Applications of the metaverse in medicine and surgery: a mini-review
The term “Metaverse” was first introduced in Neal Stephenson’s 1992 novel Snow Crash, referring to a virtual environment that transcends physical reality. In recent years, the concept has been increasingly applied in healthcare, particularly in the realms of telemedicine, medical education, and digital collaboration (1,2). However, its integration into surgical practice remains nascent. The Metaverse, integrating technologies such as virtual reality (VR), augmented reality (AR) and mixed reality (MR), enables immersive simulations and real-time interaction across distances.
VR, a technology that creates immersive and 3-dimensional (3D) digital environments in which users can immerse themselves and interact, is different from AR and MR.
AR is a technology that superimposes digital elements onto the real world, enriching the user’s perception with additional information and content, without completely replacing the physical environment.
MR instead is an emerging technology that blends VR and AR.
In surgical contexts, these tools can support training, remote consultation, operative planning and interdisciplinary discussions. Previous studies have demonstrated potential use cases in education and communication but real-world clinical implementation remains limited (3).
With verbal telementoring in open and laparoscopic surgery, and with practical telementoring connecting two or more remote robotic consoles, surgeons can improve their skills through virtual practice, breaking down the learning curve in real surgeries. Based on these concepts, expert surgeons could do remote surgery performing procedures from distant locations, homogenizing treatments also. This not only improves surgical quality but also makes the treatment of complex cases safer and improves outcomes. For these reasons, remote surgery represents a revolution in healthcare supporting care even in the most disadvantaged areas especially in critical situations or emergencies.
The use of Metaverse platform for surgical settings it has been already demonstrated for telementoring:
- Laparoscopic left colectomy of a middle-aged Caucasian men and cholecystectomy of a young Caucasian women were performed at Renato Dulbecco University Hospital (Catanzaro, Italy) under virtual supervision (4).
- Robotic left liver resection of middle-aged Caucasian men from Miulli Hospital of Acquaviva delle Fonti (Bari, Italy) during the first HepatoBilioPancreatic (HBP) workshop with important scientific presentations coordinated from the Metaverse Surgical Hospital USA (5,6).
- Robotic right colectomy of middle-aged Caucasian women broadcast from Grande Ospedale Metropolitano Hospital (Reggio Calabria, Italy) on occasion of the Iraqi Medical Conference in United Arab Emirates (UAE) (7).
- Digital pathology: remote immunohistochemical and morphovolumetric analyses performed from Renato Dulbecco University Hospital (Catanzaro, Italy) to international participants projecting an image of a tumor case at 40× magnification from AxioCam of the microscope to Metaverse in laptop application for collegial vision (7).
From 7 January 2023 to 30 April 2025, several surgical events and collaborations were conducted using SPATIAL Application (2025 Spatial Systems, Inc. All Rights Reserved) to simulate a virtual surgical hospital. All the authors and other medical specialists, residents and members of scientific societies with more or less knowledge of Hi-Tech from all over the world participated in the experiences described.
VR Platform Spatial Computing System integrates the physical world with virtual elements through technologies like AR, VR, and MR, transforming the way we work. By enabling new forms of interaction and improving productivity, communication, and training, this technology offers opportunities in sectors such as manufacturing, retail, design, medicine, and education.
In a simple way, the application has been installed by engineers on laptop with the Microsoft Windows system. After the personification with your avatar, it was possible to navigate in the parallel world and visit the virtual hospital “Metaverse Hospital USA” setting the virtual operating rooms. In the real operating rooms, laparoscopic column and robotic console were linked via High Definition Multimedia Interface (HDMI) cable to laptop to projecting and sharing real images, video and audio in the VR through functions in settings of Web Search, Create Portal or sharing directly audio-video source connected to the chosen instrument. The engineers also continuously monitored the Local Area Network (LAN) to prevent the spread of sensitive data.
This study aims to document many other applications and these suggest a pathway toward broader integration of immersive technology into clinical workflows.
Virtual education and conferences: webinar involving international faculty, including one titled “The Importance of the Metaverse to the Modern Artificial Intelligence (AI) Surgeon” (Figure 1). All participants interacted with questions by raising their hands or by writing questions in the application’s chat.
In-flight surgical consultation and emergency satellite connection: a surgical consultation conducted during a commercial flight from Rome to Dubai of ITA-Airways airlines, with the Wi-Fi 5G network provided by the plane’s crew, to improve the figure of “the doctor as an angel” for the patients who request the visit or for crew as support in case of in-flight emergencies. In the flight experiment titled “Avatar Flight Rescue Medical Team”, Professor Mohanad Al Ansari from Metaverse Hospital sent himself through avatar form and Professor Michele Ammendola was in flight from Italy to UAE (Figure 2).
Simulation of a Save Our Ship (SOS) medical alert using satellite-connected smartphones to demonstrate emergency connectivity (Figure 3). It represents the first direct connection between a patient and a virtual hospital, offering the possibility of a consultation and specialist opinion for immediate support. The ability to have a dedicated healthcare satellite connection (Figure 3A-3D) and the ability to share one’s digital medical records (Figure 3F,3G) can immediately improve patient outcomes.
Guidelines and regulations were followed for all procedures, processing of personal data, authorization to record and publish photos and videos. Ethics Committee of the Calabria Region (CET Regione Calabria) declared that it does not require specific ethical authorization, as the study does not involve the collection or processing of sensitive personal data and only utilizes anonymized data. It was not possible for the authors to identify participants during or after data collection.
Consent was obtained from all subjects involved in the study.
All sessions were conducted successfully using the SPATIAL platform. Key findings are included in Table 1.
Table 1
| Experiences | Description |
|---|---|
| Telementoring | Sessions allowed clear visualization of key anatomical landmarks and critical steps, such as ligation of the mesenteric vessels and safe identification of the cystic duct and artery |
| Digital pathology | Provided immediate access to second opinions for histological analyses with the possibility of an opinion from more experts improving diagnostic accuracy and turnaround time |
| Educational events | Enabled international participation and real-time discussion, fostering interdisciplinary learning |
| In-flight Consultation | Demonstrated uninterrupted video communication and successful remote triage of a simulated patient scenario |
| Emergency simulations | Using satellite connection showed fast data transmission, accurate geolocation and access to patient medical records |
Participants reported high satisfaction with the realism, efficiency and collaborative nature of the virtual hospital environment. No significant technical interruptions or usability issues were recorded. Each scenario was assessed based on technical functionality (audio-video quality, latency), user interaction (realism, avatar behavior), and potential clinical utility. All participants judged perceptions and experience satisfactory, effective because it offers advantages within the group (personification with avatars, video, clinical cases, scientific presentations and 3D reconstructions sharing, telementoring) and efficient because it also offers advantages outside the group being a low-cost technology.
The Metaverse represents the interactivity of different virtual worlds and technologies where users can practice many work activities. To date, there are no concrete data in the literature on its use in clinical practice and global health, particularly in surgery. Some researchers emphasize the use and applications.
Yu et al. showed the importance of the Metaverse in surgical clinical education, ultimately improving the quality and effectiveness of medical training (8). Kalbas et al., provided an overview of the “Remote Interactive Surgery Platform” (RISP)—AR-based platform for surgical telementoring—and preliminary results regarding its jotting accuracy and user experience measured with ten participants (9). Other authors describe limitations. Kayaalp et al., for example, showed and underlined some critical issues for extended reality (ER) such as high costs, sharp learning curves, limited clinical validation, ethical concerns including data security and patient privacy (10).
This study illustrates the potential of the Metaverse to transform key aspects of surgical practice, particularly in education, multidisciplinarity, second opinion, telementoring and remote diagnostics. Unlike traditional telemedicine platforms as Zoom, Teams or GoogleMeet, Metaverse technologies allow for avatar-driven interaction and immersive spatial experiences overlapping VR, AR and MR that simulate a real unique clinical environment (11,12). Based on these concepts, communication and data sharing is greatly enhanced proving to be very advantageous for patent care and clinical outcomes.
The positive aspects of Metaverse have been well described by National Aeronautics and Space Administration (NASA) Science in the recent Orion Moon Mission (Program Artemis II). Metaverse technology, encompassing VR, AR and MR, is transforming the Spatial Mission by providing high-fidelity training simulations, optimizing spacecraft design and offering real-time assistance to astronauts. NASA utilizes these technologies to prepare crews for the harsh, uncharted environments of the lunar South Pole, reducing training times and costs while increasing mission safety. Astronauts can practice procedures inside a virtual Orion spacecraft or on the future Gateway lunar station before they are fully constructed. This digital twin approach helps them familiarize themselves with controls and troubleshoot potential issues. Unlike physical field tests which take months to plan, VR labs at Johnson Space Center allow for rapid, continuous, and repeatable training for geology and extravehicular activities. During Artemis moonwalks, astronauts can use AR displays inside their helmet visors to navigate, locate equipment and follow mission-critical data in real time. The Metaverse allows science teams on Earth to collaborate in a shared virtual space with astronauts on the Moon, enabling real-time scientific direction, such as identifying, analyzing and collecting specific rock samples, even with communication delays. Using VR/AR, astronauts can operate robotic arms, rovers, and drills to build structures or extract resources, reducing the need for dangerous, in-person spacewalks. Finally, as a copilot, Metaverse systems can be coupled with AI to act as a virtual assistant, providing step-by-step guidance, object identification and tool selection during maintenance tasks, which is critical for autonomous operations when communication with Earth is interrupted.
Our early experience confirms the feasibility of using this technology in both scheduled and emergency settings. In particular, solutions as teleconferencing, laparoscopic verbal telementoring or practical robotic telementoring via the Metaverse, may reduce geographic disparities in care and training, enabling knowledge transfer to under-resourced settings thinking also about a zero-gravity surgery for spatial missions. However, several challenges must be addressed to enable wider adoption:
- Data security and patient privacy remain critical issues.
- Legal and regulatory frameworks are underdeveloped for virtual medical environments.
- Technology access and connectivity are still limited in many regions.
Despite some limitations, our findings support the Metaverse as a valuable adjunct to traditional surgical training and consultation methods. With proper safeguards and infrastructure, immersive platforms could play a key role in the future of global surgical collaboration.
Acknowledgments
None.
Footnote
Peer Review File: Available at https://asj.amegroups.com/article/view/10.21037/asj-25-82/prf
Funding: None.
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://asj.amegroups.com/article/view/10.21037/asj-25-82/coif). The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
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References
- Sandrone S. Medical education in the metaverse. Nat Med 2022;28:2456-7. [Crossref] [PubMed]
- Kim S. Metaverse: digital world, world of emerging items. Hwaseong: PlanB Design; 2020; 376 pp.
- Bai CX. Early screening and management of lung cancer: a weapon to solve the problem of lung cancer in China. International Journal of Respiration 2019;39:1601-3.
- Ammendola M, Al Ansari M, de'Angelis N, et al. The metaverse in surgery: A real life low-cost clinical application for telementoring. Asian J Surg 2023;46:4972-3. [Crossref] [PubMed]
- Ammendola M, Vescio F, Al Ansari M, et al. Metaverse and Telementoring: From Surgery to Workshop. Surg Innov 2024;31:212-9. [Crossref] [PubMed]
- Ammendola M, Memeo R, Al Ansari M. The revolution of metaverse in surgery: a mini-review with video. Updates Surg 2024;76:1699-703. [Crossref] [PubMed]
- Ammendola M, De Luca GM, Vescio F, et al. Avatar Surgeon, Digital Pathology and Telementoring: SICE New Technology and Training Research Group Experience. In: De Paolis LT, Arpaia P. Sacco M. (eds) Extended Reality. XR Salento 2024. Lecture Notes in Computer Science, vol 15028. Springer, Cham. 2024:360-8.
- Yu T, Yang Z, Zhang M, et al. The application of the metaverse in surgical clinical teaching: transforming medical education through immersive approaches. Front Oncol 2025;15:1626680. [Crossref] [PubMed]
- Kalbas Y, Jung H, Ricklin J, et al. Remote Interactive Surgery Platform (RISP): Proof of Concept for an Augmented-Reality-Based Platform for Surgical Telementoring. J Imaging 2023;9:56. [Crossref] [PubMed]
- Kayaalp ME, Konstantinou E, Karaismailoglu B, et al. The metaverse in orthopaedics: Virtual, augmented and mixed reality for advancing surgical training, arthroscopy, arthroplasty and rehabilitation. Knee Surg Sports Traumatol Arthrosc 2025;33:3039-50. [Crossref] [PubMed]
- Kye B, Han N, Kim E, et al. Educational applications of metaverse: possibilities and limitations. J Educ Eval Health Prof 2021;18:32. [Crossref] [PubMed]
- Checcucci E, Veccia A, Puliatti S, et al. Metaverse in surgery - origins and future potential. Nat Rev Urol 2026;23:50-63. [Crossref] [PubMed]
Cite this article as: Ammendola M, Vescio F, Curcio S, De Luca GM, Luposella M, de’Angelis N, Bollino C, Rizzuto A, Mazzotta AD, Memeo R, Moazin M, Khan M, Anania G, Gumbs AA, Testini M, Walsh RM, Al Ansari M. Applications of the metaverse in medicine and surgery: a mini-review. AME Surg J 2026;6:24.
