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General Surgery 4.0 - A Systematic Review of Extended Reality Interventions in General Surgery.
Mikolaj R Kowal1, Thomas Williams2, Alexios Dosis1
1Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK.
Surgical Innovation
|January 12, 2026
Summary
Extended reality (XR) technology shows promise in improving outcomes for liver surgery patients, reducing complications and improving patient experience. However, benefits are not yet seen in other general surgery procedures.
Area of Science:
- Surgical innovation and digital health applications.
Background:
- Surgery carries significant risks, with complications affecting 16.4% of patients and contributing to 7.7% of global fatalities.
- Digitisation of surgery, or
- Surgery 4.0
- , leverages extended reality (XR) to enhance peri-operative care.
Purpose of the Study:
- To explore the current applications of XR technology in improving outcomes for general surgery patients.
Main Methods:
- A systematic literature search of MEDLINE, EMBASE, and Cochrane databases was conducted in August 2024.
- Studies involving XR for pre-operative planning, navigation, or patient experience in adult general surgery were included.
- Data synthesis was performed using a narrative approach.
Main Results:
- 26 studies with 1142 patients were analyzed; liver resection was the most studied procedure (n=11).
- XR interventions significantly reduced length of stay, blood loss, operative time, and complication rates in liver resections.
- XR improved patient experience, significantly reducing anxiety, pain, and improving mood scores (n=5).
- Manual image segmentation was common (73%), costly (€650), and time-consuming (3-6 hours).
Conclusions:
- Emerging evidence suggests XR benefits for liver surgery outcomes and patient experience.
- Widespread benefits of XR in other general surgical procedures are not yet established.
- Future research should prioritize automated image segmentation and robust evidence generation frameworks.
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