Prospective Clinical Evidence on Artificial Intelligence-Enabled Augmented and Mixed Reality in Robot-Assisted...

Intraoperative digital guidance is increasingly being integrated into robot-assisted radical prostatectomy and robot-assisted partial nephrectomy to improve oncological precision while preserving functional outcomes. The supporting clinical evidence remains limited and heterogeneous. This systematic review, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and prospectively registered in PROSPERO (CRD420261400733), searched PubMed, Ovid Embase, and the Cochrane Library for English-language studies published between 1 January 2025 and 20 May 2026. Eligible studies were prospective investigations involving adults undergoing robot-assisted radical prostatectomy or robot-assisted partial nephrectomy for primary urological malignancy, evaluating intraoperative augmented reality, mixed reality, artificial intelligence (AI)-assisted pathology, and related image-guided technologies with at least one patient-level clinical or diagnostic endpoint. Narrative synthesis was performed because of substantial heterogeneity, and risk of bias was assessed using design-specific tools. Of the 131 records screened, 93 were excluded at the title and abstract screening stage, 22 reports underwent full-text eligibility assessment after removal of duplicates, 16 reports were excluded at the full-text eligibility assessment stage, and six studies were included in the narrative synthesis. In radical prostatectomy, 3D AI-augmented reality guidance and AI-enhanced stimulated Raman histopathology showed promising signals for surgical margin control, adjuvant treatment, continence, and intraoperative margin assessment. In partial nephrectomy, mixed reality improved warm ischaemia time and clamping strategy, while 3D image-guided surgery demonstrated acceptable medium-term oncological and functional outcomes. Overall, prospective evidence suggests that intraoperative digital guidance may improve selected oncological, functional, technical, and diagnostic outcomes in robotic urological surgery, but larger multicentre comparative trials with standardised endpoints and longer follow-up are required.