abstract
Surgeons changed plan in a third of casesAnswer: Yes
“In 32% of intervention cases, the surgeons modified their operative plan based on the model.”
32%
From the paper · Abstract
No significant difference in functional outcomesAnswer: No significant difference
“no significant difference in functional outcomes”
Augmented Reality for Retrosigmoid Craniotomy Planning#
Leuze C et al. · Journal of neurological surgery. Part B, Skull base · 2022
Neurosurgery · Cadaveric study
Magic Leap
Cadaveric study in which two surgeons performed 14 retrosigmoid approaches on eight heads, using a see-through AR display (Magic Leap) with a manually aligned CT rendering of the sigmoid sinus to plan the craniotomy. The authors report small, consistent margins to the dural sinuses and successful access to the internal auditory canal in all cases.
“The intended surgical approach to the internal auditory canal was successfully achieved in all cases using the proposed method”
From the paper · Abstract
“a mean margin of d avg = 0.6 ± 4.7 mm and d avg = 3.7 ± 2.3 mm between the osteotomy border and the dural sinuses over all their cases, respectively, and only positive margins for 12 of the 14 cases.”
12 of the 14 cases
From the paper · Abstract
Conclusions (2)
Intended approach achieved in all cadaver casesAnswer: Yes
“The intended surgical approach to the internal auditory canal was successfully achieved in all cases using the proposed method”
From the paper · Abstract
Positive sinus margins in 12 of 14 casesAnswer: Mixed
Removal of a foreign body by rigid bronchoscope after virtual reality-aided presurgical planning: A case report#
Torii A et al. · Respiratory medicine case reports · 2022
Thoracic · Case report · n: 1 patient
VR, platform not specified
Case report of a 22-year-old man with an orthodontic appliance lodged in the left main bronchus, in whom a VR simulation built from CT with Banana Vision software showed the metal parts embedded in the bronchial mucosa before rigid bronchoscopic removal under general anaesthesia. The authors report removal after cutting granulation tissue, and suggest VR-based planning may help in such cases.
“Furthermore, a VR-based intervention may be a useful option in such cases.”
From the paper · Abstract
“Using VR-based simulation, we were able to understand the invasion range and depth of the metallic parts more clearly than with 3D CT.”
From the paper · Fulltext
“Therefore, the planning for removal was changed to not only use gripping forceps but also to cut the granulation tissue and remove the metallic part.”
From the paper · Fulltext
Conclusions (3)
Embedding depth clearer on VR than 3D CTAnswer: Yes
“Using VR-based simulation, we were able to understand the invasion range and depth of the metallic parts more clearly than with 3D CT.”
From the paper · Full text
Removal plan changed after VR simulationAnswer: Yes
“Therefore, the planning for removal was changed to not only use gripping forceps but also to cut the granulation tissue and remove the metallic part.”
From the paper · Full text
Removal completed with no bleeding or injuryAnswer: Describes
“In this case, there were no adverse events, such as bleeding or bronchial injury.”
Using virtual reality for difficult airway management planning#
Iliff HA et al. · Anaesthesia reports · 2022
Anesthesia & pain · Case report
VR, platform not specified
Clinical article in Anaesthesia Reports describing the use of virtual reality reconstructions of upper-airway anatomy to plan difficult airway management. The open record available gave only front matter, so the number of patients and the VR set-up could not be confirmed.
Augmented Reality Device for Preoperative Marking of Spine Surgery Can Improve the Accuracy of Level Identification#
Aoyama R et al. · Spine surgery and related research · 2022
Spine · Technical note
Microsoft HoloLens
Holoeyes MD
Technical note on using Holoeyes software on a HoloLens head-mounted display to overlay a hologram of the patient's spine for preoperative marking of the surgical level. The authors report that the level misidentification rate fell from 26.5% with palpation alone to 14.3% with the HMD.
“Without an HMD, the misidentification rate of the level was at 26.5%, while with it, the rate was reduced to 14.3%.”
14.3%
From the paper · Abstract
“On preoperative marking, an HMD-projecting bone image onto a patient's body could allow us to estimate the spinal level more accurately.”
From the paper · Abstract
“Another problem is that marking with an HMD takes about 2 minutes longer than the normal marking procedure.”
From the paper · Fulltext
Conclusions (4)
Level misidentification 26.5% falling to 14.3%, untestedAnswer: Yes
“Without an HMD, the misidentification rate of the level was at 26.5%, while with it, the rate was reduced to 14.3%.”
26.5% vs 14.3%
From the paper · Abstract
Headset marking took about 2 minutes longerAnswer: No
“Another problem is that marking with an HMD takes about 2 minutes longer than the normal marking procedure.”
From the paper · Full text
Headset corrected 6 of 13 palpation errorsAnswer: Mixed
“On 13 misidentification cases without an HMD, 6 of them (46.2%) could be reconfirmed accurately with the addition of an HMD assessment.”
6 of 13 (46.2%)
From the paper · Full text
Data creation took half an hour per caseAnswer: Describes
“It took about half an hour to create the data for each case in this study.”
German narrative review of current technologies in liver surgery, including 3D segmentation, volumetry, preoperative planning, 3D printing, virtual and augmented reality and intraoperative navigation, with an outlook on the operating theatre of the future.
Single-stage cranioplasty with customized polyetheretherketone implant after tumor resection using virtual reality and augmented reality for precise implant customization and placement: illustrative case#
Rios-Vicil CI et al. · Journal of neurosurgery. Case lessons · 2022
Neurosurgery · Case report · n: 1 patient
Surgical Theater
Illustrative case of a 50-year-old woman with a frontal bone haemangioma who had single-stage resection and custom PEEK cranioplasty using an extended reality workflow (Surgical Theater) for implant customization and placement. The authors report excellent cosmesis, shorter operative time and a feasible workflow.
“Excellent cosmetic results, decreased operative time, and a feasible workflow were achieved.”
From the paper · Abstract
Conclusions (3)
Shorter operative time claimed, not measuredAnswer: Describes
“Excellent cosmetic results, decreased operative time, and a feasible workflow were achieved.”
From the paper · Abstract
VR craniectomy planning took about 5 minutesAnswer: Describes
“The senior author spent approximately 5 minutes creating a virtual craniectomy in VR using the platform’s virtual drills and patient-specific VR model.”
approximately 5 minutes
From the paper · Full text
No complications beyond temporalis painAnswer: Describes
“No complications other than some pain in the temporalis, where muscle graft was taken from to fill the sinus, were noted.”
Evaluation of virtual handles for dental implant manipulation in virtual reality implant planning procedure#
Rantamaa HR et al. · International journal of computer assisted radiology and surgery · 2022
Dental · Technical development · n: 4 radiologists
Meta Quest / Oculus
Technical development and small user study of a stereoscopic VR dental implant planning system (built on a Planmeca implementation, Oculus Quest 2), in which four dentomaxillofacial radiologists compared direct manipulation of implants with manipulation via virtual handles. The authors report that all four preferred direct interaction and valued the 3D environment despite usability issues with the handles.
“The radiologists valued the three-dimensional environment for three-dimensional object manipulation even if usability issues of the handles affected the feel of use and the evaluation results.”
From the paper · Abstract
“Direct interaction was seen as easy, accurate, and natural.”
From the paper · Abstract
Conclusions (2)
All four radiologists ranked direct interaction higherAnswer: Yes
“We found that all four participants ranked direct interaction, planning the implant placement without handles, to be better than the indirect condition where the implant model had handles.”
From the paper · Abstract
3D environment valued despite handle usability issuesAnswer: Mixed
“The radiologists valued the three-dimensional environment for three-dimensional object manipulation even if usability issues of the handles affected the feel of use and the evaluation results.”
Virtual Reality Cardiac Surgical Planning Software (CorFix) for Designing Patient-Specific Vascular Grafts: Development and Pilot Usability Study#
Kim B et al. · JMIR cardio · 2022
Congenital heart · Survey/user study · n: 1 patient dataset
Custom Unity app
Meta Quest / Oculus
Development and pilot usability study of CorFix, VR software for designing patient-specific Fontan vascular grafts and reviewing their simulated haemodynamics. Four physicians and one engineer each designed grafts for one patient after 10 minutes of training. The authors report design times of about 5-13 minutes, improved wall shear stress after users modified designs using the haemodynamic results, and no design meeting the power-loss benchmark.
“The average times for creating 1 bifurcated and 1 tube-shaped graft after a single 10-minute training session were 13.40 and 5.49 minutes, respectively, with 3 out 5 bifurcated and 1 out of 5 tube-shaped graft designs being in the benchmark range of hepatic flow distribution.”
13.40 and 5.49 minutes
From the paper · Abstract
“Participants who modified their tube-shaped graft designs were able to improve the nonphysiologic wall shear stress (WSS) percentage by 7.02%.”
7.02%
From the paper · Abstract
“None of the designs met the benchmark indexed power loss.”
From the paper · Abstract
Conclusions (4)
Graft design took 5.49 and 13.40 minutesAnswer: Describes
“Participants spent an average of 5.49 minutes creating 1 tube-shaped graft and 13.40 minutes creating 1 bifurcated graft.”
5.49 min tube-shaped, 13.40 min bifurcated
From the paper · Full text
Wall shear stress lower, none in safe rangeAnswer: Mixed
“all participants were able to create designs that were much lower in %WSS compared to that of the surgical case. However, none of the designs were under the safe range of 10% or below.”
From the paper · Full text
All designs had higher power lossAnswer: No
“All graft designs had higher iPL values than did the native Fontan surgical case.”
From the paper · Full text
Usability score of 57, marginalAnswer: Mixed
“CorFix scored an average of 57 on the SUS questionnaire with a minimum score of 42.5 and a maximum of 67.5. The average SUS value suggests that the usability of our prototype was marginal.”
Evaluation of voice commands for mode change in virtual reality implant planning procedure#
Rantamaa HR et al. · International journal of computer assisted radiology and surgery · 2022
Dental · Survey/user study
Meta Quest / Oculus
User study in which six dentomaxillofacial radiologists used a prototype VR dental implant planning tool with button presses alone or with added voice commands. The authors report that the experts could complete multiple-implant planning satisfactorily and found voice commands useful and accurate for mode changes.
“The tool was approved by the experts and they were able to do the multiple-implant planning satisfactorily.”
From the paper · Abstract
“Most of the radiologists were willing to use the tool as part of their daily work routines.”
From the paper · Abstract
“The voice commands were useful, natural, and accurate for mode change, and they could be expanded to other tasks.”
From the paper · Abstract
Conclusions (4)
Experts approved tool and planned satisfactorilyAnswer: Yes
“The tool was approved by the experts and they were able to do the multiple-implant planning satisfactorily.”
From the paper · Abstract
Most radiologists willing to use dailyAnswer: Yes
“Most of the radiologists were willing to use the tool as part of their daily work routines.”
From the paper · Abstract
Voice and button completion times not differentAnswer: No significant difference
“There were no significant differences between the two conditions on completion times.”
median Hand 167.6 s vs Voice 196.0 s
From the paper · Full text
Voice and button ratings not differentAnswer: No significant difference
“There were no significant differences between the conditions on subjective data from the questionnaire.”
MeVisLab-OpenVR prototyping platform for virtual reality medical applications#
De Buck S et al. · International journal of computer assisted radiology and surgery · 2022
Congenital heart · Technical development
VR, platform not specified
Technical paper describing a way to link the MeVisLab medical prototyping software with OpenVR so that arbitrary 3D scenes can be rendered and interacted with in virtual reality. The authors tested it by building a tool for planning transcatheter stent treatment of a sinus venosus atrial septal defect, and report that planning and checking the procedure in VR was intuitive.
“The implementation showed it is intuitive to plan and verify the procedure using VR.”
From the paper · Abstract
Conclusions (2)
Platform enabled a stent planning toolAnswer: Yes
“This approach proved to enable development of a particular implementation that facilitates planning of percutaneous treatment of a sinus venosus atrial septal defect.”
From the paper · Abstract
Planning and verifying in VR judged intuitiveAnswer: Yes
“The implementation showed it is intuitive to plan and verify the procedure using VR.”
[A Novel Virtual-reality Imaging System in Cardiovascular Surgery:a Potentially Promising Technology for Surgeons]#
Kamiya K et al. · Kyobu geka. The Japanese journal of thoracic surgery · 2022
Adult cardiac & structural heart · Technical development
VR, platform not specified
Japanese-language technical article describing the Vesalius 3D suite, which combines 3D image processing with optical-tracking spatial navigation for VR exploration and measurement of cardiovascular anatomy from one or more imaging modalities, viewed on flat-screen or stereoscopic displays. The authors present it for preoperative planning, measurement and patient-specific rehearsal in cardiovascular surgery.
Three-dimensional printing, holograms, computational modelling, and artificial intelligence for adult congenital heart disease care: an exciting future#
Chessa M et al. · European heart journal · 2022
Congenital heart · Narrative review
Multiple platforms
Review in the European Heart Journal of 3D printing, virtual and augmented reality (holograms), computational modelling and artificial intelligence in adult congenital heart disease. The authors give an overview of each technology and discuss how they could be brought into the clinical workflow.
Review and Future/Potential Application of Mixed Reality Technology in Orthopaedic Oncology#
Wong KC et al. · Orthopedic research and reviews · 2022
Orthopedics · Narrative review
Multiple platforms
Narrative review of mixed reality technology in orthopaedic oncology, covering its main features, clinical workflow, the current literature and potential applications in planning and surgery. The authors identify accurate hologram-to-patient registration, the lack of a dedicated platform and the lack of clinical results as barriers to adoption.
“The emerging MR technology adds a new dimension to digital assistive tools with a more accessible and less costly alternative in orthopaedic oncology.”
From the paper · Abstract
“However, lacking an accurate hologram-to-patient matching, an MR platform dedicated to orthopaedic oncology, and clinical results may hinder its wide adoption.”
From the paper · Abstract
Conclusions (2)
Registration, platform and clinical data may limit adoptionAnswer: Describes
“However, lacking an accurate hologram-to-patient matching, an MR platform dedicated to orthopaedic oncology, and clinical results may hinder its wide adoption.”
From the paper · Abstract
Review describes MR as cheaper, more accessible optionAnswer: Describes
“The emerging MR technology adds a new dimension to digital assistive tools with a more accessible and less costly alternative in orthopaedic oncology.”
Patient-individualized resection planning in liver surgery using 3D print and virtual reality (i-LiVR)-a study protocol for a prospective randomized controlled trial#
Protocol for a prospective randomised trial (i-LiVR, DRKS00027865) comparing four ways of presenting liver CT for planning major resections: a 3D print, a 3D model on a screen, a VR headset, and standard CT viewing. Each group is planned for 25 patients. The primary endpoint is the ratio of planned to actual resection volume; results are not yet reported.
A Novel 3D Visualized Operative Procedure in the Single-Stage Complete Repair With Unifocalization of Pulmonary Atresia With Ventricular Septal Defect and Major Aortopulmonary Collateral Arteries#
Qiu H et al. · Frontiers in cardiovascular medicine · 2022
Congenital heart · Comparative study · n: 20 patients (9 3D-visualised vs 11 conventional)
HTC VR headset
Microsoft HoloLens
Mimics
3D printing
Single-centre comparison of single-stage unifocalization repair of pulmonary atresia with VSD and MAPCAs using a 3D-visualised procedure (CT-based 3D printing, VR on an HTC headset and HoloLens mixed reality for evaluation, planning and intraoperative orientation; 9 patients, 2018-2021) versus a conventional historical group (11 patients, 2011-2017). The authors report that all 3D-group patients needed only a median sternotomy (vs 72.7% needing an extra thoracotomy) and a significantly shorter pre-CPB time per MAPCA; differences in CPB time and early mortality were not significant.
“the median pre-CPB time per MAPCAs was significantly shorter [25.7 (14.0, 46.3) vs. 65 (41.3, 75.0) min, p = 0.031]”
p = 0.031
From the paper · Abstract
“In the 3D group, the CPB time was shorter (93.2 ± 63.8 vs. 145.1 ± 68.4 min, p = 0.099)”
p = 0.099
From the paper · Abstract
“There was no early death in the 3D group, while there were 3 in the conventional group (0 vs. 27.3%, p = 0.218).”
p = 0.218
From the paper · Abstract
“All 9 patients in the 3D group were operated only through a median sternotomy, while 8 cases (72.7%) needed another posterolateral thoracotomy in the conventional group, which was statistically different ( p = 0.001).”
p = 0.001
From the paper · Fulltext
Conclusions (5)
No second thoracotomy needed with 3D planningAnswer: Yes
“All 9 patients in the 3D group were operated only through a median sternotomy, while 8 cases (72.7%) needed another posterolateral thoracotomy in the conventional group, which was statistically different ( p = 0.001).”
8 (72.7%) thoracotomy in conventional group, p = 0.001
From the paper · Full text
Pre-bypass time per collateral artery shorterAnswer: Yes
“the median pre-CPB time per MAPCAs was significantly smaller in the 3D group [25.7 (14.0, 46.3) vs. 65 (41.3, 75.0) min, p = 0.031]”
25.7 vs 65 min, p = 0.031
From the paper · Full text
Total pre-bypass time not significantly differentAnswer: No significant difference
“The mean pre-CPB time was smaller in the 3D group but without statistical significance (93.2 ± 63.8 vs. 145.1 ± 68.4 min, p = 0.099).”
93.2 vs 145.1 min, p = 0.099
From the paper · Full text
Bypass, clamp and operation time did not differAnswer: No significant difference
“There was no difference in CPB, ACC, and operation time.”
CPB 247 ± 76 vs 212 ± 71 min, p = 0.304
From the paper · Full text
Early mortality not significantly differentAnswer: No significant difference
“There was no early death in the 3D group, while there were 3 in the conventional group (0 vs. 27.3 %, p = 0.218).”
DIEP Flap Preoperative Planning Using Virtual Reality Based on CT Angiography#
Egozi D et al. · Plastic and reconstructive surgery. Global open · 2022
Plastic & reconstructive · Technical note
VR, platform not specified
Short article and video introducing Amplifier VR, a system that converts CT angiograms into patient-specific 3D reconstructions viewed in a head-mounted display with hand controllers, for preoperative planning of DIEP flaps. The authors describe faster, clearer visualisation of abdominal-wall perforators and expect better planning accuracy and shorter operations, without reporting patient outcomes.
“We postulate that preoperative planning by the new Amplifier VR tool can increase a surgeon’s understanding of the patient’s individual anatomy and facilitate the complex task of choosing the optimal perforator for flap harvest.”
Clinical 3D modeling to guide pediatric cardiothoracic surgery and intervention using 3D printed anatomic models, computer aided design and virtual reality#
Single-centre report on setting up a clinical 3D modelling service in a high-volume paediatric heart centre, using 3D-printed models, on-screen digital models, computer-aided design of repairs and virtual reality (SlicerVR with a Valve Index headset, per the full text). From 2018 to 2020 there were 112 modelling cases, 96 of them used for procedural planning, most often for complex biventricular repair and multiple ventricular septal defects. The authors report that demand tripled over the three years.
“From 2018 to 2020 there were 112 individual 3D modeling cases performed, 16 for educational purposes and 96 clinically utilized for procedural planning.”
From the paper · Abstract
“Using a multidisciplinary approach, clinical application of 3D modeling can be seamlessly integrated into pre-procedural care for patients with congenital heart disease.”
From the paper · Abstract
Conclusions (3)
96 of 112 models used for planningAnswer: Describes
“From 2018 to 2020 there were 112 individual 3D modeling cases performed, 16 for educational purposes and 96 clinically utilized for procedural planning.”
112 cases, 16 educational, 96 clinical
From the paper · Abstract
Modeling demand tripled over three yearsAnswer: Yes
“Over the 3-year period, demand for clinical modeling tripled and in 2020, 3D modeling was requested in more than one-quarter of STAT category 3, 4 and 5 cases.”
15 cases in 2018 vs 47 in 2020; 8% to 27% of STAT 3, 4 and 5 cases
From the paper · Abstract
Biventricular repair was the commonest indicationAnswer: Describes
“Of the 96 clinical 3D cases modeled during this time, nearly one-third of the patients ( n = 30, 31%) had modeling performed to evaluate intracardiac anatomy for a potential complex biventricular repair”
A comparison of input devices for precise interaction tasks in VR-based surgical planning and training#
Allgaier M et al. · Computers in biology and medicine · 2022
Multi-specialty · Survey/user study
VR, platform not specified
User study comparing VR input devices (standard controllers, a pen-like VR Ink, data gloves and a real craniotome) for precise interaction tasks in two use cases: liver surgery planning and craniotomy training. The authors report that controllers and the VR Ink were significantly more precise, and most participants preferred the VR Ink.
“Although no device stands out for both applications, most participants preferred using the VR Ink, followed by the controller and finally the data gloves and craniotome.”
From the paper · Abstract
Conclusions (1)
Most participants preferred the pen-like deviceAnswer: Describes
“Although no device stands out for both applications, most participants preferred using the VR Ink, followed by the controller and finally the data gloves and craniotome.”
User study in which four surgeons used a custom VR planning tool (HTC Vive Pro) to plan two real liver tumour resections in addition to their usual planning, with interviews before and after surgery. Planning in VR took about 14 minutes and usability was rated good. Surgeons reported better spatial understanding, better identification of anatomical variants and better recall.
“The participants used on average 14.3 min (SD = 3.59) to plan the cases in VR.”
14.3 min
From the paper · Abstract
“The reported usability was good.”
From the paper · Abstract
“They reported an improved spatial understanding of the individual anatomical structures and better identification of anatomical variants.”
A Novel Technique of Mixed Reality Systems in the Treatment of Spinal Cord Tumors#
Aoyama R et al. · Cureus · 2022
Spine · Case series · n: 5 patients
Microsoft HoloLens
Magic Leap
Meta Quest / Oculus
Holoeyes MD
Technical report of five patients with spinal cord tumours in whom myelogram-CT-based 3D models of the spine, tumour and planned laminectomy were viewed on head-mounted displays to choose the surgical approach, and the laminectomy site was confirmed intraoperatively with the headset. The authors report correct preoperative planning and less invasive surgery in all five cases.
“The 3D visualization of pathological conditions resulted in correct preoperative surgical planning and less invasive surgery in all five cases.”
From the paper · Abstract
“Stereoscopic images using HMDs allow us a more intuitive understanding of the positional relationship between the tumor and spinal structure.”
From the paper · Abstract
Conclusions (2)
Correct plan, less invasive surgery in five casesAnswer: Yes
“The 3D visualization of pathological conditions resulted in correct preoperative surgical planning and less invasive surgery in all five cases.”
From the paper · Abstract
Tumours removed and symptoms improved in all casesAnswer: Describes
“In all cases, the tumors were completely removed with a less invasive technique, and the symptoms improved postoperatively”
Feasibility study of a mixed reality tool for real 3D visualization and planning of left atrial appendage occlusion#
Pasquali M et al. · Journal of cardiovascular computed tomography · 2022
Adult cardiac & structural heart · Research letter · n: 4 patients
AR/MR, platform not specified
Research letter presenting new mixed reality software for holographic 3D visualization of CT-derived left atrial appendage models to plan LAA occlusion. In 4 patients with different LAA morphologies, the authors report successful morphological analysis in under 10 minutes each.
“The morphological analysis of the holographic anatomical models was successfully applied for all the patients (n = 4) independently from the morphology and it was performed in less than 10 minutes.”
less than 10 minutes
From the paper · Abstract
“Our findings suggest that with further developments MxR could have the potential to become a pivotal tool in LAA occlusion planning thanks to the real-3D perception, possibly leading to a more accurate and faster planning phase.”
From the paper · Abstract
Conclusions (3)
Morphological analysis succeeded in all 4 patientsAnswer: Yes
“The morphological analysis of the holographic anatomical models was successfully applied for all the patients”
n = 4
From the paper · Abstract
Analysis took under 10 minutesAnswer: Describes
“it was performed in less than 10 minutes.”
less than 10 minutes
From the paper · Abstract
Authors see potential for LAAO planningAnswer: Describes
“with further developments MxR could have the potential to become a pivotal tool in LAA occlusion planning”
Applications of Mixed Reality Technology in Orthopedics Surgery: A Pilot Study#
Lu L et al. · Frontiers in bioengineering and biotechnology · 2022
Orthopedics · Survey/user study
Microsoft HoloLens
Pilot study of a mixed-reality visualisation system (3D imaging workstation, cloud platform and Microsoft HoloLens) used across orthopaedic scenarios including fracture understanding and treatment planning, communication, intraoperative guidance and telesurgery. The authors report that nine surgeons rated MR as adding significant value for understanding, communication and spatial awareness, and that NASA-TLX workload scores were lower than with usual 2D imaging.
“Analysis of the Likert-scale questionnaire shows that MR adds significant value to understanding and communication, spatial awareness, learning and effectiveness.”
From the paper · Abstract
“Based on the NASA TLX-scale questionnaire results, mixed reality scored significantly lower under the "mental," "temporal," "performance," and "frustration" categories compared to usual 2D.”
From the paper · Abstract
Conclusions (3)
Surgeons rated understanding higher than with 2DAnswer: Yes
“Analysis of the Likert-scale questionnaire shows that MR adds significant value to understanding and communication, spatial awareness, learning and effectiveness.”
median 5 vs 1, p < 0.001
From the paper · Abstract
Four NASA-TLX workload scores lower than 2DAnswer: Yes
“Based on the NASA TLX-scale questionnaire results, mixed reality scored significantly lower under the "mental," "temporal," "performance," and "frustration" categories compared to usual 2D.”
From the paper · Abstract
Physical demand rated higher than with 2DAnswer: No
“they received significantly a significantly higher “physical demand” rating than usual 2D support”
Tailored endoscopic treatment of tracheo-oesophageal fistula using preoperative holographic assessment and a cardiac septal occluder#
Siboni S et al. · BMJ case reports · 2022
Thoracic · Case report · n: 1 patient
AR/MR, platform not specified
Case report of endoscopic closure of a post-radiotherapy tracheo-oesophageal fistula with an Amplatzer atrial septal occluder, chosen and sized using preprocedural CT with holographic 3D reconstruction. The authors report complete sealing and preserved ability to eat at 4 months.
“We report the successful endoscopic closure of a post-radiotherapy TOF using preprocedural CT scan with holographic three-dimensional reconstruction and an Amplatzer atrial septal device.”
From the paper · Abstract
“After revision of the CT scan with holographic 3D reconstruction, endoscopic closure of the fistula with an Amplatzer device (AGA Medical, Plymouth, Minnesota, USA) was planned through a combined bronchoscopic, oesophagoscopic and fluoroscopic approach.”
From the paper · Fulltext
“We managed to obtain 3D holographic reconstructions of the area surrounding the TOF to allow better understanding of the spatial relationships between the trachea and the oesophagus”
From the paper · Fulltext
Conclusions (3)
Fistula sealed, symptoms resolved at 4 monthsAnswer: Describes
“Complete TOF sealing was achieved with resolution of respiratory symptoms, and the patient was maintaining his ability to eat at 4-month follow-up.”
From the paper · Abstract
Hologram informed closure approach and deviceAnswer: Yes
“After revision of the CT scan with holographic 3D reconstruction, endoscopic closure of the fistula with an Amplatzer device (AGA Medical, Plymouth, Minnesota, USA) was planned through a combined bronchoscopic, oesophagoscopic and fluoroscopic approach.”
From the paper · Full text
Authors state hologram aided spatial understandingAnswer: Yes
“We managed to obtain 3D holographic reconstructions of the area surrounding the TOF to allow better understanding of the spatial relationships between the trachea and the oesophagus”
Single-blind randomized trial of 92 patients with complex renal tumours (RENAL score 7 or higher) undergoing robotic surgery, comparing mixed-reality-assisted planning with standard planning. The authors report shorter warm ischaemia, reconstruction and operation times, lower blood loss and fewer intraoperative complications in the MR group.
“For urologists treating complex renal tumors, MR technology can help them reduce the warm ischemia time (21.3 ± 4.0 vs 23.6 ± 5.9 minutes, p = 0.031), reconstruction time (15.4 ± 3.8 vs 17.2 ± 4.2 minutes, p = 0.034)”
p = 0.031
From the paper · Abstract
“MR-assisted surgery can reduce the incidence of intraoperative complications and improve perioperative outcomes, and MR may be a good preoperative tool for planning complex renal tumor surgery.”
From the paper · Abstract
Conclusions (2)
Shorter warm ischemia and reconstruction timesAnswer: Yes
“For urologists treating complex renal tumors, MR technology can help them reduce the warm ischemia time (21.3 ± 4.0 vs 23.6 ± 5.9 minutes, p = 0.031), reconstruction time (15.4 ± 3.8 vs 17.2 ± 4.2 minutes, p = 0.034)”
warm ischemia 21.3 vs 23.6 min, p = 0.031; reconstruction 15.4 vs 17.2 min, p = 0.034
“MR-assisted surgery can reduce the incidence of intraoperative complications and improve perioperative outcomes, and MR may be a good preoperative tool for planning complex renal tumor surgery.”
Technical report describing mandibular reconstruction that combined a digital surgical plan, mixed-reality glasses to visualise the planned reconstruction and relevant anatomy matched to the patient, a 3D-printed surgical guide plate and robotic-assisted navigation for fibula positioning and immediate dental implantation. The authors present the integrated workflow as more accurate and simpler than traditional surgery.
“In conclusion, the authors integrated the 3 technologies and constructed a new digital surgical procedure to improve surgical accuracy and simplify the procedure comparing with traditional surgery.”
From the paper · Abstract
Conclusions (3)
Authors claim accuracy gain, no comparison madeAnswer: Describes
“In conclusion, the authors integrated the 3 technologies and constructed a new digital surgical procedure to improve surgical accuracy and simplify the procedure comparing with traditional surgery.”
From the paper · Abstract
Final position matched the plan on navigation checkAnswer: Yes
“Finally, we verified the current surgical process, and the position was the same as designed by RAN.”
From the paper · Full text
CT showed correct bone and condyle positionAnswer: Yes
“The CT results showed that the reconstructed bone connection and artificial condyles position was correct”
3-Dimensional Modeling in Virtual Reality for Resection of a Pineal Region Falcotentorial Meningioma#
Karas PJ et al. · World neurosurgery · 2022
Neurosurgery · Case report (video) · n: 1 patient
VR, platform not specified
Video case report of a 78-year-old woman with a pineal region falcotentorial meningioma, in which a 3D VR model was used to compare approaches to the pineal region and visualize the deep veins before a posterior interhemispheric subsplenial resection. The authors report that cognition returned to baseline and vision improved at 1 month.
“Ultimately, surgical planning using virtual reality promotes both neurosurgical education and patient safety through clear visualization and understanding of different surgical approaches.”
From the paper · Abstract
Conclusions (2)
3D model was valuable adjunct to MRIAnswer: Yes
“Preoperative visualization of critical deep venous structures with the 3D model was a valuable adjunct to magnetic resonance imaging for achieving safe resection.”
From the paper · Abstract
Cognition at baseline, vision improved at 1 monthAnswer: Describes
“At 1-month follow-up, the patient’s cognition had returned to baseline and her vision had significantly improved.”
Feasibility study in which ten cardiothoracic surgeons reviewed CT and then 3D VR reconstructions in a head-mounted display (CardioVR) for six patients who had recently undergone ascending aortic repair, and compared their plans with the operations performed. The authors report that 80% of surgeons felt better prepared with VR and that the planned approach (open versus clamped distal anastomosis) changed in two of six cases.
“In 33% of cases (two out of six), the preoperative decision was adjusted due to the 3D VR-based evaluation of the anatomy.”
33%
From the paper · Abstract
“Compared with conventional imaging, 80% of surgeons found that VR prepared them better for surgery.”
80%
From the paper · Abstract
Conclusions (3)
Surgical plan changed in two of six casesAnswer: Yes
“In 33% of cases (two out of six), the preoperative decision was adjusted due to the 3D VR-based evaluation of the anatomy.”
33%
From the paper · Abstract
Eight of ten surgeons felt more preparedAnswer: Yes
“Compared with conventional imaging, 80% of surgeons found that VR prepared them better for surgery.”
80%
From the paper · Abstract
No significant difference in planning effectivenessAnswer: No significant difference
“surgeons experienced no significant differences in the effectiveness of preoperative planning with 2D CT scans and VR images”
Retrospective study of 95 patients who had open hepatectomy for hepatocellular carcinoma, 38 with mixed-reality assistance for 3D visualisation, surgical planning and intraoperative navigation and 57 without. The authors report shorter operative time, less bleeding, shorter portal vein occlusion, better early liver function, fewer complications and shorter hospital stay in the MR group.
“Compared to traditional hepatectomy in Group B, MR-assisted hepatectomy in Group A yielded a shorter operation time (202.86 ± 46.02 min vs 229.52 ± 57.13 min, P = 0.003)”
P = 0.003
From the paper · Abstract
“The total postoperative complications and hospitalization days in Group A were significantly less than those in Group B [14 (37.84%) vs 35 (60.34%), P = 0.032 and 12.05 ± 4.04 d vs 13.78 ± 4.13 d, P = 0.049, respectively].”
P = 0.032
From the paper · Abstract
Conclusions (4)
Operation time shorter with MR assistanceAnswer: Yes
“Compared to traditional hepatectomy in Group B, MR-assisted hepatectomy in Group A yielded a shorter operation time (202.86 ± 46.02 min vs 229.52 ± 57.13 min, P = 0.003)”
202.86 ± 46.02 vs 229.52 ± 57.13 min, P = 0.003
From the paper · Abstract
Fewer total complications with MR assistanceAnswer: Yes
“Total complications 7 (18.92) 23 (39.66) 0.034”
7 (18.92) vs 23 (39.66), P = 0.034
From the paper · Full text
Hospital stay shorter with MR assistanceAnswer: Yes
“hospitalization days in Group A were significantly less than those in Group B”
12.05 ± 4.04 vs 13.78 ± 4.13 d, P = 0.049
From the paper · Abstract
AST and total bilirubin did not differAnswer: No significant difference
“no significant differences in aspartate aminotransferase and TB were noted between the two groups ( P = 0.343 and P = 0.557, respectively)”
Clinical acceptance of advanced visualization methods: a comparison study of 3D-print, virtual reality glasses, and 3D-display#
Muff JL et al. · 3D printing in medicine · 2022
Multi-specialty · Survey/user study
SpectoVR
HTC Vive
Interview and questionnaire study in which 20 physicians from cardiology, oral and maxillofacial surgery, orthopaedics and radiology each reviewed CT-derived cases as a 3D print, in VR glasses and on a 3D display. VR glasses were rated best for understanding the pathology in most disciplines, and the 3D display for detail and ease of use. A possible change in treatment was reported by 44% with VR and 33% with each of the other two methods.
“Possible change in treatment was reported using 3D-Print in 33%, VR-Glasses in 44%, and 3D-Display in 33% of participants.”
44%
From the paper · Abstract
“Physicians with a professional experience of more than ten years reported no change in treatment using any method.”
From the paper · Abstract
“As to operability, 3D-Display was consistently rated best in all levels of professional experience and all disciplines.”
From the paper · Abstract
Conclusions (4)
VR ranked first for understanding in most disciplinesAnswer: Describes
“Concerning the understanding of the pathology and quality of the anatomical representation, VR-Glasses were rated best in three out of four disciplines and two out of three levels of professional experience.”
mean 8.1 vs 7.6 vs 7.5 (VR-Glasses, 3D-Display, 3D-Print)
From the paper · Abstract
Possible treatment change reported by 33 to 44%Answer: Yes
“Possible change in treatment was reported using 3D-Print in 33%, VR-Glasses in 44%, and 3D-Display in 33% of participants.”
33%, 44%, 33%
From the paper · Abstract
3D display ranked first for operabilityAnswer: Describes
“As to operability, 3D-Display was consistently rated best in all levels of professional experience and all disciplines.”
From the paper · Abstract
Physicians over ten years' experience saw no changeAnswer: No
“Physicians with a professional experience of more than ten years reported no change in treatment using any method.”
Developing Virtual Reality Head Mounted Display (HMD) Set-Up for Thoracoscopic Surgery of Complex Congenital Lung MalFormations in Children#
Pelizzo G et al. · Children (Basel, Switzerland) · 2022
Thoracic · Case series
3D Slicer / SlicerVR
Meta Quest / Oculus
Report describing a VR head-mounted display set-up, built with 3D Slicer and an in-house plugin, used to plan thoracoscopic surgery in a series of children with complex congenital lung malformations. The authors describe preoperative navigation into the malformation that let surgeons explore the anatomy and anticipate difficulties, and propose dedicated simulation and teaching programmes.
“The preoperative VR HMD evaluation allowed a navigation into the malformation with the aim to explore, interact, and make the surgeon more confident and skilled to answer to the traps.”
From the paper · Abstract
“Trocar positioning also had benefit from the preoperative VR HMD study in all cases.”
Chinese narrative review of mixed reality in hepatobiliary surgery. The authors describe its uses in preoperative evaluation and surgical planning, intraoperative navigation and teaching, and discuss its potential and current limitations.
Virtual reality: a useful simulation tool for planning and training#
Sharma D, Subramaniam KG · Indian journal of thoracic and cardiovascular surgery · 2022
Multi-specialty · Letter (no abstract)
VR, platform not specified
Correspondence in the Indian Journal of Thoracic and Cardiovascular Surgery presenting virtual reality as a simulation tool for planning and training. No abstract was available, so these details are from the title and venue and could not be confirmed.
Percutaneous Kidney Puncture with Three-dimensional Mixed-reality Hologram Guidance: From Preoperative Planning to Intraoperative Navigation#
Porpiglia F et al. · European urology · 2022
Urology · Comparative study · n: 10 patients
AR/MR, platform not specified
Prospective study of 10 patients undergoing endoscopic combined intrarenal surgery in whom 3D mixed-reality kidney holograms were used to plan the access point and were overlaid on the patient to guide percutaneous puncture, compared with matched patients having standard ultrasound/fluoroscopy guidance. The authors report correct lower-calyx puncture in all MR cases, shorter radiation exposure, longer puncture time and higher first-attempt success (100% vs 50%) than standard procedures.
“Matched pair analysis with the standard ECIRS group revealed a significantly shorter radiation exposure time for the 3D MR group (p < 0.001) even though the puncture time was longer in comparison to the standard group (p < 0.001).”
p < 0.001
From the paper · Abstract
“Finally, use of 3D MR led to a higher success rate for renal puncture at the first attempt (100% vs 50%; p = 0.032).”
100% vs 50%
From the paper · Abstract
“The main limitations of the study are the small sample size and manual overlapping of the rigid hologram models.”
From the paper · Abstract
Conclusions (2)
Higher first-attempt puncture successAnswer: Yes
“Finally, use of 3D MR led to a higher success rate for renal puncture at the first attempt (100% vs 50%; p = 0.032).”
100% vs 50%, p = 0.032
From the paper · Abstract
Shorter radiation time, longer puncture timeAnswer: Mixed
“Matched pair analysis with the standard ECIRS group revealed a significantly shorter radiation exposure time for the 3D MR group (p < 0.001) even though the puncture time was longer in comparison to the standard group (p < 0.001).”
Virtual reality of three-dimensional surgical field for surgical planning and intraoperative management#
Fujihara A, Ukimura O · World journal of urology · 2022
Urology · Narrative review
Multiple platforms
Non-systematic review of virtual reality technologies in the management of prostate and renal cancer. The authors describe uses in MRI/ultrasound fusion biopsy, training simulators, navigation in robotic prostatectomy, focal therapy, and 3D VR simulation and guidance for partial nephrectomy, and conclude that VR helps tailor surgical planning but needs prospective evaluation.
Virtual reality-based 3-dimensional localization of stereotactic EEG (SEEG) depth electrodes and related brain anatomy in pediatric epilepsy surgery#
Phan TN et al. · Child's nervous system · 2022
Neurosurgery · Retrospective case series · n: 46 patients (20 with VR renderings)
VR, platform not specified
Single-centre retrospective study of 46 children who had stereo-EEG; 20 had VR-based 3D renderings of their depth electrodes and surrounding anatomy. All 20 renderings were used for patient-family education and multidisciplinary epilepsy team discussion, and 7 during neuronavigation. The authors present three cases and describe applications to presurgical planning.
“Of the 46 patients identified who underwent an SEEG procedure, 43.5% (20/46) had a 3D rendering (3DR) of their SEEG depth electrodes.”
43.5%
From the paper · Abstract
“All 3DRs were used during patient-family education and discussion among the Epilepsy multidisciplinary team meetings, while 35% (7/20) were used during neuronavigation in surgery.”
35%
From the paper · Abstract
Conclusions (2)
43.5% of SEEG patients had a 3D renderingAnswer: Describes
“Of the 46 patients identified who underwent an SEEG procedure, 43.5% (20/46) had a 3D rendering (3DR) of their SEEG depth electrodes.”
43.5% (20/46)
From the paper · Abstract
Renderings used for family education and team meetingsAnswer: Describes
“All 3DRs were used during patient-family education and discussion among the Epilepsy multidisciplinary team meetings, while 35% (7/20) were used during neuronavigation in surgery.”
State-of-the-art review of VR and AR in cardiovascular care, covering education, interventional planning with VR, AR support for complex interventions, rehabilitation, and future cath-lab applications, with technical, cybersickness and ethical challenges.
“Persistent technical challenges to overcome include the integration of different imaging modalities into VR/AR and the harmonization of data flow and interfaces.”
From the paper · Abstract
“Cybersickness might exclude some patients and users from the potential benefits of VR/AR.”
Virtual reality surgical planning for endoscopic endonasal approaches to the craniovertebral junction#
Filimonov A et al. · American journal of otolaryngology · 2022
Spine · Case series · n: 5 patients
VR, platform not specified
Case series of five patients who had endoscopic endonasal surgery at the craniovertebral junction after preoperative planning with immersive VR models fused from CT and MRI. The authors describe how VR helped predict the inferior and lateral limits of dissection and identify critical structures when designing the approach.
“Such models help in the development of safe surgical plans by predicting inferior and lateral planes of dissection and assisting in the identification of critical structures.”
From the paper · Abstract
Conclusions (1)
VR models aided dissection planes and structure identificationAnswer: Yes
“Such models help in the development of safe surgical plans by predicting inferior and lateral planes of dissection and assisting in the identification of critical structures.”
VR and 3D Printing for Preop Planning of Left Ventricular Myxoma in a Child#
Qiu H et al. · The Annals of thoracic surgery · 2022
Congenital heart · Case report · n: 1 patient
VR, platform not specified
Case report of a 7-year-old boy with a large left ventricular myxoma obstructing the outflow tract. A VR model and a 3D-printed model built from end-diastolic CT were used for preoperative planning, and the mass was completely resected in one piece.
“They helped the surgeon completely manage the details of the surgery.”
From the paper · Abstract
“The mass was completely resected in one piece uneventfully.”
Percutaneous puncture during PCNL: new perspective for the future with virtual imaging guidance#
Checcucci E et al. · World journal of urology · 2022
Urology · Narrative review
Multiple platforms
Non-systematic review of virtual imaging guidance for percutaneous renal puncture in PCNL, from 3D virtual navigation for training and planning to cognitive, AR and MR navigation and early AI guidance. The authors conclude that virtual guidance is useful for simulation, training and planning, and AR/MR for real-time navigation.
“Focusing on surgery, this tool revealed to be useful both for surgical planning, allowed to achieve a better surgical performance, and for surgical navigation by using augmented reality and mixed reality systems aimed to assist the surgeon in real time during the intervention.”
From the paper · Abstract
Conclusions (2)
Potential benefit for simulation and trainingAnswer: Describes
“Nowadays, many experiences proved the potential benefit of virtual guidance for surgical simulation and training.”
From the paper · Abstract
Virtual guidance useful for planning and navigationAnswer: Yes
“Focusing on surgery, this tool revealed to be useful both for surgical planning, allowed to achieve a better surgical performance, and for surgical navigation by using augmented reality and mixed reality systems aimed to assist the surgeon in real time during the intervention.”
3D mixed-reality visualization of medical imaging data as a supporting tool for innovative, minimally invasive surgery for gastrointestinal tumors and systemic treatment as a new path in personalized treatment of advanced cancer diseases#
Wierzbicki R et al. · Journal of cancer research and clinical oncology · 2022
Hepatobiliary & pancreatic (HPB) · Case series · n: 8 patients
Microsoft HoloLens
Report of eight treatments of unresectable liver and pancreatic tumours (irreversible electroporation or microwave ablation) in which preoperative CT or MRI was converted into holograms on HoloLens 2 with CarnaLife Holo to estimate tumour volume and margins before surgery and overlaid in the surgeon's view during the operation. The authors report better appreciation of tumour size and location and more precise needle placement and ablation lines.
“The intraoperative hologram contributed to better presentation of tumor size and locations, more precise setting of needles used to irreversible electroporation and for determining ablation line in case of liver metastases.”
From the paper · Abstract
“It was used for planning the scope of the surgery and was the basis for the decision regarding the choice of the surgical technique.”
From the paper · Fulltext
Conclusions (4)
Hologram improved view of tumour size and locationAnswer: Yes
“The intraoperative hologram contributed to better presentation of tumor size and locations, more precise setting of needles used to irreversible electroporation and for determining ablation line in case of liver metastases.”
From the paper · Abstract
Visualization guided choice of surgical techniqueAnswer: Yes
“It was used for planning the scope of the surgery and was the basis for the decision regarding the choice of the surgical technique.”
From the paper · Full text
Procedure time one third shorter, no comparator dataAnswer: Describes
“The use of minimally invasive surgical techniques in combination with CarnaLifeHolo resulted in the reduction of the procedure time by 1/3 compared to the time of surgery without the use of the CarnaLife Holo system”
mean 62.5 min, SD 21.2 min
From the paper · Full text
No perioperative complications in eight patientsAnswer: Describes
Multidisciplinary Virtual Three-Dimensional Planning of a Forequarter Amputation With Chest Wall Resection#
Peek JJ et al. · The Annals of thoracic surgery · 2022
Thoracic · Case report · n: 1 patient
VR, platform not specified
Case report of a 74-year-old man with axillary squamous cell carcinoma who underwent extended forequarter amputation with chest wall resection and reconstruction, planned by a multidisciplinary team using patient-specific 3D virtual reality reconstructions alongside CT. The authors describe the approach and encourage work to automate the workflow.
Application of augmented reality (AR) technology to locate the cutaneous perforator of anterolateral thigh perforator flap: A case report#
Nuri T et al. · Microsurgery · 2022
Plastic & reconstructive · Case report · n: 1 patient
AR/MR, platform not specified
Case report of a 36-year-old woman undergoing hemiglossectomy and ALT free-flap reconstruction, in whom 3D CT angiography images shown on an AR device were used to locate the cutaneous perforator before harvest. The authors report that the intraoperative perforator position matched the AR-predicted location and that the flap healed without complications.
“There were no complications during the postoperative course.”
From the paper · Abstract
“The intraoperative location of the cutaneous perforator corresponded with the predicted location which was confirmed using the AR technique.”
From the paper · Abstract
Conclusions (2)
Perforator location matched the AR predictionAnswer: Yes
“The intraoperative location of the cutaneous perforator corresponded with the predicted location which was confirmed using the AR technique.”
From the paper · Abstract
No postoperative complications in one patientAnswer: Describes
“There were no complications during the postoperative course.”
3D imaging technologies in minimally invasive kidney and prostate cancer surgery: which is the urologists' perception?#
Amparore D et al. · Minerva urology and nephrology · 2022
Urology · Survey/user study
Microsoft HoloLens
Questionnaire survey of 180 attendees of a urology technology meeting about 3D reconstructions, 3D printing, augmented reality and mixed reality for kidney and prostate cancer surgery. The authors report that attendees rated the HoloLens headset as the best tool for surgical planning and printed models as best for patient counselling, and preferred AR for intraoperative guidance and training.
“HoloLens (Microsoft Corp., Redmond, WA, USA) was perceived as the best imaging technology for the surgical planning (50% for prostate and 60% for kidney)”
60%
From the paper · Abstract
Conclusions (1)
Headset ranked first for surgical planningAnswer: Yes
“HoloLens (Microsoft Corp., Redmond, WA, USA) was perceived as the best imaging technology for the surgical planning (50% for prostate and 60% for kidney)”
IMHOTEP: cross-professional evaluation of a three-dimensional virtual reality system for interactive surgical operation planning, tumor board discussion and immersive training for complex liver surgery in a head-mounted display#
Questionnaire study in which 158 participants (medical students, residents, attending surgeons and nurses) used IMHOTEP, a VR environment on an Oculus Rift that combines 3D liver models with clinical and imaging data, for planning and training in liver surgery using one sample patient. Most found it agreeable (89.9%) and agreed complex cases could be assessed better (94.3%) and faster (84.8%) than with 2D displays.
“In the evaluation by 158 participants (57 medical students, 35 resident surgeons, 13 attending surgeons and 53 nurses), 89.9% found the VR system agreeable to work with.”
89.9%
From the paper · Abstract
“Participants generally agreed that complex cases in particular could be assessed better (94.3%) and faster (84.8%) with VR than with traditional 2D display methods.”
94.3%
From the paper · Abstract
“Least potential was seen in nursing training (54.8%).”
54.8%
From the paper · Abstract
Conclusions (3)
Most participants found the system agreeableAnswer: Yes
“In the evaluation by 158 participants (57 medical students, 35 resident surgeons, 13 attending surgeons and 53 nurses), 89.9% found the VR system agreeable to work with.”
89.9%
From the paper · Abstract
Most favored VR over 2D for complex casesAnswer: Yes
“Participants generally agreed that complex cases in particular could be assessed better (94.3%) and faster (84.8%) with VR than with traditional 2D display methods.”
94.3% better, 84.8% faster
From the paper · Abstract
Training potential rated highest for studentsAnswer: Describes
“The highest potential was seen in student training (87.3%), resident training (84.6%), and clinical routine use (80.3%).”
Current and Future Applications of Virtual, Augmented, and Mixed Reality in Cardiothoracic Surgery#
Sadeghi AH et al. · The Annals of thoracic surgery · 2022
Thoracic · Narrative review
Multiple platforms
Non-systematic review of virtual, augmented and mixed reality in cardiothoracic surgery, covering preoperative planning, intraoperative guidance, postoperative pain and rehabilitation, simulation and patient education. The authors see promising roles in surgical planning, simulation and perioperative management, and call for further research.
Preprint (ISVC 2022) presenting a DirectX/OpenXR-based holographic DICOM viewer that renders CT/MRI image stacks in real time on Microsoft HoloLens 2 for multi-user surgical planning, with smartphones as optional input devices, plus a preliminary qualitative evaluation.
Advances in perforator imaging through holographic CTA and augmented reality: a systematic review#
Phan R et al. · Australasian Journal of Plastic Surgery · 2022
Plastic & reconstructive · Systematic review
Multiple platforms
Systematic review of 11 articles on holographic CTA and augmented reality for identifying perforators in free-flap planning. The authors conclude that projection and AR are technically achievable but objective outcome data and cost analyses are lacking.
“This, combined with a cost analysis, are the main obstructions to this technology being more widely adopted.”
From the paper · Abstract
Conclusions (2)
Projection achievable, objective outcome data lackingAnswer: Describes
“while established methods of data rendering and projection can achieve holographic projection and AR, there is a lack of objective outcome data to demonstrate its usefulness”
From the paper · Abstract
Outcome and cost data gaps limit adoptionAnswer: Describes
“This, combined with a cost analysis, are the main obstructions to this technology being more widely adopted.”
Veloso R et al. · Kalpa publications in computing · 2022
Multi-specialty · Survey/user study · n: 22 experts
Microsoft HoloLens
Preliminary Delphi study in which 22 experts from several hospitals gave opinions on mixed-reality tools such as HoloLens 2 in surgery. The experts named medical education and surgical planning as the most useful areas.
“According to experts, the most useful areas are medical education and surgical planning.”
From the paper · Abstract
Conclusions (3)
Experts rated education and planning most usefulAnswer: Yes
“According to experts, the most useful areas are medical education and surgical planning.”
From the paper · Abstract
All round-three respondents signed consensus letterAnswer: Describes
“All participants (100%) globally signed the consensus letter which emphasize that consensus was reached.”
100% of 13 third-round respondents
From the paper · Full text
Experts said technology could make planning interactiveAnswer: Describes
“Technology could also be helpful in the surgical planning, making it a more interactive process”
Realidad mixta en Hololens 2 como sistema de asistencia intraoperatoria en cirugía de escoliosis idiopática del adolescente: un caso clínico#
Ferràs-Tarragó J et al. · Revista Española de Cirugía Osteoarticular · 2022
Spine · Case report · n: 1 patient
Microsoft HoloLens
Custom Unity app
Case report (Spanish) of adolescent idiopathic scoliosis correction in which a custom Unity/C++ planning tool was used to design implant position and size at the apex of the deformity, and the holographic plan was then shown on HoloLens 2 for intraoperative assistance. The authors report implants matched the plan, short planning time and high surgeon satisfaction.
“The planning time was low and the surgeon's satisfaction was high regarding the practicality of its use and the result obtained.”
From the paper · Abstract
“the positioning and size of the implants were identical to those planned using this technology”
From the paper · Abstract
Conclusions (2)
Implant position and size matched the planAnswer: Yes
“the positioning and size of the implants were identical to those planned using this technology”
From the paper · Abstract
Low planning time and high surgeon satisfactionAnswer: Yes
“The planning time was low and the surgeon's satisfaction was high regarding the practicality of its use and the result obtained.”
Enhanced 3D visualization for planning biventricular repair of double outlet right ventricle: a pilot study on the advantages of virtual reality#
Milano EG et al. · European heart journal. Digital health · 2021
Congenital heart · Comparative study · n: 10 patients
Meta Quest / Oculus
Custom Unity app
Retrospective pilot study of 10 consecutive patients with complex double-outlet right ventricle who had biventricular repair. Two paediatric cardiac surgeons, blinded to the operation performed, reviewed each case using imaging, 3D PDFs, 3D-printed models and virtual reality (an in-house Unity application on Oculus Rift, per the full text). The authors report that agreement with the actual surgical plan was 75% after imaging, 70% with 3D PDFs, 85% with 3D prints and 95% after VR.
“There was no mortality during the follow-up (mean = 2.5 years).”
From the paper · Abstract
“Virtual reality can enhance understanding of suitability for biventricular repair in patients with complex DORV if compared to cross-sectional images and other 3D modelling techniques.”
From the paper · Abstract
“improved in four cases with the use of the physical 3D printed model and in five cases using the VR setup, changing the surgical plan from univentricular to biventricular repair”
From the paper · Fulltext
Conclusions (3)
Plan agreement 95% with VR versus 75% imagingAnswer: Yes
“increasing the accuracy of the selection of ideal candidates for biventricular repair to 95% (19/20 cases), compared to 75% (15/20 cases)”
95% (19/20) vs 75% (15/20), no test
From the paper · Full text
VR changed plan to biventricular in five casesAnswer: Yes
“improved in four cases with the use of the physical 3D printed model and in five cases using the VR setup, changing the surgical plan from univentricular to biventricular repair”
From the paper · Full text
3D PDF gave no gain over imagingAnswer: No significant difference
“the 3D pdf did not increase the accordance on the feasibility of biventricular repair in any case”
Patient-specific virtual reality technology for complex neurosurgical cases: illustrative cases#
Anthony D et al. · Journal of neurosurgery. Case lessons · 2021
Neurosurgery · Case series · n: 5 patients
Surgical Theater
Five illustrative adult cases (spinal cord cavernoma, clinoidal meningioma, oligodendroglioma, giant aneurysm and AVM) in which 360-degree VR models (Surgical Theater) were used for patient consultation, preoperative planning and/or intraoperative 3D navigation. In two cases the plan changed after reviewing the VR model.
“For two cases, the plan changed after reviewing the patient's 360°VR model from one based on conventional Digital Imaging and Communications in Medicine imaging.”
From the paper · Abstract
“The 360°VR models provided visualization to better understand the lesion's 3D anatomy, as well as to plan and execute the safest patient-specific approach, rather than a less detailed, more standardized one.”
From the paper · Abstract
“In case 1, simulating both approaches in 360°VR helped facilitate the discussion on the necessary change and alleviated anxiety.”
From the paper · Fulltext
Conclusions (3)
Plan changed in two of five casesAnswer: Yes
“For two cases, the plan changed after reviewing the patient's 360°VR model from one based on conventional Digital Imaging and Communications in Medicine imaging.”
From the paper · Abstract
Authors report better 3D grasp of lesionAnswer: Yes
“The 360°VR models provided visualization to better understand the lesion's 3D anatomy, as well as to plan and execute the safest patient-specific approach, rather than a less detailed, more standardized one.”
From the paper · Abstract
VR eased discussion of approach change with patientAnswer: Yes
“In case 1, simulating both approaches in 360°VR helped facilitate the discussion on the necessary change and alleviated anxiety.”
[Anatomic and clinical study of virtual reality technology assisted modified transtrochanteric curved varus osteotomy for osteonecrosis of the femoral head]#
Xia T et al. · Zhongguo xiu fu chong jian wai ke za zhi · 2021
Orthopedics · Case series · n: 11 patients
VR, platform not specified
Chinese study combining a cadaver study of a modified transtrochanteric curved varus osteotomy with a clinical series of 11 patients (17 hips) with osteonecrosis of the femoral head, in whom virtual reality simulation was used preoperatively to plan the osteotomy angles. The authors report that the achieved varus angle matched the plan in 3 hips and was within 1 to 4 degrees in 14, with one greater trochanter fracture, one delayed union and a significant improvement in Harris hip score.
“The anteroposterior pelvic X-ray film was rechecked at 2 days after operation, of which 3 hips were consistent with the planned varus angle of VR preoperative planning, and the error value of varus angle of the remaining 14 hips was 1°-4°.”
From the paper · Abstract
“The modified transtrochanteric curved varus osteotomy for the treatment of ONFH is theoretically feasible, and the short-term effectiveness of this operation combined with VR technology is satisfactory.”
From the paper · Abstract
Conclusions (3)
Achieved varus angle within 4° of planAnswer: Yes
“The anteroposterior pelvic X-ray film was rechecked at 2 days after operation, of which 3 hips were consistent with the planned varus angle of VR preoperative planning, and the error value of varus angle of the remaining 14 hips was 1°-4°.”
3 hips consistent with plan; error 1°-4° in remaining 14 hips
From the paper · Abstract
Harris hip score rose from 57.2 to 84.0Answer: Yes
“The Harris score was 84.0±5.6, which was significantly higher than that before operation (57.2±5.5)”
84.0±5.6 vs 57.2±5.5, P =0.000
From the paper · Abstract
One trochanter fracture and one delayed osteotomy healingAnswer: Describes
“1 case (1 hip) developed greater trochanter fracture at 2 months after operation and was treated with open reduction and plate and screw internal fixation; 1 case (1 hip) had delayed healing at osteotomy at 4 months after operation”
Examining the benefits of extended reality in neurosurgery: A systematic review#
Dadario NB et al. · Journal of clinical neuroscience · 2021
Neurosurgery · Systematic review
Multiple platforms
PRISMA systematic review of 116 studies reporting measurable effects of VR, AR and MR in neurosurgery, mostly cranial tumour applications, with a focused synthesis of 10 controlled studies reporting patient outcomes. The authors conclude that XR has shown benefits in preoperative planning and multimodal navigation, but that controlled outcome data are scarce.
“The majority (82%) included cranial based applications related to tumor surgery with 34% showing improved resection rates and functional outcomes.”
34%
From the paper · Abstract
“However, few studies have reported patient outcomes in a controlled design demonstrating a need for higher quality data.”
From the paper · Abstract
Conclusions (3)
34% of studies reported improved resection, functionAnswer: Yes
“The majority (82%) included cranial based applications related to tumor surgery with 34% showing improved resection rates and functional outcomes.”
34%
From the paper · Abstract
Few controlled studies report patient outcomesAnswer: Describes
“However, few studies have reported patient outcomes in a controlled design demonstrating a need for higher quality data.”
From the paper · Abstract
More high-quality studies from 2017 to 2020Answer: Describes
“A rise in high-quality studies was identified from 2017 to 2020 compared to all previous years (p = 0.004).”
3D Virtual Reality Imaging of Major Aortopulmonary Collateral Arteries: A Novel Diagnostic Modality#
van de Woestijne PC et al. · World journal for pediatric & congenital heart surgery · 2021
Congenital heart · Retrospective case series · n: 7 patients
CardioVR/MedicalVR
3D Slicer / SlicerVR
Retrospective proof-of-concept study in which two congenital cardiac surgeons reviewed preoperative CT scans of seven newborns with pulmonary atresia and major aortopulmonary collateral arteries in immersive 3D VR, compared with conventional CT. The authors report improved visualisation of the collaterals, new observations or different plans in 4 of 7 cases, and easy, intuitive use.
“In addition, surgical planning was improved since new observations or different preoperative plans were apparent in 4 out of 7 cases.”
4 out of 7
From the paper · Abstract
“After the initial setup, VR software and hardware was reported to be easy and intuitive to use.”
From the paper · Abstract
“3D-VR visualizations were reconstructed from CT scans of seven newborns where the enhanced topographic anatomy resulted in improved visualization of MAPCA.”
From the paper · Abstract
“Although VR assessment takes more time (∼15–20 min) than conventional imaging techniques, mainly due to setting up the VR hardware and software”
∼15–20 min
From the paper · Fulltext
Conclusions (4)
3D reconstruction feasible in all 7 newbornsAnswer: Yes
“It was technically feasible to create 3D reconstructions of segmented CTA scans of all 7 newborns in VR”
7 of 7 scans
From the paper · Full text
New observations or plans in 4/7 casesAnswer: Yes
“surgical planning was improved since new observations or different preoperative plans were apparent in 4 out of 7 cases”
4 of 7 cases
From the paper · Abstract
Improved MAPCA visualization over 2D CTAnswer: Yes
“3D-VR visualizations were reconstructed from CT scans of seven newborns where the enhanced topographic anatomy resulted in improved visualization of MAPCA”
From the paper · Abstract
VR assessment took longer than conventional imagingAnswer: No
“Although VR assessment takes more time (∼15–20 min) than conventional imaging techniques, mainly due to setting up the VR hardware and software”
Virtual embolization for treatment support of intracranial AVMs using an interactive desktop and VR application#
Sprengel U et al. · International journal of computer assisted radiology and surgery · 2021
Neurosurgery · Technical development · n: 3 patient datasets
Custom Unity app
HTC Vive
Technical development of an immersive VR application (with a desktop version) for virtual embolization of intracranial AVMs, in which users can block or unblock feeding arteries and view the resulting pre-computed simulated blood flow as particles. It was applied to three patient-specific cases, and two experienced neuroradiologists rated feeder blocking as highly beneficial.
“The feature of virtually blocking or unblocking feeders was rated highly beneficial, and a desire for the inclusion of quantitative information was formulated.”
From the paper · Abstract
Conclusions (2)
Two experts rated feeder blocking highly beneficialAnswer: Yes
“The feature of virtually blocking or unblocking feeders was rated highly beneficial, and a desire for the inclusion of quantitative information was formulated.”
From the paper · Abstract
Pilot adapted to three patient-specific casesAnswer: Describes
“In a pilot study, the application was successfully adapted to three patient-specific cases.”
Breast Magnetic Resonance Image Analysis for Surgeons Using Virtual Reality: A Comparative Study#
El Beheiry M et al. · JCO clinical cancer informatics · 2021
Plastic & reconstructive · Comparative study
Custom Unity app
Comparative study in which 18 breast surgeons (residents and practitioners) at Institut Curie analysed preoperative breast MRI using standard slice-based viewing and the DIVA system in VR mode, judged against pathology reports. The authors report significantly faster analysis with DIVA and better accuracy in identifying the affected breast and, for practising surgeons, the tumour quadrant.
“The MRI analysis time was significantly lower with the DIVA system than with the slice-based visualization for residents, practitioners, and subsequently the entire group (P < .001).”
P < .001
From the paper · Abstract
“The accuracy of determination of which breast contained the lesion significantly increased with DIVA for residents (P = .003) and practitioners (P = .04).”
P = .003
From the paper · Abstract
“The accuracy of quadrant determination was significantly improved by DIVA for practicing surgeons (P = .01) but not significantly for residents (P = .49).”
P = .49
From the paper · Abstract
Conclusions (3)
MRI analysis time significantly lowerAnswer: Yes
“The MRI analysis time was significantly lower with the DIVA system than with the slice-based visualization for residents, practitioners, and subsequently the entire group (P < .001).”
P < .001
From the paper · Abstract
Affected-breast identification more accurateAnswer: Yes
“The accuracy of determination of which breast contained the lesion significantly increased with DIVA for residents (P = .003) and practitioners (P = .04).”
residents P = .003, practitioners P = .04
From the paper · Abstract
Quadrant accuracy improved for practitioners onlyAnswer: Mixed
“The accuracy of quadrant determination was significantly improved by DIVA for practicing surgeons (P = .01) but not significantly for residents (P = .49).”
Use of Virtual Reality for Hybrid Closure of Multiple Ventricular Septal Defects#
Ghosh RM et al. · JACC. Case reports · 2021
Congenital heart · Case report · n: 1 patient
3D Slicer / SlicerVR
HTC Vive
Case report of a 28-month-old girl with multiple ventricular septal defects after previous surgical and transcatheter repair attempts. Cardiac MRI-derived 3D models were reviewed in virtual reality (SlicerVR with an HTC Vive headset, per the full text), and the authors report that this helped the team locate the defects and choose a hybrid transcatheter and surgical approach, with successful repair.
“Viewing the models in virtual reality allowed the team to precisely locate the defects and decide on a hybrid transcatheter and surgical approach to ensure successful repair.”
From the paper · Abstract
Conclusions (3)
VR guided incision site and hybrid approachAnswer: Yes
“Viewing the VSDs in virtual reality allowed the team to not only locate the defects, but also to: 1) precisely plan the RV incision site; 2) visualize the muscle bundle that would need to be divided to see the anterior muscular defect directly; and 3) decide on a hybrid transcatheter and surgical approach to ensure success in the repair.”
From the paper · Full text
Models showed all four defectsAnswer: Describes
“The models demonstrated all 4 VSDs.”
From the paper · Full text
Two small defects not found at surgeryAnswer: Describes
“The 2 small midmuscular defects identified by means of CMR could not be located.”
A workflow to generate patient-specific three-dimensional augmented reality models from medical imaging data and example applications in urologic oncology#
Wake N et al. · 3D printing in medicine · 2021
Urology · Technical note
Microsoft HoloLens
Technical article describing a workflow for building patient-specific 3D models from CT/MRI and viewing them as augmented-reality holograms on the Microsoft HoloLens, with an overview of AR and VR. The authors give example cases in prostate and renal cancer in which AR models were used for surgical planning and intraoperative guidance at their institution.
Virtual reality-guided left ventricular assist device implantation in pediatric patient: Valuable presurgical tool#
Ramaswamy RK et al. · Annals of pediatric cardiology · 2021
Congenital heart · Case report · n: 1 patient
Meta Quest / Oculus
Case report of an 11-year-old boy in whose LVAD implantation was simulated in a VR environment with Oculus headsets and touch controllers. The authors report that this helped determine the optimal device position.
“We could confirm that the inflow cannula will not impinge on the mitral valve. He was hence offered an LVAD implant.”
From the paper · Fulltext
Conclusions (3)
VR aided optimal LVAD positioning in one childAnswer: Yes
“The technology played a significant role in the optimal positioning of the LVAD.”
From the paper · Abstract
VR confirmed cannula clearance, so LVAD was offeredAnswer: Yes
“We could confirm that the inflow cannula will not impinge on the mitral valve. He was hence offered an LVAD implant.”
From the paper · Full text
Manual VR model preparation takes about 8 hoursAnswer: Describes
“Currently, the segmentation and creation of the VR images are done manually and takes around 8 h.”
The Utility of Augmented Reality in Spinal Decompression Surgery Using CT/MRI Fusion Image#
Aoyama R et al. · Cureus · 2021
Spine · Technical note
Microsoft HoloLens
Holoeyes MD
Technical report in which CT/MRI fusion 3D models of the spine and a model of the planned laminectomy were displayed on a HoloLens 2 via Holoeyes MD so surgeons could confirm the decompression area before cervical and lumbar decompression surgery. The authors describe the system as useful for preoperative planning and orientation.
“This system was useful for cervical and lumbar decompression for confirming the proper decompression area preoperatively.”
From the paper · Abstract
“It does not allow preoperative verification so far.”
From the paper · Abstract
Conclusions (3)
Useful for confirming decompression area before surgeryAnswer: Yes
“This system was useful for cervical and lumbar decompression for confirming the proper decompression area preoperatively.”
From the paper · Abstract
Surgery performed as designed with the systemAnswer: Describes
“We could perform decompression surgery just designed with this system.”
From the paper · Abstract
No preoperative verification possible so farAnswer: Describes
“It does not allow preoperative verification so far.”
Preoperative evaluation of neurovascular relationships for microvascular decompression: Visualization using Brainvis in patients with idiopathic trigeminal neuralgia#
Wang B et al. · Clinical neurology and neurosurgery · 2021
Neurosurgery · Prospective case series · n: 8 patients
VR, platform not specified
Single-centre observational study of 8 patients with idiopathic trigeminal neuralgia, in which MR (TOF, FIESTA) and CT venography were fused in Brainvis into a 3D model for VR-based preoperative assessment of neurovascular relationships before microvascular decompression. The authors report agreement with intraoperative findings in all patients, with faster and more accurate assessment than 3D MR alone.
“Moreover, the assessment duration was significantly shorter with the fusion imaging technique than with the three-dimensional MR (P<0.05).”
P<0.05
From the paper · Abstract
“The rate of an accurate assessment was significantly higher with the fusion imaging technique than with three-dimensional MR (P<0.05).”
P<0.05
From the paper · Abstract
Conclusions (3)
Model matched intraoperative findings in all patientsAnswer: Yes
“The neurovascular relationships as determined with the fusion imaging technique were consistent with intraoperative neurovascular compression findings in all patients.”
From the paper · Abstract
Assessment faster than with 3D MRAnswer: Yes
“the assessment duration was significantly shorter with the fusion imaging technique than with the three-dimensional MR (P<0.05)”
P<0.05
From the paper · Abstract
Accurate assessment rate higher than with 3D MRAnswer: Yes
“The rate of an accurate assessment was significantly higher with the fusion imaging technique than with three-dimensional MR (P<0.05).”
A Virtual Reality System for Improved Image-Based Planning of Complex Cardiac Procedures#
Deng S et al. · Journal of imaging · 2021
Congenital heart · Technical development
Custom Unity app
HTC Vive
Technical development of a VR system (Unity, HTC Vive) for immersive planning from dynamic 3D echocardiography in congenital heart disease, offering volume rendering, multiplanar reformatting, flow visualization, cropping, measurement, haptics and multiuser interaction. Imaging and non-imaging clinicians who evaluated the features reported better understanding and communication of 3D echo data.
“The available features were evaluated by imaging and nonimaging clinicians, showing that the virtual reality system can help improve the understanding and communication of three-dimensional echocardiography imaging and potentially benefit congenital heart disease treatment.”
From the paper · Abstract
“After using our system, the surgeons experienced an increase in their confidence regarding the surgical approach in two thirds of the cases and reported that they would have modified their original plan in 60% of the cases.”
60% of cases
From the paper · Fulltext
“When asked which system would be preferred, given the same features in both, 11 indicated preference for the VR system, and 2 indicated equal preference.”
11 of 13 preferred VR, 2 equal
From the paper · Fulltext
Conclusions (4)
Clinicians report VR helps understanding of 3D echoAnswer: Yes
“The available features were evaluated by imaging and nonimaging clinicians, showing that the virtual reality system can help improve the understanding and communication of three-dimensional echocardiography imaging and potentially benefit congenital heart disease treatment.”
From the paper · Abstract
Surgeons would change plan in 60% of casesAnswer: Yes
“After using our system, the surgeons experienced an increase in their confidence regarding the surgical approach in two thirds of the cases and reported that they would have modified their original plan in 60% of the cases.”
60% of cases would have modified plan; confidence increased in two thirds of cases
From the paper · Full text
11 of 13 preferred VR over desktop softwareAnswer: Yes
“When asked which system would be preferred, given the same features in both, 11 indicated preference for the VR system, and 2 indicated equal preference.”
11 of 13 preferred VR, 2 equal
From the paper · Full text
Resolution, depth and overall image preferred in VRAnswer: Yes
“The participants significantly preferred the Resolution and Depth of VR, as well as the Overall preference.”
Virtual reality and 3D printing improve preoperative visualization of 3D liver reconstructions-results from a preclinical comparison of presentation modalities and user's preference#
Huettl F et al. · Annals of translational medicine · 2021
Preclinical study in which 30 participants (students, residents, fellows and HPB experts) assigned tumour-bearing segments in 20 patients' liver reconstructions shown as 3D PDFs, 3D-printed models and VR models (Unity with HTC Vive). The authors report significantly more correct segment assignments with VR or prints than with PDFs, fastest assignment with prints, and that VR had the best usability and was preferred by 73.3%.
“Regarding usability and user experience the VR application achieved the highest scores without causing significant vegetative symptoms and was also the most preferred method (n=22, 73.3%)”
73.3%
From the paper · Abstract
“Tumor assignment was significantly shorter with 3D PR models compared to 3D PDF (P<0.001) or VR application (P<0.001).”
P<0.001
From the paper · Abstract
Conclusions (3)
More correct segments with VR, print than PDFAnswer: Yes
“Participants named significantly more correct segments in VR (P=0.040) or PR (P=0.036) compared to PDF.”
VR P=0.040, PR P=0.036 vs PDF
From the paper · Abstract
Assignment fastest with 3D printed modelsAnswer: Yes
“Tumor assignment was significantly shorter with 3D PR models compared to 3D PDF (P<0.001) or VR application (P<0.001).”
P<0.001 vs PDF and vs VR
From the paper · Abstract
VR most preferred, with highest usability scoresAnswer: Yes
“Regarding usability and user experience the VR application achieved the highest scores without causing significant vegetative symptoms and was also the most preferred method (n=22, 73.3%)”
Application of Three-Dimensional Virtual Reality Models to Improve the Pre-Surgical Plan for Robotic Partial Nephrectomy#
McDonald M, D Shirk J · JSLS · 2021
Urology · Prospective case series · n: 15 patients
Ceevra Reveal
Smartphone / tablet AR
Single-surgeon series of the first 15 patients having robotic partial nephrectomy, in which surgical plans made from CT/MRI were compared with plans made after reviewing 3D VR models (Ceevra, viewed on a smartphone and an off-the-shelf headset). The approach was changed in six cases, including switches between transperitoneal and retroperitoneal routes and two cases with vascular anatomy not appreciated on routine scans.
“Six surgical approaches were changed based on the 3D VR images.”
From the paper · Abstract
“Two patients had distinctive renal vasculature related to the renal cancers which were not appreciated on routine scans but were well delineated by VR imaging studies.”
From the paper · Abstract
Conclusions (3)
Surgical approach changed in six of 15 casesAnswer: Yes
“Six surgical approaches were changed based on the 3D VR images.”
6 of 15 patients
From the paper · Abstract
Two vascular findings missed on routine scansAnswer: Yes
“Two patients had distinctive renal vasculature related to the renal cancers which were not appreciated on routine scans but were well delineated by VR imaging studies.”
From the paper · Abstract
Surgeon judged all six changes appropriateAnswer: Yes
“In all 6 cases, the surgeon was confident postoperatively that the changes made by reviewing the 3D VR models were appropriate.”
Retrospective comparison of 21 patients who had middle cerebral artery aneurysm clipping between 2016 and 2019: 10 planned and rehearsed with patient-specific 360-degree VR models and 11 planned with standard CTA/DSA. Case complexity was similar between groups. The authors report a shorter mean procedure time in the VR group (248 vs. 328 minutes, p = 0.0115).
“The mean procedure time was significantly lower for the VR group compared with the control group (247.80 minutes vs 328.27 minutes; p = 0.0115), particularly for the patients with a CC score of 2 (95% CI, p = 0.0064).”
p = 0.0115
From the paper · Abstract
“The mean EBL and length of stay for the non-VR group were 254.54 ± 121.36 ml and 7.8 ± 7.22 days, respectively. The mean EBL and length of stay for the VR group were 260 ± 126.49 ml and 8.3 ± 7.42 days, respectively (Table 3).”
EBL 254.54 vs 260 ml; stay 7.8 vs 8.3 days
From the paper · Fulltext
Conclusions (3)
Procedure time shorter in VR groupAnswer: Yes
“The mean procedure time was significantly lower for the VR group compared with the control group (247.80 minutes vs 328.27 minutes; p = 0.0115)”
247.80 vs 328.27 min, p = 0.0115
From the paper · Abstract
No significant time gain in ruptured aneurysmsAnswer: No significant difference
“Ruptured aneurysm 339 ± 107.30 (n = 4; CC 2.25) 277 ± 42.91 (n = 4; CC 2.5) 0.32; CC 0.67”
339 vs 277 min, p = 0.32
From the paper · Full text
Blood loss and stay similar between groupsAnswer: No
“The mean EBL and length of stay for the non-VR group were 254.54 ± 121.36 ml and 7.8 ± 7.22 days, respectively. The mean EBL and length of stay for the VR group were 260 ± 126.49 ml and 8.3 ± 7.42 days, respectively (Table 3).”
Augmented reality head-mounted display-based incision planning in cranial neurosurgery: a prospective pilot study#
Ivan ME et al. · Neurosurgical focus · 2021
Neurosurgery · Feasibility study · n: 11 patients
Microsoft HoloLens
OpenSight (Novarad)
Prospective pilot study of 11 consecutive patients having elective craniotomy, in which a surgeon wearing HoloLens running the OpenSight application traced tumour borders on the scalp for incision planning, and this was compared with tracing by a StealthStation neuronavigation system. Blinded raters judged correspondence excellent in 5 cases, adequate in 5 and poor in 1.
“Five patient procedures were rated as having an excellent correspondence degree, 5 had an adequate correspondence degree, and 1 had poor correspondence.”
From the paper · Abstract
“In this small pilot study, the authors found that AR was implementable in the workflow of a neurosurgery OR, and was a feasible method of preoperative tumor border identification for incision planning.”
From the paper · Abstract
Conclusions (2)
Navigation correspondence excellent in 5, poor in 1Answer: Mixed
“Five patient procedures were rated as having an excellent correspondence degree, 5 had an adequate correspondence degree, and 1 had poor correspondence.”
5 excellent, 5 adequate, 1 poor
From the paper · Abstract
Feasible within neurosurgery OR workflowAnswer: Yes
“In this small pilot study, the authors found that AR was implementable in the workflow of a neurosurgery OR, and was a feasible method of preoperative tumor border identification for incision planning.”
On the Use of Virtual Reality for Medical Imaging Visualization#
Pires F et al. · Journal of digital imaging · 2021
Multi-specialty · Narrative review
Multiple platforms
Review of virtual reality as an alternative to slice-based workstations for medical imaging, covering uses such as diagnosis, surgical planning and training. It sets out the key features VR software should have and assesses existing tools and development frameworks, Elucis among them. The authors identify real-time performance and latency as the main barriers to clinical adoption.
“Our results suggest that prerequisites such as real-time performance and minimum latency pose the greatest limitations for clinical adoption and need to be addressed.”
From the paper · Abstract
Conclusions (3)
Real-time performance and latency limit adoptionAnswer: Describes
“Our results suggest that prerequisites such as real-time performance and minimum latency pose the greatest limitations for clinical adoption and need to be addressed.”
From the paper · Abstract
Most tools lack performance for surgical useAnswer: No
“Our research also showed that most of the existing solutions do not have sufficient performance to be adopted in the surgical environment and serve primarily as tools for education and training.”
From the paper · Full text
Further comparison with current technologies neededAnswer: Describes
“There is also a need for further research comparing mixed realities and currently used technologies.”
Virtual reality and artificial intelligence for 3-dimensional planning of lung segmentectomies#
Sadeghi AH et al. · JTCVS techniques · 2021
Thoracic · Feasibility study · n: 10 patients
CardioVR/MedicalVR
PulmoVR
Prospective pilot study of PulmoVR, an AI-assisted immersive 3D VR platform, used as a supplementary tool to plan video-assisted thoracoscopic segmentectomy in 10 patients. The authors report that the platform was applied successfully and that the surgical strategy was adjusted after the VR evaluation in 40% of cases.
“PulmoVR was successfully applied as a supplementary imaging tool to perform video-assisted thoracoscopic segmentectomies.”
From the paper · Abstract
“In 40% of the cases, the surgical strategy was adjusted due to the 3-dimensional-VR-based evaluation of anatomy.”
40%
From the paper · Abstract
“in 100% of the cases, intraoperative anatomy corresponded entirely with preoperative VR images.”
100% of cases
From the paper · Fulltext
Conclusions (3)
VR reconstructions made in all patientsAnswer: Yes
“In all patients, VR reconstructions were made successfully.”
From the paper · Full text
Target segment changed in 4 of 10 casesAnswer: Yes
“In 4 out of 10 cases, the VR-based evaluation resulted in a change in the selection of the target segment than the initially selected target segment by 2D-CT.”
Using virtual reality simulated implantation for fit-testing pediatric patients for adult ventricular assist devices#
Davies RR et al. · JTCVS techniques · 2021
Congenital heart · Case series · n: 3 patients
Includes an author who is a Realize Medical advisor.
HTC Vive
I2I (Imager to Interventionalist)
Report of three paediatric patients fit-tested for adult ventricular assist devices by virtual implantation in VR (HTC Vive with I2I software), looking at device position relative to the chest wall and AV valve before implantation.
“Patient 1 was not felt to be a candidate for HVAD implantation, because during VR placement of the pump within the chest, the pump inflow would have been located within the system AV valve annulus.”
From the paper · Fulltext
Conclusions (3)
Virtual fit-testing ruled out device in one childAnswer: Yes
“Patient 1 was not felt to be a candidate for HVAD implantation, because during VR placement of the pump within the chest, the pump inflow would have been located within the system AV valve annulus.”
From the paper · Full text
Fit-testing enabled implantation in very small childrenAnswer: Yes
“Virtual fit-testing has enabled successful implantation of the HeartMate3 in 2 of the smallest patients described in the literature to date”
From the paper · Full text
Two of three children received the deviceAnswer: Describes
“Patients 2 and 3 underwent successful HVAD implantation”
3D Holographic Virtual Surgical Planning for a Single Right Ventricle Fontan Patient Needing Heartmate III Placement#
Szugye NA et al. · ASAIO journal (American Society for Artificial Internal Organs · 2021
Congenital heart · Case report · n: 1 patient
EchoPixel True 3D
Case report of a 15-year-old with hypoplastic left heart syndrome and a failing Fontan circulation, in whom EchoPixel True 3D was used to place a HeartMate III ventricular assist device virtually before implantation. The authors report that the device was implanted as planned.
“the HM3 device was placed just anterior to the RV apex as virtually planned.”
From the paper · Abstract
Conclusions (1)
Device placed as virtually plannedAnswer: Yes
“the HM3 device was placed just anterior to the RV apex as virtually planned.”
Hybrid Simulation and Planning Platform for Cryosurgery with Microsoft HoloLens#
Condino S et al. · Sensors (Basel, Switzerland) · 2021
Interventional radiology · Technical development · n: 2 patients
Custom Unity app
Microsoft HoloLens
Technical development of a cryosurgery planning platform that combines radiological images and cryoprobe specifications in a desktop 3D environment or a hybrid simulator using 3D printing and AR on Microsoft HoloLens. Preliminary retrospective planning of two surgical cases suggested the platform was quick to learn and could ease planning and anatomical understanding.
“Results suggest that the platform is easy and quick to learn and could be used in clinical practice to improve anatomical understanding, to make surgical planning easier than the traditional method, and to strengthen the memorization of surgical planning.”
From the paper · Abstract
“Three out of seven participants preferred to modify their original plan after using the desktop application”
3 of 7 participants
From the paper · Fulltext
Conclusions (2)
Three of seven participants changed their planAnswer: Yes
“Three out of seven participants preferred to modify their original plan after using the desktop application”
3 of 7 participants
From the paper · Full text
Authors judge platform easy and quick to learnAnswer: Describes
“Results suggest that the platform is easy and quick to learn and could be used in clinical practice to improve anatomical understanding, to make surgical planning easier than the traditional method, and to strengthen the memorization of surgical planning.”
Clinical Value of Virtual Reality versus 3D Printing in Congenital Heart Disease#
Lau I et al. · Biomolecules · 2021
Congenital heart · Survey/user study · n: 4 cases
Meta Quest / Oculus
Custom Unity app
User study in which 29 analysed practitioners (radiologists, sonographers and radiographers, out of 35) compared virtual reality on an Oculus Quest 2 with 3D-printed heart models for four congenital heart disease cases. The authors report that participants rated VR somewhat more useful for education and preoperative planning, although the differences were not statistically significant.
“VR was perceived as more useful in medical education and preoperative planning compared to 3D printed heart models, although there was no significant difference in the ratings (p = 0.54 and 0.35, respectively).”
p = 0.54
From the paper · Abstract
Conclusions (4)
VR vs 3D print usefulness ratings not significantAnswer: No significant difference
“The Mann–Whitney U test shows no significant difference between VR and 3DPHM in terms of the ratings for their usefulness in medical education and preoperative planning”
p = 0.35 and p = 0.54
From the paper · Full text
Anatomy display: VR vs 3D print not significantAnswer: No significant difference
“The Kendall’s W test shows no significant difference in the frequencies between VR and 3DPHM”
p = 0.32
From the paper · Full text
72% saw added benefit over conventional imagingAnswer: Yes
“Twenty-one participants (72%) indicated both the VR and 3DPHM provided additional benefits compared to the conventional medical imaging visualizations.”
21 participants (72%)
From the paper · Abstract
76% said both aid surgeon confidenceAnswer: Yes
“22 (76%) indicated both the VR and 3DPHM were helpful to increase surgeons’ confidence for CHD surgeries”
Case-specific three-dimensional hologram with a mixed reality technique for tumor resection in otolaryngology#
Mitani S et al. · Laryngoscope investigative otolaryngology · 2021
ENT / head & neck · Survey/user study
AR/MR, platform not specified
Proof-of-concept report of case-specific 3D holograms from CT and MRI viewed on head-mounted displays for preoperative planning and intraoperative reference in otolaryngologic tumour resection, with a questionnaire completed by 18 otolaryngologists. Respondents rated the holograms significantly better than computer images for picturing tumour location, assessing the surgical approach, intraoperative use and education.
“The case-specific 3D hologram on HMDs was successfully used by means of easy gesture-handling without any monitors preoperatively and intraoperatively.”
From the paper · Abstract
“Similarly, the holograms were observed to be better for intraoperative application and surgical education than computer images (P < .01).”
P < .01
From the paper · Abstract
“the surgical approach could be better perceived and imagined using the 3D hologram, and the results were statistically significant (questions 1 to 3, P < .01)”
P < .01
From the paper · Fulltext
Conclusions (3)
Approach and anatomy rated easier to pictureAnswer: Yes
“the surgical approach could be better perceived and imagined using the 3D hologram, and the results were statistically significant (questions 1 to 3, P < .01)”
P < .01
From the paper · Full text
Rated higher for intraoperative use and educationAnswer: Yes
“the 3D hologram was observed to be better than the regular images for intraoperative analysis and surgical education (questions 4 and 5, P < .01)”
P < .01
From the paper · Full text
Most rated educational usefulness 4.5 or 5Answer: Describes
“94% (17 out of 18) of the participants gave a score of 4.5 or 5 (average 4.86) out of 5 (question 5)”
Investigating the utility of VR for spatial understanding in surgical planning: evaluation of head-mounted to desktop display#
Hattab G et al. · Scientific reports · 2021
Hepatobiliary & pancreatic (HPB) · Comparative study
HTC Vive
Experimental study comparing a head-mounted display (VR) with a desktop screen for learning the internal spatial structure of two 3D models (a liver and a pyramid), followed by recall and pointing tasks on 3D-printed versions. The authors report that display type did not affect memory, confidence or target localisation, whereas model type did.
“Results showed that the learning condition (HMD or DT) did not influence participants' memory and confidence ratings of the models.”
From the paper · Abstract
Conclusions (3)
Headset and desktop gave similar recallAnswer: No significant difference
“Results showed that the learning condition (HMD or DT) did not influence participants’ memory and confidence ratings of the models.”
F(1,53) = 0.0058, p = 0.95
From the paper · Abstract
Model type affected recall of internal structureAnswer: Yes
“In contrast, the model type, that is, whether the model to be recalled was a liver or a pyramid significantly affected participants’ memory about the internal structure of the model.”
From the paper · Abstract
Target localisation unaffected by display typeAnswer: No significant difference
“Furthermore, localizing the internal position of the target sphere was also unaffected by participants’ previous experience of the model via HMD or DT.”
DICOM 3D viewers, virtual reality or 3D printing - a pilot usability study for assessing the preference of orthopedic surgeons#
Popescu D et al. · Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine · 2021
Orthopedics · Survey/user study · n: 3 cases
Custom Unity app
Pilot usability study in which orthopaedic surgeons compared a desktop DICOM 3D viewer, two VR environments and 3D-printed replicas for three cases (knee, hip and foot). The authors report a preference for the desktop viewer combined with the Unity-based VR solution, with 3D prints seen as more useful for simulating surgery than for diagnosis.
“The following order of using the tools was preferred: DICOM viewer, followed by Unity VR and 3DP.”
From the paper · Abstract
“For the VR and 3DP models, the lack of information on bone quality was considered an important drawback.”
From the paper · Abstract
Conclusions (3)
DICOM viewer preferred over VR and 3D printingAnswer: No
“The following order of using the tools was preferred: DICOM viewer, followed by Unity VR and 3DP.”
From the paper · Abstract
3D prints more useful for simulation than diagnosisAnswer: Describes
“3D-printed replicas were considered more useful for physically simulating the surgery than for diagnosis.”
From the paper · Abstract
Missing bone quality information an important drawbackAnswer: Describes
“For the VR and 3DP models, the lack of information on bone quality was considered an important drawback.”
Early Experience With Virtual and Synchronized Augmented Reality Platform for Preoperative Planning and Intraoperative Navigation: A Case Series#
Louis RG et al. · Operative neurosurgery (Hagerstown, Md.) · 2021
Neurosurgery · Case series · n: 49 patients
Surgical Theater
Case series of 49 neurosurgical patients whose 360-degree models were used for VR planning on a surgical rehearsal platform. Intraoperatively, the models were injected as an AR overlay (SyncAR) into the microscope oculars, co-registered with neuronavigation. The authors report no SyncAR-related complications, manual realignment in 48 of 49 surgeries, and gross total resection in 34 of 40 tumour surgeries.
“SyncAR contributed positively to the 3D understanding of patient-specific anatomy and ability to operate.”
From the paper · Abstract
“Manual realignment was performed in 48/49 surgeries.”
48/49
From the paper · Abstract
“All aneurysm clipping and microvascular decompression procedures were completed without complications.”
From the paper · Abstract
Conclusions (4)
No complications related to AR overlayAnswer: Describes
“No SyncAR-related complications occurred.”
From the paper · Abstract
Surgeons reported improved 3D understanding of anatomyAnswer: Yes
“SyncAR contributed positively to the 3D understanding of patient-specific anatomy and ability to operate.”
From the paper · Abstract
Manual overlay realignment in 48 of 49 surgeriesAnswer: Describes
“Manual realignment was performed in 48/49 surgeries.”
48/49
From the paper · Abstract
Gross total resection in 34 of 40 surgeriesAnswer: Describes
“Gross total resection was achieved in 34 of 40 surgeries (85%).”
Congenital heart · Retrospective case series · n: 15 patients
HTC Vive
Retrospective case series of 15 children (median age 6 years) whose 3D echocardiography data were reviewed in virtual reality by five surgeons before surgery for congenital heart disease. The authors report that surgeons felt more confident in 67% of cases, made minor modifications to the surgical plan in 53% and a major change in 7%.
“After viewing patient cases on VR, surgeons reported that they would have made minor modifications to surgical approach in 53% and major modifications in 7% of cases.”
53%
From the paper · Abstract
“Poor-quality 3D echocardiographic data were associated with a negative impact of VR visualization”
From the paper · Abstract
“In 67% of cases presented with VR, surgeons reported having “more” or “much more” confidence in their understanding of each patient's pathology and their surgical approach.”
67%; 10 of 15 cases
From the paper · Abstract
Conclusions (3)
Surgeons would modify surgical approach in some casesAnswer: Yes
“After viewing patient cases on VR, surgeons reported that they would have made minor modifications to surgical approach in 53% and major modifications in 7% of cases.”
minor 53%, major 7%
From the paper · Abstract
Surgeons more confident in 67% of casesAnswer: Yes
“In 67% of cases presented with VR, surgeons reported having “more” or “much more” confidence in their understanding of each patient's pathology and their surgical approach.”
67%; 10 of 15 cases
From the paper · Abstract
Poor-quality echo data gave negative VR impactAnswer: No
“Poor-quality 3D echocardiographic data were associated with a negative impact of VR visualization”
Evaluation of how users interface with holographic augmented reality surgical scenes: Interactive planning MR‐Guided prostate biopsies#
Velazco-Garcia JD et al. · The International Journal of Medical Robotics and Computer Assisted Surgery · 2021
Urology · Survey/user study
Microsoft HoloLens
User study of input interfaces (joystick, mouse/keyboard, holographic menus) for planning transrectal robot-assisted MR-guided prostate biopsy in an AR environment rendered on HoloLens. The authors report that a joystick improved interaction and let operators plan the biopsy in less time.
“The studies indicated that using a joystick improved the interactive capacity and enabled operator to plan MRgPBx in less time.”
From the paper · Abstract
Conclusions (4)
Joystick planning fastest of three input interfacesAnswer: Describes
“The joystick took the least duration for planning biopsies as compared to AR menu (p < 0.0001) and mouse/keyboard (p = 0.0015).”
99 s vs 166 s vs 125 s, p < 0.0001, p = 0.0015
From the paper · Full text
Mode I more accurate than Mode IIAnswer: Yes
“Irrespective of the input interface, subjects were able to hit the targets with higher accuracy in Mode-I as compared to Mode-II (p < 0.0001).”
p < 0.0001
From the paper · Full text
All subjects completed virtual biopsies accuratelyAnswer: Yes
“All the subjects were able to successfully perform virtual biopsies during the studies within the range of required accuracy (Fig. 6).”
From the paper · Full text
No difference by professional or 3D experienceAnswer: No significant difference
“No statistically significant difference was observed among subjects based on their professional experience (researchers, general physicians, and urologists) or prior experience working in 3D environments.”
Patient-specific virtual and mixed reality for immersive, experiential anatomy education and for surgical planning in temporal bone surgery#
Yamazaki A et al. · Auris, nasus, larynx · 2021
ENT / head & neck · Survey/user study · n: 1 patient
VR, platform not specified
AR/MR, platform not specified
Study of patient-specific temporal bone models created by a web service and viewed in a VR head-mounted display and an MR headset. Eleven otorhinolaryngology trainees and specialists rated a healthy VR model favourably and preferred the headset to a flat screen; a VR model of petrous apex cholesteatoma was used for surgical planning at a preoperative conference, and the MR headset was worn during surgery for anatomical reference.
“Most participants were favorable about the VR model and considered HMD as superior to a flat computer screen. 91% of the participants agreed or somewhat agreed that VR through HMD is cost effective.”
91%
From the paper · Abstract
“Regardless of the participants' training level in otorhinolaryngology or VR experience, all participants agreed that the VR temporal bone model is useful for anatomical education.”
From the paper · Abstract
Conclusions (4)
Most participants favored headset over flat screenAnswer: Yes
“Most participants were favorable about the VR model and considered HMD as superior to a flat computer screen.”
From the paper · Abstract
All participants found model useful for teachingAnswer: Yes
“all participants agreed that the VR temporal bone model is useful for anatomical education”
From the paper · Abstract
91% at least somewhat agreed on cost effectivenessAnswer: Yes
“91% of the participants agreed or somewhat agreed that VR through HMD is cost effective.”
91%
From the paper · Abstract
Model used for planning at surgical conferenceAnswer: Describes
“the VR pathological model was used for planning and sharing the surgical approach during a pre-operative surgical conference”
A Holographic Augmented Reality Interface for Visualizing of MRI Data and Planning of Neurosurgical Procedures#
Morales Mojica CM et al. · Journal of digital imaging · 2021
Neurosurgery · Technical development
Microsoft HoloLens
Technical development of a prototype holographic AR interface on HoloLens that fuses preoperative MRI and segmented structures with a virtual tubular tool, so that access paths can be planned by voice and gesture while forbidden regions protect vital structures. In silico tests assessed computational load, and the authors report a favourable preliminary qualitative evaluation.
“A preliminary qualitative evaluation revealed that holographic visualization of high-resolution 3D MRI data offers an intuitive and interactive perspective of the complex brain vasculature and anatomical structures.”
From the paper · Abstract
Conclusions (2)
Preliminary evaluation found MRI holograms intuitiveAnswer: Yes
“A preliminary qualitative evaluation revealed that holographic visualization of high-resolution 3D MRI data offers an intuitive and interactive perspective of the complex brain vasculature and anatomical structures.”
“The holographic AR visualization was subjectively found to be superior over desktop-based volume rendering in regard to (i) 3D appreciation of the spatial relationship of segmented structures, (ii) detection and collision avoidance of critical structures (vessels), and (iii) ergonomics and ease in selecting a trajectory in stereotactic planning.”
Report of a mixed-reality workflow used to plan treatment of an extensive left maxillary tumour, involving the surgeon and radiation oncologist, with 10 examiners rating its usability. The authors report good display of 3D structures and interaction among examiners without the nausea described for other VR/AR systems, but limited intraoperative usability.
“MR showed good results during preoperative planning for a surgically extensive case in terms of displaying 3D structures and enhancing the physical and virtual interactions among the examiners.”
From the paper · Abstract
“Previously described drawbacks of other VR/AR applications such as nausea and motion sickness were not observed with MR.”
From the paper · Abstract
“However, MR seems to lack intraoperative usability, which is a drawback.”
From the paper · Abstract
Conclusions (3)
Good 3D display and examiner interactionAnswer: Yes
“MR showed good results during preoperative planning for a surgically extensive case in terms of displaying 3D structures and enhancing the physical and virtual interactions among the examiners.”
From the paper · Abstract
No nausea or motion sickness observedAnswer: Yes
“Previously described drawbacks of other VR/AR applications such as nausea and motion sickness were not observed with MR.”
From the paper · Abstract
Limited intraoperative usabilityAnswer: No
“However, MR seems to lack intraoperative usability, which is a drawback.”
Preoperative Planning Modalities for Meningoencephalocele: New Proof of Concept#
Coelho G et al. · World neurosurgery · 2021
Neurosurgery · Case report · n: 1 patient
Smartphone / tablet AR
AR/MR, platform not specified
Case report of late correction of a frontoethmoidal encephalocele in a 10-year-old girl, planned with a patient-specific hybrid hands-on model and an AR app run on a cell phone with a headset display. The authors report that the model let a multidisciplinary team choose and simulate the approach, and they present AR as aiding understanding of 3D anatomy.
Conclusions (2)
Hybrid model let team choose surgical approachAnswer: Describes
“The hybrid model recreated anatomic alterations, thereby allowing a multidisciplinary team to determine an appropriate surgical approach.”
From the paper · Abstract
Pre/post comparison highlighted AR 3D relationshipsAnswer: Describes
“A pre- to postoperative comparison was made, which emphasized benefit of tridimensional anatomical relationships using augmented reality tool and its role in preoperative planning.”
Virtual Reality in Preoperative Planning of Adolescent Idiopathic Scoliosis Surgery Using Google Cardboard#
De Salvatore S et al. · Neurospine · 2021
Spine · Comparative study · n: 60 patients
Google Cardboard
Comparative study of 60 patients with adolescent idiopathic scoliosis who had posterior fusion after planning with standard on-screen CT (30) or by exploring a 3D model in VR with Google Cardboard (30). The authors report significantly shorter operative time, less blood loss and higher surgeon satisfaction in the VR group.
“The use of VR led to a significant decrease in operative time and bleeding while increasing the surgeon's satisfaction compared to the control group.”
From the paper · Abstract
“BL (790 ± 55.68 mL vs. 865 ± 60.12 mL, p = 0.047;”
790 ± 55.68 vs 865 ± 60.12 mL, p = 0.047
From the paper · Fulltext
“The satisfaction of the surgeon was higher in the VR group (4.2 ± 0.2 with VR planning vs. 2.5 ± 0.8 with standard planning, p = 0.006)”
4.2 ± 0.2 vs 2.5 ± 0.8, p = 0.006
From the paper · Fulltext
Conclusions (4)
Operative time shorter after VR planningAnswer: Yes
“Patients treated after VR-assisted preoperative planning had significantly lower OR time (231.8 ± 32.2 minutes vs. 258.1 ± 31.6 minutes, p = 0.017;”
231.8 ± 32.2 vs 258.1 ± 31.6 min, p = 0.017
From the paper · Full text
Blood loss lower after VR planningAnswer: Yes
“BL (790 ± 55.68 mL vs. 865 ± 60.12 mL, p = 0.047;”
790 ± 55.68 vs 865 ± 60.12 mL, p = 0.047
From the paper · Full text
Surgeon satisfaction higher on 0-5 scaleAnswer: Yes
“The satisfaction of the surgeon was higher in the VR group (4.2 ± 0.2 with VR planning vs. 2.5 ± 0.8 with standard planning, p = 0.006)”
4.2 ± 0.2 vs 2.5 ± 0.8, p = 0.006
From the paper · Full text
Hospital stay difference not significantAnswer: No significant difference
“patients treated without preoperative VR planning were more likely to stay longer in the hospital (5.3 ± 0.42 days) compared to patients treated after preoperative VR planning (4.5 ± 0.22 days, p = 0.07)”
Augmented and virtual reality in spine surgery, current applications and future potentials#
Ghaednia H et al. · The spine journal · 2021
Spine · Narrative review
Multiple platforms
Narrative review of 67 papers on AR and VR in spine surgery, covering hardware, preoperative and surgical applications, education and training, and links with AI, robotics and wearables. The authors expect AR and VR to become part of standard care in spine surgery.
Technical study of DIVA, a VR tool that renders raw 3D cardiac MRI without segmentation, compared with standard 3D models (STL/3D PDF and 3D printing) in three patients with complex congenital heart disease, graded by a senior paediatric heart surgeon. The authors report that all structures were well shown by both methods, some anatomy was better shown in VR, and median post-processing time was 5 minutes for VR versus 8 hours for 3D models.
“The median post-processing time to get VR models using DIVA was 5 min in comparison to 8 h (range 8-12 h including printing time) for 3D models (PDF/printed).”
5 min
From the paper · Abstract
“All anatomical structures were well visualized in both VR and 3D PDF/printed models.”
From the paper · Abstract
Conclusions (2)
Post-processing 5 min versus 8 hAnswer: Describes
“The median post-processing time to get VR models using DIVA was 5 min in comparison to 8 h (range 8-12 h including printing time) for 3D models (PDF/printed).”
5 min vs 8 h (range 8-12 h)
From the paper · Abstract
Structures well seen in VR and 3D modelsAnswer: Describes
“All anatomical structures were well visualized in both VR and 3D PDF/printed models.”
Developing a virtual reality simulation system for preoperative planning of thoracoscopic thoracic surgery#
Ujiie H et al. · Journal of thoracic disease · 2021
Thoracic · Technical development
BananaVision
Development report of a VR simulation system in which CT-derived 3D lung models were viewed on a head-mounted display with BananaVision software, for preoperative planning (and potential intraoperative support) of thoracoscopic sublobar resection. The authors report that pulmonary vessels and the space between lesion and surrounding tissue could be clearly appreciated during simulated resections.
“The 3D anatomic structure of pulmonary vessels and a clear vision into the space between the lesion and adjacent tissues were successfully appreciated during preoperative simulation.”
From the paper · Abstract
“Surgeons could easily evaluate the real patient's anatomy in preoperative simulations to improve the accuracy and safety of actual surgery.”
From the paper · Abstract
Conclusions (2)
Pulmonary vessels and lesion surroundings clearly seenAnswer: Yes
“The 3D anatomic structure of pulmonary vessels and a clear vision into the space between the lesion and adjacent tissues were successfully appreciated during preoperative simulation.”
From the paper · Abstract
Authors judged simulation helpful for preoperative planningAnswer: Yes
“This initial experience suggests that a VR simulation with HMD facilitated preoperative simulation.”
Using virtual 3D-models in surgical planning: workflow of an immersive virtual reality application in liver surgery#
Boedecker C et al. · Langenbeck's archives of surgery · 2021
Hepatobiliary & pancreatic (HPB) · Technical development
Custom Unity app
HTC Vive
Description of an immersive VR application (Unity, OpenVR headsets such as HTC Vive Pro, per the full text) that imports STL liver reconstructions for surgical planning, with scaling, opacity control, drawing of resection lines and multi-user mode. The authors report that five experienced HPB surgeons rated it with a System Usability Scale score of 76.6%.
“Five highly experienced HPB surgeons of our department evaluated the VR application after using it for the very first time and considered it helpful according to the "System Usability Scale" (SUS) with a score of 76.6%.”
76.6%
From the paper · Abstract
“The application is easy to use and may have advantages over 3D PDF and 3D print in preoperative liver surgery planning.”
From the paper · Abstract
Conclusions (3)
Mean usability score 76.6% among five surgeonsAnswer: Yes
“The five evaluating surgeons from our department reached an average value of 76.6 %, which classified the application as rather easy to use”
SUS 76.6%
From the paper · Full text
One of five surgeons rated usability 45%Answer: Describes
“One surgeon was not convinced by the application in its current form for daily clinical use, which resulted in a rating of 45%”
45%
From the paper · Full text
Learning effort rated lowAnswer: Yes
“All 5 surgeons rated the learning effort to use the system as low (0.2 on the Likert scale 0–4)”
Modeling Tool for Rapid Virtual Planning of the Intracardiac Baffle in Double-Outlet Right Ventricle#
Vigil C et al. · The Annals of thoracic surgery · 2021
Congenital heart · Technical development · n: 3 patients
3D Slicer / SlicerVR
HTC Vive
Technical development paper describing a virtual baffle-planning tool, implemented as custom modules in 3D Slicer, for planning intraventricular baffle repair in double-outlet right ventricle. The tool was demonstrated on three cardiac MRI-derived models, which were viewed on screen and in virtual reality using SlicerVR with an HTC Vive headset, and the baffle shape could be exported for 3D printing.
“Baffles could be rapidly created and revised to facilitate planning of the surgical procedure.”
From the paper · Abstract
Conclusions (3)
Baffles created and revised rapidly in three casesAnswer: Yes
“Baffles could be rapidly created and revised to facilitate planning of the surgical procedure.”
From the paper · Abstract
Average baffle placement took 2 minutesAnswer: Describes
“The average baffle placement time with the new tool was 2 minutes.”
2 minutes
From the paper · Full text
Virtual baffles converted to physical templatesAnswer: Yes
“Virtual baffle templates were successfully transformed into physical templates in the form of both 3D printed shapes and flattened baffle templates”
Cinematic Rendering in Mixed-Reality Holograms: A New 3D Preoperative Planning Tool in Pediatric Heart Surgery#
Gehrsitz P et al. · Frontiers in cardiovascular medicine · 2021
Congenital heart · Comparative study · n: 26 patients
Microsoft HoloLens
Siemens Cinematic Rendering
Study of 26 children recruited for heart surgery (2019), whose surgeons compared Siemens cinematic-rendering holograms on HoloLens and 3D prints against 2D screen imaging using a 22-item Likert questionnaire. The authors report that holograms outscored both 2D imaging and 3D prints, and that 3D imaging shortened intraoperative preparation time in matched pairs (59 vs. 73 minutes).
“CR-holograms were superior to 3D prints in all categories (mean Likert scale 4.4 ± 1.0 vs. 3.7 ± 1.3, P < 0.05).”
P < 0.05
From the paper · Abstract
“Compared to 3D prints it especially improved the depth perception (4.7 ± 0.7 vs. 3.7 ± 1.2)”
4.7 ± 0.7 vs. 3.7 ± 1.2
From the paper · Abstract
“3D imaging reduced the intraoperative preparation time (n = 24, 59 ± 23 min vs. 73 ± 43 min, P < 0.05).”
59 ± 23 min vs. 73 ± 43 min
From the paper · Abstract
Conclusions (5)
Holograms rated above 2D imaging in all categoriesAnswer: Yes
“CR-holograms surpassed 2D-monitor imaging in all categories.”
From the paper · Abstract
Holograms rated above 3D printsAnswer: Yes
“CR-holograms were superior to 3D prints in all categories (mean Likert scale 4.4 ± 1.0 vs. 3.7 ± 1.3, P < 0.05).”
4.4 ± 1.0 vs 3.7 ± 1.3, P < 0.05
From the paper · Abstract
Intraoperative preparation time shorter with 3D imagingAnswer: Yes
“3D imaging reduced the intraoperative preparation time (n = 24, 59 ± 23 min vs. 73 ± 43 min, P < 0.05).”
59 ± 23 vs 73 ± 43 min, P < 0.05
From the paper · Abstract
Coronaries and intracardiac structures: no gain over 2DAnswer: No
“Nevertheless, both evaluated 3D-imaging methods showed no benefit compared with 2D imaging regarding the representation of the coronaries as well as the intracardial structures.”
From the paper · Full text
Hologram creation took 9 minutesAnswer: Describes
“The average time required to create a CR-hologram was 9.0 ± 2.1 min.”
Retrospective study of 24 patients with trigeminal neuralgia whose preoperative MRI was viewed in VR software. Neurosurgeons compared VR with conventional MRI by questionnaire (480 answer sheets) for identifying the neurovascular conflict. The authors report that VR significantly improved identification of the affected nerve, the conflicting vessel and the side.
“Compared to conventional MRI, image presentation using 3D-VR modality significantly influenced the identification of the affected trigeminal nerve (p = 0.004), the vascular structure involved in the NVC (p = 0.0002), and the affected side of the trigeminal nerve (p = 0.005).”
p = 0.004
From the paper · Abstract
Conclusions (1)
Nerve and vessel identification differed by modalityAnswer: Yes
“Compared to conventional MRI, image presentation using 3D-VR modality significantly influenced the identification of the affected trigeminal nerve (p = 0.004), the vascular structure involved in the NVC (p = 0.0002), and the affected side of the trigeminal nerve (p = 0.005).”
Retroperitoneal teratoma resection assisted by 3-dimensional visualization and virtual reality: A case report#
Liu T et al. · World journal of clinical cases · 2021
General & GI surgery · Case report · n: 1 patient
VR, platform not specified
Case report of a 17-year-old with a large retroperitoneal mature cystic teratoma compressing the left renal vessels, in whom a 3D reconstruction was imported into a VR simulation system and the resection rehearsed by an operator wearing a VR headset before surgery. The authors report complete resection with renal artery reconstruction and good recovery.
“The three-dimensional model was consistent with intraoperative findings”
From the paper · Fulltext
“the multidisciplinary team was able to determine preoperatively that the renal artery would be challenging to isolate but that reconstruction was possible”
From the paper · Fulltext
Conclusions (3)
3D model matched intraoperative findingsAnswer: Yes
“The three-dimensional model was consistent with intraoperative findings”
From the paper · Full text
Team anticipated renal artery reconstruction before surgeryAnswer: Yes
“the multidisciplinary team was able to determine preoperatively that the renal artery would be challenging to isolate but that reconstruction was possible”
From the paper · Full text
Operation 120 min, blood loss about 200 mLAnswer: Describes
“The total surgical time was 120 min. The operation was uneventful, and the volume of blood loss was about 200 mL”
Retrospective study of 30 patients with anterior skull base meningiomas whose CT/MRI were reconstructed and viewed in VR. Experienced neurosurgeons compared VR with 2D and screen-3D images by questionnaire (600 answer sheets). The authors report that VR significantly influenced detection of tumour-related structures, the recommended head position and the surgical approach.
“The 3D-VR modality significantly influenced the detection of tumor-related anatomical structures (p = 0.002), recommended head positioning (p = 0.005), and surgical approach (p = 0.03).”
p = 0.005
From the paper · Abstract
“Therefore, the reconstruction of conventional preoperative 2D scans into 3D images and the spatial and anatomical presentation in VR models enabled greater understanding of anatomy and pathology, and thus influenced operation planning and strategy.”
From the paper · Abstract
Conclusions (2)
VR changed anatomy detection, head position, approachAnswer: Yes
“The 3D-VR modality significantly influenced the detection of tumor-related anatomical structures ( p = 0.002), recommended head positioning ( p = 0.005), and surgical approach ( p = 0.03).”
detection p = 0.002; head positioning p = 0.005; approach p = 0.03
From the paper · Abstract
VR gave greater understanding of anatomyAnswer: Yes
“Therefore, the reconstruction of conventional preoperative 2D scans into 3D images and the spatial and anatomical presentation in VR models enabled greater understanding of anatomy and pathology, and thus influenced operation planning and strategy.”
Retrospective Comparison of Minimally Invasive and Open Monosegmental Lumbar Fusion, and Impact of Virtual Reality on Surgical Planning and Strategy#
Zawy Alsofy S et al. · Journal of neurological surgery. Part A, Central European neurosurgery · 2021
Spine · Retrospective cohort · n: 171 patients
VR, platform not specified
Retrospective study of 171 patients who had minimally invasive or open single-level lumbar fusion, comparing outcomes and, using a questionnaire, how retrospective VR visualisation of preoperative CT and MRI affected planning compared with 2D images. The authors report that VR presentation significantly changed the recommended therapy (decompression alone versus fusion) and, for rigid fusion, the recommended technique and procedure, but not the fusion method.
“Image presentation using VR significantly influenced the recommended surgical therapies (decompression only/decompression and fusion; p = 0.02), had no significant influence on the recommended fusion method (rigid/dynamic/stand-alone; p = 0.77)”
p = 0.02
From the paper · Abstract
“in cases of rigid fusion, a significant influence on the recommended technique (MIS/open; p = 0.03) and fusion procedure (p = 0.02).”
p = 0.03
From the paper · Abstract
Conclusions (3)
VR changed recommended therapy, not fusion methodAnswer: Mixed
“Image presentation using VR significantly influenced the recommended surgical therapies (decompression only/decompression and fusion; p = 0.02), had no significant influence on the recommended fusion method (rigid/dynamic/stand-alone; p = 0.77)”
therapy p = 0.02; fusion method p = 0.77
From the paper · Abstract
Rigid fusion: technique and procedure recommendations changedAnswer: Yes
“in cases of rigid fusion, a significant influence on the recommended technique (MIS/open; p = 0.03) and fusion procedure (p = 0.02).”
technique p = 0.03; procedure p = 0.02
From the paper · Abstract
No significant change in recommended fusion methodAnswer: No significant difference
“had no significant influence on the recommended fusion method (rigid/dynamic/stand-alone; p = 0.77)”
Haridas A, Miller M · Operative neurosurgery (Hagerstown, Md.) · 2021
Neurosurgery · Case report (video) · n: 1 patient
Surgical Theater
Operative video of clipping an unruptured MCA trifurcation aneurysm in a 50-year-old woman. An interactive 360-degree VR model (Surgical Theater) built from CT angiography was used before surgery to rehearse clip options and for patient education, and alongside the operation for visualization.
“Importantly, the interactive 360° VR model allowed for a detailed evaluation of the patient-specific anatomy prior to surgery and helped understand the complex anatomy in high resolution.”
From the paper · Abstract
Conclusions (3)
VR model helped understand complex anatomyAnswer: Yes
“Importantly, the interactive 360° VR model allowed for a detailed evaluation of the patient-specific anatomy prior to surgery and helped understand the complex anatomy in high resolution.”
From the paper · Abstract
VR model used to rehearse clip optionsAnswer: Describes
“the VR model was used to rehearse clip options prior to surgery.”
From the paper · Abstract
Postoperative angiogram showed no aneurysm fillingAnswer: Describes
“A postoperative angiogram confirmed no aneurysm filling.”
Randomised study of 34 patients with suspected double-outlet right ventricle, assigned to surgical planning with mixed-reality holograms or with routine 3D reconstruction. The authors report diagnostic accuracy of 95.5% versus 89.7% (not statistically significant) and a shorter planning time with holograms (51.7 versus 65.7 minutes, p<0.05).
“In the MRHG group, the 3D hologram observation was in concordance with the actual anatomical findings, and the DORV type was classified accurately in all patients.”
From the paper · Abstract
“The diagnostic accuracy for the malformation was 95.5% in the MRHG group and 89.7% in the control group, but the difference was not significant (p=0.3).”
95.5%
From the paper · Abstract
“The surgical planning time was shorter for the MRHG group (51.65 ± 11.11 min) than that for the control group (65.71 ± 18.07 min, p<0.05).”
p<0.05
From the paper · Abstract
Conclusions (4)
Planning time shorter with hologramAnswer: Yes
“The surgical planning time was shorter for the MRHG group (51.65 ± 11.11 min) than that for the control group (65.71 ± 18.07 min, p<0.05).”
51.65 ± 11.11 vs 65.71 ± 18.07 min, p<0.05
From the paper · Abstract
Diagnostic accuracy not significantly differentAnswer: No significant difference
“The diagnostic accuracy for the malformation was 95.5% in the MRHG group and 89.7% in the control group, but the difference was not significant (p=0.3).”
95.5% vs 89.7%, p=0.3
From the paper · Abstract
DORV type classified accurately in all hologram patientsAnswer: Yes
“In the MRHG group, the 3D hologram observation was in concordance with the actual anatomical findings, and the DORV type was classified accurately in all patients.”
From the paper · Abstract
Hologram-based plans carried out unchangedAnswer: Describes
“All the procedures were exactly the same as planned based on the 3D MR holographic model.”
Prospective cohort in which a multi-user VR system (BananaVision, head-mounted displays) was used in presurgical discussions for 20 of 38 cerebrovascular surgery candidates; 18 operated cases were analysed. Surgeons reported that VR improved their understanding of patient-specific anatomy in 83.3% of cases and decision-making on surgical technique in 61.1%. Trainees rated it more useful than experts.
“The VR session effectively enhanced surgeons' understanding of patient-specific anatomy in the majority of cases (83.3%).”
83.3%
From the paper · Abstract
“The VR session also effectively improved the decision-making process regarding minor surgical techniques in 61.1% of cases”
61.1%
From the paper · Abstract
“The utility of the VR system was rated significantly higher by trainees than by experts.”
From the paper · Abstract
“surgeons chose to conduct presurgical VR sessions in 20 (52.6%) patients”
20 (52.6%)
From the paper · Fulltext
Conclusions (5)
Surgeons rated anatomy understanding improved in most casesAnswer: Yes
“The VR session effectively enhanced surgeons’understanding of patient-specific anatomy in the majority of cases (83.3%).”
83.3%
From the paper · Abstract
Blinded illustration scores rose after VR sessionsAnswer: Yes
“The score of the illustrations significantly increased after VR sessions relative to before VR sessions (P < .05)”
P < .05
From the paper · Full text
Surgeons rated minor technique decisions improvedAnswer: Yes
“The VR session also effectively improved the decision-making process regarding minor surgical techniques in 61.1% of cases”
61.1%
From the paper · Abstract
Trainees rated utility higher than expertsAnswer: Yes
“The utility of the VR system was rated significantly higher by trainees than by experts.”
From the paper · Abstract
Surgeons chose VR in over half of patientsAnswer: Yes
“surgeons chose to conduct presurgical VR sessions in 20 (52.6%) patients”
Augmented Reality for Head and Neck Carcinoma Imaging: Description and Feasibility of an Instant Calibration, Markerless Approach#
Gsaxner C et al. · Computer methods and programs in biomedicine · 2021
ENT / head & neck · Technical development
AR/MR, platform not specified
Technical development and preclinical user study of a marker-free, instantly calibrated AR system that registers 2D and 3D imaging to a patient's head or face on a head-mounted display to localise head and neck cancers before intervention. Eleven medical experts gave a mean System Usability Scale score of 74.8, and the authors report about 13 minutes of training before independent use.
“Medical experts rated our application with a system usability scale score of 74.8 ± 15.9, which signifies above average, good usability and clinical acceptance.”
74.8 ± 15.9
From the paper · Abstract
“An average of 12.7 ± 6.6 minutes of training time was needed by physicians, before they were able to navigate the application without assistance.”
12.7 ± 6.6 minutes
From the paper · Abstract
Conclusions (2)
Usability rated good by 11 expertsAnswer: Yes
“Medical experts rated our application with a system usability scale score of 74.8 ± 15.9, which signifies above average, good usability and clinical acceptance.”
SUS 74.8 ± 15.9
From the paper · Abstract
12.7 minutes of training before unassisted useAnswer: Describes
“An average of 12.7 ± 6.6 minutes of training time was needed by physicians, before they were able to navigate the application without assistance.”
Virtual reality improves the accuracy of simulated preoperative planning in temporal bones: a feasibility and validation study#
Timonen T et al. · European archives of oto-rhino-laryngology · 2021
ENT / head & neck · Cadaveric study
HTC Vive
Feasibility and validation study in which five experienced otologic surgeons measured anatomical landmarks and fiducials on five cadaveric temporal bones using CT viewed in a VR headset and in conventional PACS slice viewing, checked against caliper measurements. The authors report strong agreement between the methods, fewer gross errors from misidentified fiducials in VR, and higher face and content validity ratings for VR.
“A strong correlation based on intraclass coefficient was found between the methods on both the anatomical (r > 0.900) and fiducial measurements (r > 0.916).”
r > 0.900
From the paper · Abstract
“Gross measurement errors due to the misidentification of fiducials occurred more frequently in the cross-sectional viewing.”
From the paper · Abstract
Conclusions (4)
Strong correlation between VR and PACS measurementsAnswer: Yes
“A strong correlation based on intraclass coefficient was found between the methods on both the anatomical (r > 0.900) and fiducial measurements (r > 0.916).”
r > 0.900 anatomical, r > 0.916 fiducial
From the paper · Abstract
No significant measurement difference between methodsAnswer: No significant difference
“Two-tailed paired t-test and Bland–Altman plots demonstrated high equivalences between the VR and cross-sectional viewing with mean differences of 1.9% ( p = 0.396) and 0.472 mm ( p = 0.065) for anatomical and fiducial measurements, respectively.”
1.9%, p = 0.396; 0.472 mm, p = 0.065
From the paper · Abstract
Fewer gross fiducial errors in VRAnswer: Describes
“Gross measurement errors due to the misidentification of fiducials occurred more frequently in the cross-sectional viewing.”
From the paper · Abstract
Surgeons rated VR validity higherAnswer: Yes
“The mean face and content validity rating for VR were significantly better compared to cross-sectional viewing (total mean score 4.11 vs 3.39, p < 0.001).”
Three-Dimensional Modeling of Complex Pediatric Intracranial Aneurysmal Malformations With a Virtual Reality System#
Yan EG et al. · Simulation in healthcare · 2021
Neurosurgery · Retrospective case series · n: 5 patients
Surgical Theater
Retrospective review of 5 children with complex middle cerebral artery aneurysmal malformations treated with help from Surgical Theater's SuRgical Planner (SRP) over 2 years. The authors report that preoperative interactive 3D modelling informed treatment planning, clarified perforators and fistula flow anatomy, and increased surgeon confidence, with no perioperative complications in the open-surgery cases.
“In 5 pediatric patients with complex MCA aneurysmal malformations (mean age = 33.2 ± 49.9 months), preoperative 3-dimensional (3D) interactive modeling informed treatment planning and enhanced surgeon understanding of the vascular pathology.”
From the paper · Abstract
“Despite the complexity of the lesions treated, use of simulation qualitatively enhanced surgeon confidence.”
From the paper · Abstract
“There were no perioperative complications for patients treated with open surgery.”
From the paper · Abstract
Conclusions (3)
3D modeling informed planning and surgeon understandingAnswer: Yes
“preoperative 3-dimensional (3D) interactive modeling informed treatment planning and enhanced surgeon understanding of the vascular pathology.”
Three-Dimensional Printing, Virtual Reality and Mixed Reality for Pulmonary Atresia: Early Surgical Outcomes Evaluation#
Cen J et al. · Heart, lung & circulation · 2021
Congenital heart · Case series · n: 5 patients
VR, platform not specified
AR/MR, platform not specified
Case series of five patients with pulmonary atresia, ventricular septal defect and major aortopulmonary collateral arteries in whom 3D-printed models and virtual reality glasses were used for preoperative planning, and mixed-reality holograms were used perioperatively. The authors report no deaths or reinterventions and three complications, and conclude that the combined approach helped understanding of the collateral anatomy.
“The use of these three new technologies had favourable feedback from the surgeons on intraoperative judgment.”
From the paper · Abstract
“Three (3) patients developed postoperative complications: one had right bundle branch block and ST-segment change, one had chest drainage >7 days (>40 mL/day) and one had pneumonia.”
From the paper · Abstract
“These technologies improved the understanding of complicated cardiac anatomy and achieved acceptable surgical outcomes as guiding surgical planning.”
From the paper · Abstract
Conclusions (4)
Three of five patients had complicationsAnswer: Describes
“Three (3) patients developed postoperative complications: one had right bundle branch block and ST-segment change, one had chest drainage >7 days (>40 mL/day) and one had pneumonia.”
3 of 5 patients
From the paper · Abstract
No in-hospital or early deathsAnswer: Describes
“There were no in-hospital or early deaths.”
From the paper · Abstract
Surgeons gave favourable feedback on intraoperative judgmentAnswer: Describes
“The use of these three new technologies had favourable feedback from the surgeons on intraoperative judgment.”
From the paper · Abstract
Authors state improved understanding of cardiac anatomyAnswer: Yes
“These technologies improved the understanding of complicated cardiac anatomy and achieved acceptable surgical outcomes as guiding surgical planning.”
Report of a holographic mixed-reality planning application used alongside 3D-printed models throughout the planning and operation of a face transplant. The authors report that holographic models took less time and cost less to produce than 3D prints, and allowed virtual surgical planning and rehearsal by manipulating patient-specific holograms.
“Holographic models required less time and cost for fabrication.”
From the paper · Abstract
“They provided both comprehensive visualization of 3D spatial relationships and novel means to perform VSP and virtual face transplantation by interacting with and manipulating patient-specific, anatomic holograms.”
From the paper · Abstract
Conclusions (2)
Holograms took less time and cost to makeAnswer: Yes
“Holographic models required less time and cost for fabrication.”
From the paper · Abstract
Holograms enabled 3D visualization and virtual rehearsalAnswer: Yes
“They provided both comprehensive visualization of 3D spatial relationships and novel means to perform VSP and virtual face transplantation by interacting with and manipulating patient-specific, anatomic holograms.”
3D mixed reality holograms for preoperative surgical planning of nephron-sparing surgery: evaluation of surgeons' perception#
Checcucci E et al. · Minerva urology and nephrology · 2021
Urology · Survey/user study
Microsoft HoloLens
Survey of attendees at an international urology meeting who viewed hyper-accuracy 3D kidney reconstructions as mixed-reality holograms on HoloLens for planning nephron-sparing surgery. From 172 questionnaires, the authors report high scores for planning usefulness and anatomical accuracy, and that after the MR experience 64.4% and 44.4% of surgeons changed their clamping and resection approach respectively.
“High satisfaction toward the potential role of this technology in surgical planning and understanding of surgical complexity (both scored 9/10) were expressed.”
9/10
From the paper · Abstract
“64.4% and 44.4% of the surgeons changed their clamping and resection approach”
64.4% and 44.4%
From the paper · Abstract
Conclusions (3)
Surgeons changed clamping and resection choices after hologramAnswer: Yes
“64.4% and 44.4% of the surgeons changed their clamping and resection approach”
64.4% and 44.4%
From the paper · Abstract
High satisfaction with planning roleAnswer: Yes
“High satisfaction toward the potential role of this technology in surgical planning and understanding of surgical complexity (both scored 9/10) were expressed.”
Abstract No. 593 Preprocedural evaluation of ablation zone coverage utilizing a novel augmented reality platform#
Gadodia G, Martin C · Journal of Vascular and Interventional Radiology · 2021
Interventional radiology · Conference abstract
AR/MR, platform not specified
SIR 2021 abstract on preprocedural evaluation of ablation zone coverage with a novel augmented reality platform. Title-only record: no abstract was openly available from the sources searched, so details could not be confirmed.
Two Microsoft HoloLens applications: one for urology anatomy training and one for surgical planning that gives the surgeon hands-free access to imaging, 3D planning models and history. The planning tool was used in a laparoscopic renal tumorectomy in an experimental model and a video-assisted right upper lobectomy in one patient. The authors report that surgeons found the planning tool useful and that it kept sterility.
“The solution developed for medical training was considered a useful tool for training in urological anatomy, facilitating the translation of this knowledge to clinical practice.”
From the paper · Abstract
“Regarding the solution developed for surgical planning, it allowed surgeons to access the patient’s clinical information in real-time, such as preoperative imaging studies, three-dimensional surgical planning models, or medical history, facilitating the surgical approach.”
From the paper · Abstract
“However, further studies are needed to comprehensively validate its clinical application.”
From the paper · Abstract
Conclusions (3)
Experts rated training tool useful for anatomyAnswer: Yes
“The solution developed for medical training was considered a useful tool for training in urological anatomy”
From the paper · Abstract
Planning tool gave real-time access to patient dataAnswer: Yes
“it allowed surgeons to access the patient’s clinical information in real-time”
From the paper · Abstract
Planning tool kept the surgical field sterileAnswer: Yes
“The preoperative planning tool for surgery provides real-time access to essential patient information without losing the sterility of the surgical field.”
EuroCMR/EACVI 2021 abstract (3D Heart project) extending a VR volume-rendering application to display CFD-simulated pressure and blood-flow streamlines in the right ventricle of a patient with hypoplastic left heart syndrome. The authors present it as proof of concept for VR flow visualisation in surgical and interventional planning.
“Evaluating performance, we found that visualisation of the mesh and streamlines was at an acceptably high and stable frame rate, over 150fps.”
From the paper · Abstract
“However, rendering the pressure slicing plane reduced frame rate by an unacceptable degree, to less than 10fps.”
From the paper · Abstract
Conclusions (2)
Mesh and streamlines render above 150 fpsAnswer: Yes
“Evaluating performance, we found that visualisation of the mesh and streamlines was at an acceptably high and stable frame rate, over 150fps.”
over 150fps
From the paper · Abstract
Pressure slicing plane drops below 10 fpsAnswer: No
“However, rendering the pressure slicing plane reduced frame rate by an unacceptable degree, to less than 10fps.”
Retrospective study proposing 2D and 3D quantitative asymmetry measures to compare purely virtual planning with mixed-reality planning for orthognathic surgery. The authors report midface-mandible deviations within 2 degrees and 1.5 mm, with mixed-reality planning slightly more symmetric in 3D and virtual planning slightly better in 2D contour.
“There was no significant difference, except the symmetry index of the anterior deviation angle between the virtual and mixed reality planning in the 3D asymmetry assessment.”
From the paper · Abstract
“Quantitative outcomes in 3D asymmetry indices showed that mixed reality planning was slightly more symmetric than virtual planning, with the opposite in 2D contouring.”
From the paper · Abstract
Conclusions (2)
No significant 3D difference except anterior deviation angleAnswer: No significant difference
“There was no significant difference, except the symmetry index of the anterior deviation angle between the virtual and mixed reality planning in the 3D asymmetry assessment.”
From the paper · Abstract
MR slightly more symmetric in 3D, not 2DAnswer: Describes
“Quantitative outcomes in 3D asymmetry indices showed that mixed reality planning was slightly more symmetric than virtual planning, with the opposite in 2D contouring.”
Robotic assisted partial nephrectomy and mixed reality - first surgical planning experience with brainlab elements and magic leap 1#
Paludo AO et al. · European Urology Open Science · 2021
Urology · Conference abstract · n: 1 patient
Brainlab Elements
Magic Leap
Meeting abstract describing the first robot-assisted partial nephrectomy planned in mixed reality, using Brainlab software with the Magic Leap headset. Only the introduction and objectives were openly available, so results could not be confirmed.
Conference abstract describing a same-day workflow in which zygomaticomaxillary fractures created on 16 3D-printed skulls and one cadaver were planned in ImmersiveTouch VR software and then executed with intraoperative navigation and CT verification. The authors present preliminary accuracy data for VR planning transferred to navigation.
“Data import, segmentation, and reduction of fractures within VR took on average approximately 5 minutes, and transfer of the plan to the navigation platform took 4 minutes.”
5 minutes
From the paper · Full text: main text
“Mean difference between the VR-simulated plan and the postoperative CT was 2.5 ± 1.4 mm on the right, and 1.3 ± 0.7 mm on the left side.”
2.5 ± 1.4 mm
From the paper · Full text: main text
Conclusions (3)
Plan-to-postoperative CT mean difference 2.5 and 1.3 mmAnswer: Yes
“Mean difference between the VR-simulated plan and the postoperative CT was 2.5 ± 1.4 mm on the right, and 1.3 ± 0.7 mm on the left side.”
2.5 ± 1.4 mm right, 1.3 ± 0.7 mm left
From the paper · Abstract
Planning about 5 minutes, plan transfer 4 minutesAnswer: Describes
“Data import, segmentation, and reduction of fractures within VR took on average approximately 5 minutes, and transfer of the plan to the navigation platform took 4 minutes.”
5 minutes, 4 minutes
From the paper · Abstract
Navigation ready 7 minutes after plan transferAnswer: Describes
“Overlay of the plan data on the original CT and calibration of tracker probe was achieved in 7 minutes”
Three-Dimensional Virtual Reality Simulation to Safe Planning Neurosurgical Procedure in Brain Aneurysms, Latin American Single-Center Experience: Advantages and Limitations#
Zárate-Méndez AM et al. · Indian Journal of Neurosurgery · 2021
Neurosurgery · Retrospective case series · n: 34 patients
VR, platform not specified
Single-centre series of 34 patients with brain aneurysms in whom 360-degree 3D virtual reality simulation from CTA was used to plan the clipping approach, which was then replicated in surgery. The authors report no intraoperative complications and describe the advantages and limitations.
“There were no intraoperative complications in any patient.”
From the paper · Abstract
Conclusions (1)
No intraoperative complications in any patientAnswer: Describes
“There were no intraoperative complications in any patient.”
Single-centre report of six patients who had cardiac surgery at Erasmus MC in 2020. Their CT scans were rendered and segmented for review in a VR headset before surgery, and five surgeons completed a questionnaire. The authors conclude that immersive VR may be a useful extra preoperative planning tool, and they describe how they set up the platform.
“Our study demonstrates that immersive 3D VR visualization of anatomy might be beneficial as a supplementary preoperative planning tool for cardiothoracic surgery, and further research on this topic may be considered to implement this innovative tool in daily clinical practice.”
From the paper · Abstract
“The outcomes of this preliminary study are positive, with a much more reality-like simulation for the surgeon.”
From the paper · Abstract
“Due to better preoperative planning in VR, the operation plan was modified and thoracoscopic port placement locations were changed according to the insights provided by VR-guided planning.”
From the paper · Fulltext
Conclusions (4)
Operation plan and port locations changed in MIDCABAnswer: Yes
“Due to better preoperative planning in VR, the operation plan was modified and thoracoscopic port placement locations were changed according to the insights provided by VR-guided planning.”
From the paper · Full text
CT scans rendered and reviewed within 15 minAnswer: Describes
“All CT scans were rendered, post-processed, segmented in our VR workstations (if needed) and analysed by the surgeon within 15 min for each case.”
within 15 min per case
From the paper · Full text
Surgeon ratings averaged 4, 4.4 and 4Answer: Describes
“The participants rated the aforementioned three topics with an average of 4, 4.4, and 4, respectively.”
average 4, 4.4, and 4; no statistical analysis
From the paper · Full text
Authors call for comparative researchAnswer: Describes
“More (comparative) future research is needed to define the benefits of VR in preoperative cardiothoracic surgery planning.”
Use of mixed reality for surgery planning: Assessment and development workflow#
Kumar RP et al. · Journal of biomedical informatics · 2020
Multi-specialty · Technical development
Microsoft HoloLens
Paper describing the development workflow for clinical use of mixed reality (HoloLens) in surgical planning, with a qualitative user evaluation and clinical use cases in laparoscopic liver surgery and heart surgery. The authors report high acceptance ratings, and that surgeons found the HoloLens useful and that it gave a definitive answer at a multidisciplinary team meeting.
“Furthermore, our clinical use-cases demonstrate that the surgeons perceived the HoloLens to be useful, recommendable to other surgeons and also provided a definitive answer at a multi-disciplinary team meeting.”
From the paper · Abstract
Conclusions (1)
Surgeons found mixed reality useful and recommendableAnswer: Yes
“Furthermore, our clinical use-cases demonstrate that the surgeons perceived the HoloLens to be useful, recommendable to other surgeons and also provided a definitive answer at a multi-disciplinary team meeting.”
SlicerVR for Medical Intervention Training and Planning in Immersive Virtual Reality#
Pinter C et al. · IEEE transactions on medical robotics and bionics · 2020
Multi-specialty · Technical development
3D Slicer / SlicerVR
Meta Quest / Oculus
HTC Vive
Technical paper presenting SlicerVR, a free open-source extension that adds immersive VR (with local or remote collaboration) to 3D Slicer for prototyping training, planning and guidance of medical interventions. The authors illustrate scenarios in echocardiography, neurosurgery, spine surgery, brachytherapy, intervention training and patient education.
“SlicerVR is freely available under BSD type license as an extension to 3D Slicer and it has been downloaded over 7,800 times at the time of writing this article.”
7,800
From the paper · Abstract
Conclusions (1)
Extension downloaded over 7,800 timesAnswer: Yes
“SlicerVR is freely available under BSD type license as an extension to 3D Slicer and it has been downloaded over 7,800 times at the time of writing this article.”
Comparing Computed Tomography-Derived Augmented Reality Holograms to a Standard Picture Archiving and Communication Systems Viewer for Presurgical Planning: Feasibility Study#
Dallas-Orr D et al. · JMIR perioperative medicine · 2020
Multi-specialty · Validation study
Microsoft HoloLens
Feasibility study comparing measurements of CT-derived phantom objects made with standard PACS software (OsiriX) and with a HoloLens-based augmented-reality presurgical planning system (ARPPS). The authors report no significant differences, with near-perfect agreement for circumference and angle measurements.
“Lin's concordance correlation coefficients were 1.00 and 0.98 for the circumference and angle measurements, respectively, indicating almost perfect strength of agreement between ARPPS and PACS.”
1.00 and 0.98
From the paper · Abstract
“Intraclass correlation showed no statistically significant difference between the readers for either measurement tool on each system.”
From the paper · Abstract
Conclusions (3)
No significant difference from PACS measurementsAnswer: No significant difference
“Measurements taken with the standard PACS and the ARPPS showed no statistically significant differences.”
mean difference 0.08% (circumference), –1.84% (angle)
From the paper · Abstract
Near-perfect agreement with PACS measurementsAnswer: Yes
“concordance correlation coefficients were 1.00 and 0.98 for the circumference and angle measurements, respectively, indicating almost perfect strength of agreement between ARPPS and PACS.”
CCC 1.00 and 0.98
From the paper · Abstract
No significant difference between readersAnswer: No significant difference
“Intraclass correlation showed no statistically significant difference between the readers for either measurement tool on each system.”
Retrospective study of 26 patients with unruptured anterior communicating artery aneurysms whose CT angiograms were reconstructed and viewed in VR. Neurosurgeons completed questionnaires comparing VR with conventional CTA (520 answer sheets). The authors report that VR significantly influenced detection of aneurysm-related vessels, the recommended head position and the surgical approach for clipping.
“The 3D-VR modality significantly influenced detection of the aneurysm-related vascular structure (p = 0.0001), the recommended head positioning (p = 0.005), and the surgical approach (p = 0.001) in the planning of microsurgical clipping.”
p = 0.001
From the paper · Abstract
“Thus, reconstruction of conventional preoperative CTA scans into 3D images and the spatial presentation in VR models enabled greater understanding of the anatomy and pathology, provided realistic haptic feedback for aneurysm surgery, and influenced operation planning and strategy.”
From the paper · Abstract
Conclusions (4)
Recommended head position and approach changed with VRAnswer: Yes
“The 3D-VR modality significantly influenced detection of the aneurysm-related vascular structure (p = 0.0001), the recommended head positioning (p = 0.005), and the surgical approach (p = 0.001) in the planning of microsurgical clipping.”
p = 0.0001, p = 0.005, p = 0.001
From the paper · Abstract
Anatomy depiction appropriate: 57% VR vs 40% CTAAnswer: Yes
“57% of questioned neurosurgeons found the 3D-VR-based anatomical depiction to be appropriate, compared to 40% of neurosurgeons viewing the CTA images ( p = 0.0001)”
57% vs 40%, p = 0.0001
From the paper · Full text
No effect on recommended patient positioningAnswer: No significant difference
“the visualization technique showed no influence on the recommended patient positioning (supine/other positions; p = 0.38)”
p = 0.38
From the paper · Full text
Temporary clip decision not significantly influencedAnswer: No significant difference
“not significantly influenced by the visualization technique ( p = 0.32)”
Optimization of skull base exposure using navigation-integrated, virtual reality templates#
Jean WC et al. · Journal of clinical neuroscience · 2020
Neurosurgery · Case series · n: 2 patients
VR, platform not specified
Technical report of a VR template technique for skull base tumour surgery: the bone exposure was rehearsed in patient-specific VR models, and the chosen model was integrated with navigation as a template for the craniotomy. In two cases the authors report complete resection without approach-related complications.
“Complete resections were achieved and neither patient suffered any approach-related complications.”
From the paper · Abstract
“Intuitively useful and successful in early application, there has been no identifiable disadvantages to date.”
From the paper · Abstract
Conclusions (2)
Complete resection, no approach-related complicationsAnswer: Describes
“Complete resections were achieved and neither patient suffered any approach-related complications.”
From the paper · Abstract
Authors found no disadvantages in early useAnswer: Describes
“Intuitively useful and successful in early application, there has been no identifiable disadvantages to date.”
Robotics in Pediatric Otolaryngology-Head and Neck Surgery and Advanced Surgical Planning#
Konuthula N et al. · Otolaryngologic clinics of North America · 2020
ENT / head & neck · Narrative review
Multiple platforms
Narrative review of robotic surgery in paediatric head and neck surgery and of advanced preoperative planning techniques, including 3D printing, virtual reality, cost-function optimisation of approach and mirror-image overlay. The authors suggest these planning techniques may help integrate robotic surgery into practice.
Virtual Reality Surgical Rehearsal and 2-Dimensional Operative Video of a Paramedian Supracerebellar Infratentorial Approach Endoscopic Resection of Pineocytoma: 2-Dimensional Operative Video#
Jean WC · Operative neurosurgery (Hagerstown, Md.) · 2020
Neurosurgery · Case report (video) · n: 1 patient
Surgical Theater
Operative video of the endoscopic resection of a large pineal-region tumour in a 46-year-old patient. VR rehearsal in a patient-specific model (Surgical Theater SNAP VR360) led the surgeons to choose a paramedian supracerebellar infratentorial approach, and complete resection was achieved.
“Given the rarity of pineocytoma,5 the novelty of endoscopic resection of solid tumors in the region, and the challenge of "keyhole" approaches to deep-lying targets, VR rehearsal facilitated the achievement of the surgical goal and avoided the morbidity of a more extensive exposure.”
From the paper · Abstract
Conclusions (3)
Rehearsal avoided more extensive exposure in one caseAnswer: Describes
“VR rehearsal facilitated the achievement of the surgical goal and avoided the morbidity of a more extensive exposure.”
From the paper · Abstract
Rehearsal found supratentorial approach suboptimalAnswer: Describes
“VR rehearsal showed that, with the tumor tucked under the corpus callosum and cradled by the internal cerebral veins and veins of Rosenthal, a supratentorial approach would be suboptimal.”
Visualization of 3D Models Through Virtual Reality in the Planning of Congenital Cardiothoracic Anomalies Correction: An Initial Experience#
Ayerbe VMC et al. · World journal for pediatric & congenital heart surgery · 2020
Congenital heart · Case report · n: 1 patient
VR, platform not specified
Case report of a nine-year-old girl with previously repaired double outlet right ventricle who developed right ventricular failure, conduit obstruction and left ventricular outflow tract obstruction, in whom 3D models from her imaging were viewed in a VR system to plan surgical correction. The authors report that the tool let them inspect the intracardiac anatomy immersively with a clearer sense of perspective.
“This tool allowed us to inspect the intracardiac anatomy in an immersive environment with a clearer sense of perspective.”
From the paper · Abstract
Conclusions (1)
VR gave clearer view of intracardiac anatomyAnswer: Yes
“This tool allowed us to inspect the intracardiac anatomy in an immersive environment with a clearer sense of perspective.”
Three-Dimensional Augmented Reality Visualization Informs Locoregional Therapy in a Translational Model of Hepatocellular Carcinoma#
Park BJ et al. · Journal of vascular and interventional radiology · 2020
Interventional radiology · Comparative study · n: 28 rats
Microsoft HoloLens
Preclinical study in rats with induced hepatocellular carcinoma in which preprocedural MRI was viewed in 3D augmented reality (HoloLens) before transarterial embolisation in 12 animals and compared with controls without AR. The authors report shorter fluoroscopy and catheterisation times with AR, significant only when retrospective controls were added.
“A 37% reduction in fluoroscopy time, from 11.7 min to 7.4 minutes, was observed with AR when compared prospectively, which did not reach statistical significance (P = .12)”
P = .12
From the paper · Abstract
“however, when compared with combined prospective and retrospective controls, the reduction in fluoroscopy time from 14.1 min to 7.4 minutes (48%) was significant (P = .01).”
P = .01
From the paper · Abstract
“A 27% reduction in total catheterization time, from 42.7 minutes to 31.0 minutes, was also observed with AR when compared prospectively, which did not reach statistical significance (P = .11).”
27%
From the paper · Abstract
Conclusions (4)
Fluoroscopy time not significantly shorter, prospectiveAnswer: No significant difference
“A reduction in total fluoroscopy time was also observed from 11.7 min to 7.4 min after AR that did not reach statistical significance (37%, p=0.12).”
11.7 vs 7.4 min, p=0.12
From the paper · Full text
Catheterization time not significantly shorter, prospectiveAnswer: No significant difference
“Prospective analysis showed a reduction in total catheterization time, including nonselective and selective catheterization, from 42.7 min to 31.0 min after AR that did not reach statistical significance (27%, p=0.11).”
42.7 vs 31.0 min, p=0.11
From the paper · Full text
Fluoroscopy time shorter against pooled post hoc controlsAnswer: Yes
“The increase in power afforded by combining these control groups demonstrated a significant reduction in fluoroscopy time after AR from 14.1 to 7.4 min (48%; p=0.01;”
14.1 vs 7.4 min, p=0.01
From the paper · Full text
AR added about 5.9 min pre-procedure timeAnswer: Describes
“AR system setup and operator viewing times measured approximately 3 min each, for an average total of 5.9 min of additional pre-procedure time per case”
Mini-Pterional Craniotomy and Extradural Clinoidectomy for Clinoid Meningioma: Optimization of Exposure Using Augmented Reality Template: 2-Dimensional Operative Video#
Jean WC · Operative neurosurgery (Hagerstown, Md.) · 2020
Neurosurgery · Case report (video) · n: 1 patient
Surgical Theater
Operative video of a mini-pterional craniotomy with extradural clinoidectomy for a clinoid meningioma in a 69-year-old woman. The approach was rehearsed in a 3D VR rendering (Surgical Theater SNAP VR360), and the chosen opening was saved and projected as an AR template into the navigated microscope (SyncAR). The authors report that the template guided the exposure and total resection was achieved.
“The template enhanced the planning of the incision and soft-tissue exposure, guided the drilling of the sphenoid wing, facilitated the extradural clinoidectomy,5 and ultimately facilitated the accomplishment of the surgical goal of total resection of the meningioma.”
From the paper · Abstract
Conclusions (1)
AR template guided exposure in one patientAnswer: Yes
“The template enhanced the planning of the incision and soft-tissue exposure, guided the drilling of the sphenoid wing”
Immersive virtual reality surgical planning of minimally invasive coronary artery bypass for Kawasaki disease#
Sadeghi AH et al. · European heart journal · 2020
Congenital heart · Case report (image) · n: 1 patient
CardioVR/MedicalVR
Image-based case report of a patient with Kawasaki disease in whom immersive virtual reality was used to plan minimally invasive coronary artery bypass grafting. According to the full text, a MedicalVR workstation with a head-mounted display let the team review the reconstructed coronary anatomy in 360 degrees before surgery. No abstract is available.
Emerging 3D technologies and applications within congenital heart disease: teach, predict, plan and guide#
Salavitabar A et al. · Future cardiology · 2020
Congenital heart · Narrative review
Multiple platforms
Narrative review of 3D technologies in congenital heart disease, including 3D printing and virtual/augmented reality, organised around their roles in teaching, predicting, planning and guiding interventions. The authors summarise the published experience and the practical limitations of each technology.
Virtual and augmented reality for preoperative planning in plastic surgical procedures: A systematic review#
Vles MD et al. · Journal of plastic, reconstructive & aesthetic surgery · 2020
Plastic & reconstructive · Systematic review
Multiple platforms
Systematic review comparing VR and AR with conventional methods for preoperative planning in plastic surgery, which found no VR studies and six AR studies. The authors report more accurate osteotomies in mandibular procedures, more accurate perforator identification than Doppler in DIEP flaps, and shorter harvest or operative times with AR, with no cost data.
“Intraoperative perforator identification in DIEP flap procedures was more accurate with AR compared to Doppler ultrasound.”
From the paper · Abstract
“Harvesting time (p < 0.012) and operative time (p < 0.01) in DIEP-flap procedures and mandibular angle osteotomies, respectively, were significantly reduced if AR was used.”
p < 0.012
From the paper · Abstract
“No articles were found regarding the costs of using AR for preoperative planning.”
From the paper · Abstract
Conclusions (2)
Harvest and operative time significantly reducedAnswer: Yes
“Harvesting time (p < 0.012) and operative time (p < 0.01) in DIEP-flap procedures and mandibular angle osteotomies, respectively, were significantly reduced if AR was used.”
harvesting time p < 0.012, operative time p < 0.01
From the paper · Abstract
Perforator identification more accurate than Doppler ultrasoundAnswer: Yes
“Intraoperative perforator identification in DIEP flap procedures was more accurate with AR compared to Doppler ultrasound.”
Evaluation of Interactive Virtual Reality as a Preoperative Aid in Localizing Renal Tumors#
Tapiero S et al. · Journal of endourology · 2020
Urology · Comparative study · n: 11 patients
VR, platform not specified
Study in which seven faculty urologists and six residents placed renal tumours onto 3D kidney models after reviewing CT alone and, a week later, CT plus interactive VR models, for 11 patients. The authors report that median tumour overlap improved from 28% to 42% overall (p=0.05) and significantly among faculty, but not among residents.
“The combination of CT+iVR was an independent predictor of improved overlap vs CT alone (odds ratio 2.22, 95% confidence interval 1.04-4.78, p = 0.039).”
odds ratio 2.22
From the paper · Abstract
“Among residents, there was no significant difference for either percentage overlap or 0% overlap for CT vs CT+iVR.”
0%
From the paper · Abstract
“Faculty surgeons' survey responses showed an improved understanding of the tumor location and shape with the addition of iVR (p < 0.05).”
p < 0.05
From the paper · Abstract
Conclusions (3)
CT plus VR predicted improved tumour overlapAnswer: Yes
“The combination of CT+iVR was an independent predictor of improved overlap vs CT alone (odds ratio 2.22, 95% confidence interval 1.04-4.78, p = 0.039).”
odds ratio 2.22, 95% confidence interval 1.04-4.78, p = 0.039
From the paper · Abstract
No overlap difference among residentsAnswer: No significant difference
“Among residents, there was no significant difference for either percentage overlap or 0% overlap for CT vs CT+iVR.”
From the paper · Abstract
Faculty reported improved understanding of tumour locationAnswer: Yes
“Faculty surgeons' survey responses showed an improved understanding of the tumor location and shape with the addition of iVR (p < 0.05).”
Virtual Reality in Neurosurgery: "Can You See It?"-A Review of the Current Applications and Future Potential#
Fiani B et al. · World neurosurgery · 2020
Neurosurgery · Narrative review
Multiple platforms
Narrative review of VR in neurosurgery across education, training and the operating room, including patient-specific planning for cranial tumour approaches and uses in spine, neurovascular and peripheral nerve surgery. The authors discuss cost, legal and ethical challenges and call for direct outcome comparisons.
“In cranial surgery, VR has excelled in helping neurosurgeons design unique patient-specific approaches to particularly challenging tumor excisions.”
From the paper · Abstract
“Although cost-prohibiting, legal, and ethical challenges surrounding this technology must be considered, future research and more direct quantitative outcome comparisons between standard and VR-supplemented procedures would help provide more direction regarding the feasibility of widespread adoption of VR technology in neurosurgery.”
“In cranial surgery, VR has excelled in helping neurosurgeons design unique patient-specific approaches to particularly challenging tumor excisions.”
From the paper · Abstract
Cost, legal and ethical limits on adoptionAnswer: Describes
“Although cost-prohibiting, legal, and ethical challenges surrounding this technology must be considered, future research and more direct quantitative outcome comparisons between standard and VR-supplemented procedures would help provide more direction regarding the feasibility of widespread adoption of VR technology in neurosurgery.”
3D Printing, Augmented Reality, and Virtual Reality for the Assessment and Management of Kidney and Prostate Cancer: A Systematic Review#
Wake N et al. · Urology · 2020
Urology · Systematic review
Multiple platforms
Systematic review of 3D printing, augmented reality and virtual reality for kidney and prostate cancer, covering outcomes, surgical planning, intraoperative guidance, training and patient education. The authors report evidence of improvements in clinical outcomes, planning, guidance and training, and call for studies of long-term patient outcomes.
“Existing evidence demonstrates improvement in clinical outcomes, surgical planning and intra-operative guidance, as well as training.”
From the paper · Abstract
“Future studies are needed to assess the impact of 3D technologies on long-term patient-related outcomes.”
From the paper · Abstract
Conclusions (2)
Review states improved outcomes, planning, guidance, trainingAnswer: Yes
“Existing evidence demonstrates improvement in clinical outcomes, surgical planning and intra-operative guidance, as well as training.”
From the paper · Abstract
Long-term patient outcomes still need studyAnswer: Describes
“Future studies are needed to assess the impact of 3D technologies on long-term patient-related outcomes.”
Evaluation of Surgical Approaches for Tumor Resection in the Deep Infratentorial Region and Impact of Virtual Reality Technique for the Surgical Planning and Strategy#
Zawy Alsofy S et al. · The Journal of craniofacial surgery · 2020
Retrospective review of 93 patients who had resection of deep infratentorial tumours via supracerebellar-infratentorial or suboccipital-transcerebellar approaches, with a questionnaire comparing surgical planning on 2D MRI and on 3D VR visualisations. The authors report complication rates comparable to the literature and that VR significantly influenced the recommended approach but not patient positioning or craniotomy placement.
“Image presentation using VR had a significant influence on the recommended surgical approach (P = 0.02), but no influence on the recommended patient positioning (P = 0.37) or placement of craniotomy (P = 0.09).”
P = 0.02
From the paper · Abstract
“Surgical tumor resections were associated with an overall complication rate comparable to the literature.”
From the paper · Abstract
Conclusions (2)
Approach changed; positioning and craniotomy did notAnswer: Mixed
“Image presentation using VR had a significant influence on the recommended surgical approach (P ¼ 0.02), but no influence on the recommended patient positioning (P ¼ 0.37) or placement of craniotomy (P ¼ 0.09).”
approach P = 0.02; positioning P = 0.37; craniotomy P = 0.09
From the paper · Abstract
Complication rate comparable to the literatureAnswer: Describes
“Surgical tumor resections were associated with an overall complication rate comparable to the literature.”
[Extended reality technologies for support of surgical workflows]#
Rüger C et al. · Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen · 2020
Multi-specialty · Narrative review
Multiple platforms
German narrative review of extended reality technologies in surgical workflows, covering training, preoperative planning and intraoperative assistance. The authors conclude that XR is practical for teaching, can benefit planning though technical limits hinder routine use, and that evaluation of intraoperative use and cost-effectiveness is lacking.
“In preoperative planning XR can also offer advantages, although technical limitations often impede routine use; however, for cases of intraoperative use informative evaluation studies are mostly lacking, so that an assessment is not yet possible in a meaningful way.”
From the paper · Abstract
Conclusions (2)
XR planning offers advantages, but technical limits persistAnswer: Mixed
“In preoperative planning XR can also offer advantages, although technical limitations often impede routine use; however, for cases of intraoperative use informative evaluation studies are mostly lacking, so that an assessment is not yet possible in a meaningful way.”
From the paper · Abstract
XR teaching practical, but needs multicenter evaluationAnswer: Yes
“In teaching, the use of XR can already be assessed as fundamentally practical and meaningful but still needs to be evaluated in large multicenter studies.”
A Patient-Specific Mixed-Reality Visualization Tool for Thoracic Surgical Planning#
Perkins SL et al. · The Annals of thoracic surgery · 2020
Thoracic · Technical development
Microsoft HoloLens
Technical report of a HoloLens mixed-reality application and image-processing pipeline, developed with engineers and clinicians, that lets surgeons view a patient's preoperative imaging, manipulate a 3D rendering of chest anatomy, and simulate lung deflation and instrument placement to localise small lung nodules. The authors suggest it may aid nodule identification during minimally invasive surgery and reduce the need for invasive preoperative localisation.
“Mixed-reality visualization during surgical planning may facilitate accurate and rapid identification of small lung lesions during minimally invasive surgeries and reduce the need for additional invasive preoperative localization procedures.”
Expanded Endoscopic Endonasal Transtuberculum Approach for Tuberculum Sellae Meningioma: Operative Video With 360-Degree Fly-Through and Surgical Rehearsal in Virtual Reality: 2-Dimensional Operative Video#
Jean WC, Singh A · Operative neurosurgery (Hagerstown, Md.) · 2020
Neurosurgery · Case report (video) · n: 1 patient
Surgical Theater
Operative video of an expanded endoscopic endonasal transtuberculum approach for a tuberculum sellae meningioma in a 57-year-old woman. A 360-degree VR rendering (Surgical Theater SRP 7.4.0) was used to confirm suitability for the endonasal route, and the exposure and drilling were rehearsed in VR. The authors note the lack of haptic and tissue feedback.
“Surgical planning in VR can be helpful to the early-career endoscopic surgeon.”
From the paper · Abstract
“The three-dimensional renderings are quick to set up (15 min), and the examination of the anatomy is useful for choosing the surgical approach.”
15 min
From the paper · Abstract
Conclusions (3)
VR planning helpful to early-career surgeonAnswer: Yes
“Surgical planning in VR can be helpful to the early-career endoscopic surgeon.”
From the paper · Abstract
3D renderings set up in 15 minutesAnswer: Yes
“The three-dimensional renderings are quick to set up (15 min), and the examination of the anatomy is useful for choosing the surgical approach.”
15 min
From the paper · Abstract
Software lacks haptic and tissue feedbackAnswer: Describes
“Despite the lack of haptic feedback and tissue response such as vascularity and firmness in the current software”
Advanced Medical Use of Three-Dimensional Imaging in Congenital Heart Disease: Augmented Reality, Mixed Reality, Virtual Reality, and Three-Dimensional Printing#
Goo HW et al. · Korean journal of radiology · 2020
Congenital heart · Narrative review
Multiple platforms
Narrative review in the Korean Journal of Radiology of augmented, mixed and virtual reality and 3D printing in congenital heart disease. The authors describe how these technologies are being applied to understanding complex anatomy, education and surgical planning, and discuss current limitations.
Mini Fronto-Orbital Approach: "Window Opening" Towards the Superomedial Orbit - A Virtual Reality-Planned Anatomic Study#
Donofrio CA et al. · Operative neurosurgery (Hagerstown, Md.) · 2020
Neurosurgery · Cadaveric study
Surgical Theater
Anatomical study in which a mini fronto-orbital keyhole approach to the superomedial orbit was planned and measured in virtual reality (Surgical Theater) and then performed on cadaver specimens. The authors report that the approach, with a 'window-opening' intraorbital dissection technique, gave good exposure of the target area with limited tissue disruption.
Conclusions (1)
Approach judged safe, effective and convenientAnswer: Describes
“The mFO approach associated to the window-opening dissection technique can be considered safe, effective, suitable, and convenient for treating lesions located in the superomedial orbital aspect, up to the orbital apex.”
Virtual, augmented, and mixed reality applications in orthopedic surgery#
Verhey JT et al. · The international journal of medical robotics + computer assisted surgery · 2020
Orthopedics · Narrative review
Multiple platforms
Narrative review of VR, AR and MR in orthopaedic surgery based on a MEDLINE search, covering training simulation, preoperative planning, intraoperative navigation and remote collaboration. The authors conclude that reality technologies let orthopaedic surgeons plan preoperatively and navigate with less fluoroscopy.
Evaluating the Performance of Augmented Reality in Displaying Magnetic Resonance Imaging-Derived Three-Dimensional Holographic Models#
Chang F et al. · Journal of medical imaging and radiation sciences · 2020
Multi-specialty · Validation study
AR/MR, platform not specified
Phantom study of the accuracy of an augmented-reality application displaying MRI-derived 3D holographic models, comparing distances measured with the AR caliper tool against gold-standard physical measurements and PACS. The authors report no significant difference between AR and gold-standard measurements, AR caliper precision within 1.9 to 3.9%, and a larger error for 3D T2 CUBE sequences.
“No statistically significant difference existed between AR and GS measurements (P = .6208).”
P = .6208
From the paper · Abstract
“AR caliper tool demonstrated overall lower accuracy than with physical calipers, although with MSE <10% and greatest measured difference from GS measuring <5 mm.”
10%
From the paper · Abstract
Conclusions (2)
No significant difference from gold-standard measurementsAnswer: Yes
“No statistically significant difference existed between AR and GS measurements (P = .6208).”
P = .6208
From the paper · Abstract
AR caliper less accurate than physical calipersAnswer: Mixed
“AR caliper tool demonstrated overall lower accuracy than with physical calipers, although with MSE <10% and greatest measured difference from GS measuring <5 mm.”
Neurosurgery · Retrospective case series · n: 134 cases
Surgical Theater
Retrospective series of 134 endoscopic anterior skull base and complex sinonasal procedures. Fused CT/MRI 3D models (Surgical Theater) were studied beforehand to guide the approach, then linked with Brainlab navigation to give a mixed reality overlay on the endoscopic view. The authors report that surgeons felt it helped guide bony dissection and identify critical structures.
“A total of 134 cases were performed.”
134
From the paper · Abstract
Conclusions (3)
Surgeons felt it guided dissection and critical structuresAnswer: Yes
“Surgeons felt that the technology helped to guide the extent of bony dissection and to identify critical structures.”
From the paper · Abstract
134 cases performed in one centreAnswer: Yes
“A total of 134 cases were performed.”
134
From the paper · Abstract
First clinical series on a new platformAnswer: Describes
“We describe the first clinical series of complex skull base pathologies treated using a novel mixed reality platform.”
3D-printed models and virtual reality as new tools for image-guided robot-assisted nephron-sparing surgery: a systematic review of the newest evidences#
Checcucci E et al. · Current opinion in urology · 2020
Urology · Systematic review
Multiple platforms
Systematic review of 10 studies on 3D-printed and virtual 3D models for robot-assisted nephron-sparing surgery. The authors report that printed models helped preoperative simulation and counselling, that mixed-reality 3D models enhanced preoperative planning, and that overlaying models intraoperatively enabled AR procedures, with moderate to high risk of bias in all studies.
“in a virtual reality setting the preoperative planning was enhanced by using 3D virtual models in a mixed reality environment”
From the paper · Abstract
Conclusions (3)
Printed models judged more useful for counselingAnswer: Yes
“3D-printed models were considered to be more useful during both preoperative simulations and patients’ counseling.”
Intraoperative 3D Hologram Support With Mixed Reality Techniques in Liver Surgery#
Saito Y et al. · Annals of surgery · 2020
Hepatobiliary & pancreatic (HPB) · Case series · n: 2 patients
Microsoft HoloLens
Initial experience with 3D liver holograms from preoperative CT shown on HoloLens headsets in the operating room and shared among several surgeons. The authors describe use in determining the dissection line for a patient with more than 20 colorectal liver metastases and in planning a Glissonean pedicle approach in a patient with a hilar anomaly, and describe the role as 'last-minute simulation' rather than navigation.
“The intraoperative hologram contributed to better imagination of tumor locations, and for determining the parenchymal dissection line in the hepatectomy for the patients with more than 20 multiple colo-rectal liver metastases.”
From the paper · Abstract
“In another case, the hologram enabled a safe Gliisonean pedicle approach for hepato-cellular carcinoma with a hilar anatomical anomaly.”
From the paper · Abstract
“This initial experience suggested that an intraoperative hologram with mixed reality techniques contributed to "last-minute simulation," not for "navigation." The intraoperative hologram might be a new next-generation operation-supportive tool in terms of spatial awareness, sharing, and simplicity.”
From the paper · Abstract
Conclusions (4)
Hologram aided tumor localization in multiple metastasesAnswer: Yes
“The intraoperative hologram contributed to better imagination of tumor locations, and for determining the parenchymal dissection line in the hepatectomy for the patients with more than 20 multiple colo-rectal liver metastases.”
From the paper · Abstract
Several surgeons shared one hologram without monitorsAnswer: Yes
“several surgeons wearing HoloLens succeeded in sharing the same hologram and moving that hologram from respective operators' angles by means of easy gesture-handling without any monitors.”
From the paper · Abstract
Hologram enabled Glissonean pedicle approach in anomalyAnswer: Describes
“In another case, the hologram enabled a safe Gliisonean pedicle approach for hepato-cellular carcinoma with a hilar anatomical anomaly.”
From the paper · Abstract
Role is last-minute simulation, not navigationAnswer: Describes
“This initial experience suggested that an intraoperative hologram with mixed reality techniques contributed to "last-minute simulation," not for "navigation."”
Use of mixed reality for improved spatial understanding of liver anatomy#
Pelanis E et al. · Minimally invasive therapy & allied technologies · 2020
Hepatobiliary & pancreatic (HPB) · Comparative study
Microsoft HoloLens
Study in which 28 clinicians assigned 150 liver lesions to segments using either MRI images or 3D liver models in mixed reality on Microsoft HoloLens. The authors report no difference in accuracy, but a much shorter median time to correct identification with HoloLens (6 versus 23.5 seconds, p<0.001).
“From a total of 150 lesions, 89 were correctly assigned without significant difference between the modalities.”
From the paper · Abstract
“The median time for correct identification was 23.5 [4-138] s using the magnetic resonance imaging images and 6.00 [1-35] s using HoloLens (p < 0.001)”
p < 0.001
From the paper · Abstract
Conclusions (2)
No accuracy difference between modalitiesAnswer: No significant difference
“From a total of 150 lesions, 89 were correctly assigned without significant difference between the modalities.”
89 of 150 lesions correct
From the paper · Abstract
Correct identification faster in mixed realityAnswer: Yes
“The median time for correct identification was 23.5 [4-138] s using the magnetic resonance imaging images and 6.00 [1-35] s using HoloLens (p < 0.001)”
Operative video of resecting a complex right frontal AVM in a 30-year-old woman, using a navigation-integrated VR platform with 360-degree fly-through for strategic planning and during the approach and resection. The authors report complete resection on postoperative imaging.
“The AVM was safely resected using navigation integrated with VR; careful arterial devascularization preceded resection of the draining veins and then the AVM nidus.”
From the paper · Abstract
Conclusions (2)
AVM resected safely with VR-integrated navigationAnswer: Describes
“The AVM was safely resected using navigation integrated with VR”
Towards Placental Surface Vasculature Exploration in Virtual Reality#
Novotny J et al. · IEEE computer graphics and applications · 2020
Fetal medicine · Technical development
CAVE (immersive projection)
Case study of interactive identification of placental surface blood vessels from MRI using direct volume rendering in a high-fidelity CAVE-like VR system, without prior segmentation. The authors report that participants traced most visible vessels and consistently identified vessels down to 1 mm, found the visualisation intuitive but complex interactions challenging, and propose VR MRI visualisation as a step towards planning prenatal surgery.
“Participants were able to trace most of the observable vascular structure, and consistently identified blood vessels down to diameters of 1 mm, an important requirement in diagnosing vascular diseases.”
From the paper · Abstract
“Qualitative feedback from our participants suggests that our VR visualization is easy to understand and allows intuitive data exploration, but complex user interactions remained a challenge.”
From the paper · Abstract
Conclusions (2)
Participants traced most vessels, down to 1 mmAnswer: Yes
“Participants were able to trace most of the observable vascular structure, and consistently identified blood vessels down to diameters of 1 mm, an important requirement in diagnosing vascular diseases.”
From the paper · Abstract
Easy to understand, complex interactions challengingAnswer: Mixed
“Qualitative feedback from our participants suggests that our VR visualization is easy to understand and allows intuitive data exploration, but complex user interactions remained a challenge.”
Preprint describing a prototype HoloLens application that displays CT-derived 3D models (segmented in Materialise Mimics) for pre-procedural planning of a morphologically complex brain aneurysm. The authors report that testers felt AR helped spatial understanding and depth perception and could increase confidence in planning.
“Feedback from testing the prototype indicated potential for augmented reality to assist an interventionalist in spatial understanding and depth perception of spatially complex anatomy and could increase confidence in pre-procedural planning.”
From the paper · Abstract
Conclusions (2)
One tester saw potential for spatial understandingAnswer: Describes
“Feedback from testing the prototype indicated potential for augmented reality to assist an interventionalist in spatial understanding and depth perception of spatially complex anatomy and could increase confidence in pre-procedural planning.”
From the paper · Abstract
Prototype built and deployed on one headsetAnswer: Describes
“An initial prototype app was successfully built and deployed to the HoloLens.”
CSANZ 2020 abstract working towards preoperative planning of percutaneous coronary intervention with virtual reality. Title-only record: no abstract was openly available from the sources searched, so details could not be confirmed.
Breast3D: An Augmented Reality System for Breast CT and MRI#
Allison B et al. · International Conference on Artificial Intelligence and Virtual Reality · 2020
Plastic & reconstructive · Technical development
Microsoft HoloLens
HTC Vive
AIVR 2020 paper presenting Breast3D, an extended-reality system that reconstructs breast CT and MRI volumes in 3D on HoloLens (portable to HTC Vive) to support diagnosis, multidisciplinary meetings and surgical planning.
E-195 A mixed reality spatial computing framework for preprocedural evaluation of cerebral aneurysms: approach and preliminary results#
Deib G et al. · Journal of NeuroInterventional Surgery (SNIS 2020 abstracts) · 2020
Neurosurgery · Conference abstract
Magic Leap
SNIS 2020 abstract describing early experience with Magic Leap One mixed reality as an adjunct to angiography in the pre-procedural work-up of complex cerebral aneurysms, using 3D meshes segmented from DynaCT angiography.
“MxR visualization allowed the operators to manipulate the dataset to achieve a greater understanding of the anatomy of the parent vessel, the angioarchitecture of the aneurysm, and the surface contours of all visualized structures.”
From the paper · Abstract
“This preliminary study demonstrates the feasibility of utilizing MxR for preprocedural evaluation in patients with anatomically complex neurovascular disorders.”
From the paper · Abstract
Conclusions (2)
Feasible for preprocedural aneurysm evaluationAnswer: Yes
“This preliminary study demonstrates the feasibility of utilizing MxR for preprocedural evaluation in patients with anatomically complex neurovascular disorders.”
“MxR visualization allowed the operators to manipulate the dataset to achieve a greater understanding of the anatomy of the parent vessel, the angioarchitecture of the aneurysm, and the surface contours of all visualized structures.”
ACC 2020 abstract comparing EchoPixel 3D CT with transoesophageal echocardiography for pre-procedural planning of Watchman left atrial appendage occluder implantation. Title-only record: no abstract was openly available from the sources searched, so details could not be confirmed.
Conference abstract proposing a planning framework for transcatheter mitral valve replacement that combines 3D imaging, in silico modelling and virtual reality. Only the first lines of the abstract were openly available.
Minimally Invasive Mini-orbitozygomatic Approach for Clipping an Anterior Communicating Artery Aneurysm: Virtual Reality Surgical Planning#
González Romo N, Ravera Zunino F · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery · 2020
Neurosurgery · Case report · n: 1 patient
VR, platform not specified
Case report of an unruptured anterior communicating artery aneurysm, in which a CTA-based VR model was used to simulate mini-pterional, supraorbital and mini-orbitozygomatic approaches before clipping through a mini-orbitozygomatic approach. The authors outline the VR planning steps and their advantages and disadvantages.
Novel patient-specific 3D-virtual reality visualisation software (SpectoVR) for the planning of spine surgery: a case series of eight patients#
Croci DM et al. · BMJ Innovations · 2020
Spine · Case series · n: 8 patients
SpectoVR
Case series of eight patients with complex spinal conditions (for example cervical kyphotic deformity, chordoma, lumbopelvic deformity) whose patient-specific DICOM data were studied before surgery in SpectoVR on a VR headset. The authors report that SpectoVR did not replace multiplanar review but improved holistic understanding and mental preparation, and that integration into daily planning was feasible.
“Whereas VR did not omit the need for viewing the spine in the multiplane reconstruction mode, the authors feel that SpectoVR contributed to a better holistic understanding of the anatomy.”
From the paper · Abstract
“Integrating SpectoVR in daily presurgical planning is feasible and appears to enhance the surgeon’s awareness of the case.”
From the paper · Abstract
Conclusions (2)
Daily presurgical use feasible in eight casesAnswer: Yes
“Integrating SpectoVR in daily presurgical planning is feasible and appears to enhance the surgeon’s awareness of the case.”
“Whereas VR did not omit the need for viewing the spine in the multiplane reconstruction mode, the authors feel that SpectoVR contributed to a better holistic understanding of the anatomy.”
P1417 Acceptability of a virtual reality system for examination of congenital heart disease patients#
Wheeler G et al. · European Heart Journal - Cardiovascular Imaging · 2020
Congenital heart · Conference abstract
VR, platform not specified
EuroEcho 2019 abstract (3D Heart project) testing the usability of a prototype VR system for interacting with 3D echocardiography images, in which 13 clinicians placed landmarks and found views on a TEE dataset. The authors report that most clinicians found the system easy to learn and use; the system is aimed at examining congenital heart disease and supporting decisions.
“Learning to use the system was perceived as easy for all but one participant, who rated it as ‘Somewhat difficult’.”
From the paper · Abstract
“However, once trained, all users found the system easy to use.”
From the paper · Abstract
“Our VR system was accepted by the vast majority of clinicians, both for ease of learning and use.”
From the paper · Abstract
Conclusions (3)
Most clinicians accepted the VR systemAnswer: Yes
“Our VR system was accepted by the vast majority of clinicians, both for ease of learning and use.”
From the paper · Abstract
Learning rated easy by all but oneAnswer: Yes
“Learning to use the system was perceived as easy for all but one participant, who rated it as ‘Somewhat difficult’.”
From the paper · Abstract
All users found it easy once trainedAnswer: Yes
“However, once trained, all users found the system easy to use.”
P1566 Evaluation of haptic feedback for interaction with volumetric image data in virtual reality#
Deng S et al. · European Heart Journal - Cardiovascular Imaging · 2020
Congenital heart · Conference abstract
VR, platform not specified
EuroEcho 2019 abstract (3D Heart project) evaluating vibration haptic feedback in a VR volume-visualisation system intended as an alternative to 3D printing for planning congenital heart surgery, using a synthetic cylinder measured by ten non-clinical volunteers. The authors report only a marginal accuracy gain but a clear user preference for haptics.
“The results show a marginal improvement of measurement accuracy with haptic feedback, compared to no haptics (see Figure a).”
From the paper · Abstract
“The haptic feedback did improve the participants’ confidence about their performance and increased the ease of use in VR, hence, they preferred the haptics condition to the no haptics condition (see Figure b).”
From the paper · Abstract
“Moreover, although 70% of the participants reported relying on the visual cue more than on the haptic cue, 90% found that the haptic cue was helpful for deciding where to place the measurement point.”
90%
From the paper · Abstract
Conclusions (3)
Marginal accuracy gain with haptic feedbackAnswer: Describes
“The results show a marginal improvement of measurement accuracy with haptic feedback, compared to no haptics (see Figure a).”
From the paper · Abstract
Participants preferred the haptics conditionAnswer: Yes
“The haptic feedback did improve the participants’ confidence about their performance and increased the ease of use in VR, hence, they preferred the haptics condition to the no haptics condition (see Figure b).”
From the paper · Abstract
Haptic cue helpful for placement, 90%Answer: Yes
“Moreover, although 70% of the participants reported relying on the visual cue more than on the haptic cue, 90% found that the haptic cue was helpful for deciding where to place the measurement point.”
90% found haptic cue helpful; 70% relied more on visual cue
PD07-10 USEFULNESS OF DETERMINATION OF RENAL PUNCTURE LINE IN ECIRS USING VIRTUAL REALITY#
Okada A et al. · Journal of Urology · 2020
Urology · Conference abstract
VR, platform not specified
AUA 2020 abstract on using virtual reality to determine the renal puncture line before endoscopic combined intrarenal surgery (ECIRS). Only the opening of the abstract was openly available, so results could not be confirmed.
PD23-05 INTERACTIVE VIRTUAL REALITY (iVR) AS AN EDUCATIONAL AND PREOPERATIVE PLANNING TOOL FOR LIVING DONOR NEPHRECTOMIES: A CASE-CONTROLLED STUDY#
Xie L et al. · Journal of Urology · 2020
Urology · Conference abstract
VR, platform not specified
AUA 2020 abstract on a case-controlled study of interactive VR as an educational and preoperative planning tool for living donor nephrectomy. Title-only record: no abstract was openly available from the sources searched, so details could not be confirmed.
Conference abstract (SNO 2020) reporting preliminary experience with the Surgical Theater VR system in 60 consecutive neurosurgical oncology cases, using 3D models from CT and MRI for preoperative planning, team and MDT discussion, and connection to neuronavigation. The authors report that VR helped define surgical strategy and tailor craniotomy, and was also used for informed consent.
“Use of the 3D VR was used during preoperative planning allowing a better definition of surgical strategy.”
From the paper · Abstract
“Smaller blood vessels are generally not included in the 3D rendering, however, real-time intraoperative threshold modulation of the 3D model assisted in their identification improving surgical confidence and safety during the procedure.”
From the paper · Abstract
“Finally, 3D VR was used during informed consent, improving communication with families and young patients. 3D VR allows to tailor surgical strategies to the single patient, contributing to procedural safety and efficacy and to the global improvement of neurosurgical oncology care.”
From the paper · Abstract
Conclusions (3)
VR helped define surgical strategy in planningAnswer: Yes
“Use of the 3D VR was used during preoperative planning allowing a better definition of surgical strategy.”
From the paper · Abstract
Threshold modulation helped identify small vesselsAnswer: Yes
“real-time intraoperative threshold modulation of the 3D model assisted in their identification improving surgical confidence and safety during the procedure”
From the paper · Abstract
VR used in consent discussions with familiesAnswer: Yes
“3D VR was used during informed consent, improving communication with families and young patients.”
Virtual Reality Image Processing for Effective Deep Brain Stimulation of the Anterior Thalamic Nucleus in Epilepsy Patients#
Adams CN et al. · Neurosurgery Cases and Reviews · 2020
Neurosurgery · Case report
VR, platform not specified
Open-access article in Neurosurgery Cases and Reviews on VR image processing to target the anterior thalamic nucleus for deep brain stimulation in patients with epilepsy. The publisher page could not be read by automated access, so details are based on the title.
Conclusions (2)
Electrode contacts confirmed on fused VR imageAnswer: Describes
“the Neurology team could visually confirm contacts 2 and 3 were appropriate for stimulation.”
From the paper · Full text
VR model used to plan electrode trajectoriesAnswer: Describes
“This VR model was used in conjunction with the Stealth Neuronavigation software to plan the target and entry points (on the left and right frontal bones) as well as the electrode trajectories.”
Augmented reality mastectomy surgical planning prototype using the HoloLens template for healthcare technology letters#
Amini S, Kersten-Oertel M · Healthcare technology letters · 2019
Plastic & reconstructive · Technical development
Microsoft HoloLens
Letter describing a prototype HoloLens augmented-reality application that shows candidate breast implants as 3D holograms on the patient's body to help choose an implant for reconstruction after single mastectomy, tested with a custom two-chamber implant. In a user study with 13 subjects, the authors report that subjects could compare real and holographic implants and decide which to use.
“This method can be quicker than the traditional way and eliminates sizer implants from the process.”
From the paper · Abstract
“Further advantages of the method include the use of a more accurate, user-friendly device, which is easily extendable as new implants that are on the market can be easily added to the system dataset.”
From the paper · Abstract
Conclusions (4)
Mean decision time 7 min 28 sAnswer: Describes
“On average, it took the subjects 7 min and 28 s to choose the best matching shape and declare it.”
7 min and 28 s
From the paper · Full text
7 of 13 subjects chose the correct shapeAnswer: Mixed
“seven subjects chose shape G as the best match which was considered to be the correct answer.”
7 of 13 subjects
From the paper · Full text
12 of 13 users found it usefulAnswer: Yes
“Out of 13 subjects, 12 users found the software useful for comparing shapes and objects, giving it an average score of 4.23 out of 5.”
12 of 13; average 4.23 out of 5
From the paper · Full text
10 of 13 users found system cumbersomeAnswer: No
“10 out of 13 users found the system cumbersome to use”
Intraoperative Three-dimensional Virtual Reality and Computed Tomographic Guidance in Temporomandibular Joint Arthroplasty of Syndromic Craniofacial Dysostoses#
Bradley D et al. · Plastic and reconstructive surgery. Global open · 2019
Oral & maxillofacial / craniofacial · Retrospective case series · n: 4 patients
Surgical Theater
Retrospective review of children with syndromic mandibular micrognathia, of whom four consecutive patients had interpositional temporomandibular joint arthroplasty for ankylosis: two with traditional CT guidance and two with 3D VR planning and guidance (Surgical Theater SNAP with Brainlab, per the full text). The authors report average operative times of 300 minutes with CT guidance and 134 minutes with 3D VR, with no significant differences in complications or hospital stay.
“No statistically significant differences were found among the age, complications, or inpatient hospitalization times.”
From the paper · Abstract
“The average operative time in the traditional CT guidance group was 300 minute versus 134 minutes in the 3D VR group.”
134 minutes
From the paper · Abstract
“Three-dimensional VR is a useful preoperative planning and intraoperative guidance tool.”
From the paper · Abstract
Conclusions (3)
Operative time 134 vs 300 minutesAnswer: Yes
“The latter 2 patients were treated with a combination of 3D VR and CT guidance and required an average of 134 minutes for completion ( P = 0.03).”
134 vs 300 min, P = 0.03
From the paper · Full text
No link between technology and overall outcomeAnswer: No significant difference
“we did not find any relationship between using the technology to overall outcomes as both groups demonstrated reankylosis”
From the paper · Full text
No complications in any of four patientsAnswer: Describes
“No intraoperative or postoperative complications occurred in any of the patients”
Literature overview of virtual and augmented reality in oral and maxillofacial surgery from 2009 to 2019, identifying 101 articles. The authors report that dental implantology and orthognathic surgery are the most frequent applications, with VR used mainly for prediction planning and education, and note few prospective randomised studies.
“Virtual planning improved the accuracy of inserting dental implants using either a statistic guidance or dynamic navigation.”
From the paper · Abstract
“There are limited prospective randomized studies comparing the impact of virtual reality with the standard methods in delivering oral surgery education.”
“Virtual planning improved the accuracy of inserting dental implants using either a statistic guidance or dynamic navigation.”
From the paper · Abstract
Review: contributed to planning and trainingAnswer: Describes
“Virtual and augmented reality have contributed to the planning of maxillofacial procedures and surgery training.”
From the paper · Abstract
Few randomized studies on education impactAnswer: Describes
“There are limited prospective randomized studies comparing the impact of virtual reality with the standard methods in delivering oral surgery education.”
Use of virtual reality for pre-surgical planning in separation of conjoined twins: A case report#
Juhnke B et al. · Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine · 2019
General & GI surgery · Case report · n: 1 patient
Stereoscopic monitor (custom haptic tool)
Case report of thoracopagus conjoined twins in whom CT angiography-based 3D models were reviewed by the surgical teams on a virtual stereoscopic display to locate a 1 mm interatrial communication between the two hearts before separation. The authors report that the surgical plan was significantly modified as a result, and that both twins survived and were discharged.
“The surgical plan to close the 1-mm interatrial communication was significantly modified based on the pre-procedural spatial awareness of the anatomy presented in the virtual visualization.”
From the paper · Abstract
“The virtual stereoscopic display was critical for the surgical team to successfully separate the twins and provides a useful case study for the use of virtual reality technology in surgical planning.”
From the paper · Abstract
Conclusions (3)
Surgical plan modified after virtual visualizationAnswer: Yes
“The surgical plan to close the 1-mm interatrial communication was significantly modified based on the pre-procedural spatial awareness of the anatomy presented in the virtual visualization.”
From the paper · Abstract
Both twins survived and were dischargedAnswer: Describes
“Both twins survived the operation and were subsequently discharged from the hospital.”
Effect of 3-Dimensional Virtual Reality Models for Surgical Planning of Robotic-Assisted Partial Nephrectomy on Surgical Outcomes: A Randomized Clinical Trial#
Randomized controlled trial (n = 92 analysed; 99 randomised). Blood loss and length of stay favoured the VR group; operative time (the primary outcome) and clamp time did not differ significantly.
“When controlling for case complexity and other covariates, patients whose surgical planning involved 3-D VR models showed differences in operative time (odds ratio [OR], 1.00; 95% CI, 0.37-2.70; estimated OR, 2.47), estimated blood loss (OR, 1.98; 95% CI, 1.04-3.78; estimated OR, 4.56), clamp time (OR, 1.60; 95% CI, 0.79-3.23; estimated OR, 11.22), and length of hospital stay (OR, 2.86; 95% CI, 1.59-5.14; estimated OR, 5.43).”
From the paper · Abstract
Conclusions (3)
Operative time did not differ between groupsAnswer: No significant difference
“Unadjusted mean (SD) values for operative time between control and intervention groups (172.6 [48.5] minutes vs 173.3 [49.6] minutes; P = .70)”
172.6 vs 173.3 min, P = .70
From the paper · Full text
Longer stay and high blood loss less likelyAnswer: Yes
“In the subsequent multilevel model, patients in the control group were significantly more likely than patients with 3-D VR–assisted surgical planning to have a length of stay longer than 2 days (OR, 2.86; 95% CI, 1.59-5.14) and EBL greater than 200 mL (OR, 1.98; 95% CI, 1.04-3.78).”
Stay >2 d OR 2.86, 95% CI 1.59-5.14; EBL >200 mL OR 1.98, 95% CI 1.04-3.78
From the paper · Full text
Clamp time did not differ in adjusted modelAnswer: No significant difference
“Operative time (OR, 1.00; 95% CI, 0.37-2.70) and clamp time (OR, 1.60; 95% CI, 0.79-3.23) were also examined but were not statistically different between groups in this model.”
[Value of virtual reality technology in preoperative planning of transtrochanteric curved varus osteotomy for avascular necrosis of femoral head in adults]#
Shi L et al. · Zhongguo xiu fu chong jian wai ke za zhi · 2019
Orthopedics · Case series · n: 7 patients
VR, platform not specified
Chinese study of seven adults (11 hips) with avascular necrosis of the femoral head in whom virtual reality software built from CT data was used to simulate and plan the varus angle of a transtrochanteric curved varus osteotomy. The authors report that the achieved correction matched the plan in five hips and was within 1 to 4 degrees in six, with one nonunion, one proximal femoral fracture and a significant improvement in Harris hip score.
“Among them, the difference of the neck-shaft angle was consistent with planned varus angle in 5 hips, while the error of the remaining 6 hips was 1-4°.”
From the paper · Abstract
Conclusions (3)
Neck-shaft angle change within 4° of planAnswer: Yes
“Among them, the difference of the neck-shaft angle was consistent with planned varus angle in 5 hips, while the error of the remaining 6 hips was 1-4°.”
5 of 11 hips matched; error 1-4° in 6 hips
From the paper · Abstract
Harris score differed significantly from preoperative scoreAnswer: Yes
“At last follow-up, the Harris score was 82.18±16.35, showing significant difference when compared with preoperative score ( t =–5.195, P =0.000).”
Harris 82.18±16.35, t =–5.195, P =0.000
From the paper · Abstract
One nonunion and one proximal femur fractureAnswer: Describes
“There was 1 patient (1 hip) of osteotomy nonunion at 4 months after operation, 1 patient (1 hip) of proximal femur fracture at 2 months after operation.”
Robust GPU-based virtual reality simulation of radio-frequency ablations for various needle geometries and locations#
Kath N et al. · International journal of computer assisted radiology and surgery · 2019
Interventional radiology · Technical development
VR, platform not specified
Technical paper presenting a GPU-based real-time method for simulating radiofrequency ablation zones for various needle geometries and positions, for use in an existing visuo-haptic 4D VR liver needle-intervention simulator. The authors report better agreement with an in vitro gold standard than a literature method, rendering above 480 Hz, and suggest safer, more conservative ablation planning.
Conclusions (2)
Higher in vitro correlation, 3 of 4 experimentsAnswer: Mixed
“In 3 of 4 experiments, the model of this work shows a statistically relevant better correlation to the in vitro temperatures (b, c, d).”
3 of 4 experiments, Pearson correlation, p < 0.05
From the paper · Full text
Frame rate above 480 Hz on one GPUAnswer: Describes
“On the Nvidia 1080 Ti GPU it achieves a very high frame rendering performance of >480 Hz.”
Application of Mixed Reality Technology in Visualization of Medical Operations#
Gao Y et al. · Chinese medical sciences journal · 2019
Multi-specialty · Narrative review
Multiple platforms
Chinese narrative review of mixed-reality-based visualisation systems for surgery, describing their components and technical characteristics and typical applications in case discussion, surgical planning, intraoperative guidance, postoperative evaluation and rehabilitation.
Virtual reality of three-dimensional surgical field for surgical planning and intraoperative management#
Yamada Y et al. · International journal of urology · 2019
Urology · Technical note
VR, platform not specified
Article in the International Journal of Urology on virtual reality of the three-dimensional surgical field for surgical planning and intraoperative management. No abstract was available, so these details are from the title and venue and could not be confirmed.
Virtual Reality-Based Evaluation of Surgical Planning and Outcome of Monosegmental, Unilateral Cervical Foraminal Stenosis#
Zawy Alsofy S et al. · World neurosurgery · 2019
Spine · Retrospective cohort · n: 73 patients
VR, platform not specified
Retrospective study of 73 patients with monosegmental unilateral osseous cervical foraminal stenosis treated by ventral (41) or dorsal (32) decompression. CT scans were visualized with VR software to measure the foramen, and a questionnaire assessed the technique's influence on planning. The authors report a moderate influence on the choice of approach and a significant influence on ventral approach strategy.
“Reconstruction of pre- and postoperative 2D-CT images of the cervical spine into 3D images, and the spatial and anatomical reconstructions in VR models, can be helpful in planning surgical approaches and treatment strategies for patients with cervical foraminal stenoses”
From the paper · Abstract
“A significant difference was found in the size of the smallest cross-sectional area of the intervertebral neuroforamen in the lateral resection region between ventral and dorsal approaches, with no correlation to the clinical outcome.”
From the paper · Abstract
Conclusions (3)
VR changed ventral strategy only, not positioningAnswer: Mixed
“The VR-technique had a moderate influence on the choice of the approach (ventral or dorsal), a significant influence on the ventral approach strategy, and no influence on the positioning of the patient or the dorsal approach strategy.”
approach choice P = 0.08; ventral strategy P = 0.02; positioning P = 0.69
From the paper · Abstract
Foramen area differed by surgical approachAnswer: Describes
“A significant difference was found in the size of the smallest cross-sectional area of the intervertebral neuroforamen in the lateral resection region between ventral and dorsal approaches”
P = 0.02
From the paper · Abstract
Foramen area not correlated with clinical outcomeAnswer: No significant difference
Virtual or Augmented Reality to Enhance Surgical Education and Surgical Planning#
Cao C, Cerfolio RJ · Thoracic surgery clinics · 2019
Thoracic · Narrative review
Multiple platforms
Narrative review of virtual and augmented reality technologies in thoracic surgery, covering their growing role in clinical care, surgical planning and surgical training.
[Application of diffusion tensor imaging combined with virtual reality three-dimensional reconstruction in the operation of gliomas involved eloquent regions]#
Chen SH et al. · Beijing da xue xue bao. Yi xue ban · 2019
Neurosurgery · Retrospective case series · n: 35 patients
Dextroscope
Chinese-language retrospective series of 35 patients with gliomas involving language or motor areas (2015-2019). MRI, MRA and DTI tractography were reconstructed on the Dextroscope VR system to simulate surgery and design individual plans. The authors report complete resection of enhancing tumour in 30 patients (85.7%) and neurological improvement in 34.
“Surgical simulation and surgery program of VR of the 35 patients were successfully performed.”
From the paper · Abstract
“Dextroscope virtual reality system can clearly expose and quantify the 3D anatomic relationship of tumors, neural fiber tracts and blood vessels surrounding gliomas near eloquent regions, which is helpful to design the best individualized surgery program, to improve surgical effect.”
From the paper · Abstract
“Complete resection of enhancing tumor (CRET) was achieved in 30 cases (85.7%), subtotal resection in 5 cases (14.3%), neurological function improved in 34 cases (97.1%) after operation,and 1 case had no improvement compared with that before(2.9%).”
85.7%
From the paper · Abstract
Conclusions (3)
Complete resection in 30 of 35 patientsAnswer: Describes
“Complete resection of enhancing tumor (CRET) was achieved in 30 cases (85.7%), subtotal resection in 5 cases (14.3%), neurological function improved in 34 cases (97.1%) after operation,and 1 case had no improvement compared with that before(2.9%).”
30 of 35 (85.7%) complete; 34 of 35 (97.1%) improved
From the paper · Abstract
Simulation and planning completed in all patientsAnswer: Yes
“Surgical simulation and surgery program of VR of the 35 patients were successfully performed.”
From the paper · Abstract
3D model resembled the real surgeryAnswer: Yes
“The 3D images obtained from virtual reality near to the real surgery.”
Short report in which a medical student, an OMFS resident and an OMFS consultant rated the preoperative usefulness of VR glasses for viewing cone-beam CT, CT and MRI data in three cases (an impacted wisdom tooth, a mandibular fracture and an oncological resection). The authors report that VR glasses gave a good preoperative overview, particularly for impacted teeth and hard tissue, and that the added value was smaller for more experienced surgeons.
“In addition, VR glasses seem to be a promising innovation to help in the training of surgical residents and to teach students.”
From the paper · Abstract
“Preoperative examination using VR glasses can aid better understanding and planning of the surgical site in the future, and is an innovative piece of advanced technology for displaying CT, cone-beam CT, and MRI anatomical data.”
From the paper · Abstract
“However, the more experienced the surgeon, the smaller is the additional value of VR glasses.”
From the paper · Abstract
Conclusions (3)
Good preoperative overview of intraoperative findingsAnswer: Yes
“VR glasses seem to help to simplify operations and give the surgeon a good preoperative overview of the intraoperative findings”
From the paper · Abstract
Added value smaller for experienced surgeonsAnswer: Describes
“However, the more experienced the surgeon, the smaller is the additional value of VR glasses.”
From the paper · Abstract
Promising for resident and student teachingAnswer: Describes
“VR glasses seem to be a promising innovation to help in the training of surgical residents and to teach students.”
Presurgical and Intraoperative Augmented Reality in Neuro-Oncologic Surgery: Clinical Experiences and Limitations#
Mikhail M et al. · World neurosurgery · 2019
Neurosurgery · Systematic review
Multiple platforms
Literature review (MEDLINE and EMBASE; 19 included articles) of VR and AR used before and during cranial tumour resection. The authors summarize reported qualitative advantages in visualizing anatomy and localizing lesions, and some quantitative benefits versus neuronavigation, along with registration and tracking limitations.
“The capacity to visualize three-dimensional images superimposed on patient anatomy is a potentially valuable tool in complex neurosurgical environments.”
From the paper · Abstract
Conclusions (2)
Qualitative advantage in visualization and localizationAnswer: Yes
“VR/AR were found to be qualitatively advantageous due to enhanced visualization of complex anatomy and improved intraoperative lesion localization”
From the paper · Abstract
Quantitative clinical benefits versus neuronavigation reportedAnswer: Yes
“quantitative clinical benefits were also reported”
Holographic Augmented Reality and 3D Printing for Advanced Planning of Sinus Venosus ASD/Partial Anomalous Pulmonary Venous Return Percutaneous Management#
Butera G et al. · JACC: Cardiovascular Interventions · 2019
Congenital heart · Case report (image) · n: 1 patient
AR/MR, platform not specified
Image case in JACC: Cardiovascular Interventions of a 73-year-old woman with sinus venosus ASD and partial anomalous pulmonary venous return, in whom holographic augmented reality and 3D printing were used to plan percutaneous management. Only the opening of the case text was openly available, so further details could not be confirmed.
[Three-dimensional visual assessment and virtual reality study of centrally located hepatocellular carcinoma on the axis of blood vessels]#
Zhu W et al. · Zhonghua wai ke za zhi [Chinese journal of surgery] · 2019
Hepatobiliary & pancreatic (HPB) · Case series · n: 20 patients
VR, platform not specified
Chinese study of 20 patients with centrally located hepatocellular carcinoma whose CT-based 3D reconstructions were imported into a VR engine to assess the tumour's relationship to the major vessels and plan surgery. The authors report that VR-based assessment agreed with intraoperative findings in all 20 patients, compared with 15 of 20 for CT/MRI (p=0.017), with no transfusions, deaths or major complications.
“All patients underwent successful resection of tumor under the guidance of 3D visualization and VR technology.”
From the paper · Abstract
“No death during the perioperative period and no complications such as hepatic failure, hemorrhage and biliary fistula after operation occurred.”
From the paper · Abstract
Conclusions (2)
All patients had successful tumour resectionAnswer: Describes
“All patients underwent successful resection of tumor under the guidance of 3D visualization and VR technology.”
From the paper · Abstract
No perioperative death or major complicationAnswer: Describes
“No death during the perioperative period and no complications such as hepatic failure, hemorrhage and biliary fistula after operation occurred.”
Comparison of 3-Dimensional and Augmented Reality Kidney Models With Conventional Imaging Data in the Preoperative Assessment of Children With Wilms Tumors#
Wellens LM et al. · JAMA network open · 2019
Urology · Survey/user study · n: 10 patients
Microsoft HoloLens
Custom Unity app
Survey study in which seven paediatric oncology surgeons assessed conventional imaging, 3D prints and augmented-reality holograms on a mixed-reality headset for 10 children with Wilms tumours. The authors report that both 3D prints and AR holograms were rated superior to conventional imaging for tumour, arteries, veins and collecting system, with no difference between the two 3D methods.
“In this study, the 3-D kidney models were associated with improved anatomical understanding among the surgeons and can be helpful in future preoperative planning of nephron-sparing surgery for Wilms tumors.”
From the paper · Abstract
“There were no differences in anatomical assessment between the two 3-D techniques (the 3-D print and AR hologram).”
From the paper · Abstract
Conclusions (2)
3D print and AR outscored conventional imagingAnswer: Yes
“For all 4 anatomical structures, the 3-D print and the AR hologram received higher scores compared with the conventional imaging”
Tumor median 4.07 vs 4.67 (3-D print), P = .008; 4.71 (AR), P = .002
From the paper · Full text
No difference between 3D print and AR hologramAnswer: No significant difference
“When scores for the 4 anatomical structures were compared between the 3-D print and the AR hologram, no difference was found”
Application of Dextroscope in a Rare Type of Angiomatous Meningioma Characterized With Coral-Like Vessels#
Ma SC et al. · The Journal of craniofacial surgery · 2019
Neurosurgery · Case report · n: 1 patient
Dextroscope
Case report of a 43-year-old woman with a sphenoid ridge angiomatous meningioma. CT angiography imported into the Dextroscope VR system showed coral-like vessels inside the tumour and its relationship to the skull base and internal carotid branches, and this informed the surgical plan before resection.
“Due to her progressive headache and visual deterioration, surgery was performed after comprehensive study in the Dextroscope system, details about the correlation among skull base, lesion, branches of internal carotid artery, and vessels inside the tumor were well demonstrated in this system.”
From the paper · Abstract
Conclusions (1)
Skull base and tumour vessels shown in detailAnswer: Yes
“details about the correlation among skull base, lesion, branches of internal carotid artery, and vessels inside the tumor were well demonstrated in this system.”
Mixed reality computed tomography-based surgical planning for partial nephrectomy using a head-mounted holographic computer#
Yoshida S et al. · International journal of urology · 2019
Urology · Technical note
AR/MR, platform not specified
Article in the International Journal of Urology on mixed-reality, CT-based surgical planning for partial nephrectomy using a head-mounted holographic computer. No abstract was available, so these details are from the title and venue and could not be confirmed.
The Application of Virtual Reality for Preoperative Planning of Lymphovenous Anastomosis in a Patient with a Complex Lymphatic Malformation#
Giacalone G et al. · Journal of clinical medicine · 2019
Plastic & reconstructive · Case report · n: 1 patient
Medicalholodeck / Medical Imaging XR
HTC Vive
Case report of a young woman with a complex lymphatic malformation of the thigh in whom SPECT-CT and lymphoscintigraphy were merged into a 3D model and viewed in a VR headset to plan lymphovenous anastomosis. The authors report that the model and fluorescent lymphography allowed a precise incision, and that swelling and discomfort decreased after surgery.
“Based on the combined findings of this 3D model and lymphography with a fluorescent marker, a precise skin incision could be determined and one lymph vessel was anastomosed to a nearby vein.”
From the paper · Abstract
“Although more reports are needed to confirm its efficacy, LVA planned with virtual reality constructed images appears to be a valuable treatment option for complex lesions, including LMs.”
From the paper · Abstract
Conclusions (4)
3D model and lymphography set precise incisionAnswer: Yes
“Based on the combined findings of this 3D model and lymphography with a fluorescent marker, a precise skin incision could be determined and one lymph vessel was anastomosed to a nearby vein.”
From the paper · Abstract
Swelling reduced and discomfort resolved after surgeryAnswer: Describes
“The swelling of the thigh reduced and the discomfort disappeared.”
leg volume difference 1222 mL to 224 mL
From the paper · Abstract
Authors call VR-planned LVA a valuable optionAnswer: Yes
“Although more reports are needed to confirm its efficacy, LVA planned with virtual reality constructed images appears to be a valuable treatment option for complex lesions, including LMs.”
From the paper · Abstract
15 min review, at least 1 hour preparationAnswer: Describes
“whilst only 15 min were required to study the anatomy of the lymphatic malformation in order to plan the subsequent intervention, one must account for at least 1 hour of preparation for the data to be processed by the dedicated software”
Augmented reality and three-dimensional printing in percutaneous interventions on pulmonary arteries#
Witowski J et al. · Quantitative imaging in medicine and surgery · 2019
Interventional radiology · Case series · n: 2 patients
Microsoft HoloLens
Feasibility report of two patients undergoing percutaneous pulmonary artery interventions (balloon pulmonary angioplasty for CTEPH and stent implantation for stenosis), in which CT-based holograms were displayed on HoloLens with CarnaLife Holo and life-size 3D prints were made for preoperative planning. The authors report that holograms were also used for guidance during the procedures, could be shared by several users, and were well received by clinicians.
“Clinicians expressed their satisfaction with the quality of imaging and potential clinical benefits.”
From the paper · Abstract
“This study reports the potential value of AR in pulmonary interventions, however, prospective trials need to be conducted to decide on whether novel 3D visualization techniques affect perioperative treatment and outcomes.”
From the paper · Abstract
Conclusions (3)
Clinicians satisfied with imaging qualityAnswer: Yes
“Clinicians expressed their satisfaction with the quality of imaging and potential clinical benefits.”
From the paper · Abstract
Team shared and manipulated holograms liveAnswer: Yes
“Operative team was able to manipulate the hologram and multiple users of the AR system could share the same image in real time.”
From the paper · Abstract
Prospective trials needed to test effectAnswer: Describes
“This study reports the potential value of AR in pulmonary interventions, however, prospective trials need to be conducted to decide on whether novel 3D visualization techniques affect perioperative treatment and outcomes.”
The New Frontier: A Review of Augmented Reality and Virtual Reality in Plastic Surgery#
Sayadi LR et al. · Aesthetic surgery journal · 2019
Plastic & reconstructive · Systematic review
Multiple platforms
Systematic review of 46 articles on augmented and virtual reality in plastic surgery. The authors report that most studies were in craniofacial surgery and that uses included preoperative planning, intraoperative guides and trainee education.
Conclusions (2)
Craniofacial surgery most common field in reviewAnswer: Describes
“The majority of studies were in the field of craniofacial surgery, and uses of mixed reality included preoperative planning, intraoperative guides, and education of surgical trainees.”
From the paper · Abstract
Only 46 of 2544 articles met criteriaAnswer: Describes
“The initial query of the National Center for Biotechnology Information database yielded 2544 results, and only 46 articles met our inclusion criteria.”
Advancing Cardiac Surgery Case Planning and Case Review Conferences Using Virtual Reality in Medical Libraries: Evaluation of the Usability of Two Virtual Reality Apps#
Napa S et al. · JMIR human factors · 2019
Adult cardiac & structural heart · Survey/user study
Medicalholodeck / Medical Imaging XR
Bosc (PyrusMed)
HTC Vive
Usability study of two commercial VR apps, Bosc and Medical Holodeck, on an HTC Vive headset for presurgical cardiac case planning, with 8 surgeons, fellows and residents, plus ethnographic interviews. Medical Holodeck scored better (SUS 66 vs. 37), but neither reached the usability threshold of 68. The study also discusses the role of medical libraries in VR case planning.
“Neither app passed the mean SUS score of 68 for an app to be considered usable, though Medical Holodeck (66.25 [SD 12.87]) scored a higher mean SUS than Bosc (37.19 [SD 22.41]).”
66.25
From the paper · Abstract
“Users found Medical Holodeck easier to use than Bosc.”
From the paper · Abstract
Conclusions (3)
Neither app reached the usable SUS thresholdAnswer: No
“Neither app passed the mean SUS score of 68 for an app to be considered usable, though Medical Holodeck (66.25 [SD 12.87]) scored a higher mean SUS than Bosc (37.19 [SD 22.41]).”
SUS 66.25 vs 37.19, threshold 68
From the paper · Abstract
One app rated easier to useAnswer: Describes
“Users found Medical Holodeck easier to use than Bosc.”
From the paper · Abstract
Workload higher with the lower-usability appAnswer: Describes
“Bosc had a higher cognitive burden mean TLX score (62.71 vs 40.87) and a lower mean SUS score (37.19 vs 66.25).”
Virtual reality and augmented reality in the management of intracranial tumors: A review#
Lee C, Wong GKC · Journal of clinical neuroscience · 2019
Neurosurgery · Systematic review
Multiple platforms
Literature review of VR and AR in managing intracranial tumours, covering planning, simulation, intraoperative use and training. It discusses the current status, challenges and future developments.
The Use of 3-Dimensional, Virtual Reality Models for Surgical Planning of Robotic Partial Nephrectomy#
Shirk JD et al. · Urology · 2019
Urology · Comparative study · n: 60 patients
Google Cardboard
Comparative study of 30 patients undergoing robotic partial nephrectomy whose CT/MRI-based 3D VR models were viewed on the surgeon's phone in a Google Cardboard headset before and during surgery, compared with 30 earlier patients without VR. Controlling for complexity and surgeon, the authors report significantly shorter operative time (141 versus 201 minutes) and clamp time and lower blood loss in the VR group, with no complications or positive margins.
“When controlling for case complexity and surgeon, patients with 3-dimensional, virtual reality-assisted surgical planning had significantly lower operative time (141 minutes vs 201 minutes, P < .0001), clamp time (13.2 minutes vs 17.4 minutes, P = .0274)”
P < .0001
From the paper · Abstract
“There were no complications or positive margins noted in the VR group.”
From the paper · Abstract
“Patients without 3-dimensional, virtual reality-assisted surgical planning were more likely to have a hospital stay of greater than 2 days (odds ratio 5.1, 95% confidence interval 1.0, 26.4).”
odds ratio 5.1
From the paper · Abstract
Conclusions (3)
Shorter operative and clamp time with VR planningAnswer: Yes
“When controlling for case complexity and surgeon, patients with 3-dimensional, virtual reality-assisted surgical planning had significantly lower operative time (141 minutes vs 201 minutes, P < .0001), clamp time (13.2 minutes vs 17.4 minutes, P = .0274)”
operative time 141 vs 201 min, P < .0001; clamp time 13.2 vs 17.4 min, P = .0274
From the paper · Abstract
Stay over 2 days more likely without VRAnswer: Yes
“Patients without 3-dimensional, virtual reality-assisted surgical planning were more likely to have a hospital stay of greater than 2 days (odds ratio 5.1, 95% confidence interval 1.0, 26.4).”
odds ratio 5.1, 95% CI 1.0 to 26.4
From the paper · Abstract
No complications or positive margins in VR groupAnswer: Describes
“There were no complications or positive margins noted in the VR group.”
Holographic Reconstructions for Preoperative Planning before Partial Nephrectomy: A Head-to-Head Comparison with Standard CT Scan#
Antonelli A et al. · Urologia internationalis · 2019
Urology · Comparative study · n: 10 patients
VR, platform not specified
Study in which seven raters interpreted renal anatomy from CT and from holographic reconstructions for 10 consecutive patients with complex renal masses scheduled for robotic partial nephrectomy. The authors report higher inter-observer agreement and shorter evaluation time with holographic reconstructions (1.7 versus 3.4 minutes), and that all raters felt they could aid planning.
“HR showed a higher inter-observer agreement, reaching a good level (k > 0.6) for almost all the anatomical details considered.”
k > 0.6
From the paper · Abstract
“The evaluation time was shorter for HR (mean 1.7 vs. 3.4 min, p < 0.0001).”
p < 0.0001
From the paper · Abstract
“HR can be useful for preoperative surgical planning before PN to ease the understanding of anatomy.”
From the paper · Abstract
Conclusions (3)
Higher inter-observer agreement with hologramsAnswer: Yes
“HR showed a higher inter-observer agreement, reaching a good level (k > 0.6) for almost all the anatomical details considered.”
k > 0.6
From the paper · Abstract
Evaluation time shorter with hologramsAnswer: Yes
“The evaluation time was shorter for HR (mean 1.7 vs. 3.4 min, p < 0.0001).”
1.7 vs 3.4 min, p < 0.0001
From the paper · Abstract
Holograms may ease anatomy understanding before surgeryAnswer: Yes
“HR can be useful for preoperative surgical planning before PN to ease the understanding of anatomy.”
Mixed reality holograms for heart surgery planning: first user experience in congenital heart disease#
Brun H et al. · European heart journal. Cardiovascular Imaging · 2019
Congenital heart · Survey/user study · n: 1 patient
Microsoft HoloLens
Proof-of-concept study in which a 3D heart model of a patient with double outlet right ventricle and transposition was segmented from CTA and shown as a HoloLens hologram to 36 paediatric heart team members, who rated diagnostic output and the 3D experience by questionnaire. The authors report high anatomy identification and positive ratings, with app tools rated higher by younger and female users.
“This preliminary study demonstrates that MR holograms as surgical planning tool for congenital heart disease may have a high diagnostic value and contribute to understanding complex morphology.”
From the paper · Abstract
“The first users experience of the hologram presentation was found to be very positive, with a preference among the female and the younger users.”
From the paper · Abstract
Conclusions (3)
High anatomy identification and diagnostic outputAnswer: Yes
“Anatomy identification and diagnostic output was high as well as rating of 3D experience.”
From the paper · Abstract
Very positive first-user experience of hologramAnswer: Yes
“The first users experience of the hologram presentation was found to be very positive”
From the paper · Abstract
Younger and female users rated tools higherAnswer: Describes
“Younger and female users rated the app tools higher.”
Pilot study in which four surgeons used immersive VR renal models on an Oculus Rift to plan percutaneous nephrolithotomy for 25 patients (2017-2018); patients also viewed the models. VR improved surgeons' rated understanding of the entry calyx and stone, and changed the approach in 40% of cases. Compared with 25 matched historical patients, the VR group had less fluoroscopy time and blood loss.
“iVR altered the surgical approach in 10 (40%) cases.”
10 (40%)
From the paper · Abstract
“iVR improved surgeons' understanding of the optimal calix of entry and the stone's location, size, and orientation (p < 0.01).”
p < 0.01
From the paper · Abstract
“Patients strongly agreed that iVR improved their understanding of their stone disease and reduced their preoperative anxiety.”
From the paper · Abstract
“In the retrospective matched-paired analysis, the iVR group had a statistically significant decrease in fluoroscopy time and blood loss as well as a trend toward fewer nephrostomy tracts and a higher stone-free rate.”
blood loss 50.0 vs 100 mL, p < 0.01; fluoroscopy 180 vs 226 seconds, p < 0.01; stone-free 39% vs 20%, p = 0.15
From the paper · Abstract
Conclusions (3)
Surgeons rated anatomy understanding higher than CT aloneAnswer: Yes
“iVR improved surgeons' understanding of the optimal calix of entry and the stone's location, size, and orientation (p < 0.01).”
p < 0.01
From the paper · Abstract
Approach changed in 10 of 25 casesAnswer: Yes
“iVR altered the surgical approach in 10 (40%) cases.”
10 (40%)
From the paper · Abstract
Less blood loss and fluoroscopy; stone-free not significantAnswer: Mixed
“In the retrospective matched-paired analysis, the iVR group had a statistically significant decrease in fluoroscopy time and blood loss as well as a trend toward fewer nephrostomy tracts and a higher stone-free rate.”
blood loss 50.0 vs 100 mL, p < 0.01; fluoroscopy 180 vs 226 seconds, p < 0.01; stone-free 39% vs 20%, p = 0.15
Narrative review of virtual and augmented reality in oncologic liver surgery, based on patient-specific 3D models from DICOM data. The authors give an overview of clinical use for preoperative planning and intraoperative navigation and note that clinical application is still limited.
Prospective randomised study of 30 patients with lumbar disc herniation comparing conventional 2D planning with a VR planning system for percutaneous endoscopic lumbar discectomy. The authors report that the VR plan predicted entry angle and distance accurately (but not depth), and that fluoroscopy and localisation times were shorter in the VR group.
“The use of virtual reality can predict a surgery-related angle and distance accurately except for depth.”
From the paper · Abstract
“A virtual reality planning system is an accurate preoperative planning method that can significantly improve the puncture accuracy of percutaneous endoscopic lumbar discectomy and reduce fluoroscopic and location times.”
From the paper · Abstract
“reduce fluoroscopic and location times”
fluoroscopy 13.18 vs 32.00; location 17.91 vs 33.22, P < 0.001
From the paper · Abstract
Conclusions (2)
VR plan predicted angle and distance, not depthAnswer: Mixed
“The use of virtual reality can predict a surgery-related angle and distance accurately except for depth.”
From the paper · Abstract
Fluoroscopy and location times shorter with VR planningAnswer: Yes
“reduce fluoroscopic and location times”
fluoroscopy 13.18 vs 32.00; location 17.91 vs 33.22, P < 0.001
State-of-the-art multimodality approach to assist ablations in complex anatomies-From 3D printing to virtual reality#
Knecht S et al. · Pacing and clinical electrophysiology · 2019
Congenital heart · Case report · n: 1 patient
VR, platform not specified
Case report of catheter ablation for arrhythmia in an adult with congenital heart disease, describing CT assessment, integration of 3D reconstructions into electroanatomical mapping, 3D printing and virtual reality used to plan and guide the procedure. The authors report that 3D printing and VR assessment were valuable for preprocedural planning.
“In addition to the clinical assessment of the computed tomography and the integration of 3D reconstructions into the electroanatomical mapping system, 3D printing and virtual reality assessment showed its value in preprocedural planning of the intervention.”
From the paper · Abstract
Conclusions (1)
3D printing and VR useful in ablation planningAnswer: Yes
“3D printing and virtual reality assessment showed its value in preprocedural planning of the intervention.”
Exploring the Benefits of Holographic Mixed Reality for Preoperative Planning with 3D Medical Images#
Mast M et al. · Gesellschaft für Informatik (GI) · 2019
Multi-specialty · Technical development
Microsoft HoloLens
Mensch und Computer 2019 workshop paper describing work in progress on a HoloLens 2 medical volume viewer that combines cinematic volume rendering with holographic depth perception to support preoperative planning.
Conference abstract (PSTM 2019) describing a collaborative craniofacial surgical planning and telementoring application for HoloLens, tested on seven dry human skulls with facial fractures. The authors evaluated usability on the System Usability Scale for planning and remote consultation on shared holograms.
“Holograms provided enhanced visualization of 3-dimensional spatial relationships and depth perception within and between anatomic structures which could not be observed by the conventional 2-dimensional display monitors.”
From the paper · Full text: main text
“Mean SUS score of overall participants was 3.92 ± 0.73 ( P ≤ 0.05, 1-sided).”
3.92 ± 0.73
From the paper · Full text: main text
Conclusions (3)
Usability score met acceptance criterionAnswer: Yes
“Mean SUS score of overall participants was 3.92 ± 0.73 ( P ≤ 0.05, 1-sided).”
SUS 3.92 ± 0.73, P ≤ 0.05, 1-sided
From the paper · Abstract
Holograms showed depth not seen on 2D monitorsAnswer: Yes
“Holograms provided enhanced visualization of 3-dimensional spatial relationships and depth perception within and between anatomic structures which could not be observed by the conventional 2-dimensional display monitors.”
From the paper · Abstract
Latency acceptable for shared holograms and voiceAnswer: Yes
“Latencies were acceptable for both shared holograms and Voice over Internet Protocol.”
MP35-08 IMMERSIVE VIRTUAL REALITY (IVR) RENAL MODELS AS AN EDUCATIONAL AND PREOPERATIVE PLANNING TOOL FOR LAPAROSCOPIC DONOR NEPHRECTOMY: INITIAL EXPERIENCE#
Jefferson F et al. · Journal of Urology · 2019
Urology · Conference abstract · n: 7 patients
VR, platform not specified
AUA 2019 abstract on immersive VR renal models (built in 3D Slicer, viewed on a head-mounted display) used before laparoscopic donor nephrectomy in seven patients. The authors report better surgeon understanding of arterial and venous anatomy and a 23% shorter operative time than a matched cohort.
CNS 2019 abstract on five patients with deep-seated cavernomas in eloquent areas, in whom 360-degree VR models with DTI tractography (Surgical Theater SRP) were used to compare trajectories and choose the approach, integrated with Brainlab neuronavigation. The authors report gross-total resection in all patients.
“Virtual segmentation allows for better understanding of complex anatomic relationships between the lesion and surrounding critical structures.”
From the paper · Abstract
Conclusions (3)
Gross-total resection in all five patientsAnswer: Describes
“total resection was obtained in all patients.”
From the paper · Abstract
Three intact patients stayed neurologically intactAnswer: Describes
“Three patients who were neurologically intact on presentation remained so post-op.”
Conference abstract assessing the aortic root, including the sinuses of Valsalva, with virtual reality images to support aortic valve leaflet reconstruction with three same-sized autologous pericardial leaflets (ATLAS). The authors aim to make the technique reproducible.
Clinical Feasibility of a Wearable Mixed-Reality Device in Neurosurgery#
Incekara F et al. · World neurosurgery · 2018
Neurosurgery · Feasibility study · n: 25 patients
Microsoft HoloLens
Prospective pilot study of 25 brain tumour patients, in which MRI-based holograms of the head and tumour were projected onto the patient's head with a HoloLens in the OR, and the tumour outline drawn on the skin was compared with standard neuronavigation. Holograms were created in all cases; the authors report a median difference of 0.4 cm (no difference in 9 patients) and say accuracy needs improvement.
“Holograms were successfully created in all cases.”
From the paper · Abstract
“In 9 patients tumor localization with the Hololens did not differ from the standard neuronavigation system and the overall median difference was 0.4 cm (interquartile range 0-0.8).”
0.4 cm
From the paper · Abstract
“Further development is needed to improve the accuracy of this wearable mixed-reality device.”
From the paper · Abstract
Conclusions (2)
Agreement with neuronavigation in 9 patients onlyAnswer: Mixed
“In 9 patients tumor localization with the Hololens did not differ from the standard neuronavigation system and the overall median difference was 0.4 cm (interquartile range 0-0.8).”
9 out of 25 patients; median difference 0.4 cm, IQR 0-0.8
From the paper · Abstract
Holograms created in all patientsAnswer: Yes
“Holograms were successfully created in all cases.”
Review of extended reality in cardiovascular medicine, describing advances in head-mounted displays (untethered, see-through, low latency) and applications in education, preprocedural planning, intraprocedural visualization and rehabilitation.
Mixed Reality Technology Launches in Orthopedic Surgery for Comprehensive Preoperative Management of Complicated Cervical Fractures#
Wu X et al. · Surgical Innovation · 2018
Spine · Letter (experience report)
AR/MR, platform not specified
Letter describing the introduction of mixed reality for comprehensive preoperative management of complicated cervical fractures in orthopaedic surgery. Title-only record: no abstract was openly available from the sources searched, so details could not be confirmed.
A Role for Virtual Reality in Planning Endovascular Procedures#
Mohammed MAA et al. · Journal of Vascular and Interventional Radiology · 2018
Interventional radiology · Case report (video/image)
VR, platform not specified
Pictorial report illustrating interactive VR visualisation of volumetric imaging data to plan endovascular procedures in interventional radiology. The authors describe how VR lets physicians interact with image data as physical objects and suggest it could be valuable in the IR suite.
“Increasing availability of tools that make the VR environment a possibility could potentially be valuable in the interventional radiology suite.”
From the paper · Abstract
Conclusions (1)
VR could be valuable in the IR suiteAnswer: Describes
“Increasing availability of tools that make the VR environment a possibility could potentially be valuable in the interventional radiology suite.”
Ong CS et al. · Journal of vascular and interventional neurology · 2018
Neurosurgery · Technical note · n: 1 patient
VR, platform not specified
Technical note describing VR as an adjunct to angiographic imaging before intervention in one patient with a complex distal cervical internal carotid pseudoaneurysm. Vessel meshes segmented from MR angiography were inspected and manipulated with a VR headset and two controllers. The authors report that conventional and VR viewing were equally effective at classifying the lesion, and that VR gave a better understanding of the anatomy.
“VR visualization allowed the operators to manipulate the dataset to achieve a greater understanding of the anatomy of the parent vessel, the angioarchitecture of the pseudoaneurysm, and the surface contours of all visualized structures.”
From the paper · Abstract
“This preliminary study demonstrates the feasibility of utilizing VR for preprocedural evaluation in patients with anatomically complex neurovascular disorders.”
From the paper · Abstract
Conclusions (3)
VR gave greater anatomical understanding in one patientAnswer: Yes
“VR visualization allowed the operators to manipulate the dataset to achieve a greater understanding of the anatomy of the parent vessel, the angioarchitecture of the pseudoaneurysm, and the surface contours of all visualized structures.”
From the paper · Abstract
Conventional and VR viewing classified lesion equallyAnswer: No significant difference
“Conventional and VR visualization modes were equally effective in identifying and classifying the pathology.”
From the paper · Full text
VR preprocedural evaluation feasible in one caseAnswer: Yes
“This preliminary study demonstrates the feasibility of utilizing VR for preprocedural evaluation in patients with anatomically complex neurovascular disorders.”
[Preliminary use of HoloLens glasses in surgery of liver cancer]#
Shi L et al. · Zhong nan da xue xue bao. Yi xue ban · 2018
Hepatobiliary & pancreatic (HPB) · Technical note
Microsoft HoloLens
Chinese preliminary report of MRI-based 3D models of liver cancer viewed through HoloLens glasses for preoperative assessment and surgical planning, and matched to the target organ during the operation. The authors report that the reconstruction and intraoperative matching were achieved.
“The exact match with the target organ was performed during the operation via HoloLens glasses leaded by the 3D model.”
From the paper · Abstract
Conclusions (1)
Intraoperative match with target organ achievedAnswer: Yes
“The exact match with the target organ was performed during the operation via HoloLens glasses leaded by the 3D model.”
Three-dimensional Printing and Augmented Reality: Enhanced Precision for Robotic Assisted Partial Nephrectomy#
Wake N et al. · Urology · 2018
Urology · Case report (video) · n: 1 patient
Microsoft HoloLens
Custom Unity app
Video article describing the workflow for creating 3D-printed and augmented-reality kidney models (Unity, Microsoft HoloLens) to support planning and intraoperative decisions in robotic partial nephrectomy, illustrated by a 70-year-old woman with a 3.4 cm mass in a pelvic kidney. The authors state that 15 such models had been created to date.
“The application of 3D printed and AR models is safe and feasible and can influence surgical decisions.”
From the paper · Abstract
Conclusions (1)
3D printed and AR models can influence decisionsAnswer: Yes
“The application of 3D printed and AR models is safe and feasible and can influence surgical decisions.”
Description of IMHOTEP, an open-source virtual-reality framework that renders 3D patient data in stereo and organises multimodal data (text, images, time series and 3D models) into workspaces for surgical planning. The authors report that most of 77 clinical evaluators found complex surgical situations easier to understand with it, and that it was used in planning the removal of a large central liver carcinoma in one patient.
“The majority of the group stated that a complex surgical situation is easier to comprehend by using the framework, and that it is very well suited for education.”
From the paper · Abstract
“The participants also believed the tool to be useful for the education of medical students and postgraduates (Fig. 6).”
From the paper · Fulltext
Conclusions (3)
Most evaluators found complex situations easier to understandAnswer: Yes
“The majority of the group stated that a complex surgical situation is easier to comprehend by using the framework, and that it is very well suited for education.”
From the paper · Abstract
Participants judged the tool useful for educationAnswer: Yes
“The participants also believed the tool to be useful for the education of medical students and postgraduates (Fig. 6).”
From the paper · Full text
Framework built planning and ablation toolsAnswer: Yes
“The framework has successfully been used to build an operation planning tool as well as an ablation simulation tool.”
Role of virtual reality in congenital heart disease#
Ong CS et al. · Congenital heart disease · 2018
Congenital heart · Case series · n: 2 patients
HTC Vive
Report of two infants with complex congenital heart disease whose cardiac CT data were rendered as 3D models and reviewed on an HTC Vive headset by paediatric cardiac surgeons and cardiologists before surgery. The authors found presurgical VR planning feasible with existing imaging, and users rated the software reliable with a short learning curve.
“The use of VR for cardiac presurgical planning is feasible using existing imaging data.”
From the paper · Abstract
“The software was evaluated by both pediatric cardiac surgeons and pediatric cardiologists, and felt to be reliable and operated with a very short learning curve.”
From the paper · Abstract
Conclusions (2)
VR presurgical planning feasible with existing imagingAnswer: Yes
“The use of VR for cardiac presurgical planning is feasible using existing imaging data.”
From the paper · Abstract
Clinicians rated software reliable, short learning curveAnswer: Yes
“The software was evaluated by both pediatric cardiac surgeons and pediatric cardiologists, and felt to be reliable and operated with a very short learning curve.”
[Application of virtual reality in surgical treatment of complex head and neck carcinoma]#
Zhou YQ et al. · Zhonghua er bi yan hou tou jing wai ke za zhi · 2018
ENT / head & neck · Case series · n: 8 patients
VR, platform not specified
Report of eight patients with complex head and neck cancer whose imaging was loaded into a virtual reality system to build 3D anatomical models and simulate surgery before operating, with two cases described in detail. The authors report that VR helped surgeons assess the tumour's relationship to surrounding structures and the safety of the operation.
“With the help of virtual reality, surgeons could adequately assess the condition of carcinoma and the security of operation and ensured the safety of operations.”
From the paper · Abstract
Conclusions (1)
Authors report safe operations after VR assessmentAnswer: Describes
“With the help of virtual reality, surgeons could adequately assess the condition of carcinoma and the security of operation and ensured the safety of operations.”
Virtual Reality Surgical Simulation: Implications for Resection of Intracranial Gliomas#
Dakson A et al. · Progress in neurological surgery · 2018
Neurosurgery · Narrative review
Multiple platforms
Book-series review of VR surgical simulation with haptic feedback, focused mainly on neurosurgical resident training for glioma resection. It also discusses neurosurgeons rehearsing specific parts of an operation beforehand, along with issues to resolve before VR simulation is widely adopted.
“VR holds the promise of providing a useful educational tool for neurosurgical residents to hone their surgical skills and for neurosurgeons to rehearse specific segments of the surgery prior to the actual operation.”
From the paper · Abstract
Conclusions (1)
VR may help resident training and rehearsalAnswer: Describes
“VR holds the promise of providing a useful educational tool for neurosurgical residents to hone their surgical skills and for neurosurgeons to rehearse specific segments of the surgery prior to the actual operation.”
Virtual Reality-Based Simulators for Cranial Tumor Surgery: A Systematic Review#
Mazur T et al. · World neurosurgery · 2018
Neurosurgery · Systematic review
Multiple platforms
Systematic review (PubMed and Embase to May 2017) of VR-based simulation for presurgical planning and training in cranial tumour surgery; nine studies were included and grouped into planning and training. The authors conclude that VR has documented usefulness for planning cranial surgery and for setting performance benchmarks in training, but that more studies are needed.
“In terms of surgical planning, VR has noted and documented usefulness in the planning of cranial surgeries.”
From the paper · Abstract
“Although additional studies are needed to better delineate the precise role of VR in each of these capacities, these studies stand to show the usefulness of VR in the neurosurgery and highlight the need for further investigation.”
From the paper · Abstract
Conclusions (1)
Review reports documented usefulness in cranial planningAnswer: Describes
“In terms of surgical planning, VR has noted and documented usefulness in the planning of cranial surgeries.”
4:03 PM Abstract No. 30 Augmented virtual reality assisted treatment planning for splenic artery aneurysms: a pilot study#
Devcic Z et al. · Journal of Vascular and Interventional Radiology · 2018
Interventional radiology · Conference abstract
VR, platform not specified
SIR 2018 abstract reporting a pilot study of augmented virtual reality to assist treatment planning for splenic artery aneurysms. Title-only record: no abstract was openly available from the sources searched, so details could not be confirmed.
Application of virtual reality, augmented reality and mixed reality technology in chest wall tumor resection and reconstruction of precise surgical treatment#
Chinese report of two patients with chest wall tumours in whom CT/MRI-based virtual models and 3D prints were used for surgical rehearsal, and VR/AR/MR was used to decide the resection extent before chest wall reconstruction. The authors report both operations went well and that the techniques gave more precise margins and understanding of structures behind the chest wall.
“ＶＲ＋ＡＲ＋ＭＲ技术更能精确手术切缘、切除肿瘤，并对胸壁后组织器官有更精准的了解。”
From the paper · Abstract
Conclusions (2)
Authors report more precise margins and structure understandingAnswer: Yes
“ＶＲ＋ＡＲ＋ＭＲ技术更能精确手术切缘、切除肿瘤，并对胸壁后组织器官有更精准的了解。”
From the paper · Abstract
Both patients recovered well after surgeryAnswer: Describes
Holographic Computing for MRI-based Visualization and Interactive Planning of Prostate Interventions#
Mojica CM et al. · Proc. Intl. Soc. Mag. Reson. Med. 26 (ISMRM 2018), abstract 4414 · 2018
Urology · Conference abstract
Microsoft HoloLens
ISMRM 2018 abstract presenting a HoloLens platform for holographic visualisation and interactive planning of MRI-guided prostate interventions, including segmentation, rendering and needle trajectory planning for biopsy or brachytherapy. The authors cite true 3D appreciation of anatomy and interactive planning of access trajectories.
MP26-06 INITIAL EXPERIENCE WITH RENAL VIRTUAL REALITY MODELS AS EDUCATIONAL AND PREOPERATIVE PLANNING TOOLS FOR PARTIAL NEPHRECTOMY#
Parkhomenko E et al. · Journal of Urology · 2018
Urology · Conference abstract
VR, platform not specified
AUA 2018 abstract on initial experience with renal virtual reality models as educational and preoperative planning tools for partial nephrectomy. Title-only record: no abstract was openly available from the sources searched, so details could not be confirmed.
Novel Virtual Reality Techniques Improve Virtual Implantation of Total Artificial Heart in the Pediatric Population#
Moore R et al. · The Journal of Heart and Lung Transplantation · 2018
Congenital heart · Conference abstract
VR, platform not specified
ISHLT 2018 abstract on new virtual reality techniques for virtual implantation (fit testing) of a total artificial heart in paediatric patients. Title-only record: no abstract was openly available from the sources searched, so details could not be confirmed.
Conclusions (2)
Surgeon completed virtual fit in VR unassistedAnswer: Yes
“The surgeon could successfully perform virtual fit using VR without any assistance.”
From the paper · Abstract
VR fit results closely matched 3D software fitAnswer: Describes
“Results of VR-based virtual fitting by the surgeon closely compared to prior virtual implantation using advanced 3D visualization software by the imaging team.”
An Human-Computer Interactive Augmented Reality System for Coronary Artery Diagnosis Planning and Training#
Li Q et al. · Journal of medical systems · 2017
Adult cardiac & structural heart · Technical development
AR/MR, platform not specified
Technical development of an AR system for coronary artery diagnosis, preoperative planning and intern training. It combines CT-based 3D reconstruction of the coronary arteries, static and dynamic hand-gesture interaction, and a parallel rendering and tiled display subsystem for multiple student users. The authors report high reconstruction accuracy and fluent interaction.
“The experimental results show that, with the use of ARS-CADPT, the reconstruction accuracy of CAV model is high, the HCI is natural and fluent, and the visual effect is good.”
From the paper · Abstract
Conclusions (1)
Authors report high reconstruction accuracy, fluent interactionAnswer: Yes
“The experimental results show that, with the use of ARS-CADPT, the reconstruction accuracy of CAV model is high, the HCI is natural and fluent, and the visual effect is good.”
Virtual Reality and Augmented Reality in Plastic Surgery: A Review#
Kim Y et al. · Archives of plastic surgery · 2017
Plastic & reconstructive · Systematic review
Multiple platforms
Systematic literature review of 35 studies on VR and AR technology relevant to plastic surgery, grouped into preoperative planning, navigation and training. The authors also discuss future trends for VR/AR devices such as head-mounted displays, haptics and AR glasses.
Conclusions (2)
35 studies sorted into planning, navigation, trainingAnswer: Describes
“The 35 studies that were ultimately selected were categorized into 3 representative topics: VR/AR-based preoperative planning, navigation, and training.”
From the paper · Abstract
Not widely used yet; potential in three areasAnswer: Describes
“Although VR/AR technology has not been widely used in plastic surgery, it has a great potential in the fields of surgical planning, navigation, and training.”
Technical report of stereoscopic AR smart glasses showing CT-derived 3D vessel models registered to the patient via a skin tracker, used alongside usual methods for preoperative planning and perforator selection in 12 patients having DIEP flap breast reconstruction. The authors describe the hands-free binocular display of CT-identified vessels in the operative field.
Conclusions (1)
Binocular view of CT vessels in fieldAnswer: Describes
“permettent de procurer au chirurgien une visualisation binoculaire, dans le champ opératoire des vaisseaux repérés”
Routine clinical application of virtual reality in abdominal surgery#
Sampogna G et al. · Minimally invasive therapy & allied technologies · 2017
General & GI surgery · Feasibility study · n: 15 patients
VR, platform not specified
Feasibility study of 15 patients having pancreatic, liver or kidney surgery for whom 3D reconstructions were imported into an immersive VR environment built with open-source software and low-cost hardware, and partly 3D-printed. The authors report that VR-assisted planning and intraoperative guidance were feasible in all patients, and that most of the 20 surveyed surgeons rated quality and usefulness as very good.
“Preoperative surgical planning and intraoperative guidance was feasible for all patients included in the study.”
From the paper · Abstract
“The vast majority of surgeons interviewed scored their quality and usefulness as very good.”
From the paper · Abstract
“Despite extra time, costs and efforts necessary to implement these systems, the benefits shown by the analysis of questionnaires recommend to invest more resources to train physicians to adopt these technologies routinely, even if further and larger studies are still mandatory.”
From the paper · Abstract
Conclusions (2)
Planning and guidance feasible in all patientsAnswer: Yes
“Preoperative surgical planning and intraoperative guidance was feasible for all patients included in the study.”
From the paper · Abstract
Surgeons mostly rated quality and usefulness very goodAnswer: Yes
“The vast majority of surgeons interviewed scored their quality and usefulness as very good.”
3D Virtual Reality Models Created from MRI data for Pre-operative Evaluation of Renal Cancer#
Wake N et al. · Proc. Intl. Soc. Mag. Reson. Med. 25 (ISMRM 2017), abstract 4948 · 2017
Urology · Conference abstract
VR, platform not specified
ISMRM 2017 abstract on patient-specific 3D virtual reality kidney cancer models created from MRI and compared with 3D printed models for preoperative planning decisions. The authors suggest that the models may change the surgical plan and favour nephron-sparing surgery.
“These models may alter the surgical plan, and could promote both nephron-sparing surgery and preservation of healthy parenchyma, as surgeons gain a better visualization of the size and location of a tumor in relation to normal tissue and vital structures.”
From the paper · Abstract
Conclusions (1)
Models may alter the surgical planAnswer: Describes
“These models may alter the surgical plan, and could promote both nephron-sparing surgery and preservation of healthy parenchyma, as surgeons gain a better visualization of the size and location of a tumor in relation to normal tissue and vital structures.”
A Mixed-Reality System for Breast Surgical Planning#
Perkins SL et al. · 2017 IEEE International Symposium on Mixed and Augmented Reality (ISMAR-Adjunct) · 2017
Plastic & reconstructive · Technical development
Microsoft HoloLens
ISMAR 2017 adjunct paper on a mixed-reality system that projects a 3D hologram of breast MRI onto the patient with Microsoft HoloLens to help surgeons judge tumour extent during planning for lumpectomy. A pilot study in patients with palpable tumours was under way; the authors report promising early results but note difficulty aligning holograms to the breast and handling tissue deformation.
Conclusions (2)
First cases showed holograms give tumor locationAnswer: Describes
“first results from breast cancer surgeries have shown that mixed-reality guidance can indeed provide information about tumor location”
From the paper · Abstract
Aligning holograms to the breast is difficultAnswer: Describes
“it is critical but not straightforward to align holograms to the breast and to account for tissue deformations”
Conference abstract (PSTM 2017) testing linear 3D cephalometric measurements on CT-derived skull holograms viewed in HoloLens against digital microcaliper measurements on dry skulls. The authors report good agreement between methods and conclude that HoloLens has potential for craniofacial surgical planning.
“There was no significant bias between two methods used and 95% of the values were within the limits of the agreement.”
95%
From the paper · Full text: main text
“Our results indicate that HoloLens has significant potential for surgical planning including sufficient accuracy for linear measurements.”
From the paper · Full text: main text
Conclusions (2)
Hologram and caliper measurements agreed, no biasAnswer: Yes
“There was no significant bias between two methods used and 95% of the values were within the limits of the agreement.”
95% within limits of agreement
From the paper · Abstract
Authors judge accuracy sufficient for linear measurementsAnswer: Yes
“HoloLens has significant potential for surgical planning including sufficient accuracy for linear measurements.”
Holographic Visualization of Radiation Dosimetry Towards Intuitive Plan Evaluation#
Mohiuddin I et al. · International Journal of Radiation Oncology*Biology*Physics · 2017
Radiation oncology · Conference abstract
AR/MR, platform not specified
ASTRO 2017 abstract on holographic visualisation of radiation dose distributions to support intuitive treatment plan evaluation. Title-only record: no abstract was openly available from the sources searched, so details could not be confirmed.
Interactive soft tissue modelling for virtual reality surgery simulation and planning#
El said SA et al. · International Journal of Computer Aided Engineering and Technology · 2017
Multi-specialty · Technical development
VR, platform not specified
Engineering paper on interactive soft-tissue modelling for virtual reality surgery simulation and planning. Title-only record: no abstract was openly available from the sources searched, so details could not be confirmed.
MR-Guided Mixed-Reality For Surgical Planning: Set-Up and Perceptual Accuracy#
Srinivasan S et al. · Proc. Intl. Soc. Mag. Reson. Med. 25 (ISMRM 2017), abstract 5545 · 2017
Multi-specialty · Conference abstract
Microsoft HoloLens
ISMRM 2017 abstract describing a HoloLens application that aligns holograms of preoperative MRI to the patient for surgical planning, with perceptual accuracy tested using randomly placed hologram shapes. The authors report visualisation and perception within a tolerance of under 6 mm.
“The current set-up enables visualization and perception of holograms with a margin tolerance of < 6 mm.”
< 6 mm
From the paper · Abstract
Conclusions (1)
Hologram perception within 6 mm toleranceAnswer: Describes
“The current set-up enables visualization and perception of holograms with a margin tolerance of < 6 mm.”
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Summarises published research on VR/AR surgical planning across all platforms. Not product labelling. For Elucis indications see /elucis.
Intended for healthcare professionals.
Summaries describe each study's methods and the findings its authors report. They are written by Realize Medical from public abstracts and full texts, are not claims by Realize Medical, and may contain errors: please read the original paper.
Inclusion is not an endorsement of any product or use. Some studies describe uses outside the cleared or licensed indications of the products they name, or used products before clearance; consult each product's labeling.
Elucis is FDA 510(k) cleared (K220649) in the United States. Indications for use: “Elucis is intended for use as a software interface and image segmentation system for the transfer of medical imaging information to an output file. It is also intended for measuring and treatment planning. Elucis should be used in conjunction with expert clinical judgement.” Elucis Next is intended exclusively for research and non-clinical use.
Papers co-authored by Realize Medical founders, staff, advisors or equity holders, and papers that acknowledge Realize Medical or support for Elucis, are marked on each entry.
Sources: PubMed, Europe PMC, Crossref, Semantic Scholar and the ISMRM abstract archive, plus papers added by hand. The library includes conference abstracts and preprints; related abstracts and preprints are linked under their main paper. Last updated October 3, 2026.
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