Could Extended Reality Visualization Decrease Blood Loss in Craniofacial Surgery?

Background: Blood loss is a major concern in craniofacial surgery due to extensive skeletal remodeling. Various strategies and technologies have been employed to mitigate blood loss, but the impact of Extended Reality (XR) visualization has not been extensively studied. This study investigates the effect of XR visualization on blood loss in craniofacial surgery. Materials and Methods: This retrospective cohort study included patients undergoing major craniofacial procedures at a tertiary academic medical center from January 2018 to February 2022. An internally developed XR system displaying Virtual Surgical Planning (VSP) data overlaid on patient anatomy was introduced in 2019. The study compared blood loss between patients who had XR-assisted surgeries (n = 17) and those who did not (n = 62). Primary outcome measured was calculated blood loss (ERCV%), and secondary outcomes included the incidence of sinus proximity bleeding, dural injuries, surgery duration, and transfusion volumes. Results: The XR-assisted group had significantly lower blood loss (43.7% vs 61.9%, P < .05). Sinus proximity bleeding during craniotomy was also significantly reduced in the XR group. More patients in the XR-assisted group avoided transfusion altogether (35% vs 24%) and tended to have fewer donor-units exposure (0.88 vs 1.34), but those trends did not reach statistical significance in our small study sample. Conclusion: In this pilot study, XR visualization in craniofacial surgery is associated with reduced blood loss and sinus proximity bleeding during craniotomy. While the study suggests XR can enhance surgical safety, larger, well-designed investigations are needed to confirm these results and fully understand the implications of XR technology in craniofacial surgery.