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Background <p>Intraoperative ultrasonography (IOUS) is essential in minimally invasive hepatobiliary–pancreatic surgery but requires surgeons to alternate attention between laparoscopic and ultrasound monitors, disrupting workflow. We developed Flag AR, an augmented reality system that superimposes real-time ultrasound images onto laparoscopic displays using visual marker tracking.</p> Methods <p>This prospective observational study included 14 patients undergoing minimally invasive hepatobiliary–pancreatic procedures between March and April 2025. Three experienced surgeons performed target identification tasks using both Flag AR and conventional IOUS. Eye-tracking analysis measured gaze shifts and visual focus time using wearable eye-tracking glasses.</p> Results <p>Twenty-six anatomical targets were evaluated, including liver tumors (<i>n</i> = 13), gallbladder tumors (<i>n</i> = 4), and vascular structures (<i>n</i> = 9). Although task completion time showed no significant difference between modalities (23.8 vs. 22.1&#xa0;s, <i>P</i> = 0.351), Flag AR significantly reduced gaze shifts compared to conventional IOUS (1.8 vs. 8.4 shifts, <i>P</i> &lt; 0.001) and increased time focused on a single monitor (97.9% vs. 73.8%, <i>P</i> &lt; 0.001).</p> Conclusion <p>Flag AR represents the first clinical application of purely visual marker-based ultrasound overlay technology in minimally invasive surgery. By enabling sustained visual focus on a single display, this system improves surgeon workflow efficiency during IOUS procedures without compromising task performance, potentially enhancing spatial visualization and reducing cognitive workload in complex surgical procedures.</p>

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Visual marker-based augmented reality for intraoperative ultrasound in minimally invasive surgery

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年10月23日

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  • Takeshi Takamoto,
  • Yusuke Kazami,
  • Yujiro Nishioka,
  • Akihiko Ichida,
  • Nobuhisa Akamatsu,
  • Yoshikuni Kawaguchi,
  • Kiyoshi Hasegawa

摘要

Background

Intraoperative ultrasonography (IOUS) is essential in minimally invasive hepatobiliary–pancreatic surgery but requires surgeons to alternate attention between laparoscopic and ultrasound monitors, disrupting workflow. We developed Flag AR, an augmented reality system that superimposes real-time ultrasound images onto laparoscopic displays using visual marker tracking.

Methods

This prospective observational study included 14 patients undergoing minimally invasive hepatobiliary–pancreatic procedures between March and April 2025. Three experienced surgeons performed target identification tasks using both Flag AR and conventional IOUS. Eye-tracking analysis measured gaze shifts and visual focus time using wearable eye-tracking glasses.

Results

Twenty-six anatomical targets were evaluated, including liver tumors (n = 13), gallbladder tumors (n = 4), and vascular structures (n = 9). Although task completion time showed no significant difference between modalities (23.8 vs. 22.1 s, P = 0.351), Flag AR significantly reduced gaze shifts compared to conventional IOUS (1.8 vs. 8.4 shifts, P < 0.001) and increased time focused on a single monitor (97.9% vs. 73.8%, P < 0.001).

Conclusion

Flag AR represents the first clinical application of purely visual marker-based ultrasound overlay technology in minimally invasive surgery. By enabling sustained visual focus on a single display, this system improves surgeon workflow efficiency during IOUS procedures without compromising task performance, potentially enhancing spatial visualization and reducing cognitive workload in complex surgical procedures.