First use of augmented reality headset in minimally invasive general surgery: seeing is believing

Augmented reality (AR) is an evolving technology with the potential to transform surgical practice. By superimposing digital information onto the surgeon's field of view, AR headsets provide an unobstructed view of the minimally invasive operative field, eliminating the need to divert attention to external monitors. We present the first series of minimally invasive general surgery (MIS) cases performed using the Apple Vision Pro headset in the USA.

Attending surgeons and trainees performed consecutive MIS cases at our institution while wearing the headset from August 2024 to December 2024. Using open-source software, laparoscopic/endoscopic video sources were displayed as virtual monitors in the physical operating room space. The virtual monitors served as the primary monitors through which surgeons performed each case. Standard monitors remained present to enable other members of the operative team to view the operations. At the conclusion of each case, the operating surgeon completed the NASA Task Load Index (NASA-TLX) assessment tool to evaluate perceived workload while operating with the headset. 30-day perioperative complications were also assessed.

A total of 41 MIS cases were performed by 3 attending surgeons and 4 trainees. The most common procedure was laparoscopic sleeve gastrectomy (N = 9, 22.0%). Open-source software enabled simultaneous viewing of up to 3 virtual displays that could be individually positioned in the surgeon's visual field. The mean NASA-TLX score for all participants was 22.3 ± 4.7, indicating a low perceived intraoperative workload. There was no significant difference in NASA-TLX scores between attending surgeons and trainees (19.8 ± 5.3 vs 24.8 ± 3.0, p = .23). There were no intraoperative complications; 30-day morbidity and mortality were 0%.

This study serves as a proof of concept for the use of an augmented reality headset in minimally invasive general surgery.