Augmented Reality in Surgical Training: Systematic Review of Its Impact on Technical Performance in Surgical Trainees.

Background: Surgical training has changed over the past decade. Augmented reality (AR) has become one of the more talked-about developments within that space. At its core, AR works by placing digital information over the real-world environment. This gives trainees guidance and spatial cues during a procedure as they perform it. What remains uncertain is whether AR moves the needle on technical skill development in trainees. The studies that address this directly are few, and the ones that do exist rarely speak to each other in any meaningful way. Outcome measures shift from paper to paper, the hardware studied spans a wide range of maturity, and methodological consistency is hard to find. Objective: This systematic review assesses the impact of AR on the objective technical skills of surgical trainees when compared with traditional methods. Methods: We searched PubMed, MEDLINE, Embase, IEEE Xplore, Scopus, and Web of Science for studies published between January 1, 2020, and September 15, 2025. From 4799 initial records, 1417 remained after deduplication. Of these, 101 underwent detailed abstract review and 29 were assessed in full text. Eleven studies met the inclusion criteria. Two reviewers (MEA and YA) independently screened all records, with a third senior reviewer (TY) resolving disagreements. We performed a narrative synthesis following SWiM (Synthesis Without Meta-Analysis) guidelines across 5 thematic domains to account for study heterogeneity. Results: The final analysis included 11 studies (347 participants across 7 specialties) published between 2021 and 2025. These included 9 randomized controlled trials and 2 prospective cohort studies. The studies used platforms such as the Microsoft HoloLens (1 and 2), Magic Leap One, and Vuzix M300XL. Of the 11 studies, 9 reported improvements in one or more objective technical metrics. Key findings included consistent error reduction (5/5 studies), faster learning curves (4/11 studies), and lower cognitive workload (3/11 studies). Notably, an "expertise reversal" effect was observed, where AR provided substantial benefits to novices but diminishing returns for experienced surgeons. Conclusions: AR significantly improves technical performance for surgical novices, particularly in tasks involving complex visuospatial reasoning. AR is an effective tool in surgical education. Future research should focus on multicenter trials to evaluate long-term skill retention and cost-effectiveness in clinical practice.