SP8.01 Extended reality for mapping perforator-based flaps in breast reconstruction: a systematic review and meta-analysis

Aim Advances in data processing, motion tracking, and projection technologies have expanded the potential of extended reality (ER) modalities, including augmented reality (AR) and virtual reality (VR), in surgical settings. ER applications in perioperative visualisation, planning, and simulation are promising, but their role in aiding intraoperative perforator identification for breast reconstruction remains unexplored. Methods A systematic review was conducted following PRISMA guidelines, and prospectively registered in PROSPERO (CRD42024564928). Seven databases were searched. Two reviewers independently screened articles and extracted data, resolving conflicts by consensus. Results The search identified 4957 articles, with 10 meeting inclusion criteria (229 flaps). Overall, localisation of perforator emergence with AR and VR were 4.0mm (95% CI 3.2-4.9) and 14.1mm (95% CI 5.5-22.5) respectively from the actual intraoperatively identified site. AR and VR significantly reduced harvesting time versus doppler ultrasound (19mins and 88mins respectively). Similarly, preoperative VR shortened operative times compared to doppler ultrasound (478±57mins vs 606±82mins, P<0.05). The rate of complications such as flap loss and infections where similar between ER and traditional methods of perforator identification (OR 0.6, 95% CI 0.3–1.3, P=0.20). Conclusions The results of this study suggest that ER modalities, particular AR, have high rates of accuracy for identifying perforators with reduced harvesting time compared to traditional methods. With larger sample sizes, the longitudinal effects on complications, including flap failure rates, may be determined, and their role and potential in the surgical setting be established.