Telestration With Augmented Reality in Surgery: A Comprehensive Systematic Review and Meta-analysis

Augmented reality (AR) telestration has the potential to completely transform surgical teaching and training. In contrast to traditional telestration and telestration without AR, this systematic review and meta-analysis attempted to thoroughly assess the effect of telestration with AR on a variety of performance metrics, including task completion time, error rates, GOALS task-specific scores, Objective Structured Assessments of Technical Skills (OSATS) task-specific scores, and Global Operative Assessment of Laparoscopic Skills (GOALS) global scores.

Six relevant publications were included after a thorough literature search was carried out on March 2024 across relevant databases. To evaluate the impact of telestration with AR on performance indicators, meta-analyses were carried out, and statistical analysis produced pooled effect sizes and 95% confidence intervals (CIs). The I2 statistic was used to assess heterogeneity.

The meta-analysis showed that when comparing telestration with AR to traditional approaches and without AR, the meta-analysis showed significant gains across several performance parameters. In particular, there was an improvement of 4.99 points (95% CI 0.90 to 9.08; I2 = 81%) in the task-specific OSATS scores and 1.67 points (95% CI 0.57 to 2.78; I2 = 0%) in the Global OSATS scores. Moreover, there was a 1.67 point (95% CI 0.57 to 2.78; I2 = 0%) rise in GOALS Global scores and 1.04 points (95% CI 0.25 to 1.83; I2 = 0%) in the task-specific GOALS scores. Notably, a mean difference of -10.99 (95% CI -34.07 to 56.05; I2 = 68%) was seen in the job completion time when telestration with AR was used. Error rates, however, showed no discernible decrease (mean difference: -18.92, 95% CI -57.93 to 20.08; I2 = 85%). Heterogeneity was explained in task-specific OSATS scores (P = 0.003) and task completion time (P = 0.02).

In conclusion, there is strong evidence from this systematic review and meta-analysis to suggest that telestration with augmented reality can improve surgical training outcomes. The technology has the potential to completely transform surgical education, as seen by the notable gains in task-specific scores for both GOALS and OSATS that have been observed, together with the large reductions in task completion times. To address the observed variation and investigate other factors influencing performance results, such as learning curves and long-term skill retention, more research is necessary.