Article type
Abstract
"Background: Augmented/extended reality (AR/ER) is advanced technology that superimposes computer-generated virtual objects onto e.g., a surgeon’s view of the real world to enhance that image with virtual objects.
Aim: This overview aims to synthesise evidence from systematic reviews (SRs) evaluating the effectiveness, safety, and cost-effectiveness of AR/ER in surgical practice.
Methods: PubMed and Cochrane Central were search from their inceptions to January 16th, 2024, without language restrictions. Only SRs of both observational and/or interventional studies of AR/ER in surgery were included. Non-systematic reviews or those evaluating technical features of AR; or used solely for educational purposes (including other branches of medicine/healthcare) were excluded. The ROBIS tool was used to evaluate the risk of bias in the included studies.
Results: Twenty-eight SRs met the eligibility criteria. The reviews were published between 2017 and 2024. Those SRs pertained to the following types of surgery: cerebrovascular (n=1), nephrectomy (n=2), mixed (n=1), neurosurgery (n=2), oncology (n=3), orthopaedic (n=11), otolaryngology (n=1), reconstructive microsurgery (n=2), thoracic (n=1), transsphenoidal (n=2), and urological (n=2). Studies were conducted on in vivo models, animal models, cadavers, simulators (or combinations of those). Types of AR/ER included head-mounted displays, display monitors (including smartphones or tablets), or spatial navigation technologies. Outcomes included feasibility, surgical accuracy, intraoperative blood loss, operative time, patient-centred outcomes (pain, disability), length of stay, perioperative complications, radiation dose, reoperation rate or operating surgeons' experience/satisfaction. None of the SRs reported on safety, and/or cost-effectiveness. There is a wide variety of study populations, surgical interventions as well as outcomes and measurement instruments further contributing to the existing heterogeneity, and rendering meaningful interpretations implausible. Only one SR employed meta-analytic techniques. SRs predominantly relied on observational evidence. The risk of bias of the SRs was mainly high using the ROBIS tool. Other methodological limitations of the SRs included small sample sizes and often poor methodological quality of the primary studies.
Conclusions: There is still limited evidence showing beneficial effects of AR/ER-guided surgeries. Most reviews emphasized the need for more comparative research to reduce the existing uncertainties. "
Aim: This overview aims to synthesise evidence from systematic reviews (SRs) evaluating the effectiveness, safety, and cost-effectiveness of AR/ER in surgical practice.
Methods: PubMed and Cochrane Central were search from their inceptions to January 16th, 2024, without language restrictions. Only SRs of both observational and/or interventional studies of AR/ER in surgery were included. Non-systematic reviews or those evaluating technical features of AR; or used solely for educational purposes (including other branches of medicine/healthcare) were excluded. The ROBIS tool was used to evaluate the risk of bias in the included studies.
Results: Twenty-eight SRs met the eligibility criteria. The reviews were published between 2017 and 2024. Those SRs pertained to the following types of surgery: cerebrovascular (n=1), nephrectomy (n=2), mixed (n=1), neurosurgery (n=2), oncology (n=3), orthopaedic (n=11), otolaryngology (n=1), reconstructive microsurgery (n=2), thoracic (n=1), transsphenoidal (n=2), and urological (n=2). Studies were conducted on in vivo models, animal models, cadavers, simulators (or combinations of those). Types of AR/ER included head-mounted displays, display monitors (including smartphones or tablets), or spatial navigation technologies. Outcomes included feasibility, surgical accuracy, intraoperative blood loss, operative time, patient-centred outcomes (pain, disability), length of stay, perioperative complications, radiation dose, reoperation rate or operating surgeons' experience/satisfaction. None of the SRs reported on safety, and/or cost-effectiveness. There is a wide variety of study populations, surgical interventions as well as outcomes and measurement instruments further contributing to the existing heterogeneity, and rendering meaningful interpretations implausible. Only one SR employed meta-analytic techniques. SRs predominantly relied on observational evidence. The risk of bias of the SRs was mainly high using the ROBIS tool. Other methodological limitations of the SRs included small sample sizes and often poor methodological quality of the primary studies.
Conclusions: There is still limited evidence showing beneficial effects of AR/ER-guided surgeries. Most reviews emphasized the need for more comparative research to reduce the existing uncertainties. "