Pietro Mascagni

Kun Yuan, Vinkle Srivastav, Tong Yu et al.

Recent advancements in surgical computer vision applications have been driven by vision-only models, which do not explicitly integrate the rich semantics of language into their design. These methods rely on manually annotated surgical videos to predict a fixed set of object categories, limiting their generalizability to unseen surgical procedures and downstream tasks. In this work, we put forward the idea that the surgical video lectures available through open surgical e-learning platforms can provide effective vision and language supervisory signals for multi-modal representation learning without relying on manual annotations. We address the surgery-specific linguistic challenges present in surgical video lectures by employing multiple complementary automatic speech recognition systems to generate text transcriptions. We then present a novel method, SurgVLP - Surgical Vision Language Pre-training, for multi-modal representation learning. Extensive experiments across diverse surgical procedures and tasks demonstrate that the multi-modal representations learned by SurgVLP exhibit strong transferability and adaptability in surgical video analysis. Furthermore, our zero-shot evaluations highlight SurgVLP's potential as a general-purpose foundation model for surgical workflow analysis, reducing the reliance on extensive manual annotations for downstream tasks, and facilitating adaptation methods such as few-shot learning to build a scalable and data-efficient solution for various downstream surgical applications. The [training code](https://github.com/CAMMA-public/PeskaVLP) and [weights](https://github.com/CAMMA-public/SurgVLP) are public.

Lorenzo Arboit, Dennis N. Schneider, Britty Baby et al.

Video-based assessment and surgical data science can advance surgical training, research, and quality improvement. However, widespread use remains limited by heterogeneous recording formats and privacy concerns associated with video sharing. We present Endoshare, a source-available, cross-platform application for merging, standardizing, and de-identifying endoscopic videos in minimally invasive surgery. Development followed the software development life cycle with iterative, user-centered feedback. During the analysis phase, an internal survey of clinicians and computer scientists based on ten usability heuristics identified key requirements that guided a privacy-by-design architecture. In the testing phase, an external clinician survey combined the same heuristics with Technology Acceptance Model constructs to assess usability and adoption, complemented by benchmarking across different hardware configurations. Four clinicians and four computer scientists initially tested the prototype, reporting high usability (4.68 +/- 0.40/5 and 4.03 +/- 0.51/5), with the lowest score (4.00 +/- 0.93/5) relating to label clarity. After refinement, the testing phase surveyed ten surgeons who reported high perceived usefulness (5.07 +/- 1.75/7), ease of use (5.15 +/- 1.71/7), heuristic usability (4.38 +/- 0.48/5), and strong recommendation (9.20 +/- 0.79/10). Processing time varied with processing mode, video duration (both p <= 0.001), and machine computational power (p = 0.041). Endoshare provides a transparent, user-friendly pipeline for standardized, privacy-preserving surgical video management. Compliance certification and broader interoperability validation are needed to establish it as a deployable alternative to proprietary systems. The software is available at https://camma-public.github.io/Endoshare/

Deepak Alapatt, Aditya Murali, Vinkle Srivastav et al.

Consensus amongst researchers and industry points to a lack of large, representative annotated datasets as the biggest obstacle to progress in the field of surgical data science. Advances in Self-Supervised Learning (SSL) represent a solution, reducing the dependence on large labeled datasets by providing task-agnostic initializations. However, the robustness of current self-supervised learning methods to domain shifts remains unclear, limiting our understanding of its utility for leveraging diverse sources of surgical data. Shifting the focus from methods to data, we demonstrate that the downstream value of SSL-based initializations is intricately intertwined with the composition of pre-training datasets. These results underscore an important gap that needs to be filled as we scale self-supervised approaches toward building general-purpose "foundation models" that enable diverse use-cases within the surgical domain. Through several stages of controlled experimentation, we develop recommendations for pretraining dataset composition evidenced through over 300 experiments spanning 20 pre-training datasets, 9 surgical procedures, 7 centers (hospitals), 3 labeled-data settings, 3 downstream tasks, and multiple runs. Using the approaches here described, we outperform state-of-the-art pre-trainings on two public benchmarks for phase recognition: up to 2.2% on Cholec80 and 5.1% on AutoLaparo.