Mixed Reality in Vascular Surgery - a Scoping Review

Background "Mixed reality" (MR) allows the projection of virtual objects into the user's field of view through a head-mounted display (HMD). In the interventional and surgical treatment of vascular diseases MR applications could be of future benefit. The following scoping review aims to provide orientation on the current application of the aforementioned technologies in the field of vascular surgery and to define research goals for the future. Methods A systematic literature search was performed in PubMed (MEDLINE) using the search terms "aorta", "intervention", "endovascular intervention", "vascular surgery", "aneurysm", "endovascular", "vascular access", each in combination with "mixed reality" or "augmented reality". The search was performed according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines for scoping reviews. Results From 547 references 8 relevant studies were identified. The search results could be classified into two categories: (1) MR aimed at information management and improving periprocedural ergonomics (n = 3) and (2) MR aimed at intraoperative navigation (n = 5). The registration of the physical patient with the virtual object and the tracking of instruments in the MR environment for intraoperative navigation is currently the focus of scientific interest and could be demonstrated on phantom and animal models with technical success. However, the methods presented so far are associated with high infrastructural costs and important limitations. Conclusion The use of MR in the field of vascular surgery is promising. For the future, alternative, pragmatic registration methods with appropriate quantification of the positional error should be aimed at. The developed software and hardware solutions should be adapted to the requirements of vascular surgery. Electromagnetic instrument tracking appears to be a useful complementary technology for the implementation of MR-assisted navigation.