Augmented reality for endoscopic transsphenoidal surgery: evaluating design factors with neurosurgeons

This study investigates the potential utility of augmented reality (AR) in the endoscopic transsphenoidal approach (TSA). While previous research has addressed technical challenges in AR for TSA, this paper explores how design factors can improve AR for neurosurgeons from a human-centred design perspective.

Preliminary qualitative research involved observations of TSA procedures ( \(n=2\) $n=2$ ) and semi-structured interviews with neurosurgeons ( \(n=4\) $n=4$ ). These informed the design of an AR mockup, which was evaluated with neurosurgeons ( \(n=3\) $n=3$ ). An interactive low-fidelity prototype—the “AR-assisted Navigation for the TransSphenoidal Approach (ANTSA)”—was then developed in Unity 3D. A user study ( \(n=4\) $n=4$ ) evaluated the low-fidelity prototype of ANTSA through contextual interviews, providing feedback on design factors.

AR visualisations may be beneficial in streamlining the sellar phase and reducing intraoperative errors such as excessive or inadequate exposure. Key design recommendations include a lean mesh rendering, an intuitive colour palette, and optional structure highlighting.

This research presents user-centred design guidelines to improve sensemaking and surgical workflow in the sellar phase of TSA, with the goal of improving clinical outcomes. The specific improvements that AR could bring to the workflow are discussed along with surgeons’ reservations and its possible application towards training less experienced physicians.