Technological Advances in Intra-Operative Navigation: Integrating Fluorescence, Extended Reality, and Artificial Intelligence

Surgical navigation is a rapidly advancing area of innovation that has extended from its roots as a tool based on rigid anatomical landmarks into the complex domain of soft-tissue surgery. Three complementary technologies-fluorescence-guided surgery (FGS), extended reality (XR), and artificial intelligence (AI)-are converging to provide real-time visualisation and decision support. FGS, most often currently using indocyanine green (ICG), is now widely applied for perfusion assessment, lymphatic mapping, and biliary anatomy delineation, with growing evidence of improved surgical safety and efficacy. Targeted fluorophores are under development to enable disease-specific imaging, while XR platforms can overlay three-dimensional reconstructions onto the operative field to enhance spatial orientation. AI offers the potential to standardise interpretation, reduce variability, and analyse complex intra-operative datasets to guide surgical decisions. Despite these advances, significant barriers remain before broad clinical deployment, including technical limitations, limited high-quality evidence, training demands and regulatory and ethical challenges. The near future of surgical navigation lies in integrating FGS, XR, and AI into a cohesive system that enhances precision, safety, and outcomes and remains adaptable to future imaging and therapeutic innovations.