BackgroundDevelopments in imaging technology enable better diagnostics and, thus, also safer visceral interventions. One of the most recent developments is the use of mixed reality in the operating room, a “mixture” of reality with three-dimensional (3D) reconstructed preoperative images. Thus, we present our first experiences with the application of mixed reality in the field of liver surgery.Materials and methodsEight patients (age 62–82 years) with primary liver malignancy (n = 4) or liver metastases (n = 4) were studied and documented in this work. The time required to fully prepare the preoperative reconstructions was analyzed and the benefits of the new technology were graded by the members of the treatment team for each case. We use an open-source software for image analysis and scientific visualization preoperatively.ResultsThe time required to prepare for the operation is considerable and relevant for the everyday clinical practice (150–360 min). We were able to gain more information about tumor location and the relationship to other important intra-abdominal structures preoperatively and intraoperatively through the use of the technology. We have not yet been able to demonstrate a benefit in the area of risk minimization for the patient, faster operation times or faster recovery in this study.ConclusionMixed reality technology offers an enormous range of possible applications. In particular, it has great potential for visceral surgery, patient education, but also medical training. Further investigations are necessary to more precisely assess the advantages and disadvantages in larger case series.