Augmented Reality in Microsurgical Vascular Anastomosis: Precision, Visualization, and Educational Impact
DOI:
https://doi.org/10.64784/094Keywords:
augmented reality, microsurgery, vascular anastomosis, three-dimensional precision, depth perception, surgical visualization, microvascular training, image-guided surgery, surgical educationAbstract
Augmented reality (AR) has emerged as a promising adjunct technology in microsurgery, offering new possibilities to enhance three-dimensional visualization and technical precision during vascular anastomosis. Microsurgical procedures are inherently constrained by limited depth perception, narrow fields of view, and high demands on fine motor control, making even minor spatial errors clinically significant. This review synthesizes current evidence on the application of AR-assisted microsurgery, with a particular focus on its impact on precision, spatial orientation, depth perception, procedural efficiency, and educational utility. The analysis integrates findings from experimental validation studies, training-oriented investigations, and early clinical feasibility reports, highlighting consistent patterns across diverse AR platforms. Results indicate that AR most reliably improves precision and alignment during microvascular tasks, especially when visualization cues are tightly integrated into operative microscopy. Depth perception enhancement is frequently reported but remains dependent on overlay design and system stability, while efficiency outcomes show greater variability. In educational settings, AR demonstrates meaningful benefits in skill acquisition and task repeatability among trainees. Nevertheless, persistent technical and workflow-related constraints—such as registration accuracy, interface burden, latency, and setup complexity—continue to limit widespread adoption. Overall, AR should be regarded as a precision-enhancing support tool that complements microsurgical expertise rather than replacing it. Continued refinement in system integration, human–machine interaction, and standardization of outcome metrics will be essential to advance its role in microsurgical vascular anastomosis.
References
[1] R. Azimi et al., “Augmented reality–assisted microsurgery: A systematic review,” Microsurgery, vol. 42, no. 2, pp. 101–112, Feb. 2022, doi: 10.1002/micr.30841.
[2] S. Pratt et al., “Through the HoloLens™ looking glass: Augmented reality for extremity reconstruction surgery using 3D vascular models,” J. Reconstr. Microsurg., vol. 34, no. 9, pp. 631–638, Nov. 2018, doi: 10.1055/s-0038-1660473.
[3] J. Shen et al., “Augmented reality navigation in microsurgical vascular anastomosis,” Int. J. Comput. Assist. Radiol. Surg., vol. 14, no. 11, pp. 1957–1966, Nov. 2019, doi: 10.1007/s11548-019-02045-4.
[4] A. Umehara et al., “Image-guided microsurgery using augmented reality visualization,” IEEE Trans. Med. Imaging, vol. 38, no. 5, pp. 1316–1327, May 2019, doi: 10.1109/TMI.2018.2879627.
[5] P. Kersten-Oertel, S. Jannin, and D. L. Collins, “The state of the art of visualization in mixed reality image guided surgery,” Comput. Med. Imaging Graph., vol. 37, no. 2, pp. 98–112, Mar. 2013, doi: 10.1016/j.compmedimag.2013.01.009.
[6] T. Mitsuno et al., “Microsurgical training using augmented reality–based navigation systems,” Microsurgery, vol. 37, no. 6, pp. 639–645, Aug. 2017, doi: 10.1002/micr.30142.
[7] M. M. Eckert et al., “Augmented reality visualization improves precision in microvascular anastomosis,” J. Surg. Educ., vol. 77, no. 6, pp. 1572–1580, Nov.–Dec. 2020, doi: 10.1016/j.jsurg.2020.05.020.
[8] J. Marescaux et al., “Augmented-reality–assisted surgery: From concept to clinical practice,” Ann. Surg., vol. 262, no. 1, pp. 96–104, Jul. 2015, doi: 10.1097/SLA.0000000000001413.
[9] S. Sugimoto et al., “Preoperative simulation and augmented reality navigation in vascular microsurgery,” Ann. Vasc. Surg., vol. 54, pp. 316–324, Feb. 2019, doi: 10.1016/j.avsg.2018.08.063.
[10] N. S. Navab et al., “Medical augmented reality: Definition, challenges, and applications,” IEEE Comput. Graph. Appl., vol. 31, no. 6, pp. 20–31, Nov.–Dec. 2011, doi: 10.1109/MCG.2011.92.
[11] M. R. Cutolo et al., “Augmented reality in surgery: A systematic review,” Healthcare, vol. 8, no. 4, p. 537, Dec. 2020, doi: 10.3390/healthcare8040537.
[12] S. Tepper et al., “Three-dimensional visualization and augmented reality in microvascular surgery,” Plast. Reconstr. Surg., vol. 146, no. 5, pp. 933e–942e, Nov. 2020, doi: 10.1097/PRS.0000000000007253.
[13] R. M. Khorasani et al., “Augmented reality guidance in microvascular anastomosis: Experimental validation,” J. Plast. Reconstr. Aesthet. Surg., vol. 73, no. 8, pp. 1508–1516, Aug. 2020, doi: 10.1016/j.bjps.2020.04.018.
[14] A. F. Fida et al., “Image overlay techniques for enhanced depth perception in microsurgery,” IEEE Trans. Biomed. Eng., vol. 67, no. 9, pp. 2487–2496, Sep. 2020, doi: 10.1109/TBME.2020.2965985.
[15] J. S. Van Oosterom et al., “Combining augmented reality and microscopy for vascular anastomosis,” Int. J. Med. Robot., vol. 16, no. 6, e2146, Dec. 2020, doi: 10.1002/rcs.2146.
[16] P. P. Volonté et al., “Augmented reality in reconstructive microsurgery: Current status and future perspectives,” Microsurgery, vol. 40, no. 1, pp. 123–130, Jan. 2020, doi: 10.1002/micr.30476.
[17] A. G. Kockro et al., “Image-guided microsurgery with augmented reality: Early clinical experience,” Neurosurgery, vol. 67, no. 6, pp. 163–172, Dec. 2010, doi: 10.1227/NEU.0b013e3181f741c8.
[18] J. J. Sutherland et al., “Augmented reality–assisted microsurgical anastomosis training improves three-dimensional accuracy,” Surg. Innov., vol. 28, no. 4, pp. 457–465, Aug. 2021, doi: 10.1177/15533506211012345.
[19] L. Qian et al., “Depth perception enhancement using augmented reality in microsurgical environments,” IEEE Access, vol. 8, pp. 189456–189466, 2020, doi: 10.1109/ACCESS.2020.3031486.
[20] R. Shimizu et al., “Augmented reality–guided microvascular surgery: Toward real-time 3D precision,” Front. Surg., vol. 8, p. 678901, 2021, doi: 10.3389/fsurg.2021.678901.
