Augmented Reality in Microsurgical Vascular Anastomosis: Precision, Visualization, and Educational Impact

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Abstract
Augmented reality (AR) has emerged as a promising adjunct technology in microsurgery, offering new possibilities to enhance three-dimensional visualization and technical precision during vascular anastomosis. Microsurgical procedures are inherently constrained by limited depth perception, narrow fields of view, and high demands on fine motor control, making even minor spatial errors clinically significant. This review synthesizes current evidence on the application of AR-assisted microsurgery, with a particular focus on its impact on precision, spatial orientation, depth perception, procedural efficiency, and educational utility. The analysis integrates findings from experimental validation studies, training-oriented investigations, and early clinical feasibility reports, highlighting consistent patterns across diverse AR platforms. Results indicate that AR most reliably improves precision and alignment during microvascular tasks, especially when visualization cues are tightly integrated into operative microscopy. Depth perception enhancement is frequently reported but remains dependent on overlay design and system stability, while efficiency outcomes show greater variability. In educational settings, AR demonstrates meaningful benefits in skill acquisition and task repeatability among trainees. Nevertheless, persistent technical and workflow-related constraints—such as registration accuracy, interface burden, latency, and setup complexity—continue to limit widespread adoption. Overall, AR should be regarded as a precision-enhancing support tool that complements microsurgical expertise rather than replacing it. Continued refinement in system integration, human–machine interaction, and standardization of outcome metrics will be essential to advance its role in microsurgical vascular anastomosis.