Augmented Reality (AR)‑guided TumorMargin Identification in Oncologic Surgery

Augmented Reality (AR) has been emerging as a transformative tool in oncologic surgery, particularly for tumor margin identification. AR enhances tumor margin identification in oncologic surgery by providing surgeons with  real-time, three-dimensional (3D) representation of human anatomy, helping in accurate tumor identification and preservation of critical structures during several craniofacial surgical procedures

The integration of AR with existing medical imaging techniques, such as the MRI technology, allows doctors for more precise tumor segmentation and surgical planning.This is especially important for complex body areas like the head, neck, brain, and craniofacial region, where one wrong cut can damage the most critical structures. Due to AR, instead of looking at a screen, surgeons can see holographic images of tumors directly over the patient’s body. This helps them navigate complex structures and improve surgical accuracy during tumor margin identification.

Tumor margin identification is the process of distinguishing the boundary between the cancerous tissues and the normal tissues. This is a crucial process because the Positive margins (remaining tumor cells after surgery) increase the risk of recurrence whereas the  Negative margins (complete removal) improve survival and reduce the need for additional surgeries.

In “Complex Craniofacial Cases through Augmented Reality Guidance in Surgical Oncology: A Technical Report” (Tel et al., 2024) it was shown that AR was used to guide craniofacial tumor surgery. The report showed that AR had helped surgeons visualize the complex anatomy and identify the tumor margins, leading to safer and more accurate surgical removal.

AR has the potential to also improve surgical planning by allowing surgeons to view the tumor before cutting it. This reduces the operating time and helps surgeons avoid damaging vital body nerves and blood vessels. In more complex tumor cases, AR acts like a “digital guide” making the surgery safer and more precise. As the technology continues to develop, AR will become a standard tool in oncologic surgery, especially for tumors in parts of the body that are difficult to reach.

Another main advantage of AR is that it can improve the training and education of surgeons. Medical students as well as junior surgeons often face difficulty in understanding complex anatomical structures and how tumors interact with surrounding tissues. AR can provide them with a clear visual representation of tumor anatomy margins, making it easier for  them to understand complex surgical procedures. This can improve surgical training and help future surgeons become additionally skilled and confident. AR can also be used for preoperative simulation, allowing surgeons to practice the surgery before performing it on the patient. This improves the preparation and reduces the risk of mistakes during actual surgical procedure.

AR has its own difficulties too. The accuracy of the overlay is one of the primary issues related to AR-guided oncology. The digital pictures must closely match the patient's actual anatomy for augmented reality to be successful. Inaccurate instructions and possible mistakes might result from any kind of misalignment. This requires precise setup, efficient tracking systems, and high-quality imagery. In the operating room, the technology must also be reliable and user-friendly. During a crucial procedure, surgeons cannot afford to waste time resolving technical problems. As a result, AR systems need to be extremely efficient and user-friendly.

The price and availability of AR technologies pose another difficulty. Access to high-quality AR systems can be challenging in many hospital bodies , especially in low-income nations, because of their high cost. As only well-funded hospitals and companies  can use these advanced and modern technologies, this could lead to inequality in healthcare. However, AR is anticipated to become more widely available as technology develops and becomes more reasonably priced in the future. Additionally, businesses are creating more reasonably priced augmented reality gadgets, which might lead to the technology's expansion into an increasing number of hospitals worldwide.

AR-guided surgery has several ethical issues as well. The patients need to be made aware of the possible advantages and disadvantages of using augmented reality technology during their surgery. Surgeons must make sure that patient safety is always the top priority and that technology is handled well and properly. It should be made sure that technology doesn't take the place of a surgeon's skill. AR technology should never be utilized in place of a surgeon's skills; rather, it should always be used as a supportive tool to improve them.

AR has significant potential in tumour surgery despite all these difficulties. By enabling surgeons to see what was previously invisible, augmented reality has been revolutionising tumour surgery in oncology. AR is making surgery safer, quicker, and more precise by enhancing tumour margin identification. AR may eventually become a common technique in oncologic surgery, particularly in complicated instances where accuracy is crucial in the near future. Ultimately, AR is making surgery safer, more efficient, and more human by turning the most complex cases into predictable, successful outcomes.

Written by Bidyottama Adhikari at Incisionary

References:

Chauvet, P., Collins, T., Debize, C., Novais-Gameiro, L., Pereira, B., Bartoli, A., Canis, M., & Bourdel, N. (2018). Augmented reality in a tumor resection model. Surgical Endoscopy and Other Interventional Techniques, 32(3), 1192–1201. https://doi.org/10.1007/S00464-017-5791-7

Egbuna, I. K., Olatokun, T. P., Ozo-Ogueji, P. C., Ekechi, C. C., Akinbo, O. E., Olowe, E. N., & Amaning, R. (2025). Revolutionizing cancer surgery: Harnessing artificial intelligence and augmented reality for next-generation precision oncology. International Journal of Life Science Research Archive, 9(1), 147–176. https://doi.org/10.53771/ijlsra.2025.9.1.0051

Guerroudji, M. A., Amara, K., Lichouri, M., Zenati, N., & Masmoudi, M. (2023). A 3D visualization-based augmented reality application for brain tumor segmentation. Computer Animation and Virtual Worlds. https://doi.org/10.1002/cav.2223

Kim, H.-M., Lee, M. H., & Lee, T.-K. (2022). Application of augmented reality using neuro-navigation system for individualized brain tumor surgery. Journal of Korean Skull Base Society, 17(2), 68–74. https://doi.org/10.55911/jksbs.22.0006

Prasad, K., Fassler, C., Miller, A., Aweeda, M., Pruthi, S., Fusco, J., Daniel, B. L., Miga, M. I., Wu, J., & Topf, M. C. (2024). More than meets the eye: Augmented reality in surgical oncology. Journal of Surgical Oncology. https://doi.org/10.1002/jso.27790

Robertson, L., Mei, L., Taylor, E. N., Hughes, O. F., & Bennett, S. (2025). Augmented reality device for precision-guided tumor resection via depth-based markerless registration (Preprint). https://doi.org/10.20944/preprints202509.1586.v1

Tel, A., Raccampo, L., Vinayahalingam, S., Troise, S., Abbate, V., Dell’Aversana Orabona, G., Sembronio, S., & Robiony, M. (2024). Complex craniofacial cases through augmented reality guidance in surgical oncology: A technical report. Diagnostics, 14(11), 1108. https://doi.org/10.3390/diagnostics14111108

Tong, G., Xu, J., Pfister, M., Atoum, J., Prasad, K., Miller, A., Topf, M. C., & Wu, J. (2023). Development of an augmented reality guidance system for head and neck cancer resection (Preprint). https://doi.org/10.22541/au.170013281.19016934/v1