Head-Mounted Displays in Context-Aware Systems for Open Surgery: A State-of-the-Art Review.

Surgical context-aware systems (SCAS), which leverage real-time data and analysis from the operating room to inform surgical activities, can be enhanced through the integration of head-mounted displays (HMDs). Rather than user-agnostic data derived from conventional, and often static, external sensors, HMD-based SCAS relies on dynamic user-centric sensing of the surgical context. The analyzed context-aware information is then augmented directly into a user's field of view via augmented reality (AR) to directly improve their task and decision-making capability. This stateof-the-art review complements previous reviews by exploring the advancement of HMD-based SCAS, including their development and impact on enhancing situational awareness and surgical outcomes in the operating room. The survey demonstrates that this technology can mitigate risks associated with gaps in surgical expertise, increase procedural efficiency, and improve patient outcomes. We also highlight key limitations still to be addressed by the research community, including improving prediction accuracy, robustly handling data heterogeneity, and reducing system latency.