3-dimensional reconstruction and mixed reality in thoracic surgery: a narrative review and user guide

3-dimensional (3D) reconstruction techniques, including physical forms such as 3D printing, and virtual forms such as virtual and augmented reality (VR/AR), are gaining popularity. Multiple platforms have received regulatory approval and many more are being developed for use in thoracic surgery. However, uptake of these technologies has been slow, likely owing to poor understanding, unclear guidance on implementation, and associated costs. In this context, we aim to provide a review of the existing literature on 3D reconstruction in thoracic surgery, while also forming a guide for thoracic surgeons.

We searched PubMed using MeSH term "thoracic surgery" combined individually with "augmented reality", "virtual reality", and "3D reconstruction". We limited the search to the last 15 years [2010-2025] with results totaling 287 publications. We identified the highest impact articles involving each of these technologies. We also searched the Food and Drug Administration (FDA) website and identified 510k-approved VR and AR technologies with the potential for use in thoracic surgery.

We broke up our findings into four main sections: (I) how these models are created; (II) indications for use in thoracic surgery; (III) models that are currently available; and (IV) surgeons' perceptions and limitations. These models are typically built from traditional imaging, such as computed tomography scans, segmented into individual structures either manually or via artificial intelligence, and then placed into a file compatible with either projection on VR/AR headsets or a 3D printer. These models can then be used in a variety of ways in thoracic surgery, such as training, pre-operative planning, intra-operative guidance, or creation of 3D-printed prostheses. Currently, the primary limitations are varying accuracy of models, available evidence for use, uptake by surgeons, and cost of the technology.

3D reconstruction and mixed reality platforms are an important development with many uses within thoracic surgery. Further study into their development, use, and safety will be vital in the coming years. Surgeons should understand these uses and limitations prior to implementation into practice.