Diego Dall'Alba

Ameya Pore, Martina Finocchiaro, Diego Dall'Alba et al.

Flexible endoscopes for colonoscopy present several limitations due to their inherent complexity, resulting in patient discomfort and lack of intuitiveness for clinicians. Robotic devices together with autonomous control represent a viable solution to reduce the workload of endoscopists and the training time while improving the overall procedure outcome. Prior works on autonomous endoscope control use heuristic policies that limit their generalisation to the unstructured and highly deformable colon environment and require frequent human intervention. This work proposes an image-based control of the endoscope using Deep Reinforcement Learning, called Deep Visuomotor Control (DVC), to exhibit adaptive behaviour in convoluted sections of the colon tract. DVC learns a mapping between the endoscopic images and the control signal of the endoscope. A first user study of 20 expert gastrointestinal endoscopists was carried out to compare their navigation performance with DVC policies using a realistic virtual simulator. The results indicate that DVC shows equivalent performance on several assessment parameters, being more safer. Moreover, a second user study with 20 novice participants was performed to demonstrate easier human supervision compared to a state-of-the-art heuristic control policy. Seamless supervision of colonoscopy procedures would enable interventionists to focus on the medical decision rather than on the control problem of the endoscope.

Sanat Ramesh, Diego Dall'Alba, Cristians Gonzalez et al.

Automatic recognition of fine-grained surgical activities, called steps, is a challenging but crucial task for intelligent intra-operative computer assistance. The development of current vision-based activity recognition methods relies heavily on a high volume of manually annotated data. This data is difficult and time-consuming to generate and requires domain-specific knowledge. In this work, we propose to use coarser and easier-to-annotate activity labels, namely phases, as weak supervision to learn step recognition with fewer step annotated videos. We introduce a step-phase dependency loss to exploit the weak supervision signal. We then employ a Single-Stage Temporal Convolutional Network (SS-TCN) with a ResNet-50 backbone, trained in an end-to-end fashion from weakly annotated videos, for temporal activity segmentation and recognition. We extensively evaluate and show the effectiveness of the proposed method on a large video dataset consisting of 40 laparoscopic gastric bypass procedures and the public benchmark CATARACTS containing 50 cataract surgeries.

Giovanni Menegozzo, Diego Dall'Alba, Paolo Fiorini

Causal relationships are commonly examined in manufacturing processes to support faults investigations, perform interventions, and make strategic decisions. Industry 4.0 has made available an increasing amount of data that enable data-driven Causal Discovery (CD). Considering the growing number of recently proposed CD methods, it is necessary to introduce strict benchmarking procedures on publicly available datasets since they represent the foundation for a fair comparison and validation of different methods. This work introduces two novel public datasets for CD in continuous manufacturing processes. The first dataset employs the well-known Tennessee Eastman simulator for fault detection and process control. The second dataset is extracted from an ultra-processed food manufacturing plant, and it includes a description of the plant, as well as multiple ground truths. These datasets are used to propose a benchmarking procedure based on different metrics and evaluated on a wide selection of CD algorithms. This work allows testing CD methods in realistic conditions enabling the selection of the most suitable method for specific target applications. The datasets are available at the following link: https://github.com/giovanniMen

Sabina Martyniak, Joanna Kaleta, Diego Dall'Alba et al.

Computer-assisted surgical (CAS) systems enhance surgical execution and outcomes by providing advanced support to surgeons. These systems often rely on deep learning models trained on complex, challenging-to-annotate data. While synthetic data generation can address these challenges, enhancing the realism of such data is crucial. This work introduces a multi-stage pipeline for generating realistic synthetic data, featuring a fully-fledged surgical simulator that automatically produces all necessary annotations for modern CAS systems. This simulator generates a wide set of annotations that surpass those available in public synthetic datasets. Additionally, it offers a more complex and realistic simulation of surgical interactions, including the dynamics between surgical instruments and deformable anatomical environments, outperforming existing approaches. To further bridge the visual gap between synthetic and real data, we propose a lightweight and flexible image-to-image translation method based on Stable Diffusion (SD) and Low-Rank Adaptation (LoRA). This method leverages a limited amount of annotated data, enables efficient training, and maintains the integrity of annotations generated by our simulator. The proposed pipeline is experimentally validated and can translate synthetic images into images with real-world characteristics, which can generalize to real-world context, thereby improving both training and CAS guidance. The code and the dataset are available at https://github.com/SanoScience/SimuScope.

Joel L. Lavanchy, Sanat Ramesh, Diego Dall'Alba et al.

Most studies on surgical activity recognition utilizing Artificial intelligence (AI) have focused mainly on recognizing one type of activity from small and mono-centric surgical video datasets. It remains speculative whether those models would generalize to other centers. In this work, we introduce a large multi-centric multi-activity dataset consisting of 140 videos (MultiBypass140) of laparoscopic Roux-en-Y gastric bypass (LRYGB) surgeries performed at two medical centers: the University Hospital of Strasbourg (StrasBypass70) and Inselspital, Bern University Hospital (BernBypass70). The dataset has been fully annotated with phases and steps. Furthermore, we assess the generalizability and benchmark different deep learning models in 7 experimental studies: 1) Training and evaluation on BernBypass70; 2) Training and evaluation on StrasBypass70; 3) Training and evaluation on the MultiBypass140; 4) Training on BernBypass70, evaluation on StrasBypass70; 5) Training on StrasBypass70, evaluation on BernBypass70; Training on MultiBypass140, evaluation 6) on BernBypass70 and 7) on StrasBypass70. The model's performance is markedly influenced by the training data. The worst results were obtained in experiments 4) and 5) confirming the limited generalization capabilities of models trained on mono-centric data. The use of multi-centric training data, experiments 6) and 7), improves the generalization capabilities of the models, bringing them beyond the level of independent mono-centric training and validation (experiments 1) and 2)). MultiBypass140 shows considerable variation in surgical technique and workflow of LRYGB procedures between centers. Therefore, generalization experiments demonstrate a remarkable difference in model performance. These results highlight the importance of multi-centric datasets for AI model generalization to account for variance in surgical technique and workflows.

Joanna Kaleta, Weronika Smolak-Dyżewska, Dawid Malarz et al.

Endoluminal endoscopic procedures are essential for diagnosing colorectal cancer and other severe conditions in the digestive tract, urogenital system, and airways. 3D reconstruction and novel-view synthesis from endoscopic images are promising tools for enhancing diagnosis. Moreover, integrating physiological deformations and interaction with the endoscope enables the development of simulation tools from real video data. However, constrained camera trajectories and view-dependent lighting create artifacts, leading to inaccurate or overfitted reconstructions. We present PR-ENDO, a novel 3D reconstruction framework leveraging the unique property of endoscopic imaging, where a single light source is closely aligned with the camera. Our method separates light effects from tissue properties. PR-ENDO enhances 3D Gaussian Splatting with a physically based relightable model. We boost the traditional light transport formulation with a specialized MLP capturing complex light-related effects while ensuring reduced artifacts and better generalization across novel views. PR-ENDO achieves superior reconstruction quality compared to baseline methods on both public and in-house datasets. Unlike existing approaches, PR-ENDO enables tissue modifications while preserving a physically accurate response to light, making it closer to real-world clinical use.

Lorenzo Busellato, Federico Cunico, Diego Dall'Alba et al.

To enable flexible, high-throughput automation in settings where people and robots share workspaces, collaborative robotic cells must reconcile stringent safety guarantees with the need for responsive and effective behavior. A dynamic obstacle is the stochastic, task-dependent variability of human motion: when robots fall back on purely reactive or worst-case envelopes, they brake unnecessarily, stall task progress, and tamper with the fluidity that true Human-Robot Interaction demands. In recent years, learning-based human-motion prediction has rapidly advanced, although most approaches produce worst-case scenario forecasts that often do not treat prediction uncertainty in a well-structured way, resulting in over-conservative planning algorithms, limiting their flexibility. We introduce Uncertainty-Aware Predictive Control Barrier Functions (UA-PCBFs), a unified framework that fuses probabilistic human hand motion forecasting with the formal safety guarantees of Control Barrier Functions. In contrast to other variants, our framework allows for dynamic adjustment of the safety margin thanks to the human motion uncertainty estimation provided by a forecasting module. Thanks to uncertainty estimation, UA-PCBFs empower collaborative robots with a deeper understanding of future human states, facilitating more fluid and intelligent interactions through informed motion planning. We validate UA-PCBFs through comprehensive real-world experiments with an increasing level of realism, including automated setups (to perform exactly repeatable motions) with a robotic hand and direct human-robot interactions (to validate promptness, usability, and human confidence). Relative to state-of-the-art HRI architectures, UA-PCBFs show better performance in task-critical metrics, significantly reducing the number of violations of the robot's safe space during interaction with respect to the state-of-the-art.

Ameya Pore, Riccardo Muradore, Diego Dall'Alba

Reinforcement Learning (RL) algorithms can learn robotic control tasks from visual observations, but they often require a large amount of data, especially when the visual scene is complex and unstructured. In this paper, we explore how the agent's knowledge of its shape can improve the sample efficiency of visual RL methods. We propose a novel method, Disentangled Environment and Agent Representations (DEAR), that uses the segmentation mask of the agent as supervision to learn disentangled representations of the environment and the agent through feature separation constraints. Unlike previous approaches, DEAR does not require reconstruction of visual observations. These representations are then used as an auxiliary loss to the RL objective, encouraging the agent to focus on the relevant features of the environment. We evaluate DEAR on two challenging benchmarks: Distracting DeepMind control suite and Franka Kitchen manipulation tasks. Our findings demonstrate that DEAR surpasses state-of-the-art methods in sample efficiency, achieving comparable or superior performance with reduced parameters. Our results indicate that integrating agent knowledge into visual RL methods has the potential to enhance their learning efficiency and robustness.

Ameya Pore, Eleonora Tagliabue, Marco Piccinelli et al.

The current research focus in Robot-Assisted Minimally Invasive Surgery (RAMIS) is directed towards increasing the level of robot autonomy, to place surgeons in a supervisory position. Although Learning from Demonstrations (LfD) approaches are among the preferred ways for an autonomous surgical system to learn expert gestures, they require a high number of demonstrations and show poor generalization to the variable conditions of the surgical environment. In this work, we propose an LfD methodology based on Generative Adversarial Imitation Learning (GAIL) that is built on a Deep Reinforcement Learning (DRL) setting. GAIL combines generative adversarial networks to learn the distribution of expert trajectories with a DRL setting to ensure generalisation of trajectories providing human-like behaviour. We consider automation of tissue retraction, a common RAMIS task that involves soft tissues manipulation to expose a region of interest. In our proposed methodology, a small set of expert trajectories can be acquired through the da Vinci Research Kit (dVRK) and used to train the proposed LfD method inside a simulated environment. Results indicate that our methodology can accomplish the tissue retraction task with human-like behaviour while being more sample-efficient than the baseline DRL method. Towards the end, we show that the learnt policies can be successfully transferred to the real robotic platform and deployed for soft tissue retraction on a synthetic phantom.

Ameya Pore, Davide Corsi, Enrico Marchesini et al.

Deep Reinforcement Learning (DRL) is a viable solution for automating repetitive surgical subtasks due to its ability to learn complex behaviours in a dynamic environment. This task automation could lead to reduced surgeon's cognitive workload, increased precision in critical aspects of the surgery, and fewer patient-related complications. However, current DRL methods do not guarantee any safety criteria as they maximise cumulative rewards without considering the risks associated with the actions performed. Due to this limitation, the application of DRL in the safety-critical paradigm of robot-assisted Minimally Invasive Surgery (MIS) has been constrained. In this work, we introduce a Safe-DRL framework that incorporates safety constraints for the automation of surgical subtasks via DRL training. We validate our approach in a virtual scene that replicates a tissue retraction task commonly occurring in multiple phases of an MIS. Furthermore, to evaluate the safe behaviour of the robotic arms, we formulate a formal verification tool for DRL methods that provides the probability of unsafe configurations. Our results indicate that a formal analysis guarantees safety with high confidence such that the robotic instruments operate within the safe workspace and avoid hazardous interaction with other anatomical structures.

Sanat Ramesh, Diego Dall'Alba, Cristians Gonzalez et al.

Purpose: Automatic segmentation and classification of surgical activity is crucial for providing advanced support in computer-assisted interventions and autonomous functionalities in robot-assisted surgeries. Prior works have focused on recognizing either coarse activities, such as phases, or fine-grained activities, such as gestures. This work aims at jointly recognizing two complementary levels of granularity directly from videos, namely phases and steps. Method: We introduce two correlated surgical activities, phases and steps, for the laparoscopic gastric bypass procedure. We propose a Multi-task Multi-Stage Temporal Convolutional Network (MTMS-TCN) along with a multi-task Convolutional Neural Network (CNN) training setup to jointly predict the phases and steps and benefit from their complementarity to better evaluate the execution of the procedure. We evaluate the proposed method on a large video dataset consisting of 40 surgical procedures (Bypass40). Results: We present experimental results from several baseline models for both phase and step recognition on the Bypass40 dataset. The proposed MTMS-TCN method outperforms in both phase and step recognition by 1-2% in accuracy, precision and recall, compared to single-task methods. Furthermore, for step recognition, MTMS-TCN achieves a superior performance of 3-6% compared to LSTM based models in accuracy, precision, and recall. Conclusion: In this work, we present a multi-task multi-stage temporal convolutional network for surgical activity recognition, which shows improved results compared to single-task models on the Bypass40 gastric bypass dataset with multi-level annotations. The proposed method shows that the joint modeling of phases and steps is beneficial to improve the overall recognition of each type of activity.

Luca Marzari, Ameya Pore, Diego Dall'Alba et al.

Deep Reinforcement Learning (DRL) is emerging as a promising approach to generate adaptive behaviors for robotic platforms. However, a major drawback of using DRL is the data-hungry training regime that requires millions of trial and error attempts, which is impractical when running experiments on robotic systems. Learning from Demonstrations (LfD) has been introduced to solve this issue by cloning the behavior of expert demonstrations. However, LfD requires a large number of demonstrations that are difficult to be acquired since dedicated complex setups are required. To overcome these limitations, we propose a multi-subtask reinforcement learning methodology where complex pick and place tasks can be decomposed into low-level subtasks. These subtasks are parametrized as expert networks and learned via DRL methods. Trained subtasks are then combined by a high-level choreographer to accomplish the intended pick and place task considering different initial configurations. As a testbed, we use a pick and place robotic simulator to demonstrate our methodology and show that our method outperforms a benchmark methodology based on LfD in terms of sample-efficiency. We transfer the learned policy to the real robotic system and demonstrate robust grasping using various geometric-shaped objects.