Systematic review of augmented reality in urological interventions: the evidences of an impact on surgical outcomes are yet to come

Vol.:(0123456789)1 3World Journal of Urology (2020) 38:2167–2176 https://doi.org/10.1007/s00345-019-02711-z INVITED REVIEW Systematic review of augmented reality in urological interventions: the evidences of an impact on surgical outcomes are yet to come Riccardo Bertolo1,2 · Andrew Hung3 · Francesco Porpiglia4 · Pierluigi Bove2 · Mary Schleicher5 · Prokar Dasgupta6 Received: 28 November 2018 / Accepted: 26 February 2019 / Published online: 2 March 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Purpose To perform a systematic literature review on the clinical impact of augmented reality (AR) for urological interventions. Methods As of June 21, 2018, systematic literature review was performed via Medline, Embase and Cochrane databases in accordance with the PRISMA guidelines and registered at PROSPERO (CRD42018102194). Only full text articles in English were included, without time restrictions. Articles were considered if they reported on the use of AR during uro- logical intervention and the impact on the surgical outcomes. The risk of bias and the quality of each study included were independently assessed using the standard Cochrane Collaboration risk of bias tool and the Risk Of Bias In Non-randomised Studies—of Interventions Tool (ROBINS-I). Results 131 articles were identified. 102 remained after duplicate removal and were critically reviewed for evidence synthesis. 20 studies reporting on the outcomes of the use of AR during urological interventions in a clinical setting were considered. Given the mostly non-comparative design of the studies identified, the evidence synthesis was performed in a descriptive and narrative manner. Only one comparative study was found, with the remaining 19 items being single-arm observational studies. Based on the existing evidence, we are unable to state that AR improves the outcomes of urological interventions. The major limitation of AR-assisted surgery is inaccuracy in registration, translating into a poor navigation precision. Conclusions To date, there is limited evidence showing superior therapeutic benefits of AR-guided surgery when compared with the conventional surgical approach to the respective disease.