UK and US neurosurgeons in mixed reality first
Neurosurgeons at Imperial College Healthcare NHS Trust came together with colleagues at Penn State Health and Penn State College of Medicine in the US last week (Friday 21 February) for what is believed to be the world’s first-ever publicly documented fully-remote, multi-institution neurosurgical case discussion in mixed reality (MR).
Collaborating with XARlabs and their innovative simXAR tool, two teams of neurosurgeons wearing MR headsets (one based in London, the other Pennsylvania) presented and discussed a patient case virtually, by interacting with a high-resolution 3D hologram-like image of a patient scan. This event demonstrated how cutting-edge immersive tools are transforming the way healthcare professionals can connect, share knowledge, and learn, despite being thousands of miles apart. 
The teams reviewed different surgical strategies to tackle challenging lesions, focused on patient with a tumour extending from the eye socket to the brain.
Working with XARlabs’ technology, the teams are able to bring traditional 2D patient scans to life, converting them into 3D augmented reality models. The neurosurgeons, based at St Mary’s Hospital and Penn State Health Milton S. Hershey Medical Center, were able to interact with the model, zooming in, rotating, or even ‘walking’ inside to visualise the patient’s anatomy. The teams say this is a more dynamic and immersive approach to case discussions and clinical training. They believe that this new method of sharing learning, alongside traditional imaging techniques, has the potential to revolutionize neurosurgical education and collaboration.
Mr Arthur Dalton, consultant skull base and vascular neurosurgeon at Imperial College Healthcare NHS Trust, who led the team at St Mary’s Hospital in London, said: "I'm really delighted that we could host this groundbreaking education event and am grateful to our partners at XARlabs and Penn State College of Medicine for making this possible.
“We immediately saw the potential of this technology to make complex anatomy easily understandable. We have been gradually integrating the technology into more of our clinical training and patient consultations within our neurosurgery department. We are already seeing how it can enhance both patients’ and health professionals’ understanding of complex medical imaging.
“I am really excited about the difference we can make to our patients over the coming years - and hope our work can help the NHS remain at the forefront of this emerging technology. The patient case we reviewed here, for example, showcases just how useful this technology can become for selecting the right operation for the job and planning it accordingly.”
Dr. Ephraim Church, a cerebrovascular neurosurgeon at the Milton S. Hershey Medical Center and assistant professor of neurosurgery, neurology, and radiology at Penn State College of Medicine, said: “Augmented reality is transforming the way we approach some of our most challenging operations. In the clinic, it's a powerful tool for education, for both trainees and surgeons.
“For surgeons, it offers the opportunity to rehearse procedures beforehand. In the operating room, it serves as a navigation tool, helping guide our teams through surgery with precision. This technology is revolutionizing how we learn, plan, and perform surgery, and it's something we're all eager to explore further.”
Mixed reality, which blends 3D digital content with the real world, is regarded as the next frontier in visual computing. Unlike Virtual Reality (VR), which immerses users in a completely separate 3D environment, MR enhances the user’s perception by integrating digital and physical elements. The teams believe that the ability to interact with 3D renderings of patient scans while remaining fully aware of real-world surroundings allows for a more intuitive and collaborative approach to clinical decision-making.
Ali Haddad, founder and CEO of XARlabs, neurosurgeon, and an alumni of the NHS Clinical Entrepreneur Programme, said: "We’re thrilled to be setting a new precedent for remote surgical support, in what we believe is the world’s first fully remote, multi-institution neurosurgical case discussion in mixed reality.
“Our technology pushes the boundaries of what’s possible in modern surgical care and training. This moment marks not just a step forward for neurosurgery, but for the entire medical community.
“This technology enables a transformative approach to surgical training. In the near future, trainees will be able to observe complex cases and receive guidance from leading experts remotely, enhancing their learning experience, even in locations without access to top-tier specialists.”
The teams believe the success of this remote collaboration holds significant promise for improving access to specialist knowledge worldwide, with surgeons consulting and interacting with experts in real-time, regardless of distance.
Beyond neurosurgery, the potential applications of MR technology extend to a range of surgical specialties, including trauma and orthopedics. With its ability to offer real-time remote assistance and immersive training, MR technology could play a pivotal role in improving surgical care, safety, and efficiency across the globe.
XARlabs, working with Imperial College Healthcare, is looking to assess the technology’s potential broader benefits in medical training, patient experience, and surgical guidance, subject to ethical and regulatory approvals, including clinical trials.
