Anthony Jarc

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.

Ziheng Wang, Conor Perreault, Xi Liu et al.

Endoscopic video recordings are widely used in minimally invasive robot-assisted surgery, but when the endoscope is outside the patient's body, it can capture irrelevant segments that may contain sensitive information. To address this, we propose a framework that accurately detects out-of-body frames in surgical videos by leveraging self-supervision with minimal data labels. We use a massive amount of unlabeled endoscopic images to learn meaningful representations in a self-supervised manner. Our approach, which involves pre-training on an auxiliary task and fine-tuning with limited supervision, outperforms previous methods for detecting out-of-body frames in surgical videos captured from da Vinci X and Xi surgical systems. The average F1 scores range from 96.00 to 98.02. Remarkably, using only 5% of the training labels, our approach still maintains an average F1 score performance above 97, outperforming fully-supervised methods with 95% fewer labels. These results demonstrate the potential of our framework to facilitate the safe handling of surgical video recordings and enhance data privacy protection in minimally invasive surgery.

Aneeq Zia, Max Berniker, Rogerio Nespolo et al.

Owing to recent advances in machine learning and the ability to harvest large amounts of data during robotic-assisted surgeries, surgical data science is ripe for foundational work. We present a large dataset of surgical videos and their accompanying labels for this purpose. We describe how the data was collected and some of its unique attributes. Multiple example problems are outlined. Although the dataset was curated for a particular set of scientific challenges (in an accompanying paper), it is general enough to be used for a broad range machine learning questions. Our hope is that this dataset exposes the larger machine learning community to the challenging problems within surgical data science, and becomes a touchstone for future research. The videos are available at https://storage.googleapis.com/isi-surgvu/surgvu24_videos_only.zip, the labels at https://storage.googleapis.com/isi-surgvu/surgvu24_labels_updated_v2.zip, and a validation set for tool detection problem at https://storage.googleapis.com/isi-surgvu/cat1_test_set_public.zip.

Aneeq Zia, Max Berniker, Rogerio Garcia Nespolo et al.

Robotic assisted (RA) surgery promises to transform surgical intervention. Intuitive Surgical is committed to fostering these changes and the machine learning models and algorithms that will enable them. With these goals in mind we have invited the surgical data science community to participate in a yearly competition hosted through the Medical Imaging Computing and Computer Assisted Interventions (MICCAI) conference. With varying changes from year to year, we have challenged the community to solve difficult machine learning problems in the context of advanced RA applications. Here we document the results of these challenges, focusing on surgical tool localization (SurgToolLoc). The publicly released dataset that accompanies these challenges is detailed in a separate paper arXiv:2501.09209 [1].

Yousi A. Oquendo, Zonghe Chua, Margaret M. Coad et al.

Surgical procedures require a high level of technical skill to ensure efficiency and patient safety. Due to the direct effect of surgeon skill on patient outcomes, the development of cost-effective and realistic training methods is imperative to accelerate skill acquisition. Teleoperated robotic devices allow for intuitive ergonomic control, but the learning curve for these systems remains steep. Recent studies in motor learning have shown that visual or physical exaggeration of errors helps trainees to learn to perform tasks faster and more accurately. In this study, we extended the work from two previous studies to investigate the performance of subjects in different force field training conditions, including convergent (assistive), divergent (resistive), and no force field (null).

Aneeq Zia, Kiran Bhattacharyya, Xi Liu et al.

Surgical data science is revolutionizing minimally invasive surgery by enabling context-aware applications. However, many challenges exist around surgical data (and health data, more generally) needed to develop context-aware models. This work - presented as part of the Endoscopic Vision (EndoVis) challenge at the Medical Image Computing and Computer Assisted Intervention (MICCAI) 2020 conference - seeks to explore the potential for visual domain adaptation in surgery to overcome data privacy concerns. In particular, we propose to use video from virtual reality (VR) simulations of surgical exercises in robotic-assisted surgery to develop algorithms to recognize tasks in a clinical-like setting. We present the performance of the different approaches to solve visual domain adaptation developed by challenge participants. Our analysis shows that the presented models were unable to learn meaningful motion based features form VR data alone, but did significantly better when small amount of clinical-like data was also made available. Based on these results, we discuss promising methods and further work to address the problem of visual domain adaptation in surgical data science. We also release the challenge dataset publicly at https://www.synapse.org/surgvisdom2020.

Zonghe Chua, Anthony M. Jarc, Allison M. Okamura

Knowledge of interaction forces during teleoperated robot-assisted surgery could be used to enable force feedback to human operators and evaluate tissue handling skill. However, direct force sensing at the end-effector is challenging because it requires biocompatible, sterilizable, and cost-effective sensors. Vision-based deep learning using convolutional neural networks is a promising approach for providing useful force estimates, though questions remain about generalization to new scenarios and real-time inference. We present a force estimation neural network that uses RGB images and robot state as inputs. Using a self-collected dataset, we compared the network to variants that included only a single input type, and evaluated how they generalized to new viewpoints, workspace positions, materials, and tools. We found that vision-based networks were sensitive to shifts in viewpoints, while state-only networks were robust to changes in workspace. The network with both state and vision inputs had the highest accuracy for an unseen tool, and was moderately robust to changes in viewpoints. Through feature removal studies, we found that using only position features produced better accuracy than using only force features as input. The network with both state and vision inputs outperformed a physics-based baseline model in accuracy. It showed comparable accuracy but faster computation times than a baseline recurrent neural network, making it better suited for real-time applications.

Zonghe Chua, Anthony M. Jarc, Sherry Wren et al.

The lack of haptic feedback in Robot-assisted Minimally Invasive Surgery (RMIS) is a potential barrier to safe tissue handling during surgery. Bayesian modeling theory suggests that surgeons with experience in open or laparoscopic surgery can develop priors of tissue stiffness that translate to better force estimation abilities during RMIS compared to surgeons with no experience. To test if prior haptic experience leads to improved force estimation ability in teleoperation, 33 participants were assigned to one of three training conditions: manual manipulation, teleoperation with force feedback, or teleoperation without force feedback, and learned to tension a silicone sample to a set of force values. They were then asked to perform the tension task, and a previously unencountered palpation task, to a different set of force values under teleoperation without force feedback. Compared to the teleoperation groups, the manual group had higher force error in the tension task outside the range of forces they had trained on, but showed better speed-accuracy functions in the palpation task at low force levels. This suggests that the dynamics of the training modality affect force estimation ability during teleoperation, with the prior haptic experience accessible if formed under the same dynamics as the task.

Aneeq Zia, Liheng Guo, Linlin Zhou et al.

Purpose: Surgical task-based metrics (rather than entire procedure metrics) can be used to improve surgeon training and, ultimately, patient care through focused training interventions. Machine learning models to automatically recognize individual tasks or activities are needed to overcome the otherwise manual effort of video review. Traditionally, these models have been evaluated using frame-level accuracy. Here, we propose evaluating surgical activity recognition models by their effect on task-based efficiency metrics. In this way, we can determine when models have achieved adequate performance for providing surgeon feedback via metrics from individual tasks. Methods: We propose a new CNN-LSTM model, RP-Net-V2, to recognize the 12 steps of robotic-assisted radical prostatectomies (RARP). We evaluated our model both in terms of conventional methods (e.g. Jaccard Index, task boundary accuracy) as well as novel ways, such as the accuracy of efficiency metrics computed from instrument movements and system events. Results: Our proposed model achieves a Jaccard Index of 0.85 thereby outperforming previous models on robotic-assisted radical prostatectomies. Additionally, we show that metrics computed from tasks automatically identified using RP-Net-V2 correlate well with metrics from tasks labeled by clinical experts. Conclusions: We demonstrate that metrics-based evaluation of surgical activity recognition models is a viable approach to determine when models can be used to quantify surgical efficiencies. We believe this approach and our results illustrate the potential for fully automated, post-operative efficiency reports.

Aneeq Zia, Andrew Hung, Irfan Essa et al.

Adverse surgical outcomes are costly to patients and hospitals. Approaches to benchmark surgical care are often limited to gross measures across the entire procedure despite the performance of particular tasks being largely responsible for undesirable outcomes. In order to produce metrics from tasks as opposed to the whole procedure, methods to recognize automatically individual surgical tasks are needed. In this paper, we propose several approaches to recognize surgical activities in robot-assisted minimally invasive surgery using deep learning. We collected a clinical dataset of 100 robot-assisted radical prostatectomies (RARP) with 12 tasks each and propose `RP-Net', a modified version of InceptionV3 model, for image based surgical activity recognition. We achieve an average precision of 80.9% and average recall of 76.7% across all tasks using RP-Net which out-performs all other RNN and CNN based models explored in this paper. Our results suggest that automatic surgical activity recognition during RARP is feasible and can be the foundation for advanced analytics.