Strengths and weaknesses analysis, individualized selection and future trends of surgical navigation protocols

Table 1 Single-modality navigation technology and application scenarios

Navigation technology	Core strengths	Main application scenarios	Clinical value
IOUS	Real-time imaging, radiation-free, easy to operate, low cost, and clear visualization of deep structures	Hepatopancreatobiliary surgery	Locate deep-seated lesions; demonstrate the adjacency relationship between lesions and blood vessels/bile ducts; reduce the positive margin rate
ICG-fluorescence imaging	Real-time fluorescence imaging, capable of displaying boundaries/perfusion/Lymph nodes/blood vessels	Hepatobiliary, gastrointestinal, breast and hernia surgery	Tumor boundary visualization; hepatic segment division; anastomotic perfusion assessment; sentinel lymph node biopsy; intraoperative vascular protection
X-ray	Rapid imaging, widespread equipment availability	Biliary surgery, vascular surgery	Cholangiography and stone localization, vascular surgical intervention
Gastrointestinal endoscopy	Direct visualization inside the cavity, localization of minor lesions, and assessment of anastomotic stoma	Gastrointestinal surgery	Mark tumor margins; reduce residual lesions; evaluate anastomosis and guide reinforced suturing; lower the risk of anastomotic leakage
Ultrasound elastography	Assess tissue stiffness	Thyroid surgery, breast surgery	Differentiate benign and malignant nodules; guide the scope of surgical resection

IOUS: Intraoperative ultrasound; ICG: Indocyanine green.

Table 2 Definitions and core functions of digital technologies in surgical navigation

Technology	Definition	Core function
3D reconstruction	A digital imaging technique that reconstructs 3D tomographic data such as computed tomography and magnetic resonance imaging into 3D spatial models using computer algorithms	(1) Visualization of complex anatomical structures; (2) Preoperative surgical planning and simulation; (3) Navigation guidance during surgery; and (4) Improved communication and teaching
3D printing	A digital manufacturing technology that converts 3D virtual models into physical	More intuitive than 3D reconstruction
AI	A data-driven technology that uses algorithms to analyze medical images, identify lesions, and optimize surgical decisions, with self-learning and adaptive capabilities	(1) Automatically segment lesions and distinguish benign/malignant nodules; and (2) Predict surgical risks and optimize operation plans
XR	An umbrella term for extended reality technologies, integrating VR, AR, and MR to realize the fusion of virtual information and real surgical scenes, with immersive and interactive characteristics	/
AR	A technology that overlays virtual information (e.g., 3D anatomical models, surgical plans) onto the real surgical field, realizing real-time fusion of virtual and real images	(1) Visualize deep anatomical structures (e.g., bile duct, nerve, blood vessels); (2) Assist in accurate positioning of lesions and clear surgical boundaries; and (3) Improve the visualization effect of intraoperative navigation
VR	A technology that constructs a realistic virtual surgical environment based on patient-specific anatomical data	(1) Simulate surgical procedures and optimize surgical planning; (2) Display anatomical structures to assist surgeons in understanding intraoperative anatomy; and (3) Provide a platform for surgical training
MR	A mixed reality technology that fuses virtual anatomical models and real surgical scenes, enabling real-time interaction between surgeons and virtual information in the operating field	(1) Realize “perspective” visualization of deep anatomical structures and variations; (2) Support real-time interaction and dynamic adjustment of virtual models; and (3) Assist in protecting vital structures and improving surgical precision

3D: Three-dimensional; AI: Artificial intelligence; AR: Augmented reality; VR: Virtual reality; XR: Extended reality; MR: Mixed reality.