Abstract / Summary
Abstract Purpose Simulation-based training is embedded in surgical curricula. Augmented reality (AR) overlays digital guidance onto real-world training environments while preserving haptic feedback, and recent systematic reviews have established that AR improves technical performance during training. None of these reviews, however, has formally assessed whether AR-acquired skill is retained over time or transfers to intraoperative or high-fidelity ex-vivo performance. This review aimed to systematically synthesise and appraise the evidence on skill retention and transfer of AR-acquired surgical skills to intraoperative or high-fidelity ex-vivo performance. Methods PubMed/MEDLINE, CINAHL, EMBASE, and Cochrane Library were searched from January 2000 to March 2026. Eligible studies used validated tools (OSATS, GOALS, GEARS, or equivalent) to assess AR skill retention beyond the immediate training session, or transfer to intraoperative or ex-vivo performance, in surgical trainees of any specialty. Two reviewers independently screened records and extracted data; quality and risk of bias were assessed using MERSQI and Cochrane RoB2, with narrative synthesis given the anticipated heterogeneity. This review followed PRISMA 2020 guidance and is registered on PROSPERO (CRD420261347095). Results Of 304 records screened, 18 underwent full-text review and 9 were included (324 participants; laparoscopic, urological, neurosurgical, and orthopaedic specialties). Skill retention was maintained for up to 8 weeks, though gains were outcome-dependent. Five studies assessed high-fidelity ex-vivo transfer and favoured AR on validated instruments; the sole intraoperative transfer study found no significant difference on primary outcomes despite fewer trainer corrections in the AR group. MERSQI scores ranged from 13.5 to 16.5 (all high quality); RoB2 showed some concerns in 7 studies and high risk in 2, predominantly from unblinded outcome assessment. Conclusions AR simulation shows technical benefits and short-term ex-vivo retention, but intraoperative transfer evidence rests on a single, constrained study, and no included study measured effect sizes or clinical outcomes. This small, heterogeneous evidence base, distinct from the technical-performance literature already synthesised elsewhere, warrants adequately powered, blinded intraoperative transfer trials before curricular implementation.