This paper presents a focused, systematic review of current research on augmented reality (AR) surgical navigation, covering its established clinical applications, core technical architecture and remaining barriers to widespread adoption.
The review first maps AR surgical navigation to five high-impact clinical scenarios: neurosurgery, maxillofacial surgery, orthopaedics, vascular intervention and percutaneous puncture. It explains how these systems enable surgeons to clearly visualise the spatial relationship between lesions, critical vessels, nerves and planned surgical paths, by combining pre-operative image reconstruction, real-time instrument tracking and in-situ virtual-reality fusion. This capability directly improves surgical precision and helps reduce avoidable procedural risks.
The study then outlines the full technical pipeline that underpins reliable AR surgical navigation, including intelligent pre-operative planning, high-accuracy spatial positioning, multimodal image registration, fused visualisation and rigorous navigation performance evaluation. It also highlights persistent practical bottlenecks that limit routine clinical use: residual registration errors, dynamic soft tissue deformation, uncompensated respiratory motion and constraints on real-time imaging quality.
Looking ahead, the review identifies priority development directions that can address these gaps. These include AI-assisted anatomical segmentation, advanced non-rigid registration, deformation field modelling, compact lightweight hardware and stable multimodal real-time fusion.
The review delivers three clear, practically oriented contributions:
• It grounds technology discussion in real clinical demand, summarising use cases, representative systems and proven benefits across major surgical fields.
• It systematically unpacks the end-to-end technical workflow, clarifying which components most strongly affect clinical reliability.
• It targets unmet surgical challenges to outline actionable future paths, providing a structured reference for developing next-generation precise, intelligent and translation-ready AR surgical navigation systems.