Implementation and Workflow Optimization of Augmented Reality- Assisted Neuronavigation in Neurosurgery: A Retrospective Descriptive Observational Study

Abstract Background: Augmented reality (AR)–assisted neuronavigation has improved surgical precision and intraoperative orientation. However, its integration in low- and middle-income countries (LMICs) remains limited and poorly standardized. Methods: We conducted a retrospective observational study of ten consecutive cranial procedures that incorporated AR-assisted neuronavigation (Brainlab Curve® and KINEVO 900®) at a tertiary academic center in Bogotá, Colombia, between 2022 and 2024. Surgical workflows were documented by Surgical Instrumentation Assistants (SIAs) and analyzed for setup duration, calibration accuracy, and team coordination. Based on these data, a three-phase protocol comprising preoperative preparation, intraoperative setup, and intraoperative execution was developed to improve efficiency and reproducibility. Results: Mean operating room setup time decreased from 6–8 hours to less than 3 hours following implementation of the standardized protocol. Calibration errors declined by 60%, and no navigation-related failures occurred. Qualitative feedback indicated improved communication and team confidence. Experienced SIAs achieved stable setup times (~2.5 hours) after one year, demonstrating a measurable institutional learning curve. Conclusions: Standardized workflow protocols and simulation-based training improved efficiency, reliability, and coordination in AR-assisted neuronavigation. Structured implementation enables safe integration of advanced digital technologies in resource-limited neurosurgical environments.