Usefulness of mixed reality in surgical treatment: Delphi study

Abstract

[Abstract] Background: Mixed reality (MR) combines real and virtual elements and has shown promise in diverse fields, including surgical procedures. MR headsets may support surgical navigation, planning, and training. It is crucial to determine whether medical professionals consider this technology indispensable. This study uses the Delphi method, facilitated by the Welphi web-based platform, to assess the utility of MR in surgical settings and analyzes the results of the first round using a systematic approach modeled on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework.

Objective: This study aims to examine the feasibility and advantages of MR technology in surgical contexts. The findings are intended to inform and direct health care professionals, researchers, and developers in advancing MR integration into surgical environments to optimize treatment quality and safety.

Methods: A 3-round Delphi approach was implemented to ascertain consensus on the utility of MR in surgical treatment. Participants (n=22) were purposefully selected from among experts with professional experience in technologies such as virtual reality, augmented reality, 3D laparoscopy, and robotics. In the first round, participants provided insights into the potential applications of MR in surgical procedures through open-ended questions structured across 5 distinct sections. Responses were analyzed to develop the second-round questionnaire, which was hierarchically organized into main topics and subtopics. In the third round, the questions were identical to those in the second round, including the percentage results, allowing participants to reconsider their responses. A consensus round was subsequently conducted. The majority consensus level was defined as agreement by ≥70% of the participants in a given round.

Results: The study was conducted from January to May 2024. All 22 invited experts provided responses in both the first and second rounds (100% response rate). In the third and consensus rounds, 20 (91%) of the 22 experts participated. The consensus round, conducted to present the results, yielded a majority consensus (19/20, 95%) on the usefulness of MR in surgical treatment. The primary benefits of MR in surgery were identified as surgical navigation (15/20, 75%), planning (15/20, 75%), and teaching and training (14/20, 70%). In addition, 75% (15/20) of the experts identified cost and investments as primary constraints. We used the Kendall tau-b coefficient for correlation analysis, and significant correlations were identified between distinct aspects.

Conclusions: MR technology is most beneficial in surgical navigation, planning, and training. However, the costs and investments required for implementation may present a potential limitation for the integration of this technology into surgical procedures. Moreover, it is of crucial importance to consider the ethical implications associated with MR use, particularly regarding patient safety and privacy.