TeachApproach: An AR Learning Platform for Intraoperative Orientation in Anterior Minimally Invasive Hip Surgery--a Feasibility Study

Background: This study aimed to evaluate the potential of an Augmented Reality (AR) learning application to support the training of medical residents in the anterior minimally invasive approach (AMIS), with a focus on surgical performance, instructional efficiency, and user experience. Methods: We used photogrammetry to create a 3-dimensional (3D) visualization of key AMIS steps, integrating instructional content into the Magic Leap 2 head-mounted display (HMD). Eight medical residents were divided into augmented reality (AR) and traditional learning (TL) groups. Both learned the AMIS approach and performed it on a cadaveric hip, with the AR group using the AR platform and the TL group using books and videos. Primary outcomes included procedural errors and surgical performance, assessed via the Objective Structured Assessment of Technical Skill (OSATS), operating time, muscle damage, and eye-tracking data. Secondary outcomes focused on instructional efficiency and user experience, evaluated using the NASA Task Load Index (NASA-TLX), Augmented Reality Immersion (ARI), Technology Acceptance Model (TAM), System Usability Scale (SUS), and participant feedback. Results: Although statistical significance was not reached due to the limited sample size, the AR group generally outperformed the control group across several performance measures. Muscle damage was comparable, but the AR group demonstrated greater procedural accuracy, with higher OSATS checklist scores (73% vs 54%). Despite taking longer to complete the procedure (24.25 vs 18 minutes), they achieved higher global rating scale scores (58% vs 50%) and required fewer surgeon interventions (2 vs 4), indicating greater independence. Eye-tracking data linked higher dwell frequency on the 3D model with fewer surgical errors. Both groups reported high task loads, though the AR group perceived a greater workload. Nonetheless, improved accuracy and reduced need for instructor intervention—despite similar preparation time—suggest AR’s potential for effective learning. High SUS and TAM scores indicated strong usability and acceptance of the TeachApproach platform, and participants reported high overall satisfaction. Conclusion: This pilot feasibility study supports the potential of AR to enhance surgical training. Despite limitations related to small sample size and limited statistical power, the findings suggest that AR may improve learning of standard orthopedic surgical approaches.