The use of augmented reality technologies in urological practice

Konovalov D.V., Mashin G.A., Chinenov D.V., Astashkin I.R., Amosov A.V., Shpot E.V.

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), Moscow, Russia

Introduction. Modern urology is undergoing a technological revolution, a key component of which is the integration of augmented reality (Augmented Reality, AR). By combining virtual 3D models with the real operating-room environment in real time, AR is transforming surgical planning, intraoperative navigation, and training. This technology creates opportunities to improve procedural accuracy, reduce invasiveness, and enhance clinical outcomes, particularly in robotic and laparoscopic surgery.
Aim. To systematize current data on the use of AR technologies in urology for surgical planning, intraoperative navigation, and training, and to assess their clinical efficiency.
Materials and methods. A systematic review of publications (2019–2023) was conducted in PubMed, Scopus, and IEEE Xplore in accordance with PRISMA. Inclusion criteria: clinical studies, technical reports, and reviews on the use of AR/VR in urological surgery or training with quantitative data. A total of 26 studies were included in the final analysis.
Results. Key findings:
1. Training: AR/VR platforms (HoloLens®, STAR®, RobotiX-Mentor®) substantially improve surgical skills by reducing procedure time and error rates (e.g., a 3.6-fold decrease in instrument collisions among novices) and increasing accuracy (nerve preservation 96.6% vs 72.8%). AR-based telepresence systems with AI-driven hand tracking (98% accuracy) and AI video analysis tools have also been developed.
2. Renal surgery: AR navigation during removal of complex tumors is associated with reduced estimated blood loss (~22 mL), shorter operative time (~23 min), lower rates of warm ischemia (by 50%) and shorter ischemia duration (~4 min), fewer collecting system injuries (10.4% vs 46.5%), and higher enucleation rates. Intraoperative concordance with the 3D plan reaches 86.7%.
3. Prostate surgery (RP): 3D models/AR improve the accuracy of tumor and neurovascular bundle identification (sensitivity/specificity ~90–95% for predicting extracapsular extension), reduce positive surgical margin rates (to 2.9–6.6%), and improve functional outcomes (continence up to 94.1%, potency up to 70.6%). AI systems enable accurate targeted biopsy (87.5% in pT3).
Limitations and challenges: high equipment and operating costs (up to $1500–2000 per procedure), real-time model registration accuracy issues (misalignment up to 12%), limited and heterogeneous evidence base, and the need to improve haptic feedback in VR.
Future directions: integration of AI for navigation and analysis, development of “digital twins”, hybrid AR/VR platforms for telemedicine and training, and cloud-based solutions.
Conclusion. AR has demonstrated clinical relevance in urology by improving the accuracy, safety, and outcomes of surgery and transforming training. Despite existing technical and economic barriers, integration with AI and the development of personalized approaches are shaping the future of this technology as a key element of digital urology. Large-scale randomized clinical trials are needed to confirm long-term effectiveness and cost savings.

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About the Authors

Corresponding author: Konovalov Dmitry Valeryevich – Ph.D. student, Institute of Urology and Human Reproductive Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; e-mail: dimakonovalov1997@yandex.ru

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