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Bui et al. Vessel Plus 2021;6:31 https://dx.doi.org/10.20517/2574-1209.2021.97 Page 9 of 12

Table 1. Comparison between 3D printing, virtual reality, and augmented reality
3D printing Virtual reality Augmented reality
Initial set-up costs a USD $5k to $600k Up to USD $2k Up to USD $10k
b
Recurring cost USD $100 to $2k Minimal Minimal
Processing time c Hours to days Minutes to hours Minutes to hours
Tactile experience Present Absent d Absent
e e
Learning curve Short Longer Longer
Surgical simulation Single time use Repeated use Repeated use
Environment Real Virtual Real
Use in real-time surgery Yes, only as reference No Yes
Team discussions allowed Yes Possible f Possible f
g g
Integration with EMR No Possible Possible
a b
Initial set-up cost refers to the cost of either a 3D printer, VR, or AR device, and the post-processing software. The material cost of a 3D model
c
can range from USD $100 to $2k, depending on the complexity of the model and material used. Processing time of all three modalities is
d
dependent on the complexity of the pathology, and equipment or software used. Virtual reality can sometimes be coupled with haptic devices for
e
tactile experience, but this experience is still limited. The learning curve for VR and AR simulations is user, software and hardware dependent.
f g
Team discussions on VR and AR can be possible with the correct software and hardware. Integrating VR and AR simulations with patient’s
electronic medical record is possible but is dependent on the site’s capabilities.
[50]
surgical plan that was largely unanimous and rated the overall experience as very positive . Ye et al.
[51]
agreed with the benefits of mixed reality, and concluded that the modality has higher diagnostic accuracy
and shorter surgical planning time compared to a control group using computerized 3D reconstruction of
CT angiography images in 34 DORV patients.

The use of mixed reality holograms has also proved its usefulness in telemedicine and long-distance surgical
guidance. In an experiment that measured the effectiveness of Microsoft HoloLens in telementoring, both
mentor and mentee wore the head-mounted HoloLens and communicated remotely via Skype .
[52]
Throughout the craniofacial surgical practice, there was a minimal delay in communication between the
two participants. The mentor was able to give full instructions while entirely viewing the procedures carried
out by the resident through the HoloLens. Most importantly, besides giving voice instruction, both
participants could utilize the telestration function to draw lines and arrows on 2D images in the
HoloLens . These extended features of AR technology proved it to be a useful tool for telemedicine as it
[52]
enhances long-distance communication, reduces traveling cost, enriches the knowledge among surgical
trainees, and improves patients’ access to experienced surgeons.

CONCLUSION
While some argue that VR and AR are superior to 3D cardiac models because of their magnifying
capabilities and reliable resolution that is not limited to the hardware involved, others prefer 3D printed
cardiac models because of the tactile stimulation that comes with holding the model in one’s hand. All
modalities are also limited by the availability of medical imaging like CT or MRI, reconstruction tools with
high initial set-up costs, and logistical difficulties. Despite the cons, all three modalities have proved their
usefulness in surgery as they can assist surgeons during pre-procedure planning, minimize postoperative
complications, shorten surgical hours, and improve crucial patient-physician relationships. As more
preliminary results and emerging evidence demonstrate that the use of these imaging modalities translates
to better patient outcomes, surgeons should explore the use of these technologies further and contribute to
advancing the surgical field.