Mixed reality in vascular surgery operating rooms

Background: Mixed reality (MxR) enables the integration of virtual objects into the physical perception via projection into the user's visual field via a head-mounted display (HMD). The following review article summarizes the studies on intraoperative use of MxR in vascular surgery published to date and discusses current possibilities and limitations. Methods: A literature search was conducted in PubMed (MEDLINE). The study adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Results: The search identified 691 possible publications, of which 11 fulfilled the inclusion criteria. The intraoperative applications described in the literature can be grouped into three categories: use of MxR (1) during vessel punction, (2) for navigation of catheters and instruments during endovascular procedures, and (3) for optically superimposed support during modification of a stent graft by the surgeon. Conclusion: Applications of MxR in the vascular surgery operating room are generally promising. Studies published to date are primarily limited to phantom models or isolated applications. Particularly the exact registration of virtual and physical objects represents a major challenge.