Surgi-HDTMR: Closing the Sensorimotor Loop in Bimanual Microsurgery via Haptics, Digital Twin, and Mixed Reality

Abstract: Robotic microsurgery demands precise bimanual control, intuitive interaction, and informative force feedback. However, most training platforms for robotic microsurgery lack immersive 3D interaction and high-fidelity haptics. Here, we present Surgi-HDTMR, a mixed-reality (MR) and digital-twin (DT) training system that couples bimanual haptic teleoperation with a benchtop microsurgical robotic platform, and 3D-printed phantoms. A metrically co-registered, time-synchronized DT aligns in-situ MR guidance with the physical workspace and drives a depth-adaptive haptic model that renders contact, puncture, and tissue-retraction forces. In a within-subjects study of simulated cortical navigation and tumor resection, Surgi-HDTMR shortened task time, reduced harmful contacts and collisions, and improved perceptual accuracy relative to non-haptic and non-adaptive baselines. These results suggest that tightly coupling MR overlays with a synchronized DT, together with depth-adaptive haptics, can accelerate skill acquisition and improve safety in robot-assisted microsurgery, pointing toward next-generation surgical training.