Augmented reality (AR) for surgery – investment costs and surgeons’ acceptance

Introduction Augmented reality (AR) can project visual information hands-free on goggles in a multimodal fashion. In this grant-supported (FFG) pilot study we aimed at evaluating costs for development and plastic surgeons’ acceptance of augmented reality projections of MR-A scans for marking patients planned for elective autologous perforator-based breast reconstruction. Patients & Methods Following ethical board approval we recruited 10 patients and obtained MR-A / CT-A, 3D-surface scans und doppler/ultrasound to identify perforators on the abdomen. Working hours for app development and clinical implementation were documented. User (plastic surgeon) acceptance for marking perforators in combination with doppler/ultrasound preoperatively were evaluated by the system usability scale (SUS: 25% worst imaginable usability – 100% best imaginable usability) (n=7). Results SUS revealed a 66 ±7 %(MW ±SD) „ok“ to „good“ user acceptance. The app development incorporated 1600 working hours (=Personenstunden), of which 730h for app concept / design, 570h coding, and 300h app modification. The AR algorthm for surface distorsion took 830h. Once set up, the time to clinical readiness after scanning took 147 min (from MR-A, surface scan to visual projection on the AR-system). Conclusions The working hours spent for implementing an AR system for operative planning reveal the immense upfront investment required to reach clinical readiness. Surgeons’ involvement and more importantly proper user assessment will be key for economic and scientific evaluation of new technologies. Tools for usability assessments presented in this talk provide tools for clinicians for future business evaluations.