
by videoconference) (Dinh et al., 2023), by relaying
images and audio to guide highly skilled procedures,
such as a specific diagnosis or the performance of sur-
gical or emergency interventions such as the trans-
fer of a critical patient by ambulance (Munzer et al.,
2019).
Lu et al. recently published a paper detailing their
experience of utilizing MR in the orthopedic surgical
workflow across different scenarios such as preopera-
tive planning, intraoperative guidance, surgical navi-
gation, and telesurgery consultation (Lu et al., 2022).
The study makes use of Hololens 2 and describes
in detail the different modules comprising the sys-
tem, including Data Collection and 3D Reconstruc-
tion, Cloud-Based 3D Model Storage and Rendering,
and MR Holographic Imaging.
A related work proposes an AR-based system to
remotely assist healthcare workers in taking biop-
sies (Samantaray et al., 2023), using the Microsoft
Hololens 2 headset. The system projects a 3D model
of the cervix into the real environment, allowing re-
mote annotation by specialists. Although the solution
has been tested in simulated environments with good
results, there is great potential for its application in
the remote diagnosis of cervical cancer.
Another noteworthy study involving the applica-
tion of MR in medical interventions is that of Mi-
tani et al (Mitani et al., 2021). This study repre-
sents the first reported use of this technology in the
field of otolaryngology, specifically for tumor resec-
tion. HoloLens 2 devices were utilized for each physi-
cian, allowing for the sharing and visualization of the
same holograms, alongside an associated system for
the generation of specific 3D holograms to aid in pre-
operative planning and during the intervention. A re-
lated work was presented by Ivanov and colleagues
(Ivanov et al., 2021), which reported another instance
of the HoloLens 2 device being utilized for surgical
interventions and preoperative planning, specifically
for median neck and branchial cyst excision.
Moving on to telemedicine systems based on
videoconferencing, the study published by Wang et
al. can be found (Wang et al., 2017), which presents a
HoloLens 1-based system that allows making a video-
conference and the remote intervention of the medical
expert through a 3D model of a hand that mimics the
doctor’s gestures. In 2016, Dickey et al. published
a paper presenting a system for remote guidance
of video-conferencing procedures using MR (Dickey
et al., 2016). The system allowed team planning of
the procedure and during which an expert physician
assisted the headset user via videoconference. An-
other work by Andersen et al. (Andersen et al., 2016)
shows a system (STAR, System for Telementoring
with Augmented Reality) that allows a mentor to re-
motely position annotations in the field of vision of
doctors to direct them during surgery, resulting in
improved concentration and other variables. This is
done using a tablet that acts as an AR device. The
work of Davis and colleagues (Davis et al., 2016) is
another example of a project in which AR is applied to
telemedicine. In this case, the problem of telesurgery
and its high costs compared to telepresence, i.e. the
intervention of a doctor remotely via videoconferenc-
ing, is raised. Last year, Zhang et al. presented a
study on the application of MR in telemedicine for
remote collaboration in neuroendoscopic procedures.
The system consists of a local video processing sta-
tion, a MR HMD (Hololens 2), and a remote mo-
bile device connected through 4G or 5G (Zhang et al.,
2023). Another study related to remote assistance and
tele-mentoring using MR is discussed by Tadlock et
al. in 2022 (Tadlock et al., 2022), which explores the
impact of this technology on combat casualty care-
related procedures. The authors introduce a system
composed of different devices, including HoloLens 2,
HYC Vive Pro VR, and additional cameras to record
the environments of novice participants and mentors.
Another recent paper presents Health-MR (Yin
et al., 2024), a wearable MR system designed to sup-
port medical staff in patient monitoring. Health-MR
integrates three main functions: facial recognition
for patient identification, access to medical informa-
tion from a cloud-based database, and non-invasive
heart rate monitoring using image processing and Fast
Fourier Transform (FFT). The results show that the
system streamlines the retrieval of patient information
and enables accurate, real-time monitoring.
Regarding network infrastructure for real-time
communication in telemedicine, a relevant tool is rep-
resented by WebRTC, an API that allows P2P com-
munication of audio, image, and binary data in real-
time
1
. WebRTC offers low latency and is compatible
with the most recent web browsers, making it ideal for
videoconferencing. However, there is not much work
using WebRTC in real applications for telemedicine
services. In a previously reviewed publication by
Wang et al. (Wang et al., 2017), it is noted that in
general, when adopting WebRTC, the design and im-
plementation details are very abstract and it is diffi-
cult to know which WebRTC components are being
used. In the same work, they tried to use WebRTC but
failed to integrate it with the game engine Unity. An-
other publication by Jang-Jaccard et al. (Jang-Jaccard
et al., 2016) describes a case study of the develop-
ment of a videoconferencing system for use in a real
telemedicine application based on WebRTC, enabling
1
https://webrtc.org
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