Augmented reality for perforator mapping: A systematic review and meta-analysis

Augmented reality (AR) is increasingly used to aid perioperative navigation of patient anatomy, improve intraoperative accuracy and reduce operating times. This review compares outcomes relating to AR versus conventional imaging for perforator mapping in flap reconstruction.

A systematic search was performed, suitable articles reviewed, and data extracted by 2 independent reviewers, with conflicts resolved by consensus. Meta-analysis was conducted to evaluate AR versus Doppler on outcomes including distance between imaged perforators and intraoperative findings, number of perforators identified, perforator localisation time, total operating time, and postoperative complications.

Of 1005 articles retrieved, 14 were eligible for meta-analysis. Intraoperative use of AR was associated with a significantly shorter distance between identified perforators and intraoperative findings (SMD = -1.88; 95% CI -3.69 to -0.08; P = 0.04) and identification of more perforators than conventional Doppler (SMD = 0.12; 95% CI 0.01 to 0.23; P = 0.04). AR decreased time taken for perforator localisation (SMD = -2.53; 95% CI -5.14 to 0.08; P = 0.06) and significantly reduced total operating time (SMD = -16.34; 95% CI -21.72 to -10.95; P< 0.00001). There was no significant difference between the 2 groups in the number of postoperative complications (SMD = 1.12; 95% CI 0.46 to 2.74; P = 0.80).

The results suggest that AR technologies offer increased intraoperative accuracy of perforator identification and reduced time to perforator identification and total operating times compared to conventional imaging. Further high-quality studies with larger sample sizes are required to definitively confirm the benefits to support their widespread uptake and use.