Usability Assessments for Augmented Reality Head-Mounted Displays in Open Surgery and Interventional Procedures: A Systematic Review

Augmented reality (AR) head-mounted displays (HMDs) are an increasingly popular technology. For surgical applications, the use of AR HMDs to display medical images or models may reduce invasiveness and improve task performance by enhancing understanding of the underlying anatomy. This technology may be particularly beneficial in open surgeries and interventional procedures for which the use of endoscopes, microscopes, or other visualization tools is insufficient or infeasible. While the capabilities of AR HMDs are promising, their usability for surgery is not well-defined. This review identifies current trends in the literature, including device types, surgical specialties, and reporting of user demographics, and provides a description of usability assessments of AR HMDs for open surgeries and interventional procedures. Assessments applied to other extended reality technologies are included to identify additional usability assessments for consideration when assessing AR HMDs. The PubMed, Web of Science, and EMBASE databases were searched through September 2022 for relevant articles that described user studies. User assessments most often addressed task performance. However, objective measurements of cognitive, visual, and physical loads, known to affect task performance and the occurrence of adverse events, were limited. There was also incomplete reporting of user demographics. This review reveals knowledge and methodology gaps for usability of AR HMDs and demonstrates the potential impact of future usability research.