Introduction: This study evaluates the role of augmented reality in image-guided surgery in contemporary surgical practice, assessing its impact on clinical outcomes, procedural accuracy, and patient safety in a prospective randomized analysis. Materials and Methods: A prospective randomized study was conducted on 150 patients from September 2019 to June 2024 at a tertiary care center. Patients were divided into AR-navigated (n=75) and Standard navigation (n=75) groups. Primary outcomes included procedural success rate, complication rates, and clinical efficacy measures. Results: The AR-navigated group demonstrated significantly improved primary outcomes compared to Standard navigation (p<0.05). Complication rates were lower in the study group, and procedural efficiency was maintained or improved. Multivariate analysis confirmed the imaging modality as an independent predictor of favorable outcomes. Conclusion: The findings support the integration of advanced imaging guidance in surgical practice, demonstrating measurable improvements in accuracy, safety, and clinical outcomes that justify the investment in imaging technology.