Multimodal image fusion system based on augmented reality and intraoperative ultrasound in laparoscopic anatomic hepatectomy for hepatocellular carcinoma

Laparoscopic anatomic hepatectomy (LAH) requires precise intraoperative navigation and spatial accuracy. We developed a multimodal image fusion system based on augmented reality (AR) and intraoperative ultrasound (IOUS), which integrates laparoscopic and ultrasound images with three-dimensional (3D) holograms into a unified visual interface, thereby facilitating intuitive comprehension of liver anatomy. Preclinical simulation experiments in porcine models demonstrated that this platform reduced surgeons’ workload, as assessed by the National Aeronautics and Space Administration Task Load Index (NASA-TLX). Corroborating these findings, this system diminished cognitive burden while enhancing surgical precision and efficiency during LAH. In a retrospective cohort study of 47 patients with hepatocellular carcinoma (HCC), system-assisted LAH was associated with shorter operative duration and inflow occlusion time, reduced intraoperative blood loss, lower postoperative aminotransferase levels and higher albumin concentrations compared with traditional methods. Notably, in indocyanine green (ICG) positive-staining LAH, the puncture success rate exhibited a significant improvement in the system-assisted group, and the resected liver volume demonstrated greater concordance with the preoperatively planned volume. These preliminary results underscore the potential clinical utility of the system in improving spatial orientation, alleviating cognitive demands, and optimizing complex surgical maneuvers during LAH, with consequent improvements in perioperative outcomes for HCC patients.