Dynamic Augmented Reality Cues for Telementoring in Minimally Invasive Surgeries: Scoping Review

Remote surgeons use telementoring technologies to provide real-time guidance during minimally invasive surgeries (MIS). Such technologies are continuously improving with the integration of dynamic augmented reality (AR) cues. This includes virtual overlays of hand gestures, pointers, and surgical tools onto the operating surgeon's view. The operating surgeon comprehends this augmented information to operate on the patient. Thus, understanding these dynamic AR cues (either during surgical training or live surgery) is crucial.

In this paper, we aimed to review the existing telementoring technologies that use dynamic AR cues during MIS. This review describes the MIS (including surgery type, specialty, procedure, and clinical trial), the telementoring system, the dynamic AR cues generated by these systems, and evaluation of the technology in terms of technical aspects, user perceptions, skills gained, and patient outcomes.

A scoping review was conducted using PubMed, Web of Science, Scopus, IEEE Xplore, and ACM Digital Library databases. The search terms included "telementoring," "minimally invasive surgery," and "augmented reality" without restrictions imposed on the publication year. Articles covering telementoring using dynamic AR cues during MIS, including laparoscopic and robot-assisted, were identified.

A total of 21 articles were included and categorized based on type of surgery, the telementoring technology used, and evaluation of the technology. Most of the articles reported on laparoscopic suturing performed using synthetic phantoms. Hand gestures and surgical tools were the most frequently used dynamic AR cues (10 articles on each cue), while the mentors and mentees primarily consisted of experienced surgeons and medical students. The studies assessing the telementoring technologies were either descriptive (7 articles) or analytical (14 articles) where it was compared against no cue, prerecorded visual cue, in-person guidance, audio cue, or static AR cue. Outcomes were measured mostly using skills gained (13 articles) and user perception about the telementoring system.

In general, telementoring using dynamic AR cues resulted in positive outcomes during MIS. In some cases, they were considered on par with conventional methods such as audio cues and in-person guidance. Further randomized controlled trials are required to objectively assess its clinical benefits.