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  • Rushda Ahmed

Current and future trends of extended reality in cardiothoracic surgery

What is Extended reality?

Extended reality (XR) is a novel technique used to generate combined physical reality and virtual 3- dimensional (3D) interfaces of computer-synthesized structures and environments based on reality. They also offer their users the ability to interact with digital projections of surgical targets, using wearables and remote controllers. These include the sub techniques of virtual reality (VR), augmented reality (AR), and mixed reality (MR). Primarily this technology allows for the demonstration of complex objects and simulation of performances in a wide range of clinical applications. XR-guided preoperative planning, intraoperative guidance and navigation, postoperative pain and rehabilitation management, surgical simulation, and patient education have gained popularity for a decade.

Image source: Elsevier Inc

VR increases procedural accuracy and surgical confidence through familiarization with the patient's anatomy. XR-assisted surgery may have a therapeutic use, particularly for complex cases, where conventional methods would yield inadequate outcomes due to inferior accuracy.

3-D VR models for preoperative congenital cardiac surgery planning and 3D virtual surgery planning in patients with: Congenital cardiac defects, including double-outlet right ventricle, ventricular septal defects, tetralogy of Fallot, and hypoplastic left heart syndrome.

Three main applications:

  1. Cardiothoracic surgery training

  2. Preoperative planning of cardiothoracic procedures

  3. Intraoperative assistance

Image source: GeekWire

Benefits of XR:

  1. Offer the user a 3D and more realistic representation of the surgical target.

  2. Provide better preoperative awareness of rare anatomic abnormalities.

  3. Enables the user to interact, analyze, and edit these virtual anatomic objects without obstructing the normal visual view.

  4. Guide planning of thoracoscopic port placement for minimally invasive cardiac and thoracic procedures.

  5. Promotes postoperative rehabilitation support like VR-assisted physical therapy and management of postoperative pain and anxiety.

Image source: Hati International

Drawbacks of XR:

  1. Lack of standardized software that enables fully automatic image processing for accurate segmentation without manual effort.

  2. Expensive hardware and software.

  3. Technical issues.

  4. Users need additional training before handling it.

Is XR Implementation Cost-Effective?

Over the past decade, the economic barriers to the use of VR and AR in a surgical setting have diminished as cheaper technology with significantly stronger processing power becomes commercialized and the opportunities for VR to improve patient safety, surgical training, and audit quality become evident.

Future perspective:

From a future perspective, XR brings opportunities to rapidly develop the field of surgery. XR has gained interest and acceptability in different medical and surgical fields. Right from medical education, preoperative planning, in-operative assistance, and even postoperative rehabilitation support to patients. The drive for innovation in cardiac surgery has been growing over the past years in search of methods to maximize the patient outcome and quality of life while improving training pathways for young surgeons. Perhaps one of the greatest potential future applications of VR systems in cardiothoracic surgery will be their assistance and in-shift surgical support from open sternotomy procedures to minimally invasive ones. XR represents a salient step towards improving cardiothoracic surgical training and enhancing preoperative planning and intraoperative guidance.



  1. Amir. S, Sulayman. M, et al; Current and Future Applications of Virtual, Augmented, and Mixed Reality, The Society of Thoracic Surgeons. Published by Elsevier Inc, 2022.

  2. Arian. R, Robert V, et al; Virtual and Augmented Reality in Cardiac Surgery, Braz J Cardiovasc Surg 2022;37. DOI: 10.21470/1678-9741-2020-0511.

  3. Juan. A Carlos. P, et al; Application of Mixed Reality in Medical Training and Surgical Planning Focused on Minimally Invasive Surgery, Front. Virtual Real. 28 October 2021.

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