Lars Mündermann

Martin Wagner, Beat-Peter Müller-Stich, Anna Kisilenko et al.

PURPOSE: Surgical workflow and skill analysis are key technologies for the next generation of cognitive surgical assistance systems. These systems could increase the safety of the operation through context-sensitive warnings and semi-autonomous robotic assistance or improve training of surgeons via data-driven feedback. In surgical workflow analysis up to 91% average precision has been reported for phase recognition on an open data single-center dataset. In this work we investigated the generalizability of phase recognition algorithms in a multi-center setting including more difficult recognition tasks such as surgical action and surgical skill. METHODS: To achieve this goal, a dataset with 33 laparoscopic cholecystectomy videos from three surgical centers with a total operation time of 22 hours was created. Labels included annotation of seven surgical phases with 250 phase transitions, 5514 occurences of four surgical actions, 6980 occurences of 21 surgical instruments from seven instrument categories and 495 skill classifications in five skill dimensions. The dataset was used in the 2019 Endoscopic Vision challenge, sub-challenge for surgical workflow and skill analysis. Here, 12 teams submitted their machine learning algorithms for recognition of phase, action, instrument and/or skill assessment. RESULTS: F1-scores were achieved for phase recognition between 23.9% and 67.7% (n=9 teams), for instrument presence detection between 38.5% and 63.8% (n=8 teams), but for action recognition only between 21.8% and 23.3% (n=5 teams). The average absolute error for skill assessment was 0.78 (n=1 team). CONCLUSION: Surgical workflow and skill analysis are promising technologies to support the surgical team, but are not solved yet, as shown by our comparison of algorithms. This novel benchmark can be used for comparable evaluation and validation of future work.

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.

Lena Maier-Hein, Martin Wagner, Tobias Ross et al.

Image-based tracking of medical instruments is an integral part of surgical data science applications. Previous research has addressed the tasks of detecting, segmenting and tracking medical instruments based on laparoscopic video data. However, the proposed methods still tend to fail when applied to challenging images and do not generalize well to data they have not been trained on. This paper introduces the Heidelberg Colorectal (HeiCo) data set - the first publicly available data set enabling comprehensive benchmarking of medical instrument detection and segmentation algorithms with a specific emphasis on method robustness and generalization capabilities. Our data set comprises 30 laparoscopic videos and corresponding sensor data from medical devices in the operating room for three different types of laparoscopic surgery. Annotations include surgical phase labels for all video frames as well as information on instrument presence and corresponding instance-wise segmentation masks for surgical instruments (if any) in more than 10,000 individual frames. The data has successfully been used to organize international competitions within the Endoscopic Vision Challenges 2017 and 2019.

Sebastian Bodenstedt, Martin Wagner, Lars Mündermann et al.

Purpose The course of surgical procedures is often unpredictable, making it difficult to estimate the duration of procedures beforehand. A context-aware method that analyses the workflow of an intervention online and automatically predicts the remaining duration would alleviate these problems. As basis for such an estimate, information regarding the current state of the intervention is required. Methods Today, the operating room contains a diverse range of sensors. During laparoscopic interventions, the endoscopic video stream is an ideal source of such information. Extracting quantitative information from the video is challenging though, due to its high dimensionality. Other surgical devices (e.g. insufflator, lights, etc.) provide data streams which are, in contrast to the video stream, more compact and easier to quantify. Though whether such streams offer sufficient information for estimating the duration of surgery is uncertain. Here, we propose and compare methods, based on convolutional neural networks, for continuously predicting the duration of laparoscopic interventions based on unlabeled data, such as from endoscopic images and surgical device streams. Results The methods are evaluated on 80 laparoscopic interventions of various types, for which surgical device data and the endoscopic video are available. Here the combined method performs best with an overall average error of 37% and an average halftime error of 28%. Conclusion In this paper, we present, to our knowledge, the first approach for online procedure duration prediction using unlabeled endoscopic video data and surgical device data in a laparoscopic setting. We also show that a method incorporating both vision and device data performs better than methods based only on vision, while methods only based on tool usage and surgical device data perform poorly, showing the importance of the visual channel.