Augmenting Performance: A Systematic Review of Optical See-Through Head-Mounted Displays in Surgery

Abstract

We conducted a systematic review of recent literature to understand the current challenges in the use of optical see-through head-mounted displays (OST-HMDs) for augmented reality (AR) assisted surgery. Using Google Scholar, 57 relevant articles from 1 January 2021 through 18 March 2022 were identified. Selected articles were then categorized based on a taxonomy that described the required components of an effective AR-based navigation system: data, processing, overlay, view, and validation. Our findings indicated a focus on orthopedic ((Formula presented.)) and maxillofacial surgeries ((Formula presented.)). For preoperative input data, computed tomography (CT) ((Formula presented.)), and surface rendered models ((Formula presented.)) were most commonly used to represent image information. Virtual content was commonly directly superimposed with the target site ((Formula presented.)); this was achieved by surface tracking of fiducials ((Formula presented.)), external tracking ((Formula presented.)), or manual placement ((Formula presented.)). Microsoft HoloLens devices ((Formula presented.) in 2021, (Formula presented.) in 2022) were the most frequently used OST-HMDs; gestures and/or voice ((Formula presented.)) served as the preferred interaction paradigm. Though promising system accuracy in the order of 2–5 mm has been demonstrated in phantom models, several human factors and technical challenges—perception, ease of use, context, interaction, and occlusion—remain to be addressed prior to widespread adoption of OST-HMD led surgical navigation.