Austin R. Shelton

Background: Postoperative delirium is common among older adults after major surgery, especially those with cognitive impairment, and is associated with prolonged hospitalization, functional decline, mortality, and subsequent cognitive deterioration. Nonpharmacologic delirium-prevention strategies are recommended but are difficult to deliver reliably in high-acuity environments because they require repeated staff-intensive interactions, consistent patient engagement, and integration into complex intensive care unit (ICU) workflows. Objective: This study aims to evaluate the feasibility, usability, safety, acceptance, and adherence of ReCognitionVR 2.0, an immersive virtual reality (VR)–based cognitive stimulation intervention designed for older surgical ICU patients with mild-to-moderate cognitive impairment. Methods: This is a single-center, 3-arm, parallel-group randomized pilot trial. Ninety adults aged 65 years or older undergoing major surgery with expected postoperative ICU admission and Montreal Cognitive Assessment scores of 15 to 24 will be randomized in a 1:1:1 ratio to ReCognitionVR 2.0 cognitive stimulation, passive VR control exposure, or standard-of-care nurse-led reality orientation. VR sessions will be delivered once daily for up to 20 minutes on postoperative days 1 through 3 when participants are calm and alert. The primary outcomes are feasibility metrics, including recruitment, outcome completion, safety and tolerability, usability, acceptance, and adherence. Secondary outcomes estimate preliminary changes in attention and executive function using the Months Backward Test and NIH Toolbox Flanker Inhibitory Control and Attention Test. Postoperative delirium incidence is an exploratory clinical outcome. Results: This study was funded in September 2025. Participant recruitment and data collection are currently ongoing. Preliminary data quality assessments and exploratory reviews of the collected data are underway. Formal statistical analyses of the trial outcomes will be conducted after participant enrollment is completed and the study database has been finalized and locked. As of July 29, 2026, we had enrolled 18 participants. Early operational experience informed the refinement of exploratory VR performance metrics and the documentation of protocol deviations. Following an oxygen-connection near miss, we added a preintervention oxygen/readiness checklist as an operational safety safeguard. Enrollment of 90 participants is projected to be completed in 2027 if the current recruitment pace is sustained. Results are expected to be published in winter 2027. Conclusions: This protocol will generate data on feasibility, safety, usability, adherence, digital performance, cognitive assessment, and delirium measurement, all needed to optimize ReCognitionVR 2.0 and to design a future multicenter efficacy trial of VR-enabled delirium prevention in critical care.

Medical robotics has evolved significantly over the past decades, with more robotic systems than ever now in hospitals. The use of robots for surgery has already revolutionized the surgical landscape by providing high accuracy, greater surgeon dexterity, 3-dimensional visualization capabilities, and the potential for telesurgery. At the same time, diverse medical imaging modalities such as X-ray, computed tomography, magnetic resonance imaging, and ultrasound can provide meaningful visual information required for pre- and intraoperative planning and guidance, which is particularly important for robotic surgery given the surgeon’s limited direct view of the surgical workspace in minimally invasive procedures. This review provides an overview of robotics technology for surgery and image acquisition and describes the main steps involved in the processing of medical imaging and its use. The authors also share their views on what the future of robotics and imaging may look like for surgical applications given the recent advances in artificial intelligence, computer vision, and machine learning.