Clinical efficacy and safety of augmented reality-guided hepatic resection: a systematic review and meta-analysis

Liver resection is technically challenging due to the liver's anatomical complexity. Augmented reality (AR), especially when combined with indocyanine green (ICG) fluorescence, has been adopted to enhance resection precision, reduce intraoperative complications, and improve outcomes. This systematic review and meta-analysis aimed to evaluate whether AR-guided liver surgery is associated with reduced intraoperative bleeding and improved clinical outcomes compared to conventional techniques.

A comprehensive search was conducted in Embase, PubMed, and the Cochrane Library, following PRISMA 2020 guidelines. Studies comparing AR-guided liver resections were included. Outcomes analyzed included blood loss, transfusion rates, Clavien-Dindo classification, operative time, liver failure, surgical site infection (SSI), resection-related complications, hospital stay length, and tumor recurrence. Statistical analysis was performed using Review Manager 5.4 and R Studio 4.5, applying a random-effects model when heterogeneity was high.

Of 284 identified studies, 5 met inclusion criteria, totaling 410 patients (AR group n = 141), with 56% male and a mean age of 57 years. AR use was significantly associated with reduced blood loss (MD: -75.9 mL; 95% CI -103.4 to -48.3; p < 0.001), lower transfusion rates (RR: 0.47; 95% CI 0.26 to 0.85; p = 0.01), and fewer resection-related complications (RR: 0.64; 95% CI 0.46 to 0.90; p = 0.009). Subgroup analysis in patients with liver tumors confirmed these benefits, including a lower recurrence rate (RR: 0.52; 95% CI 0.34 to 0.79; p = 0.002). No significant differences were found for Clavien-Dindo classification, operative time, liver failure, SSI, or hospital stay duration.

AR-guided liver surgery demonstrated significant clinical benefits, notably reducing intraoperative bleeding, transfusion needs, resection-related complications, and tumor recurrence. Despite limitations in study number and methodological variability, this meta-analysis supports AR as a safe and effective tool in liver surgery, warranting further research to standardize its application.