Real-time image-guided and computer augmented reality in minimally invasive hepatopancreatobiliary surgery cutting edge technology transforming HPB surgery

Background: The minimally invasive hepatopancreatobiliary (MI-HPB) surgery demands a greater depth of concentration and a thorough understanding of anatomy, along with advanced technical skills for precise tissue manipulation. Robotic surgery, with its precision and refined control, is increasingly replacing conventional laparoscopic approaches in MI-HPB procedures. Modern robotic systems serve as intuitive extensions of the surgeon’s hands, offering exceptional dexterity and enhanced sensory feedback, though they remain functionally limited in some respects. The integration of augmented reality features is now feasible and holds promise as a safety enhancement, providing real-time intraoperative support to surgeons. Method: In this review article, we describe currently available real-time image technologies and their clinical applications in HPB surgery, including an indocyanine-green fluorescence view, integrated intraoperative ultrasound using a miniature drop-in probe, and novel 3D simulation imaging system. Results: The technology described in this article is readily available to support surgeons in perceiving and understanding relevant anatomy and serves as a navigation system in surgery. Technology and its users are mutually intertwined, continuously shaping and influencing one another. Conclusion: These innovations are not only redefining safety standards in minimally invasive HPB surgery but also ushering in a new era of digital surgery in HPB through increasingly advanced application of augmented reality.