Virtual and augmented reality for preoperative planning in plastic surgical procedures: A systematic review

Virtual and augmented reality (VR and AR) are fast-developing technologies that allow the three-dimensional visualization of digital information.This systematic review aimed to compare the application of VR and AR to conventional methods in preoperative planning of plastic surgical procedures.A systematic literature search was conducted in Embase, Medline (Ovid), Web-of-Science, Cochrane, and Google Scholar databases on October 11, 2019. All literature comparing AR and/or VR with conventional methods for preoperative planning was collected. Only articles that studied at least one of the following outcomes were included: technical accuracy of the procedure, operative time, complications, and costs of total intervention.No articles on VR were found. Six articles were found on interventions performed with AR assistance. AR showed to be significantly better for the accuracy of osteotomies in mandibular angle osteotomies and intraoral mandible distraction compared to conventional methods. For synostotic plagiocephaly and orbital hypertelorism correction, the use of AR demonstrated a precise osteotomy. Intraoperative perforator identification in DIEP flap procedures was more accurate with AR compared to Doppler ultrasound. Harvesting time (p0.012) and operative time (p0.01) in DIEP-flap procedures and mandibular angle osteotomies, respectively, were significantly reduced if AR was used. No articles were found regarding the costs of using AR for preoperative planning.AR technology has the potential to assist the plastic surgeon in operating more accurately, safely, and fast. Studies on VR technology for preoperative planning in plastic surgery are lacking. More comparative studies are necessary, including data on clinical outcomes and cost-effectiveness.