# Augmented Reality in Surgical Navigation: A Review of Evaluation and Validation Metrics
## 4 Discussion
### Future Outlook  
An essential prerequisite for enabling AR assisted navigation is medical imaging. The progress of AR surgical navigation is still being influenced by ingenious surgeons. To address their surgical concerns, these surgeons pushed for the development of this new technology. Thus, to better comprehend how to correlate intuitive and natural multi-sensory manipulation with the patient, some more research must be conducted. The potential for shared control in robotics will be further expanded by the integration of AR with active guidance mechanisms, leading to advancements in navigation, spatial orientation, and intra-operative confidence. AR in medical must overcome its obstacles in addition to technological ones in order to justify its cost, portability, and utility. In the field of AR based navigation surgery, the creation of new interaction strategies has received less attention than that of hardware development, precise and reliable calibration techniques, and AR visual analytics. However, properly designed interface strategies have the ability to make tasks simpler, enable more natural ways to handle image guided surgery systems and optimize surgical workflow, as well as improve how the guided visuals and augmented reality representations are perceived. Tangible user interfaces are another strategy that might offer a cutting-edge response to interactions for surgical domain management, even though they are not completely investigated in the literature. There is a lot of room for future research, especially when it comes to letting the surgeon interact within the surgical field of vision to adjust for system errors (such as brain shift, registration error, etc.). As a result, AR based image guided surgery devices could be employed more frequently and with greater accuracy. For appropriate guidance, it is necessary to have a better understanding of the spatial relationships between virtual elements in the surgical field of view and virtual anatomy, as well as their depth perception. AR will become more prevalent in clinical practice if interactivity and visualization are combined in a way that improves perception and enables correct localization of anatomy. It is also crucial to keep in mind that representation and perception are user-dependent; therefore, depending on their area of expertise, level of skill, and psychological makeup, different users will respond differently to various representations. In conclusion, this paper focused on the need for effective evaluation and validation of the AR assisted navigation systems being employed in surgery. This strategy will enable the creation of clinically applicable systems with an emphasis on evaluating adequate comprehension of key functional concepts (such as data, information, and knowledge) to support decision-making during surgery. To make sure that the reliance on the operational work domain is maintained, evaluation of the AR assisted navigation systems is necessary both at the clinical and technological levels. It will be challenging to guarantee the patient's surgical safety without a thorough validation of the system by the surgeons. Thus, the AR approach in surgery cannot be translated into a genuine product until it does not meet the stringent certification standards with a credible validation methodology. To successfully integrate AR technology into current practice, academic researchers, technical industries, and clinical users must work together to pool their knowledge, resources, and expertise in order to migrate AR based navigation technology from the research laboratory to the medical environment. With advances in computer technology and a move towards sophisticated information processing, AR navigation will soon become a more common part of surgical procedures, although further study is required to assess its long-term clinical effect on patients, surgeons, and administrators in hospitals.