Atharva Deo

Rafal Kocielnik, J. Everett Knudsen, Steven Y. Cen et al.

Verbal feedback delivered by attending surgeons in the operating room plays a critical formative role in resident trainee skill acquisition. Yet, assessing the quality of trainer feedback and its effectiveness in influencing trainee behavior during live surgery remains a challenge. Prior studies assessed feedback content relying on extensive manual annotation by expert human raters and focused on developing broad taxonomies that overlook the qualitative aspects of feedback delivery such as clarity or urgency. Limited existing automated methods, including keyword analysis and topic modeling, also fail to capture these nuanced aspects. We introduce a two-stage LLM-based framework that discovers interpretable feedback quality criteria grounded in the context of surgical training. Our method uses multi-agent prompting and surgical domain knowledge injection to discover a small set of human interpretable scoring criteria (e.g., Encouraging, Urgent, Clear). These criteria are then used to automatically score live surgical feedback via an LLM-as-a-judge approach. Evaluation on 4.2k trainer feedback instances demonstrates that our AI-discovered criteria outperform prior content-based frameworks in predicting feedback effectiveness, including observed trainee behavioral adjustments and trainer approval. This work advances scalable, human-aligned assessment of communication quality in the operating room and provides a foundation for improving surgical teaching practices.

Xi Li, Nicholas Matsumoto, Ujjwal Pasupulety et al.

Fine-grained analysis of intraoperative behavior and its impact on patient outcomes remain a longstanding challenge. We present Frame-to-Outcome (F2O), an end-to-end system that translates tissue dissection videos into gesture sequences and uncovers patterns associated with postoperative outcomes. Leveraging transformer-based spatial and temporal modeling and frame-wise classification, F2O robustly detects consecutive short (~2 seconds) gestures in the nerve-sparing step of robot-assisted radical prostatectomy (AUC: 0.80 frame-level; 0.81 video-level). F2O-derived features (gesture frequency, duration, and transitions) predicted postoperative outcomes with accuracy comparable to human annotations (0.79 vs. 0.75; overlapping 95% CI). Across 25 shared features, effect size directions were concordant with small differences (~ 0.07), and strong correlation (r = 0.96, p < 1e-14). F2O also captured key patterns linked to erectile function recovery, including prolonged tissue peeling and reduced energy use. By enabling automatic interpretable assessment, F2O establishes a foundation for data-driven surgical feedback and prospective clinical decision support.

Atharva Deo, Nicholas Matsumoto, Sun Kim et al.

We present an AI based approach to automate the End-to-end Assessment of Suturing Expertise (EASE), a suturing skills assessment tool that comprehensively defines criteria around relevant sub-skills.1 While EASE provides granular skills assessment related to suturing to provide trainees with an objective evaluation of their aptitude along with actionable insights, the scoring process is currently performed by human evaluators, which is time and resource consuming. The AI based approach solves this by enabling real-time score prediction with minimal resources during model inference. This enables the possibility of real-time feedback to the surgeons/trainees, potentially accelerating the learning process for the suturing task and mitigating critical errors during the surgery, improving patient outcomes. In this study, we focus on the following 7 EASE domains that come under 3 suturing phases: 1) Needle Handling: Number of Repositions, Needle Hold Depth, Needle Hold Ratio, and Needle Hold Angle; 2) Needle Driving: Driving Smoothness, and Wrist Rotation; 3) Needle Withdrawal: Wrist Rotation.