Augmented reality-assisted cholangioscopy for biliary interventions: initial clinical experience in four cases

BACKGROUND: To evaluate the feasibility, safety, and workflow integration of augmented reality (AR)-assisted visualization using the Apple Vision Pro headset during live biliary interventions incorporating cholangioscopy. MATERIALS AND METHODS: In this single-center, IRB-approved pilot study, four biliary interventions were performed by a single attending interventional radiologist wearing an AR headset. Cholangioscopic video output from the SpyGlass™ DS system was transmitted via HDMI/SDI encoders over a local area network and rendered as virtual displays within the headset. The AR interface functioned as the primary visualization modality for guidance during each procedure. RESULTS: Four complex biliary cases were performed-all procedures were technically successful (100%) without complications (0%). AR-assisted visualization enabled continuous intraprocedural integration of cholangioscopy without technical failure, latency-related interruption, or breach of sterility. Qualitative operator feedback suggested improved procedural continuity, enhanced visualization during balloon dilation and stent deployment, and reduced need for repetitive head movement between monitors. The system was successfully incorporated into the standard sterile procedural workflows. CONCLUSION: AR-assisted cholangioscopy during live biliary interventions is technically feasible and safe in this initial clinical experience. Spatial computing platforms may provide workflow consolidation and ergonomic advantages during complex procedures.