Russell H. Taylor

Weiyu Guo, Zhaoshuo Li, Yongkui Yang et al.

Stereo depth estimation is of great interest for computer vision research. However, existing methods struggles to generalize and predict reliably in hazardous regions, such as large uniform regions. To overcome these limitations, we propose Context Enhanced Path (CEP). CEP improves the generalization and robustness against common failure cases in existing solutions by capturing the long-range global information. We construct our stereo depth estimation model, Context Enhanced Stereo Transformer (CSTR), by plugging CEP into the state-of-the-art stereo depth estimation method Stereo Transformer. CSTR is examined on distinct public datasets, such as Scene Flow, Middlebury-2014, KITTI-2015, and MPI-Sintel. We find CSTR outperforms prior approaches by a large margin. For example, in the zero-shot synthetic-to-real setting, CSTR outperforms the best competing approaches on Middlebury-2014 dataset by 11%. Our extensive experiments demonstrate that the long-range information is critical for stereo matching task and CEP successfully captures such information.

Zhaoshuo Li, Thomas Müller, Alex Evans et al.

Neural surface reconstruction has been shown to be powerful for recovering dense 3D surfaces via image-based neural rendering. However, current methods struggle to recover detailed structures of real-world scenes. To address the issue, we present Neuralangelo, which combines the representation power of multi-resolution 3D hash grids with neural surface rendering. Two key ingredients enable our approach: (1) numerical gradients for computing higher-order derivatives as a smoothing operation and (2) coarse-to-fine optimization on the hash grids controlling different levels of details. Even without auxiliary inputs such as depth, Neuralangelo can effectively recover dense 3D surface structures from multi-view images with fidelity significantly surpassing previous methods, enabling detailed large-scale scene reconstruction from RGB video captures.

Hao Ding, Lalithkumar Seenivasan, Hongchao Shu et al.

Large language model-based (LLM) agents are emerging as a powerful enabler of robust embodied intelligence due to their capability of planning complex action sequences. Sound planning ability is necessary for robust automation in many task domains, but especially in surgical automation. These agents rely on a highly detailed natural language representation of the scene. Thus, to leverage the emergent capabilities of LLM agents for surgical task planning, developing similarly powerful and robust perception algorithms is necessary to derive a detailed scene representation of the environment from visual input. Previous research has focused primarily on enabling LLM-based task planning while adopting simple yet severely limited perception solutions to meet the needs for bench-top experiments, but lacks the critical flexibility to scale to less constrained settings. In this work, we propose an alternate perception approach -- a digital twin (DT)-based machine perception approach that capitalizes on the convincing performance and out-of-the-box generalization of recent vision foundation models. Integrating our DT representation and LLM agent for planning with the dVRK platform, we develop an embodied intelligence system and evaluate its robustness in performing peg transfer and gauze retrieval tasks. Our approach shows strong task performance and generalizability to varied environmental settings. Despite a convincing performance, this work is merely a first step towards the integration of DT representations. Future studies are necessary for the realization of a comprehensive DT framework to improve the interpretability and generalizability of embodied intelligence in surgery.

Zhaoshuo Li, Hongchao Shu, Ruixing Liang et al.

Purpose: Tracking the 3D motion of the surgical tool and the patient anatomy is a fundamental requirement for computer-assisted skull-base surgery. The estimated motion can be used both for intra-operative guidance and for downstream skill analysis. Recovering such motion solely from surgical videos is desirable, as it is compliant with current clinical workflows and instrumentation. Methods: We present Tracker of Anatomy and Tool (TAToo). TAToo jointly tracks the rigid 3D motion of patient skull and surgical drill from stereo microscopic videos. TAToo estimates motion via an iterative optimization process in an end-to-end differentiable form. For robust tracking performance, TAToo adopts a probabilistic formulation and enforces geometric constraints on the object level. Results: We validate TAToo on both simulation data, where ground truth motion is available, as well as on anthropomorphic phantom data, where optical tracking provides a strong baseline. We report sub-millimeter and millimeter inter-frame tracking accuracy for skull and drill, respectively, with rotation errors below 1°. We further illustrate how TAToo may be used in a surgical navigation setting. Conclusion: We present TAToo, which simultaneously tracks the surgical tool and the patient anatomy in skull-base surgery. TAToo directly predicts the motion from surgical videos, without the need of any markers. Our results show that the performance of TAToo compares favorably to competing approaches. Future work will include fine-tuning of our depth network to reach a 1 mm clinical accuracy goal desired for surgical applications in the skull base.

Cong Gao, Benjamin D. Killeen, Yicheng Hu et al.

Artificial intelligence (AI) now enables automated interpretation of medical images for clinical use. However, AI's potential use for interventional images (versus those involved in triage or diagnosis), such as for guidance during surgery, remains largely untapped. This is because surgical AI systems are currently trained using post hoc analysis of data collected during live surgeries, which has fundamental and practical limitations, including ethical considerations, expense, scalability, data integrity, and a lack of ground truth. Here, we demonstrate that creating realistic simulated images from human models is a viable alternative and complement to large-scale in situ data collection. We show that training AI image analysis models on realistically synthesized data, combined with contemporary domain generalization or adaptation techniques, results in models that on real data perform comparably to models trained on a precisely matched real data training set. Because synthetic generation of training data from human-based models scales easily, we find that our model transfer paradigm for X-ray image analysis, which we refer to as SyntheX, can even outperform real data-trained models due to the effectiveness of training on a larger dataset. We demonstrate the potential of SyntheX on three clinical tasks: Hip image analysis, surgical robotic tool detection, and COVID-19 lung lesion segmentation. SyntheX provides an opportunity to drastically accelerate the conception, design, and evaluation of intelligent systems for X-ray-based medicine. In addition, simulated image environments provide the opportunity to test novel instrumentation, design complementary surgical approaches, and envision novel techniques that improve outcomes, save time, or mitigate human error, freed from the ethical and practical considerations of live human data collection.

Jan Emily Mangulabnan, Roger D. Soberanis-Mukul, Timo Teufel et al.

Generating accurate 3D reconstructions from endoscopic video is a promising avenue for longitudinal radiation-free analysis of sinus anatomy and surgical outcomes. Several methods for monocular reconstruction have been proposed, yielding visually pleasant 3D anatomical structures by retrieving relative camera poses with structure-from-motion-type algorithms and fusion of monocular depth estimates. However, due to the complex properties of the underlying algorithms and endoscopic scenes, the reconstruction pipeline may perform poorly or fail unexpectedly. Further, acquiring medical data conveys additional challenges, presenting difficulties in quantitatively benchmarking these models, understanding failure cases, and identifying critical components that contribute to their precision. In this work, we perform a quantitative analysis of a self-supervised approach for sinus reconstruction using endoscopic sequences paired with optical tracking and high-resolution computed tomography acquired from nine ex-vivo specimens. Our results show that the generated reconstructions are in high agreement with the anatomy, yielding an average point-to-mesh error of 0.91 mm between reconstructions and CT segmentations. However, in a point-to-point matching scenario, relevant for endoscope tracking and navigation, we found average target registration errors of 6.58 mm. We identified that pose and depth estimation inaccuracies contribute equally to this error and that locally consistent sequences with shorter trajectories generate more accurate reconstructions. These results suggest that achieving global consistency between relative camera poses and estimated depths with the anatomy is essential. In doing so, we can ensure proper synergy between all components of the pipeline for improved reconstructions that will facilitate clinical application of this innovative technology.

Hongchao Shu, Ruixing Liang, Zhaoshuo Li et al.

Purpose: Digital twins are virtual interactive models of the real world, exhibiting identical behavior and properties. In surgical applications, computational analysis from digital twins can be used, for example, to enhance situational awareness. Methods: We present a digital twin framework for skull-base surgeries, named Twin-S, which can be integrated within various image-guided interventions seamlessly. Twin-S combines high-precision optical tracking and real-time simulation. We rely on rigorous calibration routines to ensure that the digital twin representation precisely mimics all real-world processes. Twin-S models and tracks the critical components of skull-base surgery, including the surgical tool, patient anatomy, and surgical camera. Significantly, Twin-S updates and reflects real-world drilling of the anatomical model in frame rate. Results: We extensively evaluate the accuracy of Twin-S, which achieves an average 1.39 mm error during the drilling process. We further illustrate how segmentation masks derived from the continuously updated digital twin can augment the surgical microscope view in a mixed reality setting, where bone requiring ablation is highlighted to provide surgeons additional situational awareness. Conclusion: We present Twin-S, a digital twin environment for skull-base surgery. Twin-S tracks and updates the virtual model in real-time given measurements from modern tracking technologies. Future research on complementing optical tracking with higher-precision vision-based approaches may further increase the accuracy of Twin-S.

Jan Emily Mangulabnan, Akshat Chauhan, Laura Fleig et al.

In endoscopic surgery, surgeons continuously locate the endoscopic view relative to the anatomy by interpreting the evolving visual appearance of the intraoperative scene in the context of their prior knowledge. Vision-based navigation systems seek to replicate this capability by recovering camera pose directly from endoscopic video, but most approaches do not embody the same principles of reasoning about new frames that makes surgeons successful. Instead, they remain grounded in feature matching and geometric optimization over keyframes, an approach that has been shown to degrade under the challenging conditions of endoscopic imaging like low texture and rapid illumination changes. Here, we pursue an alternative approach and investigate a policy-based formulation of endoscopic camera pose recovery that seeks to imitate experts in estimating trajectories conditioned on the previous camera state. Our approach directly predicts short-horizon relative motions without maintaining an explicit geometric representation at inference time. It thus addresses, by design, some of the notorious challenges of geometry-based approaches, such as brittle correspondence matching, instability in texture-sparse regions, and limited pose coverage due to reconstruction failure. We evaluate the proposed formulation on cadaveric sinus endoscopy. Under oracle state conditioning, we compare short-horizon motion prediction quality to geometric baselines achieving lowest mean translation error and competitive rotational accuracy. We analyze robustness by grouping prediction windows according to texture richness and illumination change indicating reduced sensitivity to low-texture conditions. These findings suggest that a learned motion policy offers a viable alternative formulation for endoscopic camera pose recovery.

Russell H. Taylor, Gregory D. Hager, Ralph Etienne-Cummings. Eric Grimson et al.

In the last ten years, medical robotics has moved from the margins to the mainstream. Since the Engineering Research Center for Computer-Integrated Surgical Systems and Technology was Launched in 1998 with National Science Foundation funding, medical robots have been promoted from handling routine tasks to performing highly sophisticated interventions and related assignments. The CISST ERC has played a significant role in this transformation. And thanks to NSF support, the ERC has built the professional infrastructure that will continue our mission: bringing data and technology together in clinical systems that will dramatically change how surgery and other procedures are done. The enhancements we envision touch virtually every aspect of the delivery of care: - More accurate procedures - More consistent, predictable results from one patient to the next - Improved clinical outcomes - Greater patient safety - Reduced liability for healthcare providers - Lower costs for everyone - patients, facilities, insurers, government - Easier, faster recovery for patients - Effective new ways to treat health problems - Healthier patients, and a healthier system The basic science and engineering the ERC is developing now will yield profound benefits for all concerned about health care - from government agencies to insurers, from clinicians to patients to the general public. All will experience the healing touch of medical robotics, thanks in no small part to the work of the CISST ERC and its successors.

Benjamin D. Killeen, Liam J. Wang, Blanca Inigo et al.

Language promptable X-ray image segmentation would enable greater flexibility for human-in-the-loop workflows in diagnostic and interventional precision medicine. Prior efforts have contributed task-specific models capable of solving problems within a narrow scope, but expanding to broader use requires additional data, annotations, and training time. Recently, language-aligned foundation models (LFMs) -- machine learning models trained on large amounts of highly variable image and text data thus enabling broad applicability -- have emerged as promising tools for automated image analysis. Existing foundation models for medical image analysis focus on scenarios and modalities where large, richly annotated datasets are available. However, the X-ray imaging modality features highly variable image appearance and applications, from diagnostic chest X-rays to interventional fluoroscopy, with varying availability of data. To pave the way toward an LFM for comprehensive and language-aligned analysis of arbitrary medical X-ray images, we introduce FluoroSAM, a language-promptable variant of the Segment Anything Model, trained from scratch on 3M synthetic X-ray images from a wide variety of human anatomies, imaging geometries, and viewing angles. These include pseudo-ground truth masks for 128 organ types and 464 tools with associated text descriptions. FluoroSAM is capable of segmenting myriad anatomical structures and tools based on natural language prompts, thanks to the novel incorporation of vector quantization (VQ) of text embeddings in the training process. We demonstrate FluoroSAM's performance quantitatively on real X-ray images and showcase on several applications how FluoroSAM is a key enabler for rich human-machine interaction in the X-ray image acquisition and analysis context. Code is available at https://github.com/arcadelab/fluorosam.

Xingtong Liu, Zhaoshuo Li, Masaru Ishii et al.

In endoscopy, many applications (e.g., surgical navigation) would benefit from a real-time method that can simultaneously track the endoscope and reconstruct the dense 3D geometry of the observed anatomy from a monocular endoscopic video. To this end, we develop a Simultaneous Localization and Mapping system by combining the learning-based appearance and optimizable geometry priors and factor graph optimization. The appearance and geometry priors are explicitly learned in an end-to-end differentiable training pipeline to master the task of pair-wise image alignment, one of the core components of the SLAM system. In our experiments, the proposed SLAM system is shown to robustly handle the challenges of texture scarceness and illumination variation that are commonly seen in endoscopy. The system generalizes well to unseen endoscopes and subjects and performs favorably compared with a state-of-the-art feature-based SLAM system. The code repository is available at https://github.com/lppllppl920/SAGE-SLAM.git.

David Z. Li, Masaru Ishii, Russell H. Taylor et al.

In this work, we explore whether it is possible to learn representations of endoscopic video frames to perform tasks such as identifying surgical tool presence without supervision. We use a maximum mean discrepancy (MMD) variational autoencoder (VAE) to learn low-dimensional latent representations of endoscopic videos and manipulate these representations to distinguish frames containing tools from those without tools. We use three different methods to manipulate these latent representations in order to predict tool presence in each frame. Our fully unsupervised methods can identify whether endoscopic video frames contain tools with average precision of 71.56, 73.93, and 76.18, respectively, comparable to supervised methods. Our code is available at https://github.com/zdavidli/tool-presence/

Zhaoshuo Li, Alex Gordon, Thomas Looi et al.

This paper presents a dynamic constraint formulation to provide protective virtual fixtures of 3D anatomical structures from polygon mesh representations. The proposed approach can anisotropically limit the tool motion of surgical robots without any assumption of the local anatomical shape close to the tool. Using a bounded search strategy and Principle Directed tree, the proposed system can run efficiently at 180 Hz for a mesh object containing 989,376 triangles and 493,460 vertices. The proposed algorithm has been validated in both simulation and skull cutting experiments. The skull cutting experiment setup uses a novel piezoelectric bone cutting tool designed for the da Vinci research kit. The result shows that the virtual fixture assisted teleoperation has statistically significant improvements in the cutting path accuracy and penetration depth control. The code has been made publicly available at https://github.com/mli0603/PolygonMeshVirtualFixture.

Xingtong Liu, Maia Stiber, Jindan Huang et al.

Reconstructing accurate 3D surface models of sinus anatomy directly from an endoscopic video is a promising avenue for cross-sectional and longitudinal analysis to better understand the relationship between sinus anatomy and surgical outcomes. We present a patient-specific, learning-based method for 3D reconstruction of sinus surface anatomy directly and only from endoscopic videos. We demonstrate the effectiveness and accuracy of our method on in and ex vivo data where we compare to sparse reconstructions from Structure from Motion, dense reconstruction from COLMAP, and ground truth anatomy from CT. Our textured reconstructions are watertight and enable measurement of clinically relevant parameters in good agreement with CT. The source code is available at https://github.com/lppllppl920/DenseReconstruction-Pytorch.

Xingtong Liu, Yiping Zheng, Benjamin Killeen et al.

High-quality 3D reconstructions from endoscopy video play an important role in many clinical applications, including surgical navigation where they enable direct video-CT registration. While many methods exist for general multi-view 3D reconstruction, these methods often fail to deliver satisfactory performance on endoscopic video. Part of the reason is that local descriptors that establish pair-wise point correspondences, and thus drive reconstruction, struggle when confronted with the texture-scarce surface of anatomy. Learning-based dense descriptors usually have larger receptive fields enabling the encoding of global information, which can be used to disambiguate matches. In this work, we present an effective self-supervised training scheme and novel loss design for dense descriptor learning. In direct comparison to recent local and dense descriptors on an in-house sinus endoscopy dataset, we demonstrate that our proposed dense descriptor can generalize to unseen patients and scopes, thereby largely improving the performance of Structure from Motion (SfM) in terms of model density and completeness. We also evaluate our method on a public dense optical flow dataset and a small-scale SfM public dataset to further demonstrate the effectiveness and generality of our method. The source code is available at https://github.com/lppllppl920/DenseDescriptorLearning-Pytorch.

Xingtong Liu, Ayushi Sinha, Masaru Ishii et al.

We present a self-supervised approach to training convolutional neural networks for dense depth estimation from monocular endoscopy data without a priori modeling of anatomy or shading. Our method only requires monocular endoscopic videos and a multi-view stereo method, e.g., structure from motion, to supervise learning in a sparse manner. Consequently, our method requires neither manual labeling nor patient computed tomography (CT) scan in the training and application phases. In a cross-patient experiment using CT scans as groundtruth, the proposed method achieved submillimeter mean residual error. In a comparison study to recent self-supervised depth estimation methods designed for natural video on in vivo sinus endoscopy data, we demonstrate that the proposed approach outperforms the previous methods by a large margin. The source code for this work is publicly available online at https://github.com/lppllppl920/EndoscopyDepthEstimation-Pytorch.

Ayushi Sinha, Masaru Ishii, Russell H. Taylor et al.

Registering images from different modalities is an active area of research in computer aided medical interventions. Several registration algorithms have been developed, many of which achieve high accuracy. However, these results are dependent on many factors, including the quality of the extracted features or segmentations being registered as well as the initial alignment. Although several methods have been developed towards improving segmentation algorithms and automating the segmentation process, few automatic initialization algorithms have been explored. In many cases, the initial alignment from which a registration is initiated is performed manually, which interferes with the clinical workflow. Our aim is to use scene classification in endoscopic procedures to achieve coarse alignment of the endoscope and a preoperative image of the anatomy. In this paper, we show using simulated scenes that a neural network can predict the region of anatomy (with respect to a preoperative image) that the endoscope is located in by observing a single endoscopic video frame. With limited training and without any hyperparameter tuning, our method achieves an accuracy of 76.53 (+/-1.19)%. There are several avenues for improvement, making this a promising direction of research. Code is available at https://github.com/AyushiSinha/AutoInitialization.

Jecia Z. Y. Mao, Francis X. Creighton, Russell H. Taylor et al.

We introduce a speech-guided embodied agent framework for video-guided skull base surgery that dynamically executes perception and image-guidance tasks in response to surgeon queries. The proposed system integrates natural language interaction with real-time visual perception directly on live intraoperative video streams, thereby enabling surgeons to request computational assistance without disengaging from operative tasks. Unlike conventional image-guided navigation systems that rely on external optical trackers and additional hardware setup, the framework operates purely on intraoperative video. The system begins with interactive segmentation and labeling of the surgical instrument. The segmented instrument is then used as a spatial anchor that is autonomously tracked in the video stream to support downstream workflows, including anatomical segmentation, interactive registration of preoperative 3D models, monocular video-based estimation of the surgical tool pose, and support image guidance through real-time anatomical overlays.We evaluate the proposed system in video-guided skull base surgery scenarios and benchmark its tracking performance against a commercially available optical tracking system. Results demonstrate that speech-guided embodied agents can achieve competitive spatial accuracy while improving workflow integration and enabling rapid deployment of video-guided surgical systems.

Jan Emily Mangulabnan, Roger D. Soberanis-Mukul, Timo Teufel et al.

Purpose: Preoperative imaging plays a pivotal role in sinus surgery where CTs offer patient-specific insights of complex anatomy, enabling real-time intraoperative navigation to complement endoscopy imaging. However, surgery elicits anatomical changes not represented in the preoperative model, generating an inaccurate basis for navigation during surgery progression. Methods: We propose a first vision-based approach to update the preoperative 3D anatomical model leveraging intraoperative endoscopic video for navigated sinus surgery where relative camera poses are known. We rely on comparisons of intraoperative monocular depth estimates and preoperative depth renders to identify modified regions. The new depths are integrated in these regions through volumetric fusion in a truncated signed distance function representation to generate an intraoperative 3D model that reflects tissue manipulation. Results: We quantitatively evaluate our approach by sequentially updating models for a five-step surgical progression in an ex vivo specimen. We compute the error between correspondences from the updated model and ground-truth intraoperative CT in the region of anatomical modification. The resulting models show a decrease in error during surgical progression as opposed to increasing when no update is employed. Conclusion: Our findings suggest that preoperative 3D anatomical models can be updated using intraoperative endoscopy video in navigated sinus surgery. Future work will investigate improvements to monocular depth estimation as well as removing the need for external navigation systems. The resulting ability to continuously update the patient model may provide surgeons with a more precise understanding of the current anatomical state and paves the way toward a digital twin paradigm for sinus surgery.

Mengya Xu, Daiyun Shen, Jie Zhang et al.

Artificial intelligence, imaging, and large language models have the potential to transform surgical practice, training, and automation. Understanding and modeling of basic surgical actions (BSA), the fundamental unit of operation in any surgery, is important to drive the evolution of this field. In this paper, we present a BSA dataset comprising 10 basic actions across 6 surgical specialties with over 11,000 video clips, which is the largest to date. Based on the BSA dataset, we developed a new foundation model that conducts general-purpose recognition of basic actions. Our approach demonstrates robust cross-specialist performance in experiments validated on datasets from different procedural types and various body parts. Furthermore, we demonstrate downstream applications enabled by the BAS foundation model through surgical skill assessment in prostatectomy using domain-specific knowledge, and action planning in cholecystectomy and nephrectomy using large vision-language models. Multinational surgeons' evaluation of the language model's output of the action planning explainable texts demonstrated clinical relevance. These findings indicate that basic surgical actions can be robustly recognized across scenarios, and an accurate BSA understanding model can essentially facilitate complex applications and speed up the realization of surgical superintelligence.

Sue Min Cho, Alexander Do, Russell H. Taylor et al.

Purpose: As surgery increasingly integrates advanced imaging, algorithms, and robotics to automate complex tasks, human judgment of system correctness remains a vital safeguard for patient safety. A critical example is 2D/3D registration, where small registration misalignments can lead to surgical errors. Current visualization strategies alone are insufficient to reliably enable humans to detect these misalignments, highlighting the need for enhanced decision-support tools. Methods: We propose the first artificial intelligence (AI) model tailored to 2D/3D registration quality assessment, augmented with explainable AI (XAI) mechanisms to clarify the model's predictions. Using both objective measures (e.g., accuracy, sensitivity, precision, specificity) and subjective evaluations (e.g., workload, trust, and understanding), we systematically compare decision-making across four conditions: AI-only, Human-only, Human+AI, and Human+XAI. Results: The AI-only condition achieved the highest accuracy, whereas collaborative paradigms (Human+AI and Human+XAI) improved sensitivity, precision, and specificity compared to standalone approaches. Participants experienced significantly lower workload in collaborative conditions relative to the Human-only condition. Moreover, participants reported a greater understanding of AI predictions in the Human+XAI condition than in Human+AI, although no significant differences were observed between the two collaborative paradigms in perceived trust or workload. Conclusion: Human-AI collaboration can enhance 2D/3D registration quality assurance, with explainability mechanisms improving user understanding. Future work should refine XAI designs to optimize decision-making performance and efficiency. Extending both the algorithmic design and human-XAI collaboration elements holds promise for more robust quality assurance of 2D/3D registration.

Yonghao Long, Jianfeng Cao, Anton Deguet et al.

Robot-assisted surgery has become progressively more and more popular due to its clinical advantages. In the meanwhile, the artificial intelligence and augmented reality in robotic surgery are developing rapidly and receive lots of attention. However, current methods have not discussed the coherent integration of AI and AR in robotic surgery. In this paper, we develop a novel system by seamlessly merging artificial intelligence module and augmented reality visualization to automatically generate the surgical guidance for robotic surgery education. Specifically, we first leverage reinforcement leaning to learn from expert demonstration and then generate 3D guidance trajectory, providing prior context information of the surgical procedure. Along with other information such as text hint, the 3D trajectory is then overlaid in the stereo view of dVRK, where the user can perceive the 3D guidance and learn the procedure. The proposed system is evaluated through a preliminary experiment on surgical education task peg-transfer, which proves its feasibility and potential as the next generation of robot-assisted surgery education solution.

Zhaoshuo Li, Wei Ye, Dilin Wang et al.

Temporally consistent depth estimation is crucial for online applications such as augmented reality. While stereo depth estimation has received substantial attention as a promising way to generate 3D information, there is relatively little work focused on maintaining temporal stability. Indeed, based on our analysis, current techniques still suffer from poor temporal consistency. Stabilizing depth temporally in dynamic scenes is challenging due to concurrent object and camera motion. In an online setting, this process is further aggravated because only past frames are available. We present a framework named Consistent Online Dynamic Depth (CODD) to produce temporally consistent depth estimates in dynamic scenes in an online setting. CODD augments per-frame stereo networks with novel motion and fusion networks. The motion network accounts for dynamics by predicting a per-pixel SE3 transformation and aligning the observations. The fusion network improves temporal depth consistency by aggregating the current and past estimates. We conduct extensive experiments and demonstrate quantitatively and qualitatively that CODD outperforms competing methods in terms of temporal consistency and performs on par in terms of per-frame accuracy.

Adnan Munawar, Zhaoshuo Li, Punit Kunjam et al.

Surgical simulators not only allow planning and training of complex procedures, but also offer the ability to generate structured data for algorithm development, which may be applied in image-guided computer assisted interventions. While there have been efforts on either developing training platforms for surgeons or data generation engines, these two features, to our knowledge, have not been offered together. We present our developments of a cost-effective and synergistic framework, named Asynchronous Multibody Framework Plus (AMBF+), which generates data for downstream algorithm development simultaneously with users practicing their surgical skills. AMBF+ offers stereoscopic display on a virtual reality (VR) device and haptic feedback for immersive surgical simulation. It can also generate diverse data such as object poses and segmentation maps. AMBF+ is designed with a flexible plugin setup which allows for unobtrusive extension for simulation of different surgical procedures. We show one use case of AMBF+ as a virtual drilling simulator for lateral skull-base surgery, where users can actively modify the patient anatomy using a virtual surgical drill. We further demonstrate how the data generated can be used for validating and training downstream computer vision algorithms

Zhaoshuo Li, Nathan Drenkow, Hao Ding et al.

Scene depth estimation from stereo and monocular imagery is critical for extracting 3D information for downstream tasks such as scene understanding. Recently, learning-based methods for depth estimation have received much attention due to their high performance and flexibility in hardware choice. However, collecting ground truth data for supervised training of these algorithms is costly or outright impossible. This circumstance suggests a need for alternative learning approaches that do not require corresponding depth measurements. Indeed, self-supervised learning of depth estimation provides an increasingly popular alternative. It is based on the idea that observed frames can be synthesized from neighboring frames if accurate depth of the scene is known - or in this case, estimated. We show empirically that - contrary to common belief - improvements in image synthesis do not necessitate improvement in depth estimation. Rather, optimizing for image synthesis can result in diverging performance with respect to the main prediction objective - depth. We attribute this diverging phenomenon to aleatoric uncertainties, which originate from data. Based on our experiments on four datasets (spanning street, indoor, and medical) and five architectures (monocular and stereo), we conclude that this diverging phenomenon is independent of the dataset domain and not mitigated by commonly used regularization techniques. To underscore the importance of this finding, we include a survey of methods which use image synthesis, totaling 127 papers over the last six years. This observed divergence has not been previously reported or studied in depth, suggesting room for future improvement of self-supervised approaches which might be impacted the finding.

Yonghao Long, Zhaoshuo Li, Chi Hang Yee et al.

Reconstructing the scene of robotic surgery from the stereo endoscopic video is an important and promising topic in surgical data science, which potentially supports many applications such as surgical visual perception, robotic surgery education and intra-operative context awareness. However, current methods are mostly restricted to reconstructing static anatomy assuming no tissue deformation, tool occlusion and de-occlusion, and camera movement. However, these assumptions are not always satisfied in minimal invasive robotic surgeries. In this work, we present an efficient reconstruction pipeline for highly dynamic surgical scenes that runs at 28 fps. Specifically, we design a transformer-based stereoscopic depth perception for efficient depth estimation and a light-weight tool segmentor to handle tool occlusion. After that, a dynamic reconstruction algorithm which can estimate the tissue deformation and camera movement, and aggregate the information over time is proposed for surgical scene reconstruction. We evaluate the proposed pipeline on two datasets, the public Hamlyn Centre Endoscopic Video Dataset and our in-house DaVinci robotic surgery dataset. The results demonstrate that our method can recover the scene obstructed by the surgical tool and handle the movement of camera in realistic surgical scenarios effectively at real-time speed.

Claudia D'Ettorre, Andrea Mariani, Agostino Stilli et al.

Robotic-assisted surgery is now well-established in clinical practice and has become the gold standard clinical treatment option for several clinical indications. The field of robotic-assisted surgery is expected to grow substantially in the next decade with a range of new robotic devices emerging to address unmet clinical needs across different specialities. A vibrant surgical robotics research community is pivotal for conceptualizing such new systems as well as for developing and training the engineers and scientists to translate them into practice. The da Vinci Research Kit (dVRK), an academic and industry collaborative effort to re-purpose decommissioned da Vinci surgical systems (Intuitive Surgical Inc, CA, USA) as a research platform for surgical robotics research, has been a key initiative for addressing a barrier to entry for new research groups in surgical robotics. In this paper, we present an extensive review of the publications that have been facilitated by the dVRK over the past decade. We classify research efforts into different categories and outline some of the major challenges and needs for the robotics community to maintain this initiative and build upon it.

Antonio Di Lallo, Robin R. Murphy, Axel Krieger et al.

Medical robots can play an important role in mitigating the spread of infectious diseases and delivering quality care to patients during the COVID-19 pandemic. Methods and procedures involving medical robots in the continuum of care, ranging from disease prevention, screening, diagnosis, treatment, and homecare have been extensively deployed and also present incredible opportunities for future development. This paper provides an overview of the current state-of-the-art, highlighting the enabling technologies and unmet needs for prospective technological advances within the next 5-10 years. We also identify key research and knowledge barriers that need to be addressed in developing effective and flexible solutions to ensure preparedness for rapid and scalable deployment to combat infectious diseases.

Zhaoshuo Li, Xingtong Liu, Nathan Drenkow et al.

Stereo depth estimation relies on optimal correspondence matching between pixels on epipolar lines in the left and right images to infer depth. In this work, we revisit the problem from a sequence-to-sequence correspondence perspective to replace cost volume construction with dense pixel matching using position information and attention. This approach, named STereo TRansformer (STTR), has several advantages: It 1) relaxes the limitation of a fixed disparity range, 2) identifies occluded regions and provides confidence estimates, and 3) imposes uniqueness constraints during the matching process. We report promising results on both synthetic and real-world datasets and demonstrate that STTR generalizes across different domains, even without fine-tuning.

Lena Maier-Hein, Matthias Eisenmann, Duygu Sarikaya et al.

Recent developments in data science in general and machine learning in particular have transformed the way experts envision the future of surgery. Surgical Data Science (SDS) is a new research field that aims to improve the quality of interventional healthcare through the capture, organization, analysis and modeling of data. While an increasing number of data-driven approaches and clinical applications have been studied in the fields of radiological and clinical data science, translational success stories are still lacking in surgery. In this publication, we shed light on the underlying reasons and provide a roadmap for future advances in the field. Based on an international workshop involving leading researchers in the field of SDS, we review current practice, key achievements and initiatives as well as available standards and tools for a number of topics relevant to the field, namely (1) infrastructure for data acquisition, storage and access in the presence of regulatory constraints, (2) data annotation and sharing and (3) data analytics. We further complement this technical perspective with (4) a review of currently available SDS products and the translational progress from academia and (5) a roadmap for faster clinical translation and exploitation of the full potential of SDS, based on an international multi-round Delphi process.

Balazs P. Vagvolgyi, Mikhail Khrenov, Jonathan Cope et al.

Since the first reports of a novel coronavirus (SARS-CoV-2) in December 2019, over 33 million people have been infected worldwide and approximately 1 million people worldwide have died from the disease caused by this virus, COVID-19. In the US alone, there have been approximately 7 million cases and over 200,000 deaths. This outbreak has placed an enormous strain on healthcare systems and workers. Severe cases require hospital care, and 8.5\% of patients require mechanical ventilation in an intensive care unit (ICU). One major challenge is the necessity for clinical care personnel to don and doff cumbersome personal protective equipment (PPE) in order to enter an ICU unit to make simple adjustments to ventilator settings. Although future ventilators and other ICU equipment may be controllable remotely through computer networks, the enormous installed base of existing ventilators do not have this capability. This paper reports the development of a simple, low cost telerobotic system that permits adjustment of ventilator settings from outside the ICU. The system consists of a small Cartesian robot capable of operating a ventilator touch screen with camera vision control via a wirelessly connected tablet master device located outside the room. Engineering system tests demonstrated that the open-loop mechanical repeatability of the device was 7.5\,mm, and that the average positioning error of the robotic finger under visual servoing control was 5.94\,mm. Successful usability tests in a simulated ICU environment were carried out and are reported. In addition to enabling a significant reduction in PPE consumption, the prototype system has been shown in a preliminary evaluation to significantly reduce the total time required for a respiratory therapist to perform typical setting adjustments on a commercial ventilator, including donning and doffing PPE, from 271 seconds to 109 seconds.

Farshid Alambeigi, Zerui Wang, Yun-Hui Liu et al.

This paper addresses the problem of controlling a continuum manipulator (CM) in free or obstructed environments with no prior knowledge about the deformation behavior of the CM and the stiffness and geometry of the interacting obstructed environment. We propose a versatile data-driven priori-model-independent (PMI) control framework, in which various control paradigms (e.g. CM's position or shape control) can be defined based on the provided feedback. This optimal iterative algorithm learns the deformation behavior of the CM in interaction with an unknown environment, in real time, and then accomplishes the defined control objective. To evaluate the scalability of the proposed framework, we integrated two different CMs, designed for medical applications, with the da Vinci Research Kit (dVRK). The performance and learning capability of the framework was investigated in 11 sets of experiments including PMI position and shape control in free and unknown obstructed environments as well as during manipulation of an unknown deformable object. We also evaluated the performance of our algorithm in an ex-vivo experiment with a lamb heart.The theoretical and experimental results demonstrate the adaptivity, versatility, and accuracy of the proposed framework and, therefore, its suitability for a variety of applications involving continuum manipulators.

Henry Phalen, Prasad Vagdargi, Mariah L. Schrum et al.

The treatment of malaria is a global health challenge that stands to benefit from the widespread introduction of a vaccine for the disease. A method has been developed to create a live organism vaccine using the sporozoites (SPZ) of the parasite Plasmodium falciparum (Pf), which are concentrated in the salivary glands of infected mosquitoes. Current manual dissection methods to obtain these PfSPZ are not optimally efficient for large-scale vaccine production. We propose an improved dissection procedure and a mechanical fixture that increases the rate of mosquito dissection and helps to deskill this stage of the production process. We further demonstrate the automation of a key step in this production process, the picking and placing of mosquitoes from a staging apparatus into a dissection assembly. This unit test of a robotic mosquito pick-and-place system is performed using a custom-designed micro-gripper attached to a four degree of freedom (4-DOF) robot under the guidance of a computer vision system. Mosquitoes are autonomously grasped and pulled to a pair of notched dissection blades to remove the head of the mosquito, allowing access to the salivary glands. Placement into these blades is adapted based on output from computer vision to accommodate for the unique anatomy and orientation of each grasped mosquito. In this pilot test of the system on 50 mosquitoes, we demonstrate a 100% grasping accuracy and a 90% accuracy in placing the mosquito with its neck within the blade notches such that the head can be removed. This is a promising result for this difficult and non-standard pick-and-place task.

Zhaoshuo Li, Mahya Shahbazi, Niravkumar Patel et al.

High-resolution real-time intraocular imaging of retina at the cellular level is very challenging due to the vulnerable and confined space within the eyeball as well as the limited availability of appropriate modalities. A probe-based confocal laser endomicroscopy (pCLE) system, can be a potential imaging modality for improved diagnosis. The ability to visualize the retina at the cellular level could provide information that may predict surgical outcomes. The adoption of intraocular pCLE scanning is currently limited due to the narrow field of view and the micron-scale range of focus. In the absence of motion compensation, physiological tremors of the surgeons' hand and patient movements also contribute to the deterioration of the image quality. Therefore, an image-based hybrid control strategy is proposed to mitigate the above challenges. The proposed hybrid control strategy enables a shared control of the pCLE probe between surgeons and robots to scan the retina precisely, with the absence of hand tremors and with the advantages of an image-based auto-focus algorithm that optimizes the quality of pCLE images. The hybrid control strategy is deployed on two frameworks - cooperative and teleoperated. Better image quality, smoother motion, and reduced workload are all achieved in a statistically significant manner with the hybrid control frameworks.

Xingtong Liu, Ayushi Sinha, Masaru Ishii et al.

We present a self-supervised learning-based pipeline for dense 3D reconstruction from full-length monocular endoscopic videos without a priori modeling of anatomy or shading. Our method only relies on unlabeled monocular endoscopic videos and conventional multi-view stereo algorithms, and requires neither manual interaction nor patient CT in both training and application phases. In a cross-patient study using CT scans as groundtruth, we show that our method is able to produce photo-realistic dense 3D reconstructions with submillimeter mean residual errors from endoscopic videos from unseen patients and scopes.

Shahriar Sefati, Shahin Sefati, Iulian Iordachita et al.

Due to their flexibility, dexterity, and compact size, Continuum Manipulators (CMs) can enhance minimally invasive interventions. In these procedures, the CM may be operated in proximity of sensitive organs; therefore, requiring accurate and appropriate feedback when colliding with their surroundings. Conventional CM collision detection algorithms rely on a combination of exact CM constrained kinematics model, geometrical assumptions such as constant curvature behavior, a priori knowledge of the environmental constraint geometry, and/or additional sensors to scan the environment or sense contacts. In this paper, we propose a data-driven machine learning approach using only the available sensory information, without requiring any prior geometrical assumptions, model of the CM or the surrounding environment. The proposed algorithm is implemented and evaluated on a non-constant curvature CM, equipped with Fiber Bragg Grating (FBG) optical sensors for shape sensing purposes. Results demonstrate successful detection of collisions in constrained environments with soft and hard obstacles with unknown stiffness and location.

Robert B. Grupp, Rachel A. Hegeman, Ryan J. Murphy et al.

Objective: State of the art navigation systems for pelvic osteotomies use optical systems with external fiducials. We propose the use of X-Ray navigation for pose estimation of periacetabular fragments without fiducials. Methods: A 2D/3D registration pipeline was developed to recover fragment pose. This pipeline was tested through an extensive simulation study and 6 cadaveric surgeries. Using osteotomy boundaries in the fluoroscopic images, the preoperative plan is refined to more accurately match the intraoperative shape. Results: In simulation, average fragment pose errors were 1.3°/1.7 mm when the planned fragment matched the intraoperative fragment, 2.2°/2.1 mm when the plan was not updated to match the true shape, and 1.9°/2.0 mm when the fragment shape was intraoperatively estimated. In cadaver experiments, the average pose errors were 2.2°/2.2 mm, 3.8°/2.5 mm, and 3.5°/2.2 mm when registering with the actual fragment shape, a preoperative plan, and an intraoperatively refined plan, respectively. Average errors of the lateral center edge angle were less than 2° for all fragment shapes in simulation and cadaver experiments. Conclusion: The proposed pipeline is capable of accurately reporting femoral head coverage within a range clinically identified for long-term joint survivability. Significance: Human interpretation of fragment pose is challenging and usually restricted to rotation about a single anatomical axis. The proposed pipeline provides an intraoperative estimate of rigid pose with respect to all anatomical axes, is compatible with minimally invasive incisions, and has no dependence on external fiducials.

Mariah Schrum, Amanda Canezin, Sumana Chakravarty et al.

Malaria is the one of the leading causes of morbidity and mortality in many developing countries. The development of a highly effective and readily deployable vaccine represents a major goal for world health. There has been recent progress in developing a clinically effective vaccine manufactured using Plasmodium falciparum sporozoites (PfSPZ) extracted from the salivary glands of Anopheles sp. Mosquitoes. The harvesting of PfSPZ requires dissection of the mosquito and manual removal of the salivary glands from each mosquito by trained technicians. While PfSPZ-based vaccines have shown highly promising results, the process of dissection of salivary glands is tedious and labor intensive. We propose a mechanical device that will greatly increase the rate of mosquito dissection and deskill the process to make malaria vaccines more affordable and more readily available. This device consists of several components: a sorting stage in which the mosquitoes are sorted into slots, a cutting stage in which the heads are removed, and a squeezing stage in which the salivary glands are extracted and collected. This method allows mosquitoes to be dissected twenty at a time instead of one by one as previously done and significantly reduces the dissection time per mosquito.

Murilo M. Marinho, Bruno V. Adorno, Kanako Harada et al.

In adult laparoscopy, robot-aided surgery is a reality in thousands of operating rooms worldwide, owing to the increased dexterity provided by the robotic tools. Many robots and robot control techniques have been developed to aid in more challenging scenarios, such as pediatric surgery and microsurgery. However, the prevalence of case-specific solutions, particularly those focused on non-redundant robots, reduces the reproducibility of the initial results in more challenging scenarios. In this paper, we propose a general framework for the control of surgical robotics in constrained workspaces under teleoperation, regardless of the robot geometry. Our technique is divided into a slave-side constrained optimization algorithm, which provides virtual fixtures, and with Cartesian impedance on the master side to provide force feedback. Experiments with two robotic systems, one redundant and one non-redundant, show that smooth teleoperation can be achieved in adult laparoscopy and infant surgery.

Xingtong Liu, Ayushi Sinha, Mathias Unberath et al.

We present a self-supervised approach to training convolutional neural networks for dense depth estimation from monocular endoscopy data without a priori modeling of anatomy or shading. Our method only requires sequential data from monocular endoscopic videos and a multi-view stereo reconstruction method, e.g. structure from motion, that supervises learning in a sparse but accurate manner. Consequently, our method requires neither manual interaction, such as scaling or labeling, nor patient CT in the training and application phases. We demonstrate the performance of our method on sinus endoscopy data from two patients and validate depth prediction quantitatively using corresponding patient CT scans where we found submillimeter residual errors.

Ayushi Sinha, Xingtong Liu, Austin Reiter et al.

Clinical examinations that involve endoscopic exploration of the nasal cavity and sinuses often do not have a reference image to provide structural context to the clinician. In this paper, we present a system for navigation during clinical endoscopic exploration in the absence of computed tomography (CT) scans by making use of shape statistics from past CT scans. Using a deformable registration algorithm along with dense reconstructions from video, we show that we are able to achieve submillimeter registrations in in-vivo clinical data and are able to assign confidence to these registrations using confidence criteria established using simulated data.

Javad Fotouhi, Mathias Unberath, Giacomo Taylor et al.

In unilateral pelvic fracture reductions, surgeons attempt to reconstruct the bone fragments such that bilateral symmetry in the bony anatomy is restored. We propose to exploit this "structurally symmetric" nature of the pelvic bone, and provide intra-operative image augmentation to assist the surgeon in repairing dislocated fragments. The main challenge is to automatically estimate the desired plane of symmetry within the patient's pre-operative CT. We propose to estimate this plane using a non-linear optimization strategy, by minimizing Tukey's biweight robust estimator, relying on the partial symmetry of the anatomy. Moreover, a regularization term is designed to enforce the similarity of bone density histograms on both sides of this plane, relying on the biological fact that, even if injured, the dislocated bone segments remain within the body. The experimental results demonstrate the performance of the proposed method in estimating this "plane of partial symmetry" using CT images of both healthy and injured anatomy. Examples of unilateral pelvic fractures are used to show how intra-operative X-ray images could be augmented with the forward-projections of the mirrored anatomy, acting as objective road-map for fracture reduction procedures.

Javad Fotouhi, Clayton P. Alexander, Mathias Unberath et al.

Reproducibly achieving proper implant alignment is a critical step in total hip arthroplasty (THA) procedures that has been shown to substantially affect patient outcome. In current practice, correct alignment of the acetabular cup is verified in C-arm X-ray images that are acquired in an anterior-posterior (AP) view. Favorable surgical outcome is, therefore, heavily dependent on the surgeon's experience in understanding the 3D orientation of a hemispheric implant from 2D AP projection images. This work proposes an easy to use intra-operative component planning system based on two C-arm X-ray images that is combined with 3D augmented reality (AR) visualization that simplifies impactor and cup placement according to the planning by providing a real-time RGBD data overlay. We evaluate the feasibility of our system in a user study comprising four orthopedic surgeons at the Johns Hopkins Hospital, and also report errors in translation, anteversion, and abduction as low as 1.98 mm, 1.10 degrees, and 0.53 degrees, respectively. The promising performance of this AR solution shows that deploying this system could eliminate the need for excessive radiation, simplify the intervention, and enable reproducibly accurate placement of acetabular implants.

Anand Malpani, S. Swaroop Vedula, Henry C. Lin et al.

With introduction of new technologies in the operating room like the da Vinci Surgical System, training surgeons to use them effectively and efficiently is crucial in the delivery of better patient care. Coaching by an expert surgeon is effective in teaching relevant technical skills, but current methods to deliver effective coaching are limited and not scalable. We present a virtual reality simulation-based framework for automated virtual coaching in surgical education. We implement our framework within the da Vinci Skills Simulator. We provide three coaching modes ranging from a hands-on teacher (continuous guidance) to a handsoff guide (assistance upon request). We present six teaching cues targeted at critical learning elements of a needle passing task, which are shown to the user based on the coaching mode. These cues are graphical overlays which guide the user, inform them about sub-par performance, and show relevant video demonstrations. We evaluated our framework in a pilot randomized controlled trial with 16 subjects in each arm. In a post-study questionnaire, participants reported high comprehension of feedback, and perceived improvement in performance. After three practice repetitions of the task, the control arm (independent learning) showed better motion efficiency whereas the experimental arm (received real-time coaching) had better performance of learning elements (as per the ACS Resident Skills Curriculum). We observed statistically higher improvement in the experimental group based on one of the metrics (related to needle grasp orientation). In conclusion, we developed an automated coach that provides real-time cues for surgical training and demonstrated its feasibility.

Seth D. Billings, Ayushi Sinha, Austin Reiter et al.

Functional endoscopic sinus surgery (FESS) is a surgical procedure used to treat acute cases of sinusitis and other sinus diseases. FESS is fast becoming the preferred choice of treatment due to its minimally invasive nature. However, due to the limited field of view of the endoscope, surgeons rely on navigation systems to guide them within the nasal cavity. State of the art navigation systems report registration accuracy of over 1mm, which is large compared to the size of the nasal airways. We present an anatomically constrained video-CT registration algorithm that incorporates multiple video features. Our algorithm is robust in the presence of outliers. We also test our algorithm on simulated and in-vivo data, and test its accuracy against degrading initializations.