Applicability of augmented reality in perioperative liver resection.

Abstract

Introduction: Liver resection ranks among the most technically demanding abdominal procedures, requiring detailed knowledge of complex three-dimensional anatomy. Augmented reality (AR) represents an innovative technology that overlays digital information on the surgical field and may serve as a tool for perioperative navigation.

Methods: A systematic search of PubMed, MEDLINE, and Cochrane databases was conducted for studies published between January 2022 and August 2025. Only articles in En-glish focusing on human subjects and describing the use of AR during liver resection were included. A total of 133 studies were identified; after removing duplicates, 67 remained. Based on predefined criteria, 10 studies were finally considered relevant for analysis.

Results: The analyzed studies involved 649 patients, of whom 245 underwent liver resection with AR assistance. Five were retrospective with control groups, three were single-arm, and one was prospective. Most studies demonstrated that AR improved intraoperative orientation, facilitated lesion localization, and could reduce blood loss and operative time. In cases of deep-seated lesions, AR was associated with wider resection margins, higher R0 resection rates, and fewer conversions. Conversely, long-term oncologic outcomes and postoperative complication rates were not consistently affected.

Conclusion: AR appears to be a safe technique with the potential to enhance the precision of liver resections and support intraoperative decision-making. Nevertheless, large prospective trials and further technological advances in registration and tissue deformation correction are required before routine clinical implementation.