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

Abstract

The advancement of surgery consistently pursues the core goals of precision, minimal invasiveness, safety and efficiency. Precise surgical navigation serves as a pivotal link for individualized and refined surgical treatment, and it plays a vital role in reducing surgical difficulty, mitigating operative risks and improving patient prognosis. A recent study applied intraoperative ultrasound combined with indocyanine green fluorescence imaging for surgical navigation in complex hepatocellular carcinoma resection, which reduced intraoperative blood loss, improved the detection rate of occult lesions, enabled timely surgical plan adjustment and lowered postoperative complication rates, while achieving superior oncological outcomes. This research inspires in-depth thinking on surgical navigation technologies. What is the current developmental status of surgical navigation technologies in general surgery? What are the main categories of available surgical navigation modalities, and what are their respective inherent strengths and limitations? Furthermore, what core trends and developmental directions will shape the evolution of surgical navigation technology in the future? This article conducts an in-depth analysis and review of the above key issues, providing references for the clinical application and further technological innovation of surgical navigation in the field of precision general surgery.

Key Words: Surgical navigation; Precision surgery; Intraoperative ultrasound; Indocyanine green fluorescence; Individualized surgery

Core Tip: Surgical advancement continuously pursues precision, minimal invasiveness, safety, and efficiency. Surgical navigation in general surgery has evolved from empirical navigation to single-modality imaging and further to multimodal integrated precision navigation. The combination of intraoperative ultrasound and indocyanine green fluorescence imaging demonstrated significant advantages with favorable safety and efficacy, as well as low application thresholds. Different navigation modalities have distinct advantages and limitations, supporting individualized selection based on disease and patient conditions. Future development will focus on artificial intelligence-assisted and next-generation digital navigation technologies to further improve surgical accuracy and safety, providing evidence for personalized and refined precision surgery.

INTRODUCTION

Surgical practice is evolving in constant pursuit of the core tenets of precision, minimal invasiveness, safety and efficiency[1-3]. For oncological diseases, traditional operations rely predominantly on surgeons’ clinical experience, preoperative imaging, laboratory examinations, and intraoperative exploration. Nevertheless, such an empirical strategy carries inherent limitations in identifying deep-seated lesions. Conventional surgery is restricted in detecting occult micro-lesions invisible on preoperative imaging, assessing potential lymph node and micrometastases, and clarifying the precise spatial anatomical relationships between tumor lesions and adjacent vascular structures[4]. These deficiencies are liable to result in an elevated positive margin rate, missed occult lesions, and consequently a higher postoperative recurrence rate. In contrast, surgical navigation technology is poised to address these clinical dilemmas by enabling accurate intraoperative localization of tumor boundaries, precise determination of resection scope, and effective protection of vital vascular structures, thus furnishing a pivotal technical underpinning for the advancement of modern precision surgery[5,6].

A compelling illustration of the clinical value of surgical navigation is the recent study conducted by Zhang et al[7], which incorporated a multimodal navigation strategy of intraoperative ultrasound (IOUS) combined with indocyanine green (ICG) fluorescence imaging into the resection of complex hepatocellular carcinoma (HCC). Their research findings confirmed that this integrated navigation approach not only reduced intraoperative blood loss, improved the detection rate of occult lesions, facilitated timely intraoperative adjustment of surgical plans and lowered the incidence of postoperative complications, but also achieved superior oncological outcomes. This high-quality single-center retrospective study yields encouraging clinical evidence, demonstrating notable improvements in surgical safety, postoperative complication control and radical tumor treatment efficacy with the application of combined surgical navigation technology. Beyond validating the tangible clinical benefits of IOUS-ICG combined navigation in complex hepatic surgery, this study further highlights the enormous application potential of surgical navigation technologies in the practice of precision surgery. More importantly, it provokes in-depth reflections on the current developmental landscape, clinical utility and future optimization directions of surgical navigation technologies, which constitutes the core impetus for the compilation of this article.

To date, the field of surgical navigation for general surgery has witnessed considerable advancement, yet critical questions remain to be addressed in clinical practice and technological development[8-10]. What is the current developmental status of surgical navigation technologies in general surgery? What are the main categories of available surgical navigation modalities, and what are their respective inherent strengths and limitations? In the context of the IOUS-ICG combined navigation approach validated in Zhang et al’s research[7], what specific clinical advantages and practical limitations does this multimodal strategy present? Furthermore, what core trends and developmental directions will shape the evolution of surgical navigation technology in the future? This article seeks to conduct an in-depth analysis and systematic discussion of these key issues, with the aim of providing insights for the clinical application and further advancement of surgical navigation technologies in precision general surgery.

DEVELOPMENT AND APPLICATION OF NAVIGATION IN SURGERY

The evolution of surgical navigation technology is inherently a process of technical iteration driven by core clinical objectives, including the accurate intraoperative localization of lesions, clear identification of anatomical boundaries, real-time alerts for anatomical variations, maximal preservation of normal tissues, and enhancement of surgical safety[8]. General surgery, as a comprehensive discipline encompassing hepatobiliary, gastrointestinal, breast, thyroid, and hernia and abdominal wall subspecialties, is characterized by diverse lesion locations, intricate anatomical structures, and frequent vascular variations. These unique challenges demand an exceptionally high level of surgical precision, thereby serving as a pivotal driving force behind the continuous development and expanding clinical application of surgical navigation technologies. To date, surgical navigation has evolved from a single auxiliary tool to a sophisticated system of multimodal integrated precision navigation (Figure 1)[5,11,12].

Figure 1 Flowchart of the evolution, clinical application and future development of surgical navigation technologies in general surgery. IOUS: Intraoperative ultrasound; ICG: Indocyanine green; 3D: Three-dimensional; AI: Artificial intelligence.

Empirical navigation

The most traditional form of surgical navigation is “empirical navigation”, which relies solely on the surgeon’s clinical experience and inherent anatomical landmarks, lacking a dedicated technical carrier. For instance, in cholecystectomy, the dissection of the cystic artery is navigated primarily by the local anatomical landmarks of the “Calot’s triangle”. In colorectal cancer (CRC) surgery, the dissection of Gerota’s fascia and Toldt’s space often uses critical anatomical structures such as the hypogastric nerves, gonadal vessels or ureters as navigational references[13]. This experience-dependent model places extremely high demands on the surgeon’s technical proficiency and clinical acumen, and it presents distinct limitations. When dealing with deep-seated lesions, micro-lesions (e.g., metastatic lymph nodes), lesions adjacent to vital blood vessels or tissues, or unexpected anatomical variations, this approach is prone to localization errors and ambiguous identification of anatomical boundaries. For example, anatomical variations of the inferior mesenteric artery and vein are quite common[14]. These shortcomings can lead to residual lesions, excessive damage to normal tissues, and increased intraoperative blood loss, ultimately resulting in elevated surgical difficulty, a higher incidence of postoperative complications, and suboptimal therapeutic outcomes. As the fundamental form of surgical navigation in general surgery, careful navigation based on physiological and anatomical landmarks still represents the primary and important approach in hospitals with limited medical resources.

Single-modality navigation technology

With the rapid advancement of medical imaging, preoperative modalities such as computed tomography and magnetic resonance imaging have laid a solid foundation for surgical planning. Preoperative imaging allows for the precise delineation of anatomical structures and the formulation of optimized surgical pathways, which serve as a roadmap for intraoperative navigation. The subsequent introduction of intraoperative imaging techniques, including intraoperative X-ray, IOUS, ICG-based intraoperative fluorescence imaging, intraoperative gastrointestinal endoscopy, and ultrasound elastography, etc., marked a paradigm shift from “empirical” to “visualized” navigation (Table 1)[15-19]. Single-modality imaging navigation has become a fundamental navigation tool in clinical practice across all subspecialties of general surgery, characterized by independent operability, strong equipment compatibility, and straightforward clinical applicability. Owing to their distinct advantages, different modalities have formed targeted application systems in hepatopancreatobiliary, gastrointestinal, breast, thyroid and other surgical disciplines.

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.

IOUS has emerged as the dominant single-modality navigation technology in hepatopancreatobiliary surgery due to its advantages of operational convenience, real-time imaging, lack of ionizing radiation, and relatively low cost[20,21]. It can clearly display the location, size, and morphology of lesions, as well as their spatial anatomical relationship with surrounding blood vessels and bile ducts, significantly improving the accuracy of localizing deep-seated lesions and reducing the rate of positive resection margins.

Intraoperative fluorescence imaging, represented primarily by ICG fluorescence imaging, is the most widely used fluorescence-based single-modality navigation technique in general surgery, demonstrating unique clinical value across multiple subspecialties[7,22,23]. In hepatobiliary surgery, it enables real-time visualization of tumor boundaries, precise segmentation of hepatic segments, and rapid assessment of hepatic tissue perfusion postoperatively[24]. In gastrointestinal surgery, it is crucial for evaluating tissue perfusion at intestinal anastomoses in gastrectomy and CRC surgery, effectively predicting the risk of anastomotic leakage, while allowing accurate localization of suspicious metastatic lymph nodes to provide a basis for individualized lymphadenectomy[25,26]. In breast surgery, ICG fluorescence imaging can be used for real-time navigated biopsy of sentinel lymph nodes in breast cancer, replacing the traditional blue dye method and improving the accuracy and convenience of lymph node detection[27]. In laparoscopic hernia repair, ICG can be used for intraoperative vascular visualization to prevent inadvertent vascular injury and rupture of the hernial sac[28].

Intraoperative X-ray (fluoroscopy) is a classic single-modality navigation technique in biliary and vascular surgery. It is characterized by rapid operation, real-time imaging, and high equipment availability. In biliary surgery, intraoperative X-ray combined with cholangiography clearly delineates biliary anatomy, stone distribution, and stricture sites, providing precise imaging guidance for common bile duct exploration and stone extraction[19]. It serves as a major navigation modality for both biliary surgery and interventional procedures.

Intraoperative endoscopy is a specialized and important navigation tool in gastrointestinal surgery. In radical gastrectomy and CRC surgery, it allows real-time localization of small lesions and marking of tumor resection margins, effectively reducing the risk of residual disease caused by inaccurate preoperative imaging. Meanwhile, intraoperative endoscopy enables intraluminal inspection and evaluation of anastomotic status to determine whether reinforcement suturing is needed, thereby lowering the incidence of anastomotic leakage[29,30].

In addition, emerging single-modality imaging techniques such as near-infrared imaging and ultrasound elastography have been increasingly adopted in general surgery. Ultrasound elastography aids in distinguishing benign from malignant thyroid and breast nodules by measuring tissue stiffness, providing valuable guidance for determining the extent of surgical resection[17,31].

However, single-modality navigation technologies are typically designed to address specific clinical needs and thus lack the versatility to meet the multifaceted demands of complex surgical procedures. For example, IOUS enables precise visualization of deep anatomical structures but cannot clearly define tumor boundaries. ICG fluorescence imaging allows visualization of tumor margins and tissue perfusion but has limited capability for exploring deep anatomical structures. Besides, intraoperative endoscopy only inspects the intraluminal condition of the gastrointestinal tract and cannot assess the spatial relationship between lesions and extraluminal vessels or tissues. This inherent limitation has catalyzed the transition toward multimodal integration.

Multimodal navigation technology

With the rapid advancement of medical imaging and digital technology, multimodal navigation technology has gradually become an important auxiliary tool in various surgical fields, effectively solving the limitations of single-modality navigation and improving the safety and precision of complex surgeries[32-34]. Different surgical fields have formed targeted multimodal navigation strategies based on their anatomical characteristics and surgical needs. The combined application of various navigation technologies, including three-dimensional (3D) reconstruction, 3D printing, augmented reality (AR), virtual reality (VR), mixed reality (MR), and artificial intelligence (AI), indicates that surgical navigation has entered the era of multimodal precision navigation (Table 2)[35,36].

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.

Hepatobiliary and pancreatic surgery involves complex anatomical structures, frequent anatomical variations, and close proximity of lesions to important blood vessels and bile ducts, making precise navigation crucial for surgical outcomes[37]. Preoperative imaging-based 3D reconstruction and 3D printing have been widely used in complex hepatobiliary and pancreatic surgeries, such as HCC resection and pancreaticoduodenectomy[38,39]. Multiple studies have demonstrated that preoperative 3D reconstruction and 3D printing can assist surgeons in surgical planning, reduce operative difficulty, enhance anatomical understanding, and decrease postoperative complications[39-41]. Further, the combination of 3D reconstruction with AR navigation is increasingly applied in pancreatic surgery and complex hepatectomy[32]. Intraoperatively, AR overlays digital models onto the surgical field in real time, enabling “perspective” visualization of deep anatomical structures and variations, which helps surgeons avoid injury to important blood vessels and bile ducts[42]. Previous studies have applied 3D printing/reconstruction combined with ICG fluorescence imaging technology for surgical navigation in complex laparoscopic hepatectomy[43,44]. This technology helps optimize and adjust surgical strategies intraoperatively, ensuring the safe and effective completion of complex laparoscopic hepatectomy. Other studies have applied AR navigation combined with ICG fluorescence imaging in laparoscopic anatomical segmentectomy, which can effectively reduce intraoperative blood loss and the incidence of remnant liver ischemia, and significantly improve patients’ oncological outcomes[45]. Encouragingly, several studies have combined AI with AR to assist surgeons in achieving accurate automated liver segmentation during surgery, yielding preliminary and satisfactory clinical outcomes[46,47].

IOUS combined with ICG fluorescence imaging is a mature and practical multimodal navigation modality for complex HCC resection, and the European Association of Endoscopic Surgery strongly recommends this combination for improving the identification of superficial liver tumours, including colorectal liver metastases (CRLM)[48]. In addition, it has been hypothesized that discontinuities in the fluorescent rim surrounding CRLM or the absence of overlying healthy hepatic parenchyma may serve as predictive indicators of potential tumour-positive resection margins[49]. However, relative to 3D reconstruction/printing and AR-related navigation technologies, this modality has unique advantages and inherent limitations in liver surgery, with its core strengths as follows. First, IOUS enables real-time visualization of deep anatomical structures to clarify the spatial relationship between tumors and adjacent blood vessels/bile ducts, while ICG fluorescence imaging identifies tumor boundaries and occult micro-lesions to facilitate precise resection and reduce residuals. Second, it has a low application threshold, requiring no complex equipment (e.g., 3D reconstruction, 3D printing, AR), which lowers promotion difficulty and cost, making it suitable for primary hospitals with limited medical resources. Third, it is easy to operate, highly real-time, radiation-free, and does not increase surgical complexity, ensuring high surgeon acceptability. However, the IOUS combined with ICG navigation also has obvious limitations. First, it is susceptible to liver dysfunction and poor perfusion, which may reduce its sensitivity for detecting small lesions[50]. Second, it lacks preoperative simulation and planning, making it difficult to adjust surgical plans intraoperatively. Third, it cannot achieve "perspective" visualization of deep anatomical variations.

Multimodal surgical navigation in gastrointestinal surgery is mainly used for precise lesion localization, resection margin identification, vascular navigation, and assessment of anastomotic perfusion. Studies have shown that in laparoscopic CRC surgery, preoperative imaging-based 3D reconstruction and 3D printing have been applied to guide anatomical navigation of critical intraoperative blood vessels, helping surgeons avoid vascular injury and optimize lymphadenectomy[14,51,52]. Besides, some studies have also used MR to assist intraoperative navigation in colorectal surgery, with advantages including improved understanding of anatomical structures, reduced surgical difficulty, and alleviated mental burden on surgeons[53,54]. As a core technique of multimodal navigation in gastrointestinal surgery, ICG fluorescence imaging offers advantages including localization of suspicious metastatic lymph nodes and evaluation of intestinal anastomotic tissue perfusion[48]. Its combination with other navigation modalities achieves synergistic effects, thereby improving the accuracy of lesion detection and anastomotic safety.

In breast surgery, ICG fluorescence replaces traditional blue dye for real-time navigation, improving lymph node detection accuracy, whereas IOUS clarifies tumor margins to enable precise resection and secure negative margins[17,55]. ICG fluorescence is expected to be combined with IOUS, thereby leveraging the complementary advantages of both navigation modalities[56].

FUTURE PERSPECTIVES

The continuous evolution of surgical navigation is closely intertwined with the rapid advancement of AI, next-generation AR, VR, and digital imaging technologies. Future surgical navigation systems are expected to evolve toward real-time, intelligent, fully integrated, and patient-tailored platforms. AI-driven image recognition, automatic anatomical segmentation, and predictive navigation may further liberate surgeons from heavy image interpretation and repetitive decision-making, enabling more consistent and standardized performance even in complex anatomical environments[8,34].

Although bold visions such as fully autonomous surgical robots, as conceptualized by some technology pioneers, remain far from clinical reality in the near future[57]. This gap arises from multiple formidable challenges. Intraoperative physiological changes and surgical complications are inherently unpredictable. Entrusting core surgical decision-making entirely to machines brings notable ethical and legal risks[58]. Additionally, there are technical hurdles in achieving real-time dynamic adaptation to the unique anatomical and pathological features of individual patients. In sharp contrast, AI-assisted intelligent navigation is a highly feasible, clinically translatable and promising development direction that aligns with current clinical needs and technological capabilities. In the foreseeable future, AI-integrated surgical navigation systems will never replace surgeons in their core roles of clinical judgment, ethical decision-making and intraoperative adaptive operation. Instead, these systems will serve as reliable, real-time and professional “intelligent surgical assistants” that complement surgeons’ clinical expertise. They provide real-time anatomical visualization and accurate early warnings of surgical risks[50]. This enhances the accuracy of lesion localization and resection, improves the safety of protecting vital structures during surgery, and increases the reproducibility of standardized surgical procedures[59]. Ultimately, these benefits translate into better short-term and long-term clinical outcomes for patients, and further drive the development of precision and personalized general surgery to a new stage.

DISCUSSION

The evolution of surgical navigation technology in general surgery is a continuous iterative process driven by unmet clinical needs and technological breakthroughs, which essentially reflects the transformation of surgical concepts from “experience-dependent” to “precision-oriented”. This article systematically traces this evolutionary trajectory: Progressing from the early empirical navigation, which relied exclusively on surgeons’ anatomical knowledge and clinical acumen, to the era of single-modality imaging navigation, and ultimately culminating in the era of multimodal integration precision navigation. The clinical study by Zhang et al[7], which applied IOUS combined with ICG fluorescence imaging in complex HCC resection, provides compelling clinical evidence for the practical value of multimodal navigation in challenging hepatobiliary surgery. This combined strategy achieves synergistic complementarity: IOUS provides real-time, visualization of deep tumors and vital structures to prevent injury, while ICG fluorescence precisely identifies tumor margins and occult lesions, thereby facilitating R0 resection. Notably, unlike 3D reconstruction, 3D printing, or AR-based navigation, this combined approach boasts superior accessibility with minimal entry barriers. Free from reliance on high-end equipment or dedicated digital teams, it is ideally suited for dissemination in institutions with constrained resources, consistent with the global push for universal access to precision healthcare.

Each navigation modality has its own strengths and limitations, which determine its clinical applicability in different scenarios. For example, 3D reconstruction combined with AR navigation excels in preoperative personalized planning and intraoperative “perspective” visualization of anatomical variations, especially in complex hepatopancreatobiliary surgeries with abnormal vascular anatomy[60,61]. However, its static preoperative models are prone to spatiotemporal mismatch caused by dynamic intraoperative anatomical changes, leading to registration errors. In contrast, ICG fluorescence imaging enables real-time intraoperative navigation and can effectively compensate for the registration deviation of AR navigation. Therefore, surgeons should make individualized and prudent selections based on surgical type, lesion characteristics, and clinical needs, and rationally combine different navigation technologies to achieve optimal intraoperative guidance.

The future development of surgical navigation technology is closely intertwined with the advancement of AI, next-generation AR, and digital imaging technologies, moving toward the direction of intelligence, real-time integration, and individualization. AI algorithms can automatically segment key anatomical structures from multimodal imaging data with higher precision and efficiency, enable real-time fusion of intraoperative images with AR views, and even predict potential anatomical variations and surgical risks, thereby providing intelligent decision-making support for surgeons[62]. This not only reduces the dependence on surgeons’ experience but also improves the standardization and reproducibility of surgical procedures. It is worth noting that while technological pioneers have proposed bold visions of fully autonomous surgical robots replacing surgeons, this remains a distant prospect in clinical practice due to ethical concerns, technical complexity, and the unpredictability of surgical scenarios[57]. In contrast, AI-assisted intelligent navigation, which serves as a reliable “intelligent assistant” rather than a replacement for surgeons, is a more feasible and promising developmental direction, as it can enhance surgical accuracy and safety while retaining the surgeon’s core decision-making role.

This article has several inherent limitations that should be acknowledged. First, this article mainly focuses on hepatopancreatobiliary and gastrointestinal surgery, and the coverage of surgical navigation in other surgical subspecialties is relatively limited. Second, this article primarily summarizes the current status of surgical navigation technologies, with relatively insufficient discussion of the ethical and economic issues related to the promotion and application of new navigation technologies (e.g., cost-effectiveness analysis, equity in access to technologies in different regions). Third, due to the rapid development of surgical navigation technologies, some latest clinical studies and technological innovations may not be fully included, which may affect the comprehensiveness of the discussion.

CONCLUSION

This review systematically summarizes the evolution of general surgery navigation from empirical to single-modality and multimodal precision navigation, clarifying the distinct strengths, limitations and clinical applicability of each modality. IOUS-ICG combined navigation stands out as practical and ease of use, while 3D reconstruction/AR offers distinct advantages in surgeries with complex anatomical structures. Future development hinges on AI and digital technologies, with AI-assisted intelligent navigation as the core direction that acts as surgeons’ reliable assistant to boost surgical precision, safety and standardization. Fully autonomous surgical robots remain clinically unfeasible for now.