Evans Thomas, Turna Adam, Stringfellow Thomas D, Jones Gareth G
Trauma and Orthopaedic Registrar, Department of Trauma and Orthopaedics, Isle of Wight NHS Trust, Newport, United Kingdom.
Resident Doctor, Department of Trauma and Orthopaedics, East and North Hertfordshire NHS Trust, Stevenage, United Kingdom.
PLOS Digit Health. 2025 Apr 28;4(4):e0000777. doi: 10.1371/journal.pdig.0000777. eCollection 2025 Apr.
Augmented reality (AR) allows the real environment to be altered with superimposed graphics using a head-mounted-display (HMD), smartphone or tablet. AR in surgery is being explored as a potential disruptive technology and could be used to improve patient understanding of treatment and as an adjunct for surgery. The aim was to explore this use of AR and assess potential benefits for consent and patient education. A systematic review was conducted using PRISMA-SCR guidelines. 4 major bibliographic databases were searched using the terms: '(augmented reality OR mixed reality) AND surgery AND (consent OR patient education)'. Included papers evaluated an AR intervention on consenting patients for enhancing surgical consent or education about a procedure. Non-English language papers and studies which did evaluate an intervention were excluded. Three reviewers screened all abstracts and full text papers for inclusion. The review protocol was prospectively registered with PROSPERO (ID: CRD42020207360). 52 records were identified. Following removal of 13 duplicates, 21 were removed after abstract screening leaving 17 articles for full assessment. One article was a letter and 8 did not evaluate interventions, leaving 8 articles published between 2019 and 2023. 3 papers were randomised controlled trials comparing AR enhanced processes to standard consent, 2 cohort studies evaluated patient satisfaction with AR interventions and there was one randomised crossover trial of AR against traditional consent consultation. The Cochrane risk of bias tool was used most studies were deemed as high risk of bias. Patient satisfaction and understanding were improved using AR. However, advantages over other enhanced techniques are less clear. Using AR to enhance written literature was shown to require less mental effort from patients and was preferred to standard resources to understand complex surgery. The few randomised trials are limited by bias and lack of power calculation, highlighting the need for further research.
增强现实（AR）可通过头戴式显示器（HMD）、智能手机或平板电脑，利用叠加的图形来改变真实环境。手术中的AR作为一种潜在的颠覆性技术正在被探索，可用于提高患者对治疗的理解，并作为手术的辅助手段。目的是探索AR的这种用途，并评估其在知情同意和患者教育方面的潜在益处。使用PRISMA-SCR指南进行了系统评价。使用以下检索词在4个主要书目数据库中进行检索：“（增强现实或混合现实）与手术以及（知情同意或患者教育）”。纳入的论文评估了针对同意参与的患者进行的AR干预，以加强手术知情同意或关于某一手术程序的教育。非英语语言的论文以及未评估干预措施的研究被排除。三名评审员筛选了所有摘要和全文论文以确定是否纳入。该综述方案已在PROSPERO（标识符：CRD42020207360）上进行了前瞻性注册。共识别出52条记录。在去除13条重复记录后，摘要筛选后又排除了21条记录，剩下17篇文章进行全面评估。1篇文章是一封信件，8篇未评估干预措施，剩下2019年至2023年发表的8篇文章。3篇论文是随机对照试验，将AR增强流程与标准知情同意进行比较，2项队列研究评估了患者对AR干预的满意度，还有1项AR与传统知情同意咨询的随机交叉试验。大多数研究使用了Cochrane偏倚风险工具，被认为存在高偏倚风险。使用AR可提高患者满意度和理解。然而，与其他增强技术相比的优势尚不太明确。研究表明，使用AR增强书面资料可减少患者的脑力消耗，并且在理解复杂手术方面比标准资源更受青睐。少数随机试验受到偏倚和缺乏功效计算的限制，凸显了进一步研究的必要性。
