In Norway, the health sector has recently been looking to the petroleum industry for inspiration with respect to innovative solutions for telemedicine and patient safety. In this article, the potential for and challenges associated with augmented reality (AR) tools and practices in surgery and surgical telemedicine are investigated. Work practices in co-localised surgical operations in a neurosurgical operating theatre are investigated and analysed using central organising principles for distributed collaborative work as envisioned by Integrated Operations in the petroleum industry. Digital representations are found to take on a central role in surgical work, and they show a promising potential for the future inclusion of neurosurgery into the portfolio of telemedicine. However, the article warns against organising telemedical work processes according to theoretical principles for division of labour that are not rooted in actual practices. In line with a constructivist approach to ontology, there are many realities that may be augmented, and inadequate work processes may cause construction and augmentation of inadequate realities and hence suboptimal outcomes of surgical procedures. This possibility of AR enabling both desired and undesired outcomes is in the article referred to as the Janus face of augmented reality.