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

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: see text]) and maxillofacial surgeries ([Formula: see text]). For preoperative input data, computed tomography (CT) ([Formula: see text]), and surface rendered models ([Formula: see text]) were most commonly used to represent image information. Virtual content was commonly directly superimposed with the target site ([Formula: see text]); this was achieved by surface tracking of fiducials ([Formula: see text]), external tracking ([Formula: see text]), or manual placement ([Formula: see text]). Microsoft HoloLens devices ([Formula: see text] in 2021, [Formula: see text] in 2022) were the most frequently used OST-HMDs; gestures and/or voice ([Formula: see text]) 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.