A Comparative Study of MR‐Guided Needle Insertion for Surgical Procedures: Insights From HoloLens 2, Magic Leap 2 and Apple Vision Pro

Numerous minimally invasive procedures, including biopsies, ablations and neurostimulation, rely on the accurate placement of a needle under image guidance. Mixed reality (MR) head-mounted displays (HMDs) offer a promising solution to enhance the guidance of these procedures without radiation. While the performance of the established HoloLens 2, now discontinued, is well-documented, the clinical viability of its potential successors remains unproven. This study provides the first direct comparative benchmark of the HoloLens 2, Magic Leap 2 and Apple Vision Pro for a high-precision needle insertion task, using sacral nerve stimulation (SNS) as a validation scenario. We developed custom applications for each platform and evaluated the performance with 11 users, including nine clinicians without prior HMD experience, through a randomized protocol. Quantitative and qualitative analyses were conducted to assess procedural efficiency and user experience. Results identified the Magic Leap 2 as the most effective platform, demonstrating significantly higher success rates and superior usability scores, driven by its ergonomic design and stable tracking. In contrast, the Apple Vision Pro, despite offering superior visual fidelity, proved unsuitable for this navigation task. Its performance was critically hampered by unstable marker tracking, significant device weight, and a lack of accommodation for prescription glasses, which disrupted the clinical workflow. The HoloLens 2 performed as a reliable, albeit less usable, baseline. We conclude that, for this surgical navigation purpose, the optimal HMD is determined by a balanced combination of tracking reliability, user comfort, and practical workflow integration, over the technical specifications of the device. These findings emphasize the importance of device selection in enhancing procedural outcomes and clinical training.