Evidence map›Paper›PMID 41131376›Full record

Observational studySurgical endoscopy2025

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

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

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Takeshi TakamotoHepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. takamotot-sur@h.u-tokyo.ac.jp.ORCID http://orcid.org/0000-0003-0455-6412
Yusuke KazamiHepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Yujiro NishiokaHepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Akihiko IchidaHepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Nobuhisa AkamatsuHepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Yoshikuni KawaguchiHepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Kiyoshi HasegawaHepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. Hasegawa-2su@h.u-tokyo.ac.jp.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIntraoperative 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.

methodsThis 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.

resultsTwenty-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).

conclusionFlag 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.

Indexed as

Augmented RealityLaparoscopyMinimally Invasive Surgical ProceduresUltrasonography, InterventionalAdultAgedEye-Tracking TechnologyFemaleHumansMaleMiddle AgedProspective StudiesAugmented realityEye trackingMinimally invasive surgeryNtraoperative ultrasonographyVisual marker tracking

Identifiers

PMID41131376
PMCPMC12708687

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.