Augmented Reality for Surgical Navigation: A Review of Advanced Needle Guidance Systems for Percutaneous Tumor Ablation.

Percutaneous tumor ablation has become a widely accepted and used treatment option for both soft and hard tissue malignancies. The current standard-of-care techniques for performing these minimally invasive procedures require providers to navigate a needle to their intended target using two-dimensional (2D) US or CT to obtain complete local response. These traditional image-guidance systems require operators to mentally transpose what is visualized on a 2D screen into the inherent three-dimensional (3D) context of human anatomy. Advanced navigation systems designed specifically for percutaneous needle-based procedures often fuse multiple imaging modalities to provide greater awareness and planned needle trajectories for the avoidance of critical structures. However, even many of these advanced systems still require mental transposition of anatomy from a 2D screen to human anatomy. Augmented reality (AR)-based systems have the potential to provide a 3D view of the patient's anatomy, eliminating the need for mental transposition by the operator. The purpose of this article is to review commercially available advanced percutaneous surgical navigation platforms and discuss the current state of AR-based navigation systems, including their potential benefits, challenges for adoption, and future developments.