Celdrán Francisco Javier, Jiménez-Ruescas Javier, Lobato Carlos, Salazar Lucía, Sánchez-Margallo Juan Alberto, Sánchez-Margallo Francisco M, González Pascual
I3A, LoUISE Research Group, University of Castilla-La Mancha, Albacete, Spain.
Bioengineering and Health Technologies Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain.
J Med Internet Res. 2025 Jan 28;27:e58108. doi: 10.2196/58108.
Laparoscopic surgery training is a demanding process requiring technical and nontechnical skills. Surgical training has evolved from traditional approaches to the use of immersive digital technologies such as virtual, augmented, and mixed reality. These technologies are now integral to laparoscopic surgery training.
This scoping literature review aimed to analyze the current augmented reality (AR) solutions used in laparoscopic surgery training.
Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we conducted a scoping review using 4 databases: Scopus, IEEE Xplore, PubMed, and ACM. Inclusion and exclusion criteria were applied to select relevant articles. Exclusion criteria were studies not using AR, not focused on laparoscopic surgery, not focused on training, written in a language other than English, or not providing relevant information on the topics studied. After selecting the articles, research questions (RQs) were formulated to guide the review. In total, 2 independent reviewers then extracted relevant data, and a descriptive analysis of the results was conducted.
Of 246 initial records, 172 (69.9%) remained after removing duplicates. After applying the exclusion criteria, 76 articles were selected, with 25 (33%) later excluded for not meeting quality standards, leaving 51 (67%) in the final review. Among the devices analyzed (RQ 1), AR video-based devices were the most prevalent (43/51, 84%). The most common information provided by AR devices (RQ 1) focused on task execution and patient-related data, both appearing in 20% (10/51) of studies. Regarding sensorization (RQ 2), most studies (46/51, 90%) incorporated some form of sensorized environment, with computer vision being the most used technology (21/46, 46%) and the trainee the most frequently sensorized element (41/51, 80%). Regarding training setups (RQ 3), 39% (20/51) of the studies used commercial simulators, and 51% (26/51) made use of artificial models. Concerning the evaluation methods (RQ 4), objective evaluation was the most used, featured in 71% (36/51) of the studies. Regarding tasks (RQ 5), 43% (22/51) of studies focused on full surgical procedures, whereas 57% (29/51) focused on simple training tasks, with suturing being the most common among the latter (11/29, 38%).
This scoping review highlights the evolving role of AR technologies in laparoscopic surgery training, although the impact of optical see-through devices remains unclear due to their limited use. It underscores the potential of emerging technologies such as haptic feedback, computer vision, and eye tracking to further enhance laparoscopic skill acquisition. While most relevant articles from other databases were included, some studies may have been missed due to the specific databases and search strategies used. Moreover, the need for standardized evaluation metrics is emphasized, paving the way for future research into AR's full potential in laparoscopic skill acquisition.
腹腔镜手术培训是一个要求苛刻的过程，需要技术和非技术技能。手术培训已从传统方法发展到使用沉浸式数字技术，如虚拟、增强和混合现实。这些技术现在已成为腹腔镜手术培训不可或缺的一部分。
本综述性文献分析旨在分析目前用于腹腔镜手术培训的增强现实（AR）解决方案。
按照PRISMA-ScR（系统评价与Meta分析扩展版的范围综述首选报告项目）指南，我们使用4个数据库进行了范围综述：Scopus、IEEE Xplore、PubMed和ACM。应用纳入和排除标准来选择相关文章。排除标准包括未使用AR的研究、未聚焦于腹腔镜手术的研究、未聚焦于培训的研究、非英文撰写的研究或未提供所研究主题相关信息的研究。在选择文章后，制定了研究问题（RQs）以指导综述。然后，总共2名独立评审员提取了相关数据，并对结果进行了描述性分析。
在246条初始记录中，去除重复项后剩下172条（69.9%）。应用排除标准后，选择了76篇文章，其中25篇（33%）后来因不符合质量标准而被排除，最终综述中留下51篇（67%）。在所分析的设备中（研究问题1），基于AR视频的设备最为普遍（43/51，84%）。AR设备提供的最常见信息（研究问题1）集中在任务执行和患者相关数据上，两者均出现在20%（10/51）的研究中。关于传感（研究问题2），大多数研究（46/51，90%）采用了某种形式的传感环境，计算机视觉是最常用的技术（21/46，46%），受训者是最常被传感的元素（41/51，80%）。关于培训设置（研究问题3），39%（20/51）的研究使用了商业模拟器，51%（26/51）使用了人工模型。关于评估方法（研究问题4），客观评估是最常用的，71%（36/51）的研究中有此特征。关于任务（研究问题5），43%（22/51）的研究聚焦于完整的手术过程，而57%（29/51）聚焦于简单的培训任务，其中缝合在后者中最为常见（11/29，38%）。
本范围综述突出了AR技术在腹腔镜手术培训中不断演变的作用，尽管光学透视设备的影响由于其使用有限仍不明确。它强调了触觉反馈、计算机视觉和眼动追踪等新兴技术在进一步提高腹腔镜技能获取方面的潜力。虽然纳入了其他数据库的大多数相关文章，但由于所使用的特定数据库和搜索策略，可能遗漏了一些研究。此外，强调了对标准化评估指标的需求，为未来研究AR在腹腔镜技能获取方面的全部潜力铺平了道路。
