The digital evolution of surgical planning: a systematic review of immersive and interactive technologies

Background: Immersive and interactive technologies such as Virtual Reality (VR), Augmented Reality (AR), and Mixed Reality (MR) are reshaping surgical planning by enhancing anatomical visualization, enabling personalized procedures, and improving intraoperative navigation and decision-making across diverse surgical specialties. Methods: This systematic review was conducted in accordance with the PRISMA guidelines, and was registered in PROSPERO (CRD420251066149), analyzing 30 studies (1,270 participants) from PubMed, Google Scholar Web of Science and Ovid MEDLINE up to February 2025. Included studies evaluated VR, AR, or MR in preoperative or intraoperativesurgical planning, reporting outcomes on accuracy, time efficiency, or plan modifications. Risk of bias was assessed using RoB 2.0 for RCTs and ROBINS-I for non-randomized studies. Results: VR was the most utilized technology (17 studies), improving spatial understanding and prompting plan modifications in 32%-52% of cases (e.g., lung segmentectomies, TAVR). AR (8 studies) enhanced intraoperative accuracy, reducing pedicle screw placement errors (98% vs. 91.7% control) and procedure times (e.g., 50% faster spinal screw placement). MR (2 studies) demonstrated potential in reducing thoracic epidural needle adjustments (7.2 vs. 14.4 movements) and sentinel node biopsy durations (3.6 vs. 7.9 min). Heterogeneity in study designs and outcomes limited meta-analysis. Conclusion: VR enhanced anatomical understanding and preoperative planning, while AR, and MR were better for procedural accuracy and intraoperative workflow. Future multicenter trials with standardized protocols are needed to establish long-term clinical efficacy and cost-effectiveness in diverse surgical settings. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251066149, PROSPERO CRD420251066149.