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The Impact of XR Technology in Surgery

the impact of xr technology in surgery

The Impact of XR Technology in Surgery

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Today’s podcast focuses on the incredible growth of XR (AR/VR) technology in surgery including neurosurgery, cardiac surgery, spinal surgery, sinus surgery, and more.

While XR technology is becoming widely applied in many industries – from gaming to retail – each industry derives unique benefits from the technology. But few, if any, derive the benefit of helping to save lives and improving surgical outcomes. Not that long ago doctors learned how to perform surgery in a physical hospital conference room or a physical lab using human cadavers. Extraordinary note-taking abilities and memorization were essential.

Over the past 5 years, technology has radically altered the way surgeons train and perform surgeries. Today, surgeons can virtually learn the latest surgical techniques by putting on a VR headset and watching a simulation, or by putting on AR glasses to learn how to perform a better surgical procedure. Surgeons today wear AR headsets as they operate, allowing them to see information such as patient imagery without turning away from their critical task. With the addition of cameras and AI software, surgeons and their AR/AI solutions can see what is going on inside a patient, process vast amounts of data to interpret it, and return on-the-fly diagnoses or procedural suggestions right into the AR headset.

Some notable AR surgical navigation applications include:

  • Neurosurgery: AR technology has revolutionized neurosurgical procedures by providing surgeons with precise visualization and navigation capabilities. AR technology allows for accurate planning and execution of delicate procedures, such as tumor resections, spinal surgeries, and deep brain stimulation.
  • Orthopedic Surgery: AR-based surgical navigation has been particularly beneficial in orthopedic procedures, such as joint replacements and spine surgeries. Surgeons can precisely align implants, accurately track bone structures, and ensure optimal placement resulting in improved functional outcomes and reduced complications.
  • Minimally Invasive Surgery: AR technology has significantly advanced the field of minimally invasive surgery by providing real-time guidance and visualization that is less invasive and more accurate than previously used robot-assisted navigation. Using AR, surgeons can navigate complex anatomical structures with enhanced precision, reducing complications and speeding up patient recovery. Learn more about this application in our August 2023 Mayo Clinic podcast.

What is driving the interest in AR-assisted surgery? The answer is a multitude of measurable benefits that include:

  1. Improved surgical planning: By visualizing the patient’s anatomy before the procedure, surgeons can identify potential risks and create more accurate surgical plans.
  2. Enhanced accuracy: AR technology allows surgeons to ‘see through’ the patient’s skin and tissues, helping them navigate complex anatomical structures more precisely.
  3. Reduced surgical complications: With better visualization and guidance, surgeons can minimize damage to healthy tissues, reducing the risk of complications, and improving patient outcomes.
  4. Shorter operation times: The improved efficiency and accuracy provided by AR technology can help reduce the duration of a surgery.
  5. Faster recovery times: Minimally invasive procedures made possible by AR technology often result in quicker patient recovery times and reduced postoperative pain.

I want to share with you the story of Dr. Robert Louis, a neurosurgeon practicing at HOAG Hospital in Newport Beach, CA. Dr Louis was a fellow speaker in 2021 at the Augmented World Expo that takes place annually in California. I was absolutely fascinated by Dr. Louis’ presentation titled: “Solving Problems in Medicine with Advanced Visualization and Immersive Therapeutics.” In his presentation, which you can watch on YouTube, he addressed 3 common problems associated with traditional surgery systems and how XR-driven systems are solving these problems.

Problem #1: There has never been a way to practice an operation.

Dr. Louis said prior to XR technology, surgeons used to just scroll through old-school information to plan the operation, but now using XR technology surgeons can practice an operation. He showed the case of a man with a brain tumor. Using traditional surgical systems, Dr. Louis was planning to remove the tumor by going in just above the eyebrow. After using XR technology including 3D graphical overlays of the tumor, Dr. Louis decided because of the hooks coming out of the tumor, it made better sense to go in from the side of the head to ensure he could see and remove the entire tumor. He spoke about Mount Sinai Hospital surgeons rehearsing surgery for specific patients using XR technology that led to a change in the surgical plan a quarter of the time. If you think about that differently, almost 25% of the time the surgeon would have been performing the wrong operation for a particular patient had the surgeon not simulated the operation utilizing XR technologies prior to the surgery. Wow!

Problem #2: Patients do not understand medical imaging.

Dr. Louis said prior to XR technology, he would show traditional medical imaging (e.g., an MRI) to a patient and their family and spend hours and hours trying to explain where the brain tumor was in the image and how he intended to remove it. But the average patient did not understand traditional medical images and got lost in the conversation. Yet when Dr. Louis showed imaging from XR technology systems, the patient understood much better what was going on and Dr. Louis was able to take away the fear of the unknown.

Problem #3: Traditional navigation requires the surgeon to divert attention away from the operative field.

Dr. Louis spoke about the importance of staying focused on the tumor during the operation. Using traditional medical technology, he would be obliged to look at the microscope on a separate monitor, reconstruct this image in his mind and then go back to the operation. This meaningfully slowed down the operation. However, the XR technology allowed his AR glasses to work as a microscope magnifying the tumor 10 times, and the AR surgical navigation system color coded the tumor so he could more easily identify the tumor without diverting his attention from the operative field, which allowed Dr. Louis to perform a more precise operation that had a better patient outcome.

Here’s how Dr. Louis summed up his presentation: “Just like we make pilots practice for hours in a simulator prior to flying, surgeons should do the same using VR simulations. I would prefer to make mistakes in the VR model safely rather than in the patient themselves. I also use VR to enhance the ability for the patient to understand the surgical plan. And I use AR during the operation to view an accurate overlay of the tumor that improves my visualization and performance during the surgery.”

Who are the Key Players Driving the Growth in XR Surgical Navigation Systems?

There is an interesting mix of manufacturers offering XR technology solutions for surgery. While most global brands are active, my take is the smaller, VC-backed XR companies will be the real drivers in advancing the application of XR technology to surgery.

  • Medtronics: Among other areas, Medtronics focuses on brain surgery and have integrated real-time AR technology with their StelthStation S8 surgical platform used to tackle tumors, aneurysms, vessel malfunctions and other conditions. Their platform gives neurosurgeons a way to test different approaches virtually before they enter the operating room, as well as to provide a live, 3D rendering laid on top of the surgical site during brain procedures to help surgeons perform a more precise and successful operation.
  • Stryker: Among other areas, Stryker focuses on sinus surgery technology and have developed their Target Guided Surgery system that uses AR hardware including an endoscopic camera, coupled with AR software. This marriage of high-tech hardware and software adds a guided path for surgical tools to pass through.
  • Abbott: Among other areas, Abbott focuses on cardiac surgery. In 2021, Abbott launched a global Optical Coherent Tomography (OCT) VR training program for cardiologists to increase their expertise using Abbott’s OCT imaging technology and to improve the outcome in patients needing a stent to open a clogged artery. VR training improved cath lab staff learning engagement by 45%, and knowledge retention by 72%.
  • Augmedics: This VC-backed company focuses uniquely on spinal surgery. Their FDA-cleared xvision Spine System includes a headset for real-time spinal anatomy projection, allowing for 3D visualization of the spinal anatomy during surgery. It is designed as if the surgeon has X-ray vision into the patient’s anatomy to accurately navigate instruments and implants while looking directly at the patient instead of a screen. The first two spinal surgeries using Augmedics’ AR technology took place in 2020 at Johns Hopkins University in Baltimore. In 2023, less than 4 years later, the 5,000th spinal surgery using their AR technology took place at the Hospital for Special Surgery in NY. I was not surprised to learn Augmedics recently closed an $82.5 million Series D funding round.

Key Challenges

XR has shown great promise in improving the precision and outcomes of surgery, but this innovative technology comes with a new set of challenges:

  • Discomfort and wearability issues. Historically, VR/AR headsets have been cumbersome to wear for extended periods of time.
  • Cost. AR technology used for surgical navigation requires advanced imaging capabilities in operating rooms and expenses for hardware, software, training, and personnel. For now, AR technology used for surgical navigation are still affordable for most major hospitals, plus AR surgical navigation may also save on implicit costs such as human error, surgical error, and potential lawsuits resulting from malpractice.
  • Surgeon training and familiarization. Surgeons need to be proficient in XR systems to reap their full benefits. Medical schools, manufacturers, and hospitals need to provide training programs and ongoing support to ensure that surgeons are comfortable and skilled in using XR technology effectively.
  • The newness of the XR technology. Even though FDA-approved systems exist, many surgeons are wary of trying these systems that seem like science fiction. The industry needs to push awareness of this groundbreaking technology that is FDA-approved and available for use now.

Closing Comments

The future of XR technology in surgery holds tremendous potential to further revolutionize healthcare and improve patient outcomes in two major areas:

  • Enhanced Precision and Personalization:XR technology will continue to advance, offering even greater precision and personalized guidance for surgeons. Real-time intraoperative imaging, patient-specific anatomical overlays and predictive analytics will further optimize surgical decision making and outcomes.
  • Surgical Education and Training:XR surgical navigation systems will play a vital role in medical education, allowing students and trainees to observe and learn from surgical procedures in an immersive and interactive manner. XR technology can help bridge the gap between theory and practice, enhancing the skills and proficiency of future surgeons. Additionally, XR technology has the potential to aid in telemedicine, enabling remote surgeons to assist in complex procedures from anywhere in the world.

The incredible impact of XR technology in surgery is still in its infancy. The integration of innovative AI with XR technology applications in surgery will blossom over the next few years and deliver new surgical systems, approaches, and patient outcomes. We sure are living in exciting times!


My Metaverse business partner, Tim Bajarin, and I are keen to assist healthcare companies at each step of the way to ensure their successful entry into the Metaverse. To read about additional healthcare and related Metaverse case studies, I strongly encourage you to visit ISM’s award-winning Metaverse Resource Center –  – where in addition to gaining access to more than 275 Metaverse case studies, more than 275 Metaverse articles, and more than 100 Metaverse videos, you can download ISM’s new ‘8 Steps to Do Business Successfully in the Metaverse’ White Paper, download ISM’s New ‘VR Training Guide for the Enterprise,’ learn about and sign-up for ISM’s complimentary 2-hour Metaverse Executive Bootcamp, and more. 

Barton Goldenberg ( is president of ISM, Inc. Since 1985, ISM has established itself as the premier strategic advisor leveraging leading edge technologies – the Metaverse, Digital Communities, and CRM – to create and implement customer strategy with a focus on sales, marketing and customer service. His thought leadership including creator of the ‘Business Success in a Virtual World’ podcast, creator of the award winning Metaverse Resource Center, and author of three business books including The Definitive Guide to Social CRM. He is also in high demand as a keynote speaker (




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