Remote Support for Military Surgery Using a Head-Mounted Augmented Reality Device or a Mechanical Arm Exoscope: An Experimental Study.

INTRODUCTION: Military surgery requires a broad operative skill set to manage complex injuries. Expert support may be necessary but is often limited to voice- or image-based communication. Recent advances in telemedicine, including exoscopes and augmented reality (AR) devices, enable real-time visual guidance, yet comparative evaluation in combat surgery remains limited. This study evaluated efficiency, effectiveness, and usability of an AR device and an exoscope for intraoperative support during a military surgical intervention. MATERIALS AND METHODS: This experimental study was conducted as part of a research project of the German Bundeswehr Medical Service. Surgeons performed a simulated exploratory laparotomy on a perfused abdominal model under remote expert supervision. In a 2-arm design, telemedical support was provided using either an exoscope (VITOM-3D) or a head-mounted AR device (Microsoft HoloLens 2). Usability, functionality, user-friendliness, and technical performance were assessed using standardized questionnaires. RESULTS: Thirty-six surgeons participated (exoscope n = 20; AR n = 16). Introduction and procedure times were significantly shorter with the exoscope (P < .001). Both systems received similarly positive ratings for usability and functionality. Qualitative feedback highlighted stable visualization with the exoscope and hands-free, immersive guidance with the AR device. Nevertheless, connection loss occurred in 20% (4/20) of exoscope sessions and 50% (8/16) of AR sessions, with reconnection achieved in 2/4 and 7/8 cases, respectively. The supervising expert confirmed suitability of both systems for telemedical support with comparable learning curves. CONCLUSION: Exoscopes and AR devices demonstrated usability and effectiveness as telemedical systems in military surgery settings. Each system showed strengths and limitations, underlining the need for further research. Remote support may assist military surgeons. Further studies, clinical use cases, and data security are required.