Next-Generation Liver Surgery: Integrating Artificial Intelligence, Robotics, and Nanotechnology, A Narrative Review

Liver resection for hepatocellular carcinoma (HCC) and hepatic metastases (primarily from colorectal origins, but including various primaries) demands careful navigation of anatomical complexities, tumor heterogeneity, and risks like bleeding and tissue deformation. This narrative review reframes the integration of artificial intelligence (AI), robotics, and nanotechnology within the surgical workflow preoperative planning, intraoperative execution, and postoperative monitoring emphasizing hybrid systems (defined as combinations of two or more technologies, such as AI-guided robotics with nanotechnology) that could leverage synergies for enhanced decision making. Unlike prior reviews that assess individual technologies in silos, focus on performance metrics without workflow integration, or overlook cases where hybrids fail to add value, we prioritize surgeon centered challenges, translational readiness, and barriers to adoption, drawing from 2020-2026 evidence. Emerging data suggest potential for AI's predictive analytics, robotics' dexterity, and nanotechnology's molecular targeting in hybrid setups, though evidence is often from small, retrospective cohorts with limited external validity. As hybrid surgical systems are increasingly proposed but rarely evaluated as integrated workflows, this review addresses a critical gap between technological innovation and clinical decision-making. We propose a speculative roadmap for multidisciplinary validation, addressing ethical, regulatory, and equity issues to guide cautious clinical integration. This review is primarily intended for hepatobiliary surgeons and translational researchers evaluating near to mid term clinical adoption.