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Hyperspectral imaging (HSI) is a technique that captures and processes information across a wide spectrum of wavelengths, providing detailed spectral data for each pixel in an image to identify and analyze materials or objects. In the surgical domain, it can provide quantitative and qualitative tissue information without the need of any contrast agent, thereby making it possible to distinguish between different tissue types objectively. In this article, we review the applications of hyperspectral imaging in surgery, focusing on: (1) hardware components and scanning mechanisms of HSI devices, (2) image preprocessing and processing/analysis methods, including classification, segmentation, tissue characterization, and perfusion analysis, and (3) the feasibility of HSI in various surgical procedures, based on human and animal studies. A systematic review of hyperspectral imaging based on PRISMA guideline was conducted using specific keywords: allintitle: hyperspectral AND intraoperative OR intervention OR surgery. After applying predefined inclusion and exclusion criteria, 85 papers from the literature were selected for analysis. Our systematic review shows that HSI has demonstrated significant potential as an intraoperative guidance tool, assisting surgeons during tumor resection by generating detailed tissue density maps. Additionally, HSI can play a role in hemodynamic monitoring, providing perfusion maps to assess blood flow during surgery and detect postoperative complications. Despite its promise, challenges, such as hardware limitations, real-time processing, and clinical integration remain, highlighting the need for further research and development to advance HSI in surgical applications.