Christian Heiliger

Lennart Bastian, Tobias Czempiel, Christian Heiliger et al.

The surgical operating room (OR) presents many opportunities for automation and optimization. Videos from various sources in the OR are becoming increasingly available. The medical community seeks to leverage this wealth of data to develop automated methods to advance interventional care, lower costs, and improve overall patient outcomes. Existing datasets from OR room cameras are thus far limited in size or modalities acquired, leaving it unclear which sensor modalities are best suited for tasks such as recognizing surgical action from videos. This study demonstrates that surgical action recognition performance can vary depending on the image modalities used. We perform a methodical analysis on several commonly available sensor modalities, presenting two fusion approaches that improve classification performance. The analyses are carried out on a set of multi-view RGB-D video recordings of 18 laparoscopic procedures.

Kun Yuan, Tingxuan Chen, Shi Li et al.

The complexity and diversity of surgical workflows, driven by heterogeneous operating room settings, institutional protocols, and anatomical variability, present a significant challenge in developing generalizable models for cross-institutional and cross-procedural surgical understanding. While recent surgical foundation models pretrained on large-scale vision-language data offer promising transferability, their zero-shot performance remains constrained by domain shifts, limiting their utility in unseen surgical environments. To address this, we introduce Surgical Phase Anywhere (SPA), a lightweight framework for versatile surgical workflow understanding that adapts foundation models to institutional settings with minimal annotation. SPA leverages few-shot spatial adaptation to align multi-modal embeddings with institution-specific surgical scenes and phases. It also ensures temporal consistency through diffusion modeling, which encodes task-graph priors derived from institutional procedure protocols. Finally, SPA employs dynamic test-time adaptation, exploiting the mutual agreement between multi-modal phase prediction streams to adapt the model to a given test video in a self-supervised manner, enhancing the reliability under test-time distribution shifts. SPA is a lightweight adaptation framework, allowing hospitals to rapidly customize phase recognition models by defining phases in natural language text, annotating a few images with the phase labels, and providing a task graph defining phase transitions. The experimental results show that the SPA framework achieves state-of-the-art performance in few-shot surgical phase recognition across multiple institutions and procedures, even outperforming full-shot models with 32-shot labeled data. Code is available at https://github.com/CAMMA-public/SPA

Tony Danjun Wang, Lennart Bastian, Tobias Czempiel et al.

Surgical domain models improve workflow optimization through automated predictions of each staff member's surgical role. However, mounting evidence indicates that team familiarity and individuality impact surgical outcomes. We present a novel staff-centric modeling approach that characterizes individual team members through their distinctive movement patterns and physical characteristics, enabling long-term tracking and analysis of surgical personnel across multiple procedures. To address the challenge of inter-clinic variability, we develop a generalizable re-identification framework that encodes sequences of 3D point clouds to capture shape and articulated motion patterns unique to each individual. Our method achieves 86.19% accuracy on realistic clinical data while maintaining 75.27% accuracy when transferring between different environments - a 12% improvement over existing methods. When used to augment markerless personnel tracking, our approach improves accuracy by over 50%. Through extensive validation across three datasets and the introduction of a novel workflow visualization technique, we demonstrate how our framework can reveal novel insights into surgical team dynamics and space utilization patterns, advancing methods to analyze surgical workflows and team coordination.

Maximilian Fehrentz, Nicolas Stellwag, Robert Wiebe et al.

Spatiotemporal reasoning is a fundamental capability for artificial intelligence (AI) in soft tissue surgery, paving the way for intelligent assistive systems and autonomous robotics. While 2D vision-language models show increasing promise at understanding surgical video, the spatial complexity of surgical scenes suggests that reasoning systems may benefit from explicit 4D representations. Here, we propose a framework for equipping surgical agents with spatiotemporal tools based on an explicit 4D representation, enabling AI systems to ground their natural language reasoning in both time and 3D space. Leveraging models for point tracking, depth, and segmentation, we develop a coherent 4D model with spatiotemporally consistent tool and tissue semantics. A Multimodal Large Language Model (MLLM) then acts as an agent on tools derived from the explicit 4D representation (e.g., trajectories) without any fine-tuning. We evaluate our method on a new dataset of 134 clinically relevant questions and find that the combination of a general purpose reasoning backbone and our 4D representation significantly improves spatiotemporal understanding and allows for 4D grounding. We demonstrate that spatiotemporal intelligence can be "assembled" from 2D MLLMs and 3D computer vision models without additional training. Code, data, and examples are available at https://tum-ai.github.io/surg4d/

Maximilian Fehrentz, Alexander Winkler, Thomas Heiliger et al.

We introduce BridgeSplat, a novel approach for deformable surgical navigation that couples intraoperative 3D reconstruction with preoperative CT data to bridge the gap between surgical video and volumetric patient data. Our method rigs 3D Gaussians to a CT mesh, enabling joint optimization of Gaussian parameters and mesh deformation through photometric supervision. By parametrizing each Gaussian relative to its parent mesh triangle, we enforce alignment between Gaussians and mesh and obtain deformations that can be propagated back to update the CT. We demonstrate BridgeSplat's effectiveness on visceral pig surgeries and synthetic data of a human liver under simulation, showing sensible deformations of the preoperative CT on monocular RGB data. Code, data, and additional resources can be found at https://maxfehrentz.github.io/ct-informed-splatting/ .

Tony Danjun Wang, Christian Heiliger, Nassir Navab et al.

Providing intelligent support to surgical teams is a key frontier in automated surgical scene understanding, with the long-term goal of improving patient outcomes. Developing personalized intelligence for all staff members requires maintaining a consistent state of who is located where for long surgical procedures, which still poses numerous computational challenges. We propose TrackOR, a framework for tackling long-term multi-person tracking and re-identification in the operating room. TrackOR uses 3D geometric signatures to achieve state-of-the-art online tracking performance (+11% Association Accuracy over the strongest baseline), while also enabling an effective offline recovery process to create analysis-ready trajectories. Our work shows that by leveraging 3D geometric information, persistent identity tracking becomes attainable, enabling a critical shift towards the more granular, staff-centric analyses required for personalized intelligent systems in the operating room. This new capability opens up various applications, including our proposed temporal pathway imprints that translate raw tracking data into actionable insights for improving team efficiency and safety and ultimately providing personalized support.