Surgeons at Sahlgrenska University Hospital have used a new augmented-reality system to reveal tumors that lie beneath the surface of the liver during laparoscopic, or keyhole, surgery, the research team reported. The technology overlays a continually updated three-dimensional visualization of a tumor and surrounding anatomy on the surgeon’s camera view, offering guidance inside an otherwise featureless organ.
How the system works
The method combines three elements: a preoperative X-ray scan, the laparoscopic camera’s live view and a small fiducial marker placed on the liver surface. The marker is roughly one square centimeter (0.16 square inches) and contains a QR-style code. While the camera can see that sticker, the software calculates where structures beneath the tissue should appear and projects a semitransparent visualization that follows the camera angle.
"You can think of it as a GPS inside the organ. Instead of just having a map before surgery, we get continuous guidance based on the current camera angle," said Niclas Kvarnström, transplant surgeon and head of the Transplant Centre at Sahlgrenska University Hospital, who also works with Sahlgrenska Academy at the University of Gothenburg.
Mathematical tools developed by researchers at Chalmers University of Technology and the University of Gothenburg calculate the geometry required to indicate where a tumor would be visible if the liver were partially transparent, according to Torbjörn Lundh, a professor at the Department of Mathematical Sciences.
First clinical use and immediate outcome
The system was used in an operation in June 2026. Surgeons Niclas Kvarnström and Fatuma Shieriye performed the first procedure using the technology. According to the team, the augmented overlay functioned as planned during the operation and the workflow integrated with the surgical procedure. The patient was discharged the day after surgery.
Researchers described the sticker as an "artificial landmark" on the liver surface, which is normally smooth and offers few visual cues for orientation during minimally invasive procedures. That landmark, together with the camera’s tracked position and the preoperative X-ray, allows the software to compute and display the expected location of subsurface lesions.
- Marker size: about 1 square centimeter (0.16 square inches)
- First in-human use: June 2026
- Institutions involved: Chalmers University of Technology, University of Gothenburg, Sahlgrenska University Hospital and Sahlgrenska Academy
The team emphasized that the overlay updates as the camera moves, maintaining alignment with the current viewpoint. That continuous update differentiates the approach from static preoperative maps that do not reflect intraoperative camera angles.
Potential implications and next steps
Augmented reality that reliably reveals subsurface lesions could assist surgeons in locating tumors that are difficult to see on the liver surface during laparoscopic procedures. Because laparoscopic access provides limited tactile feedback and field of view compared with open surgery, the ability to visualize hidden structures in real time addresses a significant intraoperative challenge.
The development represents a cross-disciplinary effort combining transplant surgery, clinical practice and mathematical modeling. The research team framed the tool as a navigational aid that augments — rather than replaces — existing imaging and surgical judgment. Further clinical evaluations and broader clinical adoption will determine how the technology performs across a wider range of patients and tumor types.
| Feature | Detail |
|---|---|
| Marker type | QR-style sticker, ~1 cm² |
| Primary institutions | Chalmers University of Technology; University of Gothenburg; Sahlgrenska University Hospital; Sahlgrenska Academy |
| First clinical use | June 2026 |
| Immediate patient outcome | Discharged the following day |
The team’s description notes that the system depends on constant visual contact between the laparoscopic camera and the surface marker; if the marker is out of view, the overlay cannot be maintained. The researchers say the approach draws on geometric techniques to project where hidden lesions would become visible if tissue were partially transparent.
As augmented and mixed reality technologies advance in medicine, tools that can mesh live surgical imaging with preoperative scans are likely to draw attention from surgical centers seeking to improve precision in minimally invasive procedures. This instance marks an early clinical demonstration of one such approach and highlights the collaborative work required to move imaging innovations from lab to operating room.
