Apple Vision Pro as a wearable display for endoscopic dacryocystorhinostomy: Surgical experience, efficiency, and cost

Objective To evaluate the Apple Vision Pro (AVP), a wearable spatial computing headset, as the primary intraoperative display for endoscopic dacryocystorhinostomy (DCR), assessing operative efficiency, ergonomics, cognitive workload, and cost. Design Consecutive, non-randomized comparative study at a single academic center, following institutional review board approval. Subjects and Controls Thirty-two consecutive endoscopic DCR procedures were analyzed: 16 with the AVP and 16 size-matched controls. Two fellows were the primary surgeons; three attending surgeons assisted. Methods Endoscopic DCR for primary unilateral nasolacrimal duct obstruction was performed using either the AVP or a traditional tower-mounted monitor for intraoperative visualization. Outcomes were operative time, functional success, intraoperative complications, surgeon-reported ergonomics, and perceived workload measured with the NASA Task Load Index (NASA-TLX). An exploratory cost analysis was also performed. Results Groups were comparable in age and sex. Operative time was shorter with the AVP (34.4 ± 8.6 vs 42.7 ± 8.5 minutes; reduction approximately 8.3 minutes, about 19%; p = 0.006). Functional success was 100% in both groups (16 of 16) with no complications; follow-up was 4 to 12 months. Overall workload was lower with the AVP (median 19.2 vs 40.0; one-sided p = 0.031; mean reduction 14.3 points, 95% CI 2.4 to 26.2; dz = 1.50); all five surgeons favored the AVP, with the largest reduction in physical demand, and subscale differences did not survive multiplicity correction. Surgeons reported improved comfort and a more neutral head and neck posture. The AVP occupied a small fraction of the cost and footprint of standard operating-room equipment. Conclusions In this preliminary, non-randomized series, use of the AVP as a wearable display for endoscopic DCR was associated with shorter operative times and lower surgeon-reported workload while occupying minimal space. As among the first prospective evaluations of the device for endoscopic lacrimal surgery, these findings suggest ergonomic and workflow advantages but require confirmation in larger, controlled studies.