BACKGROUND: Augmented reality (AR) is the process of visually overlaying digital information on top of the physical world and can include interactions between the digital display and physical world. Within the field of plastic and reconstructive surgery (PRS), AR can utilize patient imaging to aid preoperative surgical planning, intraoperative image guidance, as well as patient and resident education. Previous reviews of AR in PRS have been limited in not addressing the underlying technological shortcomings of AR nor fully evaluating physician usability limitations. In this review, we discuss both current uses as well limitations that need to be addressed as development moves forward.
METHODS: A review of relevant literature was conducted. Electronic databases were screened using keywords including “augmented reality,” “mixed reality,” and “plastic surgery.” Studies were individually assessed for quality using technological usability heuristics.
RESULTS: A total of 90 studies were reviewed. Several studies used the phrase “augmented reality” interchangeably with other imaging and guidance modalities, especially other types of extended reality, such as mixed reality (MR) or virtual reality (VR). Of the applied AR device studies, primary usage fell into one of three categories: preoperative surgical planning, intraoperative surgical guidance, or surgical education. A wide range of devices within the AR umbrella were utilized, with studies most commonly citing the HoloLens (Microsoft LLC, Redmond, Wash.). Across several plastic surgical subspecialties, AR has demonstrated practicality and success in surgical planning and education but minimal intraoperative usage due to device specific limitations or issues with physician usability. The most cited technical issues hampering widespread adoption were software difficulties distinguishing soft tissue and need to streamline artificial marker registration. Meanwhile, physician usability issues included limited field of vision, insufficient battery life and dim viewing conditions.
CONCLUSION: The utility of augmented reality in plastic surgery is an exciting and nascent field of study. While there have been many initial attempts to develop relevant technology, significant limitations remain that constrain AR’s ability to be used as an autonomous intraoperative guidance system. Promoting engineering-physician partnerships will allow for prioritization of key physician usability issues critical for AR’s success in the operating room.