General Surgery 4.0 – A Systematic Review of Extended Reality Interventions in General Surgery

BackgroundSurgery is a central component of healthcare but involves significant risks, with complications occurring in 16.4% patients, accounting for 7.7% of worldwide fatalities. "Surgery 4.0" or digitisation of surgery, has introduced extended reality (XR) technology, offering opportunities to enhance peri-operative care. This study explored the current uses of XR to improve outcomes for general surgery patients.MethodA systematic search of MEDLINE, EMBASE, and Cochrane databases was performed in August 2024 to include studies using XR for pre-operative planning, navigation or patient experience for adult patients undergoing general surgery. Data on pre-operative planning, post-operative complications, patient experience, image segmentation and study reporting were presented using a narrative approach.ResultsThe search returned 966 articles. 26 studies were included featuring 1142 patients. The most investigated procedure was liver resection (n = 11, 42%), with XR interventions showing significant reductions in length of stay, blood loss, operative time and complication rates. Improved outcomes were only seen for patients undergoing liver resection. For patient experience (n = 5, 19%), XR systems were shown to significantly improve anxiety, pain and mood scores. Most studies (n = 11, 73%%) utilised manual methods for image segmentation, costing up to €650 and taking 3-6 hours per model. Reporting of the XR technology, assessment and future development was variable.ConclusionThe benefits of XR technology to improve patient outcomes in liver surgery are emerging but are yet to materialise in other general surgical procedures. Future research should focus on automatic image segmentation to improve workflow efficiency and innovation frameworks to generate robust evidence.