Mixed reality in surgical telepresence has not been practically implemented as yet and research done, until now, is only theoretical. Aiming to implement a proposed new solution by merging virtual and augmented realities and bringing about improvements by removing occlusion and the noise caused by hand motions during surgery. The proposed system consists of an extended Camshift algorithm for the detection of the remote expert surgeon’s hand during surgery and enhancement of an image synthesization algorithm to remove the occlusion by including two Red-Green-Blue-Depth (RGBD) cameras. The experimental results from 10 breast samples reduce the average accuracy error of the video frame image overlay from 1.44 mm to 1.28 mm with average processing time enhanced to 76 sec compared to the state-of-the-art method. The proposed system provides a satisfactory outcome in terms of accuracy and operating time, which allows surgeons in local and remote sites to collaborate more effectively.