# Utility of Optical See-Through Head Mounted Displays in Augmented Reality-Assisted Surgery: A systematic review

arXiv: https://arxiv.org/abs/2202.04141 · HTML: https://mlsanity.com/paper/2202.04141/

## Key facts

- Cited by 9 papers in the map (data through 14 Oct 2026).
- First posted on arXiv 8 Feb 2022.

## Built on by (most cited first, 9 of 9)

- [Automatic registration with continuous pose updates for marker-less surgical navigation in spine surgery](https://mlsanity.com/paper/2308.02917/) (2023)
- [SurgicalPart-SAM: Part-to-Whole Collaborative Prompting for Surgical Instrument Segmentation](https://mlsanity.com/paper/2312.14481/) (2023)
- [The HoloLens in Medicine: A systematic Review and Taxonomy](https://mlsanity.com/paper/2209.03245/) (2022)
- [EasyREG: Easy Depth-Based Markerless Registration and Tracking using Augmented Reality Device for Surgical Guidance](https://mlsanity.com/paper/2504.09498/) (2025)
- [A Review on Organ Deformation Modeling Approaches for Reliable Surgical Navigation using Augmented Reality](https://mlsanity.com/paper/2408.02713/) (2024)
- [Toward Reliable AR-Guided Surgical Navigation: Interactive Deformation Modeling with Data-Driven Biomechanics and Prompts](https://mlsanity.com/paper/2506.08048/) (2025)
- [Markerless Augmented Reality Registration for Surgical Guidance: A Multi-Anatomy Clinical Accuracy Study](https://mlsanity.com/paper/2511.02086/) (2025)
- [Impact of Target and Tool Visualization on Depth Perception and Usability in Optical See-Through AR](https://mlsanity.com/paper/2508.18481/) (2025)
- [Artificial Intelligence in Elementary STEM Education: A Systematic Review of Current Applications and Future Challenges](https://mlsanity.com/paper/2511.00105/) (2025)

## Abstract (arXiv)

This article presents a systematic review of optical see-through head mounted display (OST-HMD) usage in augmented reality (AR) surgery applications from 2013 to 2020. Articles were categorised by: OST-HMD device, surgical speciality, surgical application context, visualisation content, experimental design and evaluation, accuracy and human factors of human-computer interaction. 91 articles fulfilled all inclusion criteria. Some clear trends emerge. The Microsoft HoloLens increasingly dominates the field, with orthopaedic surgery being the most popular application (28.6%). By far the most common surgical context is surgical guidance (n=58) and segmented preoperative models dominate visualisation (n = 40). Experiments mainly involve phantoms (n = 43) or system setup (n = 21), with patient case studies ranking third (n = 19), reflecting the comparative infancy of the field. Experiments cover issues from registration to perception with very different accuracy results. Human factors emerge as significant to OST-HMD utility. Some factors are addressed by the systems proposed, such as attention shift away from the surgical site and mental mapping of 2D images to 3D patient anatomy. Other persistent human factors remain or are caused by OST-HMD solutions, including ease of use, comfort and spatial perception issues. The significant upward trend in published articles is clear, but such devices are not yet established in the operating room and clinical studies showing benefit are lacking. A focused effort addressing technical registration and perceptual factors in the lab coupled with design that incorporates human factors considerations to solve clear clinical problems should ensure that the significant current research efforts will succeed.