Danail Stoyanov

Yueming Jin, Yang Yu, Cheng Chen et al.

Automatic surgical scene segmentation is fundamental for facilitating cognitive intelligence in the modern operating theatre. Previous works rely on conventional aggregation modules (e.g., dilated convolution, convolutional LSTM), which only make use of the local context. In this paper, we propose a novel framework STswinCL that explores the complementary intra- and inter-video relations to boost segmentation performance, by progressively capturing the global context. We firstly develop a hierarchy Transformer to capture intra-video relation that includes richer spatial and temporal cues from neighbor pixels and previous frames. A joint space-time window shift scheme is proposed to efficiently aggregate these two cues into each pixel embedding. Then, we explore inter-video relation via pixel-to-pixel contrastive learning, which well structures the global embedding space. A multi-source contrast training objective is developed to group the pixel embeddings across videos with the ground-truth guidance, which is crucial for learning the global property of the whole data. We extensively validate our approach on two public surgical video benchmarks, including EndoVis18 Challenge and CaDIS dataset. Experimental results demonstrate the promising performance of our method, which consistently exceeds previous state-of-the-art approaches. Code is available at https://github.com/YuemingJin/STswinCL.

Razvan Caramalau, Binod Bhattarai, Danail Stoyanov et al.

Active learning(AL) has recently gained popularity for deep learning(DL) models. This is due to efficient and informative sampling, especially when the learner requires large-scale labelled datasets. Commonly, the sampling and training happen in stages while more batches are added. One main bottleneck in this strategy is the narrow representation learned by the model that affects the overall AL selection. We present MoBYv2AL, a novel self-supervised active learning framework for image classification. Our contribution lies in lifting MoBY, one of the most successful self-supervised learning algorithms, to the AL pipeline. Thus, we add the downstream task-aware objective function and optimize it jointly with contrastive loss. Further, we derive a data-distribution selection function from labelling the new examples. Finally, we test and study our pipeline robustness and performance for image classification tasks. We successfully achieved state-of-the-art results when compared to recent AL methods. Code available: https://github.com/razvancaramalau/MoBYv2AL

Matthias Eisenmann, Annika Reinke, Vivienn Weru et al. · utoronto

The number of international benchmarking competitions is steadily increasing in various fields of machine learning (ML) research and practice. So far, however, little is known about the common practice as well as bottlenecks faced by the community in tackling the research questions posed. To shed light on the status quo of algorithm development in the specific field of biomedical imaging analysis, we designed an international survey that was issued to all participants of challenges conducted in conjunction with the IEEE ISBI 2021 and MICCAI 2021 conferences (80 competitions in total). The survey covered participants' expertise and working environments, their chosen strategies, as well as algorithm characteristics. A median of 72% challenge participants took part in the survey. According to our results, knowledge exchange was the primary incentive (70%) for participation, while the reception of prize money played only a minor role (16%). While a median of 80 working hours was spent on method development, a large portion of participants stated that they did not have enough time for method development (32%). 25% perceived the infrastructure to be a bottleneck. Overall, 94% of all solutions were deep learning-based. Of these, 84% were based on standard architectures. 43% of the respondents reported that the data samples (e.g., images) were too large to be processed at once. This was most commonly addressed by patch-based training (69%), downsampling (37%), and solving 3D analysis tasks as a series of 2D tasks. K-fold cross-validation on the training set was performed by only 37% of the participants and only 50% of the participants performed ensembling based on multiple identical models (61%) or heterogeneous models (39%). 48% of the respondents applied postprocessing steps.

Netanell Avisdris, Leo Joskowicz, Brian Dromey et al.

Fetal growth assessment from ultrasound is based on a few biometric measurements that are performed manually and assessed relative to the expected gestational age. Reliable biometry estimation depends on the precise detection of landmarks in standard ultrasound planes. Manual annotation can be time-consuming and operator dependent task, and may results in high measurements variability. Existing methods for automatic fetal biometry rely on initial automatic fetal structure segmentation followed by geometric landmark detection. However, segmentation annotations are time-consuming and may be inaccurate, and landmark detection requires developing measurement-specific geometric methods. This paper describes BiometryNet, an end-to-end landmark regression framework for fetal biometry estimation that overcomes these limitations. It includes a novel Dynamic Orientation Determination (DOD) method for enforcing measurement-specific orientation consistency during network training. DOD reduces variabilities in network training, increases landmark localization accuracy, thus yields accurate and robust biometric measurements. To validate our method, we assembled a dataset of 3,398 ultrasound images from 1,829 subjects acquired in three clinical sites with seven different ultrasound devices. Comparison and cross-validation of three different biometric measurements on two independent datasets shows that BiometryNet is robust and yields accurate measurements whose errors are lower than the clinically permissible errors, outperforming other existing automated biometry estimation methods. Code is available at https://github.com/netanellavisdris/fetalbiometry.

Ronast Subedi, Rebati Raman Gaire, Sharib Ali et al.

This paper presents a solution to the cross-domain adaptation problem for 2D surgical image segmentation, explicitly considering the privacy protection of distributed datasets belonging to different centers. Deep learning architectures in medical image analysis necessitate extensive training data for better generalization. However, obtaining sufficient diagnostic and surgical data is still challenging, mainly due to the inherent cost of data curation and the need of experts for data annotation. Moreover, increased privacy and legal compliance concerns can make data sharing across clinical sites or regions difficult. Another ubiquitous challenge the medical datasets face is inevitable domain shifts among the collected data at the different centers. To this end, we propose a Client-server deep federated architecture for cross-domain adaptation. A server hosts a set of immutable parameters common to both the source and target domains. The clients consist of the respective domain-specific parameters and make requests to the server while learning their parameters and inferencing. We evaluate our framework in two benchmark datasets, demonstrating applicability in computer-assisted interventions for endoscopic polyp segmentation and diagnostic skin lesion detection and analysis. Our extensive quantitative and qualitative experiments demonstrate the superiority of the proposed method compared to competitive baseline and state-of-the-art methods. Codes are available at: https://github.com/thetna/distributed-da

Shrawan Kumar Thapa, Pranav Poudel, Binod Bhattarai et al.

Semantic segmentation of polyps and depth estimation are two important research problems in endoscopic image analysis. One of the main obstacles to conduct research on these research problems is lack of annotated data. Endoscopic annotations necessitate the specialist knowledge of expert endoscopists and due to this, it can be difficult to organise, expensive and time consuming. To address this problem, we investigate an active learning paradigm to reduce the number of training examples by selecting the most discriminative and diverse unlabelled examples for the task taken into consideration. Most of the existing active learning pipelines are task-agnostic in nature and are often sub-optimal to the end task. In this paper, we propose a novel task-aware active learning pipeline and applied for two important tasks in endoscopic image analysis: semantic segmentation and depth estimation. We compared our method with the competitive baselines. From the experimental results, we observe a substantial improvement over the compared baselines. Codes are available at https://github.com/thetna/endo-active-learn.

Mona Sheikh Zeinoddin, Chiara Lena, Jiongqi Qu et al.

Robotic-assisted surgery (RAS) relies on accurate depth estimation for 3D reconstruction and visualization. While foundation models like Depth Anything Models (DAM) show promise, directly applying them to surgery often yields suboptimal results. Fully fine-tuning on limited surgical data can cause overfitting and catastrophic forgetting, compromising model robustness and generalization. Although Low-Rank Adaptation (LoRA) addresses some adaptation issues, its uniform parameter distribution neglects the inherent feature hierarchy, where earlier layers, learning more general features, require more parameters than later ones. To tackle this issue, we introduce Depth Anything in Robotic Endoscopic Surgery (DARES), a novel approach that employs a new adaptation technique, Vector Low-Rank Adaptation (Vector-LoRA) on the DAM V2 to perform self-supervised monocular depth estimation in RAS scenes. To enhance learning efficiency, we introduce Vector-LoRA by integrating more parameters in earlier layers and gradually decreasing parameters in later layers. We also design a reprojection loss based on the multi-scale SSIM error to enhance depth perception by better tailoring the foundation model to the specific requirements of the surgical environment. The proposed method is validated on the SCARED dataset and demonstrates superior performance over recent state-of-the-art self-supervised monocular depth estimation techniques, achieving an improvement of 13.3% in the absolute relative error metric. The code and pre-trained weights are available at https://github.com/mobarakol/DARES.

Bohan Zhan, Wang Zhao, Yi Fang et al.

Accurate tracking of tissues and instruments in videos is crucial for Robotic-Assisted Minimally Invasive Surgery (RAMIS), as it enables the robot to comprehend the surgical scene with precise locations and interactions of tissues and tools. Traditional keypoint-based sparse tracking is limited by featured points, while flow-based dense two-view matching suffers from long-term drifts. Recently, the Tracking Any Point (TAP) algorithm was proposed to overcome these limitations and achieve dense accurate long-term tracking. However, its efficacy in surgical scenarios remains untested, largely due to the lack of a comprehensive surgical tracking dataset for evaluation. To address this gap, we introduce a new annotated surgical tracking dataset for benchmarking tracking methods for surgical scenarios, comprising real-world surgical videos with complex tissue and instrument motions. We extensively evaluate state-of-the-art (SOTA) TAP-based algorithms on this dataset and reveal their limitations in challenging surgical scenarios, including fast instrument motion, severe occlusions, and motion blur, etc. Furthermore, we propose a new tracking method, namely SurgMotion, to solve the challenges and further improve the tracking performance. Our proposed method outperforms most TAP-based algorithms in surgical instruments tracking, and especially demonstrates significant improvements over baselines in challenging medical videos. Our code and dataset are available at https://github.com/zhanbh1019/SurgicalMotion.

Chinedu Innocent Nwoye, Deepak Alapatt, Tong Yu et al.

Context-aware decision support in the operating room can foster surgical safety and efficiency by leveraging real-time feedback from surgical workflow analysis. Most existing works recognize surgical activities at a coarse-grained level, such as phases, steps or events, leaving out fine-grained interaction details about the surgical activity; yet those are needed for more helpful AI assistance in the operating room. Recognizing surgical actions as triplets of <instrument, verb, target> combination delivers comprehensive details about the activities taking place in surgical videos. This paper presents CholecTriplet2021: an endoscopic vision challenge organized at MICCAI 2021 for the recognition of surgical action triplets in laparoscopic videos. The challenge granted private access to the large-scale CholecT50 dataset, which is annotated with action triplet information. In this paper, we present the challenge setup and assessment of the state-of-the-art deep learning methods proposed by the participants during the challenge. A total of 4 baseline methods from the challenge organizers and 19 new deep learning algorithms by competing teams are presented to recognize surgical action triplets directly from surgical videos, achieving mean average precision (mAP) ranging from 4.2% to 38.1%. This study also analyzes the significance of the results obtained by the presented approaches, performs a thorough methodological comparison between them, in-depth result analysis, and proposes a novel ensemble method for enhanced recognition. Our analysis shows that surgical workflow analysis is not yet solved, and also highlights interesting directions for future research on fine-grained surgical activity recognition which is of utmost importance for the development of AI in surgery.

Binod Bhattarai, Ronast Subedi, Rebati Raman Gaire et al.

We present our novel deep multi-task learning method for medical image segmentation. Existing multi-task methods demand ground truth annotations for both the primary and auxiliary tasks. Contrary to it, we propose to generate the pseudo-labels of an auxiliary task in an unsupervised manner. To generate the pseudo-labels, we leverage Histogram of Oriented Gradients (HOGs), one of the most widely used and powerful hand-crafted features for detection. Together with the ground truth semantic segmentation masks for the primary task and pseudo-labels for the auxiliary task, we learn the parameters of the deep network to minimise the loss of both the primary task and the auxiliary task jointly. We employed our method on two powerful and widely used semantic segmentation networks: UNet and U2Net to train in a multi-task setup. To validate our hypothesis, we performed experiments on two different medical image segmentation data sets. From the extensive quantitative and qualitative results, we observe that our method consistently improves the performance compared to the counter-part method. Moreover, our method is the winner of FetReg Endovis Sub-challenge on Semantic Segmentation organised in conjunction with MICCAI 2021.

Jialang Xu, Jiacheng Wang, Lequan Yu et al.

Personalized federated learning (PFL) for surgical instrument segmentation (SIS) is a promising approach. It enables multiple clinical sites to collaboratively train a series of models in privacy, with each model tailored to the individual distribution of each site. Existing PFL methods rarely consider the personalization of multi-headed self-attention, and do not account for appearance diversity and instrument shape similarity, both inherent in surgical scenes. We thus propose PFedSIS, a novel PFL method with visual trait priors for SIS, incorporating global-personalized disentanglement (GPD), appearance-regulation personalized enhancement (APE), and shape-similarity global enhancement (SGE), to boost SIS performance in each site. GPD represents the first attempt at head-wise assignment for multi-headed self-attention personalization. To preserve the unique appearance representation of each site and gradually leverage the inter-site difference, APE introduces appearance regulation and provides customized layer-wise aggregation solutions via hypernetworks for each site's personalized parameters. The mutual shape information of instruments is maintained and shared via SGE, which enhances the cross-style shape consistency on the image level and computes the shape-similarity contribution of each site on the prediction level for updating the global parameters. PFedSIS outperforms state-of-the-art methods with +1.51% Dice, +2.11% IoU, -2.79 ASSD, -15.55 HD95 performance gains. The corresponding code and models will be released at https://github.com/wzjialang/PFedSIS.

Mauro Orazio Drago, Luca Carlini, Pelinsu Celebi Balyemez et al.

Video Question Answering (VideoQA) in the surgical domain aims to enhance intraoperative understanding by enabling AI models to reason over temporally coherent events rather than isolated frames. Current approaches are limited to static image features, and available datasets often lack temporal annotations, ignoring the dynamics critical for accurate procedural interpretation. We propose SurgViVQA, a surgical VideoQA model that extends visual reasoning from static images to dynamic surgical scenes. It uses a Masked Video--Text Encoder to fuse video and question features, capturing temporal cues such as motion and tool--tissue interactions, which a fine-tuned large language model (LLM) then decodes into coherent answers. To evaluate its performance, we curated REAL-Colon-VQA, a colonoscopic video dataset that includes motion-related questions and diagnostic attributes, as well as out-of-template questions with rephrased or semantically altered formulations to assess model robustness. Experimental validation on REAL-Colon-VQA and the public EndoVis18-VQA dataset shows that SurgViVQA outperforms existing image-based VQA benchmark models, particularly in keyword accuracy, improving over PitVQA by +11\% on REAL-Colon-VQA and +9\% on EndoVis18-VQA. A perturbation study on the questions further confirms improved generalizability and robustness to variations in question phrasing. SurgViVQA and the REAL-Colon-VQA dataset provide a framework for temporally-aware understanding in surgical VideoQA, enabling AI models to interpret dynamic procedural contexts more effectively. Code and dataset available at https://github.com/madratak/SurgViVQA.

Dennis Pierantozzi, Luca Carlini, Mauro Orazio Drago et al.

Safety and reliability are essential for deploying Visual Question Answering (VQA) in surgery, where incorrect or ambiguous responses can harm the patient. Most surgical VQA research focuses on accuracy or linguistic quality while overlooking safety behaviors such as ambiguity awareness, referral to human experts, or triggering a second opinion. Inspired by Automatic Failure Detection (AFD), we study uncertainty estimation as a key enabler of safer decision making. We introduce Question Aligned Semantic Nearest Neighbor Entropy (QA-SNNE), a black box uncertainty estimator that incorporates question semantics into prediction confidence. It measures semantic entropy by comparing generated answers with nearest neighbors in a medical text embedding space, conditioned on the question. We evaluate five models, including domain specific Parameter-Efficient Fine-Tuned (PEFT) models and zero-shot Large Vision-Language Models (LVLMs), on EndoVis18-VQA and PitVQA. PEFT models degrade under mild paraphrasing, while LVLMs are more resilient. Across three LVLMs and two PEFT baselines, QA-SNNE improves AUROC in most in-template settings and enhances hallucination detection. The Area Under the ROC Curve (AUROC) increases by 15-38% for zero-shot models, with gains maintained under out-of-template stress. QA-SNNE offers a practical and interpretable step toward AFD in surgical VQA by linking semantic uncertainty to question context. Combining LVLM backbones with question aligned uncertainty estimation can improve safety and clinician trust. The code and model are available at https://github.com/DennisPierantozzi/QASNNE

Anita Rau, Binod Bhattarai, Lourdes Agapito et al.

Deducing the 3D structure of endoscopic scenes from images is exceedingly challenging. In addition to deformation and view-dependent lighting, tubular structures like the colon present problems stemming from their self-occluding and repetitive anatomical structure. In this paper, we propose SimCol, a synthetic dataset for camera pose estimation in colonoscopy, and a novel method that explicitly learns a bimodal distribution to predict the endoscope pose. Our dataset replicates real colonoscope motion and highlights the drawbacks of existing methods. We publish 18k RGB images from simulated colonoscopy with corresponding depth and camera poses and make our data generation environment in Unity publicly available. We evaluate different camera pose prediction methods and demonstrate that, when trained on our data, they generalize to real colonoscopy sequences, and our bimodal approach outperforms prior unimodal work.

Maria Grammatikopoulou, Ricardo Sanchez-Matilla, Felix Bragman et al.

Semantic segmentation in surgical videos has applications in intra-operative guidance, post-operative analytics and surgical education. Segmentation models need to provide accurate and consistent predictions since temporally inconsistent identification of anatomical structures can impair usability and hinder patient safety. Video information can alleviate these challenges leading to reliable models suitable for clinical use. We propose a novel architecture for modelling temporal relationships in videos. The proposed model includes a spatio-temporal decoder to enable video semantic segmentation by improving temporal consistency across frames. The encoder processes individual frames whilst the decoder processes a temporal batch of adjacent frames. The proposed decoder can be used on top of any segmentation encoder to improve temporal consistency. Model performance was evaluated on the CholecSeg8k dataset and a private dataset of robotic Partial Nephrectomy procedures. Segmentation performance was improved when the temporal decoder was applied across both datasets. The proposed model also displayed improvements in temporal consistency.

Yitong Zhang, Sophia Bano, Ann-Sophie Page et al.

In minimally invasive surgery, surgical workflow segmentation from video analysis is a well studied topic. The conventional approach defines it as a multi-class classification problem, where individual video frames are attributed a surgical phase label. We introduce a novel reinforcement learning formulation for offline phase transition retrieval. Instead of attempting to classify every video frame, we identify the timestamp of each phase transition. By construction, our model does not produce spurious and noisy phase transitions, but contiguous phase blocks. We investigate two different configurations of this model. The first does not require processing all frames in a video (only <60% and <20% of frames in 2 different applications), while producing results slightly under the state-of-the-art accuracy. The second configuration processes all video frames, and outperforms the state-of-the art at a comparable computational cost. We compare our method against the recent top-performing frame-based approaches TeCNO and Trans-SVNet on the public dataset Cholec80 and also on an in-house dataset of laparoscopic sacrocolpopexy. We perform both a frame-based (accuracy, precision, recall and F1-score) and an event-based (event ratio) evaluation of our algorithms.

Anita Rau, Sophia Bano, Yueming Jin et al.

Colorectal cancer is one of the most common cancers in the world. While colonoscopy is an effective screening technique, navigating an endoscope through the colon to detect polyps is challenging. A 3D map of the observed surfaces could enhance the identification of unscreened colon tissue and serve as a training platform. However, reconstructing the colon from video footage remains difficult. Learning-based approaches hold promise as robust alternatives, but necessitate extensive datasets. Establishing a benchmark dataset, the 2022 EndoVis sub-challenge SimCol3D aimed to facilitate data-driven depth and pose prediction during colonoscopy. The challenge was hosted as part of MICCAI 2022 in Singapore. Six teams from around the world and representatives from academia and industry participated in the three sub-challenges: synthetic depth prediction, synthetic pose prediction, and real pose prediction. This paper describes the challenge, the submitted methods, and their results. We show that depth prediction from synthetic colonoscopy images is robustly solvable, while pose estimation remains an open research question.

Sophia Bano, Alessandro Casella, Francisco Vasconcelos et al.

Fetoscopy laser photocoagulation is a widely adopted procedure for treating Twin-to-Twin Transfusion Syndrome (TTTS). The procedure involves photocoagulation pathological anastomoses to regulate blood exchange among twins. The procedure is particularly challenging due to the limited field of view, poor manoeuvrability of the fetoscope, poor visibility, and variability in illumination. These challenges may lead to increased surgery time and incomplete ablation. Computer-assisted intervention (CAI) can provide surgeons with decision support and context awareness by identifying key structures in the scene and expanding the fetoscopic field of view through video mosaicking. Research in this domain has been hampered by the lack of high-quality data to design, develop and test CAI algorithms. Through the Fetoscopic Placental Vessel Segmentation and Registration (FetReg2021) challenge, which was organized as part of the MICCAI2021 Endoscopic Vision challenge, we released the first largescale multicentre TTTS dataset for the development of generalized and robust semantic segmentation and video mosaicking algorithms. For this challenge, we released a dataset of 2060 images, pixel-annotated for vessels, tool, fetus and background classes, from 18 in-vivo TTTS fetoscopy procedures and 18 short video clips. Seven teams participated in this challenge and their model performance was assessed on an unseen test dataset of 658 pixel-annotated images from 6 fetoscopic procedures and 6 short clips. The challenge provided an opportunity for creating generalized solutions for fetoscopic scene understanding and mosaicking. In this paper, we present the findings of the FetReg2021 challenge alongside reporting a detailed literature review for CAI in TTTS fetoscopy. Through this challenge, its analysis and the release of multi-centre fetoscopic data, we provide a benchmark for future research in this field.

Alexander Saikia, Chiara Di Vece, Zhehua Mao et al.

Purpose: 3D reconstruction in minimally invasive surgery (MIS) enables enhanced surgical guidance through improved visualisation, tool tracking, and augmented reality. However, traditional RGB-based keypoint detection and matching pipelines struggle with surgical challenges, such as poor texture and complex illumination. We investigate whether using snapshot hyperspectral imaging (HSI) can provide improved results on keypoint detection and matching surgical scenes. Methods: We developed HyKey, a HYperspectral KEYpoint detection and description model made up of a hybrid 3D-2D convolutional neural network that jointly extracts spatial-spectral features from HSI. The model was trained using synthetic homographic augmentation and epipolar geometry constraints on a robotically-acquired dual-camera RGB-HSI laparoscopic dataset of ex-vivo organs with calibrated camera poses. We benchmarked performance against established RGB-based methods, including SuperPoint and ALIKE. Results: Our HSI-based model outperformed RGB baselines on registered RGB frames, achieving 96.62% mean matching accuracy and 67.18% mean average accuracy at 10 degree on pose estimation, demonstrating consistent improvements across multiple evaluation metrics. Conclusion: Integrating spectral information from an HSI cube offers a promising approach for robust monocular 3D reconstruction in MIS, addressing limitations of texture-poor surgical environments through enhanced spectral-spatial feature discrimination. Our model and dataset are available at https://github.com/alexsaikia/HyKey-Hyperspectral-Keypoint-Detection

Alessandro Casella, Sophia Bano, Francisco Vasconcelos et al.

In Twin-to-Twin Transfusion Syndrome (TTTS), abnormal vascular anastomoses in the monochorionic placenta can produce uneven blood flow between the two fetuses. In the current practice, TTTS is treated surgically by closing abnormal anastomoses using laser ablation. This surgery is minimally invasive and relies on fetoscopy. Limited field of view makes anastomosis identification a challenging task for the surgeon. To tackle this challenge, we propose a learning-based framework for in-vivo fetoscopy frame registration for field-of-view expansion. The novelties of this framework relies on a learning-based keypoint proposal network and an encoding strategy to filter (i) irrelevant keypoints based on fetoscopic image segmentation and (ii) inconsistent homographies. We validate of our framework on a dataset of 6 intraoperative sequences from 6 TTTS surgeries from 6 different women against the most recent state of the art algorithm, which relies on the segmentation of placenta vessels. The proposed framework achieves higher performance compared to the state of the art, paving the way for robust mosaicking to provide surgeons with context awareness during TTTS surgery.

Simone Foti, Bongjin Koo, Danail Stoyanov et al.

Designing realistic digital humans is extremely complex. Most data-driven generative models used to simplify the creation of their underlying geometric shape do not offer control over the generation of local shape attributes. In this paper, we overcome this limitation by introducing a novel loss function grounded in spectral geometry and applicable to different neural-network-based generative models of 3D head and body meshes. Encouraging the latent variables of mesh variational autoencoders (VAEs) or generative adversarial networks (GANs) to follow the local eigenprojections of identity attributes, we improve latent disentanglement and properly decouple the attribute creation. Experimental results show that our local eigenprojection disentangled (LED) models not only offer improved disentanglement with respect to the state-of-the-art, but also maintain good generation capabilities with training times comparable to the vanilla implementations of the models.

Jinfan Zhou, William Muirhead, Simon C. Williams et al.

Purpose: Microsurgical Aneurysm Clipping Surgery (MACS) carries a high risk for intraoperative aneurysm rupture. Automated recognition of instances when the aneurysm is exposed in the surgical video would be a valuable reference point for neuronavigation, indicating phase transitioning and more importantly designating moments of high risk for rupture. This article introduces the MACS dataset containing 16 surgical videos with frame-level expert annotations and proposes a learning methodology for surgical scene understanding identifying video frames with the aneurysm present in the operating microscope's field-of-view. Methods: Despite the dataset imbalance (80% no presence, 20% presence) and developed without explicit annotations, we demonstrate the applicability of Transformer-based deep learning architectures (MACSSwin-T, vidMACSSwin-T) to detect the aneurysm and classify MACS frames accordingly. We evaluate the proposed models in multiple-fold cross-validation experiments with independent sets and in an unseen set of 15 images against 10 human experts (neurosurgeons). Results: Average (across folds) accuracy of 80.8% (range 78.5%-82.4%) and 87.1% (range 85.1%-91.3%) is obtained for the image- and video-level approach respectively, demonstrating that the models effectively learn the classification task. Qualitative evaluation of the models' class activation maps show these to be localized on the aneurysm's actual location. Depending on the decision threshold, MACSWin-T achieves 66.7% to 86.7% accuracy in the unseen images, compared to 82% of human raters, with moderate to strong correlation.

Jinglu Zhang, Santiago Barbarisi, Abdolrahim Kadkhodamohammadi et al.

Purpose: Advances in surgical phase recognition are generally led by training deeper networks. Rather than going further with a more complex solution, we believe that current models can be exploited better. We propose a self-knowledge distillation framework that can be integrated into current state-of-the-art (SOTA) models without requiring any extra complexity to the models or annotations. Methods: Knowledge distillation is a framework for network regularization where knowledge is distilled from a teacher network to a student network. In self-knowledge distillation, the student model becomes the teacher such that the network learns from itself. Most phase recognition models follow an encoder-decoder framework. Our framework utilizes self-knowledge distillation in both stages. The teacher model guides the training process of the student model to extract enhanced feature representations from the encoder and build a more robust temporal decoder to tackle the over-segmentation problem. Results: We validate our proposed framework on the public dataset Cholec80. Our framework is embedded on top of four popular SOTA approaches and consistently improves their performance. Specifically, our best GRU model boosts performance by +3.33% accuracy and +3.95% F1-score over the same baseline model. Conclusion: We embed a self-knowledge distillation framework for the first time in the surgical phase recognition training pipeline. Experimental results demonstrate that our simple yet powerful framework can improve performance of existing phase recognition models. Moreover, our extensive experiments show that even with 75% of the training set we still achieve performance on par with the same baseline model trained on the full set.

Chiara Di Vece, Maela Le Lous, Brian Dromey et al.

In obstetric ultrasound (US) scanning, the learner's ability to mentally build a three-dimensional (3D) map of the fetus from a two-dimensional (2D) US image represents a significant challenge in skill acquisition. We aim to build a US plane localization system for 3D visualization, training, and guidance without integrating additional sensors. This work builds on top of our previous work, which predicts the six-dimensional (6D) pose of arbitrarily oriented US planes slicing the fetal brain with respect to a normalized reference frame using a convolutional neural network (CNN) regression network. Here, we analyze in detail the assumptions of the normalized fetal brain reference frame and quantify its accuracy with respect to the acquisition of transventricular (TV) standard plane (SP) for fetal biometry. We investigate the impact of registration quality in the training and testing data and its subsequent effect on trained models. Finally, we introduce data augmentations and larger training sets that improve the results of our previous work, achieving median errors of 2.97 mm and 6.63 degrees for translation and rotation, respectively.

Simone Foti, Alexander J. Rickart, Bongjin Koo et al.

The use of deep learning to undertake shape analysis of the complexities of the human head holds great promise. However, there have traditionally been a number of barriers to accurate modelling, especially when operating on both a global and local level. In this work, we will discuss the application of the Swap Disentangled Variational Autoencoder (SD-VAE) with relevance to Crouzon, Apert and Muenke syndromes. Although syndrome classification is performed on the entire mesh, it is also possible, for the first time, to analyse the influence of each region of the head on the syndromic phenotype. By manipulating specific parameters of the generative model, and producing procedure-specific new shapes, it is also possible to simulate the outcome of a range of craniofacial surgical procedures. This opens new avenues to advance diagnosis, aids surgical planning and allows for the objective evaluation of surgical outcomes.

Aneeq Zia, Kiran Bhattacharyya, Xi Liu et al.

Timely and effective feedback within surgical training plays a critical role in developing the skills required to perform safe and efficient surgery. Feedback from expert surgeons, while especially valuable in this regard, is challenging to acquire due to their typically busy schedules, and may be subject to biases. Formal assessment procedures like OSATS and GEARS attempt to provide objective measures of skill, but remain time-consuming. With advances in machine learning there is an opportunity for fast and objective automated feedback on technical skills. The SimSurgSkill 2021 challenge (hosted as a sub-challenge of EndoVis at MICCAI 2021) aimed to promote and foster work in this endeavor. Using virtual reality (VR) surgical tasks, competitors were tasked with localizing instruments and predicting surgical skill. Here we summarize the winning approaches and how they performed. Using this publicly available dataset and results as a springboard, future work may enable more efficient training of surgeons with advances in surgical data science. The dataset can be accessed from https://console.cloud.google.com/storage/browser/isi-simsurgskill-2021.

Adrito Das, Danyal Z. Khan, Dimitrios Psychogyios et al.

The field of computer vision applied to videos of minimally invasive surgery is ever-growing. Workflow recognition pertains to the automated recognition of various aspects of a surgery: including which surgical steps are performed; and which surgical instruments are used. This information can later be used to assist clinicians when learning the surgery; during live surgery; and when writing operation notes. The Pituitary Vision (PitVis) 2023 Challenge tasks the community to step and instrument recognition in videos of endoscopic pituitary surgery. This is a unique task when compared to other minimally invasive surgeries due to the smaller working space, which limits and distorts vision; and higher frequency of instrument and step switching, which requires more precise model predictions. Participants were provided with 25-videos, with results presented at the MICCAI-2023 conference as part of the Endoscopic Vision 2023 Challenge in Vancouver, Canada, on 08-Oct-2023. There were 18-submissions from 9-teams across 6-countries, using a variety of deep learning models. A commonality between the top performing models was incorporating spatio-temporal and multi-task methods, with greater than 50% and 10% macro-F1-score improvement over purely spacial single-task models in step and instrument recognition respectively. The PitVis-2023 Challenge therefore demonstrates state-of-the-art computer vision models in minimally invasive surgery are transferable to a new dataset, with surgery specific techniques used to enhance performance, progressing the field further. Benchmark results are provided in the paper, and the dataset is publicly available at: https://doi.org/10.5522/04/26531686.

Abhinav Joshi, Naman Gupta, Jinang Shah et al.

A real-world application or setting involves interaction between different modalities (e.g., video, speech, text). In order to process the multimodal information automatically and use it for an end application, Multimodal Representation Learning (MRL) has emerged as an active area of research in recent times. MRL involves learning reliable and robust representations of information from heterogeneous sources and fusing them. However, in practice, the data acquired from different sources are typically noisy. In some extreme cases, a noise of large magnitude can completely alter the semantics of the data leading to inconsistencies in the parallel multimodal data. In this paper, we propose a novel method for multimodal representation learning in a noisy environment via the generalized product of experts technique. In the proposed method, we train a separate network for each modality to assess the credibility of information coming from that modality, and subsequently, the contribution from each modality is dynamically varied while estimating the joint distribution. We evaluate our method on two challenging benchmarks from two diverse domains: multimodal 3D hand-pose estimation and multimodal surgical video segmentation. We attain state-of-the-art performance on both benchmarks. Our extensive quantitative and qualitative evaluations show the advantages of our method compared to previous approaches.

Baoru Huang, Tuan Vo, Chayun Kongtongvattana et al.

Real-time visual feedback from catheterization analysis is crucial for enhancing surgical safety and efficiency during endovascular interventions. However, existing datasets are often limited to specific tasks, small scale, and lack the comprehensive annotations necessary for broader endovascular intervention understanding. To tackle these limitations, we introduce CathAction, a large-scale dataset for catheterization understanding. Our CathAction dataset encompasses approximately 500,000 annotated frames for catheterization action understanding and collision detection, and 25,000 ground truth masks for catheter and guidewire segmentation. For each task, we benchmark recent related works in the field. We further discuss the challenges of endovascular intentions compared to traditional computer vision tasks and point out open research questions. We hope that CathAction will facilitate the development of endovascular intervention understanding methods that can be applied to real-world applications. The dataset is available at https://airvlab.github.io/cathaction/.

Anita Rau, Binod Bhattarai, Lourdes Agapito et al.

Colorectal cancer remains one of the deadliest cancers in the world. In recent years computer-aided methods have aimed to enhance cancer screening and improve the quality and availability of colonoscopies by automatizing sub-tasks. One such task is predicting depth from monocular video frames, which can assist endoscopic navigation. As ground truth depth from standard in-vivo colonoscopy remains unobtainable due to hardware constraints, two approaches have aimed to circumvent the need for real training data: supervised methods trained on labeled synthetic data and self-supervised models trained on unlabeled real data. However, self-supervised methods depend on unreliable loss functions that struggle with edges, self-occlusion, and lighting inconsistency. Methods trained on synthetic data can provide accurate depth for synthetic geometries but do not use any geometric supervisory signal from real data and overfit to synthetic anatomies and properties. This work proposes a novel approach to leverage labeled synthetic and unlabeled real data. While previous domain adaptation methods indiscriminately enforce the distributions of both input data modalities to coincide, we focus on the end task, depth prediction, and translate only essential information between the input domains. Our approach results in more resilient and accurate depth maps of real colonoscopy sequences.

Bidur Khanal, Binod Bhattarai, Bishesh Khanal et al.

Acquiring properly annotated data is expensive in the medical field as it requires experts, time-consuming protocols, and rigorous validation. Active learning attempts to minimize the need for large annotated samples by actively sampling the most informative examples for annotation. These examples contribute significantly to improving the performance of supervised machine learning models, and thus, active learning can play an essential role in selecting the most appropriate information in deep learning-based diagnosis, clinical assessments, and treatment planning. Although some existing works have proposed methods for sampling the best examples for annotation in medical image analysis, they are not task-agnostic and do not use multimodal auxiliary information in the sampler, which has the potential to increase robustness. Therefore, in this work, we propose a Multimodal Variational Adversarial Active Learning (M-VAAL) method that uses auxiliary information from additional modalities to enhance the active sampling. We applied our method to two datasets: i) brain tumor segmentation and multi-label classification using the BraTS2018 dataset, and ii) chest X-ray image classification using the COVID-QU-Ex dataset. Our results show a promising direction toward data-efficient learning under limited annotations.

Antonio S Soares, Sophia Bano, Neil T Clancy et al.

Background: Fluorescence angiography has shown very promising results in reducing anastomotic leaks by allowing the surgeon to select optimally perfused tissue. However, subjective interpretation of the fluorescent signal still hinders broad application of the technique, as significant variation between different surgeons exists. Our aim is to develop an artificial intelligence algorithm to classify colonic tissue as 'perfused' or 'not perfused' based on intraoperative fluorescence angiography data. Methods: A classification model with a Resnet architecture was trained on a dataset of fluorescence angiography videos of colorectal resections at a tertiary referral centre. Frames corresponding to fluorescent and non-fluorescent segments of colon were used to train a classification algorithm. Validation using frames from patients not used in the training set was performed, including both data collected using the same equipment and data collected using a different camera. Performance metrics were calculated, and saliency maps used to further analyse the output. A decision boundary was identified based on the tissue classification. Results: A convolutional neural network was successfully trained on 1790 frames from 7 patients and validated in 24 frames from 14 patients. The accuracy on the training set was 100%, on the validation set was 80%. Recall and precision were respectively 100% and 100% on the training set and 68.8% and 91.7% on the validation set. Conclusion: Automated classification of intraoperative fluorescence angiography with a high degree of accuracy is possible and allows automated decision boundary identification. This will enable surgeons to standardise the technique of fluorescence angiography. A web based app was made available to deploy the algorithm.

Krittin Pachtrachai, Francisco Vasconcelos, Danail Stoyanov

Hand-eye calibration algorithms are mature and provide accurate transformation estimations for an effective camera-robot link but rely on a sufficiently wide range of calibration data to avoid errors and degenerate configurations. To solve the hand-eye problem in robotic-assisted minimally invasive surgery and also simplify the calibration procedure by using neural network method cooporating with the new objective function. We present a neural network-based solution that estimates the transformation from a sequence of images and kinematic data which significantly simplifies the calibration procedure. The network utilises the long short-term memory architecture to extract temporal information from the data and solve the hand-eye problem. The objective function is derived from the linear combination of remote centre of motion constraint, the re-projection error and its derivative to induce a small change in the hand-eye transformation. The method is validated with the data from da Vinci Si and the result shows that the estimated hand-eye matrix is able to re-project the end-effector from the robot coordinate to the camera coordinate within 10 to 20 pixels of accuracy in both testing dataset. The calibration performance is also superior to the previous neural network-based hand-eye method. The proposed algorithm shows that the calibration procedure can be simplified by using deep learning techniques and the performance is improved by the assumption of non-static hand-eye transformations.

Luca Carlini, Chiara Lena, Cesare Hassan et al.

Surgical Video Question Answering (VideoQA) requires accurate temporal grounding while remaining robust to natural variation in how clinicians phrase questions, where linguistic bias can arise. Standard Parameter Efficient Fine Tuning (PEFT) methods adapt pretrained projections without explicitly modeling frame-to-frame interactions within the adaptation pathway, limiting their ability to exploit sparse temporal evidence. We introduce TemporalDoRA, a video-specific PEFT formulation that extends Weight-Decomposed Low-Rank Adaptation by (i) inserting lightweight temporal Multi-Head Attention (MHA) inside the low-rank bottleneck of the vision encoder and (ii) selectively applying weight decomposition only to the trainable low-rank branch rather than the full adapted weight. This design enables temporally-aware updates while preserving a frozen backbone and stable scaling. By mixing information across frames within the adaptation subspace, TemporalDoRA steers updates toward temporally consistent visual cues and improves robustness with minimal parameter overhead. To benchmark this setting, we present REAL-Colon-VQA, a colonoscopy VideoQA dataset with 6,424 clip--question pairs, including paired rephrased Out-of-Template questions to evaluate sensitivity to linguistic variation. TemporalDoRA improves Out-of-Template performance, and ablation studies confirm that temporal mixing inside the low-rank branch is the primary driver of these gains. We also validate on EndoVis18-VQA adapted to short clips and observe consistent improvements on the Out-of-Template split. Code and dataset available at~\href{https://anonymous.4open.science/r/TemporalDoRA-BFC8/}{Anonymous GitHub}.

Sierra Bonilla, Chiara Di Vece, Rema Daher et al.

Three-dimensional (3D) reconstruction from two-dimensional images is an active research field in computer vision, with applications ranging from navigation and object tracking to segmentation and three-dimensional modeling. Traditionally, parametric techniques have been employed for this task. However, recent advancements have seen a shift towards learning-based methods. Given the rapid pace of research and the frequent introduction of new image matching methods, it is essential to evaluate them. In this paper, we present a comprehensive evaluation of various image matching methods using a structure-from-motion pipeline. We assess the performance of these methods on both in-domain and out-of-domain datasets, identifying key limitations in both the methods and benchmarks. We also investigate the impact of edge detection as a pre-processing step. Our analysis reveals that image matching for 3D reconstruction remains an open challenge, necessitating careful selection and tuning of models for specific scenarios, while also highlighting mismatches in how metrics currently represent method performance.

Hanyuan Zhang, Lucas He, Zijie Cheng et al.

Registration between preoperative CT and intraoperative laparoscopic video plays a crucial role in augmented reality (AR) guidance for minimally invasive surgery. Learning-based methods have recently achieved registration errors comparable to optimization-based approaches while offering faster inference. However, many supervised methods produce coarse alignments that rely on additional optimization-based refinement, thereby increasing inference time. We present a discrete-action reinforcement learning (RL) framework that formulates CT-to-video registration as a sequential decision-making process. A shared feature encoder, warm-started from a supervised pose estimation network to provide stable geometric features and faster convergence, extracts representations from CT renderings and laparoscopic frames, while an RL policy head learns to choose rigid transformations along six degrees of freedom and to decide when to stop the iteration. Experiments on a public laparoscopic dataset demonstrated that our method achieved an average target registration error (TRE) of 15.70 mm, comparable to supervised approaches with optimization, while achieving faster convergence. The proposed RL-based formulation enables automated, efficient iterative registration without manually tuned step sizes or stopping criteria. This discrete framework provides a practical foundation for future continuous-action and deformable registration models in surgical AR applications.

Adrito Das, Bilal Sidiqi, Laurent Mennillo et al.

Improved surgical skill is generally associated with improved patient outcomes, although assessment is subjective; labour-intensive; and requires domain specific expertise. Automated data driven metrics can alleviate these difficulties, as demonstrated by existing machine learning instrument tracking models in minimally invasive surgery. However, these models have been tested on limited datasets of laparoscopic surgery, with a focus on isolated tasks and robotic surgery. In this paper, a new public dataset is introduced, focusing on simulated surgery, using the nasal phase of endoscopic pituitary surgery as an exemplar. Simulated surgery allows for a realistic yet repeatable environment, meaning the insights gained from automated assessment can be used by novice surgeons to hone their skills on the simulator before moving to real surgery. PRINTNet (Pituitary Real-time INstrument Tracking Network) has been created as a baseline model for this automated assessment. Consisting of DeepLabV3 for classification and segmentation; StrongSORT for tracking; and the NVIDIA Holoscan SDK for real-time performance, PRINTNet achieved 71.9% Multiple Object Tracking Precision running at 22 Frames Per Second. Using this tracking output, a Multilayer Perceptron achieved 87% accuracy in predicting surgical skill level (novice or expert), with the "ratio of total procedure time to instrument visible time" correlated with higher surgical skill. This therefore demonstrates the feasibility of automated surgical skill assessment in simulated endoscopic pituitary surgery. The new publicly available dataset can be found here: https://doi.org/10.5522/04/26511049.

Anjana Wijekoon, Adrito Das, Roxana R. Herrera et al.

Accurate intra-operative Remaining Surgery Duration (RSD) predictions allow for anaesthetists to more accurately decide when to administer anaesthetic agents and drugs, as well as to notify hospital staff to send in the next patient. Therefore RSD plays an important role in improving patient care and minimising surgical theatre costs via efficient scheduling. In endoscopic pituitary surgery, it is uniquely challenging due to variable workflow sequences with a selection of optional steps contributing to high variability in surgery duration. This paper presents PitRSDNet for predicting RSD during pituitary surgery, a spatio-temporal neural network model that learns from historical data focusing on workflow sequences. PitRSDNet integrates workflow knowledge into RSD prediction in two forms: 1) multi-task learning for concurrently predicting step and RSD; and 2) incorporating prior steps as context in temporal learning and inference. PitRSDNet is trained and evaluated on a new endoscopic pituitary surgery dataset with 88 videos to show competitive performance improvements over previous statistical and machine learning methods. The findings also highlight how PitRSDNet improve RSD precision on outlier cases utilising the knowledge of prior steps.

Hanna Hoffmann, Setareh Bady, Claas de Boer et al.

Achieving high levels of surgical skill through effective training is essential for optimal patient outcomes. Automated, data-driven skill assessment holds significant potential to improve surgical training. While machine learning-based methods are increasingly popular for assessing skills in minimally invasive surgery, their application to open surgery remains limited. We present the results of a dedicated MICCAI challenge designed to benchmark and advance vision-based skill assessment in open surgery. The challenge dataset comprises videos of an open suturing training task recorded with a static GoPro camera in a dry-lab setting, with instrument trajectories available in addition to the primary video modality. The OSS Challenge was hosted over two consecutive years, comprising two and three independent tasks, respectively: (1) classifying skill level into four classes, (2) predicting the full Objective Structured Assessment of Technical Skills across eight categories, and (3) tracking hands and surgical tools. Participants submitted diverse solutions including deep learning-based video models, tracking-driven methods, and hybrid approaches. General-purpose spatiotemporal video models consistently achieved the strongest performance, though conceptually diverse approaches reached competitive levels when well-executed. Predicting fine-grained OSATS scores remains challenging but benefits substantially from increased training data. Keypoint tracking proves difficult given frequent occlusions and out-of-frame instances, limiting current applicability for motion-based skill analysis. This work benchmarks innovative and diverse solutions for surgical skill assessment, highlighting both the promise and current limitations of video-based evaluation in open surgery and identifying critical directions for advancing automated skill assessment toward clinical impact.

Chiara Di Vece, Zhehua Mao, Netanell Avisdris et al.

Accurate fetal growth assessment from ultrasound (US) relies on precise biometry measured by manually identifying anatomical landmarks in standard planes. Manual landmarking is time-consuming, operator-dependent, and sensitive to variability across scanners and sites, limiting the reproducibility of automated approaches. There is a need for multi-source annotated datasets to develop artificial intelligence-assisted fetal growth assessment methods. To address this bottleneck, we present an open, multi-centre, multi-device benchmark dataset of fetal US images with expert anatomical landmark annotations for clinically used fetal biometric measurements. These measurements include head bi-parietal and occipito-frontal diameters, abdominal transverse and antero-posterior diameters, and femoral length. The dataset comprises 4,513 de-identified US images from 1,904 subjects acquired at three clinical sites using seven different US devices. We provide standardised, subject-disjoint train/test splits, evaluation code, and baseline results to enable fair and reproducible comparison of methods. Using an automatic biometry model, we quantify domain shift and demonstrate that training and evaluation confined to a single centre substantially overestimate performance relative to multi-centre testing. To the best of our knowledge, this is the first publicly available multi-centre, multi-device, landmark-annotated dataset that covers all primary fetal biometry measures, providing a robust benchmark for domain adaptation and multi-centre generalisation in fetal biometry and enabling more reliable AI-assisted fetal growth assessment across centres. All data, annotations, training code, and evaluation pipelines are made publicly available.

Xiangyi Tan, Aoife McDonald-Bowyer, Danail Stoyanov et al.

Miniaturised soft pneumatic actuators are crucial for robotic intervention within highly constrained anatomical pathways. This work presents the design and validation of a fibre-reinforced soft actuator at the centimetre scale for inte- gration into an endoluminal robotic platform for natural-orifice interventional and diagnostic applications. A single-chamber geometry reinforced with embedded Kevlar fibre was de- signed to maximise curvature while preserving sealing integrity, fabricated using a multi-stage multi-stiffness silicone casting process, and validated against a high-fidelity Abaqus FEM using experimentally parametrised hyperelastic material models and embedded beam reinforcement. The semi-cylindrical actuator has an outer diameter of 18,mm and a length of 37.5,mm. Single and double helix winding configurations, fibre pitch, and fibre density were investigated. The optimal 100 SH configuration achieved a bending angle of 202.9° experimentally and 297.6° in simulation, with structural robustness maintained up to 100,kPa and radial expansion effectively constrained by the fibre reinforcement. Workspace evaluation confirmed suitability for integration into the target device envelope, demonstrating that fibre-reinforcement strategies can be effectively translated to the centimetre regime while retaining actuator performance.

Muhammad Asad, Emanuele Colleoni, Pritesh Mehta et al.

Purpose: Monocular depth estimation (MDE) is vital for scene understanding in minimally invasive surgery (MIS). However, endoscopic video sequences are often contaminated by smoke, specular reflections, blur, and occlusions, limiting the accuracy of MDE models. In addition, current MDE models do not output depth confidence, which could be a valuable tool for improving their clinical reliability. Methods: We propose a novel confidence-aware MDE framework featuring three significant contributions: (i) Calibrated confidence targets: an ensemble of fine-tuned stereo matching models is used to capture disparity variance into pixel-wise confidence probabilities; (ii) Confidence-aware loss: Baseline MDE models are optimized with confidence-aware loss functions, utilizing pixel-wise confidence probabilities such that reliable pixels dominate training; and (iii) Inference-time confidence: a confidence estimation head is proposed with two convolution layers to predict per-pixel confidence at inference, enabling assessment of depth reliability. Results: Comprehensive experimental validation across internal and public datasets demonstrates that our framework improves depth estimation accuracy and can robustly quantify the prediction's confidence. On the internal clinical endoscopic dataset (StereoKP), we improve dense depth estimation accuracy by ~8% as compared to the baseline model. Conclusion: Our confidence-aware framework enables improved accuracy of MDE models in MIS, addressing challenges posed by noise and artifacts in pre-clinical and clinical data, and allows MDE models to provide confidence maps that may be used to improve their reliability for clinical applications.

Hanyuan Zhang, Lucas He, Runlong He et al.

Augmented reality can improve tumor localization in laparoscopic liver surgery. Existing registration pipelines typically depend on organ contours; deformable (non-rigid) alignment is often handled with finite-element (FE) models coupled to dimensionality-reduction or machine-learning components. We integrate laparoscopic depth maps with a foundation pose estimator for camera-liver pose estimation and replace FE-based deformation with non-rigid iterative closest point (NICP) to lower engineering/modeling complexity and expertise requirements. On real patient data, the depth-augmented foundation pose approach achieved 9.91 mm mean registration error in 3 cases. Combined rigid-NICP registration outperformed rigid-only registration, demonstrating NICP as an efficient substitute for finite-element deformable models. This pipeline achieves clinically relevant accuracy while offering a lightweight, engineering-friendly alternative to FE-based deformation.

Dimitrios Anastasiou, Santiago Barbarisi, Lucy Culshaw et al.

Purpose: Accurate assessment of surgical complexity is essential in Laparoscopic Cholecystectomy (LC), where severe inflammation is associated with longer operative times and increased risk of postoperative complications. The Parkland Grading Scale (PGS) provides a clinically validated framework for stratifying inflammation severity; however, its automation in surgical videos remains largely unexplored, particularly in realistic scenarios where complete videos must be analyzed without prior manual curation. Methods: In this work, we introduce STC-Net, a novel framework for SingleTimestamp-based Complexity estimation in LC via the PGS, designed to operate under weak temporal supervision. Unlike prior methods limited to static images or manually trimmed clips, STC-Net operates directly on full videos. It jointly performs temporal localization and grading through a localization, window proposal, and grading module. We introduce a novel loss formulation combining hard and soft localization objectives and background-aware grading supervision. Results: Evaluated on a private dataset of 1,859 LC videos, STC-Net achieves an accuracy of 62.11% and an F1-score of 61.42%, outperforming non-localized baselines by over 10% in both metrics and highlighting the effectiveness of weak supervision for surgical complexity assessment. Conclusion: STC-Net demonstrates a scalable and effective approach for automated PGS-based surgical complexity estimation from full LC videos, making it promising for post-operative analysis and surgical training.

Runlong He, Mengya Xu, Adrito Das et al.

Visual Question Answering (VQA) within the surgical domain, utilizing Large Language Models (LLMs), offers a distinct opportunity to improve intra-operative decision-making and facilitate intuitive surgeon-AI interaction. However, the development of LLMs for surgical VQA is hindered by the scarcity of diverse and extensive datasets with complex reasoning tasks. Moreover, contextual fusion of the image and text modalities remains an open research challenge due to the inherent differences between these two types of information and the complexity involved in aligning them. This paper introduces PitVQA, a novel dataset specifically designed for VQA in endonasal pituitary surgery and PitVQA-Net, an adaptation of the GPT2 with a novel image-grounded text embedding for surgical VQA. PitVQA comprises 25 procedural videos and a rich collection of question-answer pairs spanning crucial surgical aspects such as phase and step recognition, context understanding, tool detection and localization, and tool-tissue interactions. PitVQA-Net consists of a novel image-grounded text embedding that projects image and text features into a shared embedding space and GPT2 Backbone with an excitation block classification head to generate contextually relevant answers within the complex domain of endonasal pituitary surgery. Our image-grounded text embedding leverages joint embedding, cross-attention and contextual representation to understand the contextual relationship between questions and surgical images. We demonstrate the effectiveness of PitVQA-Net on both the PitVQA and the publicly available EndoVis18-VQA dataset, achieving improvements in balanced accuracy of 8% and 9% over the most recent baselines, respectively. Our code and dataset is available at https://github.com/mobarakol/PitVQA.

Shreyas C. Dhake, Jiayuan Huang, Runlong He et al.

Anticipating forthcoming surgical events is vital for real-time assistance in endonasal transsphenoidal pituitary surgery, where visibility is limited and workflow changes rapidly. Most visual question answering (VQA) systems reason on isolated frames with static vision language alignment, providing little support for forecasting next steps or instrument needs. Existing surgical VQA datasets likewise center on the current scene rather than the near future. We introduce PitVQA-Anticipation, the first VQA dataset designed for forward looking surgical reasoning. It comprises 33.5 hours of operative video and 734,769 question answer pairs built from temporally grouped clips and expert annotations across four tasks: predicting the future phase, next step, upcoming instrument, and remaining duration. We further propose SurgAnt-ViVQA, a video language model that adapts a large language model using a GRU Gated Temporal Cross-Attention module. A bidirectional GRU encodes frame to frame dynamics, while an adaptive gate injects visual context into the language stream at the token level. Parameter efficient fine tuning customizes the language backbone to the surgical domain. SurgAnt-ViVQA tested upon on PitVQA-Anticipation and EndoVis datasets, surpassing strong image and video based baselines. Ablations show that temporal recurrence and gated fusion drive most of the gains. A frame budget study indicates a trade-off: 8 frames maximize fluency, whereas 32 frames slightly reduce BLEU but improve numeric time estimation. By pairing a temporally aware encoder with fine grained gated cross-attention, SurgAnt-ViVQA advances surgical VQA from retrospective description to proactive anticipation. PitVQA-Anticipation offers a comprehensive benchmark for this setting and highlights the importance of targeted temporal modeling for reliable, future aware surgical assistance.

Manuel Birlo, Razvan Caramalau, Philip J. "Eddie" Edwards et al.

We present HUP-3D, a 3D multi-view multi-modal synthetic dataset for hand-ultrasound (US) probe pose estimation in the context of obstetric ultrasound. Egocentric markerless 3D joint pose estimation has potential applications in mixed reality based medical education. The ability to understand hand and probe movements programmatically opens the door to tailored guidance and mentoring applications. Our dataset consists of over 31k sets of RGB, depth and segmentation mask frames, including pose related ground truth data, with a strong emphasis on image diversity and complexity. Adopting a camera viewpoint-based sphere concept allows us to capture a variety of views and generate multiple hand grasp poses using a pre-trained network. Additionally, our approach includes a software-based image rendering concept, enhancing diversity with various hand and arm textures, lighting conditions, and background images. Furthermore, we validated our proposed dataset with state-of-the-art learning models and we obtained the lowest hand-object keypoint errors. The dataset and other details are provided with the supplementary material. The source code of our grasp generation and rendering pipeline will be made publicly available.

Runlong He, Danyal Z. Khan, Evangelos B. Mazomenos et al.

Vision-Language Models (VLMs) in visual question answering (VQA) offer a unique opportunity to enhance intra-operative decision-making, promote intuitive interactions, and significantly advancing surgical education. However, the development of VLMs for surgical VQA is challenging due to limited datasets and the risk of overfitting and catastrophic forgetting during full fine-tuning of pretrained weights. While parameter-efficient techniques like Low-Rank Adaptation (LoRA) and Matrix of Rank Adaptation (MoRA) address adaptation challenges, their uniform parameter distribution overlooks the feature hierarchy in deep networks, where earlier layers, that learn general features, require more parameters than later ones. This work introduces PitVQA++ with an open-ended PitVQA dataset and vector matrix-low-rank adaptation (Vector-MoLoRA), an innovative VLM fine-tuning approach for adapting GPT-2 to pituitary surgery. Open-Ended PitVQA comprises around 101,803 frames from 25 procedural videos with 745,972 question-answer sentence pairs, covering key surgical elements such as phase and step recognition, context understanding, tool detection, localization, and interactions recognition. Vector-MoLoRA incorporates the principles of LoRA and MoRA to develop a matrix-low-rank adaptation strategy that employs vector ranking to allocate more parameters to earlier layers, gradually reducing them in the later layers. Our approach, validated on the Open-Ended PitVQA and EndoVis18-VQA datasets, effectively mitigates catastrophic forgetting while significantly enhancing performance over recent baselines. Furthermore, our risk-coverage analysis highlights its enhanced reliability and trustworthiness in handling uncertain predictions. Our source code and dataset is available at~\url{https://github.com/HRL-Mike/PitVQA-Plus}.

Sandesh Pokhrel, Sanjay Bhandari, Sharib Ali et al.

The integration of deep learning tools in gastrointestinal vision holds the potential for significant advancements in diagnosis, treatment, and overall patient care. A major challenge, however, is these tools' tendency to make overconfident predictions, even when encountering unseen or newly emerging disease patterns, undermining their reliability. We address this critical issue of reliability by framing it as an out-of-distribution (OOD) detection problem, where previously unseen and emerging diseases are identified as OOD examples. However, gastrointestinal images pose a unique challenge due to the overlapping feature representations between in- Distribution (ID) and OOD examples. Existing approaches often overlook this characteristic, as they are primarily developed for natural image datasets, where feature distinctions are more apparent. Despite the overlap, we hypothesize that the features of an in-distribution example will cluster closer to the centroids of their ground truth class, resulting in a shorter distance to the nearest centroid. In contrast, OOD examples maintain an equal distance from all class centroids. Based on this observation, we propose a novel nearest-centroid distance deficit (NCCD) score in the feature space for gastrointestinal OOD detection. Evaluations across multiple deep learning architectures and two publicly available benchmarks, Kvasir2 and Gastrovision, demonstrate the effectiveness of our approach compared to several state-of-the-art methods. The code and implementation details are publicly available at: https://github.com/bhattarailab/NCDD

Adam Schmidt, Mert Asim Karaoglu, Soham Sinha et al.

Understanding tissue motion in surgery is crucial to enable applications in downstream tasks such as segmentation, 3D reconstruction, virtual tissue landmarking, autonomous probe-based scanning, and subtask autonomy. Labeled data are essential to enabling algorithms in these downstream tasks since they allow us to quantify and train algorithms. This paper introduces a point tracking challenge to address this, wherein participants can submit their algorithms for quantification. The submitted algorithms are evaluated using a dataset named surgical tattoos in infrared (STIR), with the challenge aptly named the STIR Challenge 2024. The STIR Challenge 2024 comprises two quantitative components: accuracy and efficiency. The accuracy component tests the accuracy of algorithms on in vivo and ex vivo sequences. The efficiency component tests the latency of algorithm inference. The challenge was conducted as a part of MICCAI EndoVis 2024. In this challenge, we had 8 total teams, with 4 teams submitting before and 4 submitting after challenge day. This paper details the STIR Challenge 2024, which serves to move the field towards more accurate and efficient algorithms for spatial understanding in surgery. In this paper we summarize the design, submissions, and results from the challenge. The challenge dataset is available here: https://zenodo.org/records/14803158 , and the code for baseline models and metric calculation is available here: https://github.com/athaddius/STIRMetrics