Augmented Reality in Surgery: A Scoping Review

Round 1

Reviewer 1 Report

This manuscript is well aligned with the journal and special issue content. The objective of the study, which was to analyze the application of AR in medicine and which of its technical solutions are the most used, is achieved. On the other hand, the inclusion criteria for the systematic review are adequate. However, it would be advisable to expand and include more reflection in the conclusions so that they are more solid in relation to the results obtained. Finally, it is recommended to delve into the usefulness and contribution of the study to the medical scientific community.

Author Response

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Author Response File: Author Response.docx

Reviewer 2 Report

As the title indicates, the article describes a scoping review of augmented reality in the surgery domain. The authors should rephrase some how the sentence in line 101 saying that the aim of  the study is to describe the state of art relating to the use of AR in the medical field  (in general).

The first section intoduces what is augmented reality along with common techniques and hardware used. At the end of it, there are many spelling mistakes (please check line 100). The last setence promises to the reader that an analysis of different procedures used to create virtual images follows (unfortunately, it does not).

Table 1 reports most recent AR applications relevant to the scope if this research and is quite interesting along with summary provided in charts 4,5,6. However, lines 165-178 are identical to 136-150.

In Results section, there is a listing of augmented reality application (Oncology, Orthopedics, etc). It is not very clear if they came up after summary/analysis of most recent applications presented in Table 1. Authors should provide a brief introduction regarding the afforementioned categories.

The authors could consider enhancing their discussion with a summary of problems reported/addressed in the referenced articles (i.e. accuracy of VOs placement, ergonomics such as users' discomfort, etc).

Author Response

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Author Response File: Author Response.pdf

Reviewer 3 Report

The authors have advocated in their study to collect through a review of the state of the art and perform an analysis of articles employing applications, hardware and techniques in AR in image-guided surgery from 2019 to February 2022.

The topic presented in the paper is of special interest, the authors perform the search in the Scopus database, subsequently the authors in line 282 indicate that they also performed the search in Pubmed. In my opinion, it would also have been appropriate to include WoS or Google Scholar. In turn, and after carrying out the search process, the authors consider 34 articles suitable for review and analyze some aspects of interest. However, the authors do not use any reliability reference of the measurement scale, such as Crombach's alpha.

In the manuscript, two sections should be clearly differentiated: Introduction and Theoretical Background. In addition, both sections allow room for further elaboration. For example, in line 36, a collection of research [1-8] is cited, but nothing explicit is stated about that collection of sources and/or their contribution. It would be useful to explain what uses the cited works attribute to RA, what their most frequent limitations are, whether there is a strong convergence between the theses of the various works or whether there are elements of divergence, etc.

Similarly, it is reasonable that the authors have focused their attention on RA technology. However, the notion of AR may not be familiar to all potential readers of the article. It would be appropriate to spend a few words introducing what AR means and justifying in a more contextualized way that the study has focused on this type of technology for IGS.

Also, the authors' effort to illustrate with images such as Figures 3, 4, 5 or 6 is appreciated, but I believe that these data would be much better presented in tables.

Finally, I would like to emphasize the importance that the analysis, discussion and conclusions could be much better structured if the authors had previously defined research questions and developed those contributions around them. This contribution is fundamental in a systematic review of the literature or of the state of the art, since it will help the reader to understand all the aspects that the authors wish to cover and to detect in a better way the indicators of strengths and weaknesses of RA in the area of image-guided surgery in a correctly structured and justified manner.

Author Response

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Author Response File: Author Response.pdf

Reviewer 4 Report

The manuscript is a synthesis of knowledge about AR for surgery. The article is pretty well structured. 34 articles were extracted from 2,649 articles between 2019 and 2022. The article showed the development trend of AR in medical support. There are still some points to improve to make the article better and support researchers interested in AR in the field of surgery. Here are a few key suggestions for the authors to further improve the quality of the manuscript:

#1. The authors should add some illustrations of the overall image of an AR system used in surgery: it may include HMD, projector, and related components, devices... to help readers able to grasp the content of the manuscript.

#2. Some images need to be improved and modified. Specifically, in Figure 1, the author needs to edit the arrows as well as the group of elements. The font size needs to be larger to fit the image size. In figure 2, the text size is too small. 

#3. In Figure 5, the title needs to be reconsidered. It is not clear.  The Hololen 1 appears twice, and please explain more about the 'display'.

#4. In the conclusion, the author considers rewriting, there is quite a lot of overlapping content with the abstract. 

#5. Please check and correct the spelling. For example, line 100 summarized, line 143 '5' means Figure 5? And there should be consistency in the use of the words "FIgure", "Fig.", Table" and "Tab."

Author Response

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Author Response File: Author Response.pdf

Round 2

Reviewer 4 Report

Thanks for the author's responses. The article has improved for the better, however, there are still a few points that need further clarification:

#1 Figure 1 should show the workflow of an AR-enabled system, not an HMD device. The author needs show to help the reader understand the working process of AR in a surgical system.

#2 Figures 5, 6, and 7 are actually Tables, please reproduce accordingly.

Author Response

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Author Response File: Author Response.pdf

Round 3

Reviewer 4 Report

Thanks for your response 

Author Response

Thanks for your suggestions.