• Florentine Huettl, Florian Heinrich, Christian Boedecker, Lukas Vradelis, Annekatrin Ludt, Werner Kneist, Hauke Lang, Christian Hansen, and Tobias Huber.
• From the Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany (Huettl, Boedecker, Vradelis, Kneist, Lang, Huber).
• J. Am. Coll. Surg. 2023 Aug 1; 237 (2): 292300292-300.

BackgroundWe developed an interactive augmented reality tool (HoloPointer) that enables real-time annotation on a laparoscopy monitor for intraoperative guidance. This application operates exclusively via verbal commands and head movements to ensure a sterile workflow.Study DesignPurpose of this randomized controlled clinical trial was to evaluate the integration of this new technology into the operating room. This prospective single-center study included 32 elective laparoscopic cholecystectomies (29 surgical teams, 15 trainees, and 13 trainers). The primary objective and assessment measure was the HoloPointer's influence on surgical performance (subjective assessment, global operative assessment of laparoscopic skills [GOALS] and critical view of safety [CVS]). The secondary objectives and outcome variables were its influence on operation time, quality of assistance (5-point Likert scale), and user-friendliness (system usability scale, 0 to 100 points).ResultsGestural corrections were reduced by 59.4% (4.6 SD 8.1 vs 1.9 SD 4.7, p > 0.05) and verbal corrections by 36.1% (17.8 SD 12.9 vs 11.4 SD 8.1, p > 0.05). Subjective surgical performance could be improved by 84.6% of participants. No statistically significant differences were observed for objective parameters GOALS, CVS, and operation time. In the system usability scale, the application achieved an average score of 72.5 SD 16.3 (good user-friendliness). Of the participants, 69.2% wanted to use the HoloPointer more frequently.ConclusionsThe majority of trainees improved their surgical performance using the HoloPointer in elective laparoscopic cholecystectomies, and the rate of classic but potentially misleading corrections was noticeably reduced. The HoloPointer has the potential to improve education in minimally invasive surgery.Copyright © 2023 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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