Augmented and virtual reality in surgery: a disruptive frontier in visualization, training, and precision

Technological innovation has been the driving force for advancement in surgical practice for a long time. Over the past few decades, virtual and augmented reality technologies have held tremendous potential to transform the practice, study, and experience of surgery. Once limited to entertainment and simulation domains, these immersive technologies are now starting to be employed to break into operating rooms, surgical residency programs, and preoperative planning, unlocking new frontiers of accuracy, safety, and efficiency. This manuscript upholds the ethical use and communication of AI-powered technologies in surgical caregiving routines under the TITAN 2025 Guidelines, focusing on AI reporting in healthcare systems1. AR and VR share little in common but possess outstanding potential to enhance surgery. AR superimposes computer-generated anatomical data on the real operating space in real time, enabling surgeons to visualize structures such as blood vessels, nerves, and tumors without breaking eye contact with the patient2. VR offers fully simulated spaces where procedures can be practiced repeatedly without the risks of real surgeries3. Both technologies enhance surgeons’ cognitive and spatial abilities and, in doing so, have the potential to optimize decision-making and improve outcomes across all surgical specialties4. Within the operating theater, AR can be used to perform intraoperative navigation by superimposing real-time anatomical overlays over the patient to enhance the surgeon’s awareness. In neurosurgery or hepatobiliary surgery, for example, AR has been used to guide the surgeon through sensitive planes of tissue and enable improved tumor localization5. This not only reduces the risk of complications but also lowers operative times and enhances overall precision. In contrast to static imaging on the external displays, AR offers the capability to bring anatomical guidance into the surgeon’s line of sight, reducing cognitive loading and enhancing workflow continuity6. Parallel to this, VR is gaining significance in the training and learning of surgical skills. The traditional modes of training, such as cadaver dissection and operating room observation, are valuable but limited by availability, expense, and ethics7. VR-based simulators offer standardized, interactive, and immersive training zones where surgical residents can practice and improve their skills with real-time feedback. The simulations currently include haptic feedback, whereby the user can experience resistance from tissue and instruments and thereby increase the realism of the simulation. Recent publications have shown that surgical trainees trained by VR-based modules are better on objective skill assessments and more confident compared to conventionally trained trainees8. Uses of AR and VR also encompass preoperative planning. Surgeons can now rehearse procedures on patient-specific 3D reconstructions, anticipate trouble spots, and adjust technique accordingly. In orthopedics and craniofacial surgery, this capability has led to the development of more precise surgical guides and implants, reducing variability and improving functional results. Patients benefit from these technologies as well, as complex procedures can be described more simply through visual simulations, enhancing education, confidence, and satisfaction in the informed consent process9. Despite the immense surgical potential of AR and VR, we must address a series of challenges before these technologies gain universal acceptance. The design of comfortable headsets, the accuracy of image alignment, and the delay in real-time overlays need to be improved before this technology can be smoothly used in everyday surgeries. Interestingly, the existing evidence base on the clinical utility of AR/VR technologies continues to accumulate. The initial findings are encouraging, but large series and randomized controlled trials are necessary to determine the efficacy, safety, and cost-effectiveness of these technologies for various differing surgical subspecialties10. In the future, interdisciplinary partnerships among surgeons, software engineers, educators, and policymakers will be necessary. Institutions will have to decide whether to incorporate AR and VR into programs of surgical education and how to incorporate them into clinical practice in a responsible manner. Regulatory bodies and health care systems must work together to establish standards, processes for accreditation, and funding sources to facilitate their safe and equitable use. With this, we conclude, AR and VR are not technology supplements—they are a paradigm shift in surgery practice. They have the potential to enhance surgical accuracy, make education accessible to all, empower patients, and enhance clinical outcomes. Challenges notwithstanding, the way forward in surgery is now to embrace such innovation judiciously and ethically. The era is now to transition from pilot adoption to evidence-based adoption, so the maximum potential of AR and VR can be harnessed to the advantage of surgeons as well as patients.