A review of recent methods and applications of virtual fixtures in robot-assisted surgery

Recent advancements in robotic technology have significantly redefined the landscape of modern surgical practices, enabling precise and efficient procedures. Despite ongoing challenges, research has consistently focused on improving patient safety, enhancing surgical accuracy, and reducing cognitive load for surgeons. This study examines the impact of haptic virtual fixtures (VFs) - a control strategy primarily employed to enhance safety, accuracy, and speed during robot-assisted manipulation tasks. We conducted a comprehensive review of the literature using the IEEE Xplore, Scopus, and ScienceDirect databases to identify articles covering multifaceted aspects of VFs, including constraint geometry definition, enforcement techniques, adaptation strategies, performance metrics, and stability analysis. A set of keywords was logically combined to retrieve relevant studies published between 2018 and 2025, which included virtual fixture, active constraint, motion constraint, surgery, robotic surgery, robot-assisted surgery, minimally invasive surgery, MIS, and RAMIS. A total of 35 relevant articles were identified following the screening process. Research indicates that VF constraints can improve surgical performance across a range of procedures, including neurosurgery, endonasal surgery, and fetal laser surgery. Moreover, VFs have proven effective in surgical training by enabling haptic guidance for trainees, helping them overcome the long learning curve. Numerous techniques are available for generating constraint geometry and enforcing it in robotics environments. Understanding the strengths and weaknesses of each approach will aid users in optimizing VFs for specific contexts. Selecting the best approach is dependent upon task and context, particularly upon the level of complexity of the surgical scenario.