Technology Assisted Intraoperative Anatomic Visualization: Surgeon Perspectives and Unmet Needs

Iatrogenic injury to critical anatomic structures remains a leading source of surgical morbidity, most commonly due to visual misperception rather than technical error. Despite a rapidly expanding ecosystem of intraoperative visualization adjuncts, the surgeon's perspective on current limitations and unmet needs has not been evaluated. The objective of this study was to characterize practicing surgeons' experiences with intraoperative anatomical visualization, the strategies and adjuncts they currently employ, the perceived limitations of available technologies, and the features they would prioritize in future solutions.

Qualitative study using semi-structured one-on-one interviews conducted between September 2025 and March 2026 at a single large academic medical center in the United States. Purposive sampling was used to recruit attending surgeons and fellows representing a range of surgical specialties and levels of experience. Interviews were transcribed and analyzed using a deductive and inductive thematic approach with team-based coding. Data analysis was conducted from October 2025 to April 2026. Outcomes were themes reflecting surgeons' perspectives on intraoperative visualization, current adjunct use, barriers to adoption of new technologies, and features of an ideal solution.

Nineteen attending surgeons and fellows were interviewed (10 [53%] males; 12 [63%] attendings; median duration of independent practice, 14.7 years [IQR, 12.2-19.0]). Five themes emerged: (1) identification of critical structures as a safety imperative tied to injury avoidance and functional preservation; (2) structural, patient-level, and case-level factors as barriers to visualization; (3) reliance on direct visualization supplemented by intraoperative adjuncts and preoperative planning, with adjuncts perceived as imprecise, workflow-disruptive, or limited in depth and specificity; (4) openness to new technology contingent on trade-offs across safety, intraoperative time, cost, operational feasibility, and training implications; and (5) convergence on two paradigms for an ideal solution: real-time, structure-specific identification within the operative field and dynamic superimposition of preoperative imaging onto the operative field.

Findings from this qualitative study suggest that surgeons evaluate new visualization technologies based on more than clinical effectiveness alone. Grounding the development and evaluation of these technologies in surgeons' experiential knowledge, and engaging explicitly with operational feasibility, cost, training, and equity of access, will improve the likelihood that emerging tools translate into improved intraoperative safety.