JMIR Publications

ABSTRACT

Mixed reality and augmented reality technologies are increasingly being explored for intraoperative visualization, navigation, and surgical decision support. However, translation into routine surgical practice will depend not only on technical accuracy, but also on whether these systems are usable, physically tolerable, and robust in the operating-room environment. In this viewpoint, informed by selected peer-reviewed literature, we highlight three human factors domains that require greater attention in the evaluation of mixed reality surgical guidance systems: physical characteristics, dexterity and motor skills, and environmental factors. Across the literature, recurrent challenges include ergonomic burden, limited field of view, headset weight, visual and perceptual constraints, fatigue, interaction burden associated with gesture and voice control, and vulnerability to noise, glare, crowding, and occlusion in real clinical environments. Although mixed reality may improve spatial awareness and reduce attention shifts in some settings, these benefits remain constrained by persistent usability, workflow, and environmental limitations. Viewed through a broader systems human factors lens, current literature appears concentrated mainly on user-device interaction and selected task-level issues, with comparatively less attention to team, organisational, training, and governance factors. We argue that future human factors research should move beyond technical validation alone and adopt a broader systems perspective that explicitly addresses user diversity, sterile and low-burden interaction, environmental resilience, and the wider conditions required for safe clinical integration. Such an approach is essential if mixed reality surgical guidance systems are to become safe, usable, and clinically adoptable.