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Review
. 2025 Jul 30;14(15):5385.
doi: 10.3390/jcm14155385.

Technological Advances in Pre-Operative Planning

Mikolaj R Kowal  1 , Mohammed Ibrahim  2 , André L Mihaljević  2 , Philipp Kron  2 , Peter Lodge  1
Affiliations
Review

Technological Advances in Pre-Operative Planning

Mikolaj R Kowal et al. J Clin Med. .

Abstract

Surgery remains a healthcare intervention with significant risks for patients. Novel technologies can now enhance the peri-operative workflow, with artificial intelligence (AI) and extended reality (XR) to assist with pre-operative planning. This review focuses on innovation in AI, XR and imaging for hepato-biliary surgery planning. The clinical challenges in hepato-biliary surgery arise from heterogeneity of clinical presentations, the need for multiple imaging modalities and highly variable local anatomy. AI-based models have been developed for risk prediction and multi-disciplinary tumor (MDT) board meetings. The future could involve an on-demand and highly accurate AI-powered decision tool for hepato-biliary surgery, assisting the surgeon to make the most informed decision on the treatment plan, conferring the best possible outcome for individual patients. Advances in AI can also be used to automate image interpretation and 3D modelling, enabling fast and accurate 3D reconstructions of patient anatomy. Surgical navigation systems utilizing XR are already in development, showing an early signal towards improved patient outcomes when used for hepato-biliary surgery. Live visualization of hepato-biliary anatomy in the operating theatre is likely to improve operative safety and performance. The technological advances in AI and XR provide new applications in pre-operative planning with potential for patient benefit. Their use in surgical simulation could accelerate learning curves for surgeons in training. Future research must focus on standardization of AI and XR study reporting, robust databases that are ethically and data protection-compliant, and development of inter-disciplinary tools for various healthcare applications and systems.

Keywords: 3D imaging; AR in surgery; artificial intelligence in surgery; extended realities; robotic surgery; surgical navigation; surgical training.

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Conflict of interest statement

Author P.L. has previously acted as a paid consultant for HoloCare Limited but declares no non-financial competing interests. All other authors declare no financial or non-financial competing interests.

Figures

Figure 1
Figure 1
Innovation in pre-operative planning.
Figure 2
Figure 2
Illustration of imaging fusion for hepatic anatomy.
Figure 3
Figure 3
Images from HoloCare© Studio for liver surgery planning, 3D reconstructions of CRLMs using portal venous phase CT images (blue: hepatic veins; purple: portal veins; yellow: CRLM). (a) Single large CRLM threatening FLR; (b) multiple CRLMs in close proximity to hepatic and portal veins.
Figure 4
Figure 4
Graphical illustration of extended reality technology.
Figure 5
Figure 5
Picture illustrating patient consultation using a 3D hologram. Image from HoloCare©.
See this image and copyright information in PMC

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