Klaus Schoeffmann

Negin Ghamsarian, Javier Gamazo Tejero, Pablo Márquez Neila et al.

Models capable of leveraging unlabelled data are crucial in overcoming large distribution gaps between the acquired datasets across different imaging devices and configurations. In this regard, self-training techniques based on pseudo-labeling have been shown to be highly effective for semi-supervised domain adaptation. However, the unreliability of pseudo labels can hinder the capability of self-training techniques to induce abstract representation from the unlabeled target dataset, especially in the case of large distribution gaps. Since the neural network performance should be invariant to image transformations, we look to this fact to identify uncertain pseudo labels. Indeed, we argue that transformation invariant detections can provide more reasonable approximations of ground truth. Accordingly, we propose a semi-supervised learning strategy for domain adaptation termed transformation-invariant self-training (TI-ST). The proposed method assesses pixel-wise pseudo-labels' reliability and filters out unreliable detections during self-training. We perform comprehensive evaluations for domain adaptation using three different modalities of medical images, two different network architectures, and several alternative state-of-the-art domain adaptation methods. Experimental results confirm the superiority of our proposed method in mitigating the lack of target domain annotation and boosting segmentation performance in the target domain.

Sahar Nasirihaghighi, Negin Ghamsarian, Daniela Stefanics et al.

Action recognition is a prerequisite for many applications in laparoscopic video analysis including but not limited to surgical training, operation room planning, follow-up surgery preparation, post-operative surgical assessment, and surgical outcome estimation. However, automatic action recognition in laparoscopic surgeries involves numerous challenges such as (I) cross-action and intra-action duration variation, (II) relevant content distortion due to smoke, blood accumulation, fast camera motions, organ movements, object occlusion, and (III) surgical scene variations due to different illuminations and viewpoints. Besides, action annotations in laparoscopy surgeries are limited and expensive due to requiring expert knowledge. In this study, we design and evaluate a CNN-RNN architecture as well as a customized training-inference framework to deal with the mentioned challenges in laparoscopic surgery action recognition. Using stacked recurrent layers, our proposed network takes advantage of inter-frame dependencies to negate the negative effect of content distortion and variation in action recognition. Furthermore, our proposed frame sampling strategy effectively manages the duration variations in surgical actions to enable action recognition with high temporal resolution. Our extensive experiments confirm the superiority of our proposed method in action recognition compared to static CNNs.

Negin Ghamsarian, Mario Taschwer, Raphael Sznitman et al.

Semantic segmentation in cataract surgery has a wide range of applications contributing to surgical outcome enhancement and clinical risk reduction. However, the varying issues in segmenting the different relevant structures in these surgeries make the designation of a unique network quite challenging. This paper proposes a semantic segmentation network, termed DeepPyramid, that can deal with these challenges using three novelties: (1) a Pyramid View Fusion module which provides a varying-angle global view of the surrounding region centering at each pixel position in the input convolutional feature map; (2) a Deformable Pyramid Reception module which enables a wide deformable receptive field that can adapt to geometric transformations in the object of interest; and (3) a dedicated Pyramid Loss that adaptively supervises multi-scale semantic feature maps. Combined, we show that these modules can effectively boost semantic segmentation performance, especially in the case of transparency, deformability, scalability, and blunt edges in objects. We demonstrate that our approach performs at a state-of-the-art level and outperforms a number of existing methods with a large margin (3.66% overall improvement in intersection over union compared to the best rival approach).

Hao Ding, Yuqian Zhang, Tuxun Lu et al.

Surgical data science has seen rapid advancement due to the excellent performance of end-to-end deep neural networks (DNNs) for surgical video analysis. Despite their successes, end-to-end DNNs have been proven susceptible to even minor corruptions, substantially impairing the model's performance. This vulnerability has become a major concern for the translation of cutting-edge technology, especially for high-stakes decision-making in surgical data science. We introduce SegSTRONG-C, a benchmark and challenge in surgical data science dedicated, aiming to better understand model deterioration under unforeseen but plausible non-adversarial corruption and the capabilities of contemporary methods that seek to improve it. Through comprehensive baseline experiments and participating submissions from widespread community engagement, SegSTRONG-C reveals key themes for model failure and identifies promising directions for improving robustness. The performance of challenge winners, achieving an average 0.9394 DSC and 0.9301 NSD across the unreleased test sets with corruption types: bleeding, smoke, and low brightness, shows inspiring improvement of 0.1471 DSC and 0.2584 NSD in average comparing to strongest baseline methods with UNet architecture trained with AutoAugment. In conclusion, the SegSTRONG-C challenge has identified some practical approaches for enhancing model robustness, yet most approaches relied on conventional techniques that have known, and sometimes quite severe, limitations. Looking ahead, we advocate for expanding intellectual diversity and creativity in non-adversarial robustness beyond data augmentation or training scale, calling for new paradigms that enhance universal robustness to corruptions and may enable richer applications in surgical data science.

Sabrina Kletz, Klaus Schoeffmann, Jenny Benois-Pineau et al.

Recorded videos from surgeries have become an increasingly important information source for the field of medical endoscopy, since the recorded footage shows every single detail of the surgery. However, while video recording is straightforward these days, automatic content indexing - the basis for content-based search in a medical video archive - is still a great challenge due to the very special video content. In this work, we investigate segmentation and recognition of surgical instruments in videos recorded from laparoscopic gynecology. More precisely, we evaluate the achievable performance of segmenting surgical instruments from their background by using a region-based fully convolutional network for instance-aware (1) instrument segmentation as well as (2) instrument recognition. While the first part addresses only binary segmentation of instances (i.e., distinguishing between instrument or background) we also investigate multi-class instrument recognition (i.e., identifying the type of instrument). Our evaluation results show that even with a moderately low number of training examples, we are able to localize and segment instrument regions with a pretty high accuracy. However, the results also reveal that determining the particular instrument is still very challenging, due to the inherently high similarity of surgical instruments.

Andreas Leibetseder, Sabrina Kletz, Klaus Schoeffmann et al.

Gynecologic laparoscopy as a type of minimally invasive surgery (MIS) is performed via a live feed of a patient's abdomen surveying the insertion and handling of various instruments for conducting treatment. Adopting this kind of surgical intervention not only facilitates a great variety of treatments, the possibility of recording said video streams is as well essential for numerous post-surgical activities, such as treatment planning, case documentation and education. Nonetheless, the process of manually analyzing surgical recordings, as it is carried out in current practice, usually proves tediously time-consuming. In order to improve upon this situation, more sophisticated computer vision as well as machine learning approaches are actively developed. Since most of such approaches heavily rely on sample data, which especially in the medical field is only sparsely available, with this work we publish the Gynecologic Laparoscopy ENdometriosis DAtaset (GLENDA) - an image dataset containing region-based annotations of a common medical condition named endometriosis, i.e. the dislocation of uterine-like tissue. The dataset is the first of its kind and it has been created in collaboration with leading medical experts in the field.

Negin Ghamsarian, Yosuf El-Shabrawi, Sahar Nasirihaghighi et al.

In recent years, the landscape of computer-assisted interventions and post-operative surgical video analysis has been dramatically reshaped by deep-learning techniques, resulting in significant advancements in surgeons' skills, operation room management, and overall surgical outcomes. However, the progression of deep-learning-powered surgical technologies is profoundly reliant on large-scale datasets and annotations. Particularly, surgical scene understanding and phase recognition stand as pivotal pillars within the realm of computer-assisted surgery and post-operative assessment of cataract surgery videos. In this context, we present the largest cataract surgery video dataset that addresses diverse requisites for constructing computerized surgical workflow analysis and detecting post-operative irregularities in cataract surgery. We validate the quality of annotations by benchmarking the performance of several state-of-the-art neural network architectures for phase recognition and surgical scene segmentation. Besides, we initiate the research on domain adaptation for instrument segmentation in cataract surgery by evaluating cross-domain instrument segmentation performance in cataract surgery videos. The dataset and annotations will be publicly available upon acceptance of the paper.

Negin Ghamsarian, Sebastian Wolf, Martin Zinkernagel et al.

Semantic Segmentation plays a pivotal role in many applications related to medical image and video analysis. However, designing a neural network architecture for medical image and surgical video segmentation is challenging due to the diverse features of relevant classes, including heterogeneity, deformability, transparency, blunt boundaries, and various distortions. We propose a network architecture, DeepPyramid+, which addresses diverse challenges encountered in medical image and surgical video segmentation. The proposed DeepPyramid+ incorporates two major modules, namely "Pyramid View Fusion" (PVF) and "Deformable Pyramid Reception," (DPR), to address the outlined challenges. PVF replicates a deduction process within the neural network, aligning with the human visual system, thereby enhancing the representation of relative information at each pixel position. Complementarily, DPR introduces shape- and scale-adaptive feature extraction techniques using dilated deformable convolutions, enhancing accuracy and robustness in handling heterogeneous classes and deformable shapes. Extensive experiments conducted on diverse datasets, including endometriosis videos, MRI images, OCT scans, and cataract and laparoscopy videos, demonstrate the effectiveness of DeepPyramid+ in handling various challenges such as shape and scale variation, reflection, and blur degradation. DeepPyramid+ demonstrates significant improvements in segmentation performance, achieving up to a 3.65% increase in Dice coefficient for intra-domain segmentation and up to a 17% increase in Dice coefficient for cross-domain segmentation. DeepPyramid+ consistently outperforms state-of-the-art networks across diverse modalities considering different backbone networks, showcasing its versatility.

Sahar Nasirihaghighi, Negin Ghamsarian, Raphael Sznitman et al.

Accurate surgical phase recognition is crucial for advancing computer-assisted interventions, yet the scarcity of labeled data hinders training reliable deep learning models. Semi-supervised learning (SSL), particularly with pseudo-labeling, shows promise over fully supervised methods but often lacks reliable pseudo-label assessment mechanisms. To address this gap, we propose a novel SSL framework, Dual Invariance Self-Training (DIST), that incorporates both Temporal and Transformation Invariance to enhance surgical phase recognition. Our two-step self-training process dynamically selects reliable pseudo-labels, ensuring robust pseudo-supervision. Our approach mitigates the risk of noisy pseudo-labels, steering decision boundaries toward true data distribution and improving generalization to unseen data. Evaluations on Cataract and Cholec80 datasets show our method outperforms state-of-the-art SSL approaches, consistently surpassing both supervised and SSL baselines across various network architectures.

Negin Ghamsarian, Doris Putzgruber-Adamitsch, Stephanie Sarny et al.

A critical yet unpredictable complication following cataract surgery is intraocular lens dislocation. Postoperative stability is imperative, as even a tiny decentration of multifocal lenses or inadequate alignment of the torus in toric lenses due to postoperative rotation can lead to a significant drop in visual acuity. Investigating possible intraoperative indicators that can predict post-surgical instabilities of intraocular lenses can help prevent this complication. In this paper, we develop and evaluate the first fully-automatic framework for the computation of lens unfolding delay, rotation, and instability during surgery. Adopting a combination of three types of CNNs, namely recurrent, region-based, and pixel-based, the proposed framework is employed to assess the possibility of predicting post-operative lens dislocation during cataract surgery. This is achieved via performing a large-scale study on the statistical differences between the behavior of different brands of intraocular lenses and aligning the results with expert surgeons' hypotheses and observations about the lenses. We exploit a large-scale dataset of cataract surgery videos featuring four intraocular lens brands. Experimental results confirm the reliability of the proposed framework in evaluating the lens' statistics during the surgery. The Pearson correlation and t-test results reveal significant correlations between lens unfolding delay and lens rotation and significant differences between the intra-operative rotations stability of four groups of lenses. These results suggest that the proposed framework can help surgeons select the lenses based on the patient's eye conditions and predict post-surgical lens dislocation.

Sahar Nasirihaghighi, Negin Ghamsarian, Leonie Peschek et al.

Recent advances in deep learning have transformed computer-assisted intervention and surgical video analysis, driving improvements not only in surgical training, intraoperative decision support, and patient outcomes, but also in postoperative documentation and surgical discovery. Central to these developments is the availability of large, high-quality annotated datasets. In gynecologic laparoscopy, surgical scene understanding and action recognition are fundamental for building intelligent systems that assist surgeons during operations and provide deeper analysis after surgery. However, existing datasets are often limited by small scale, narrow task focus, or insufficiently detailed annotations, limiting their utility for comprehensive, end-to-end workflow analysis. To address these limitations, we introduce GynSurg, the largest and most diverse multi-task dataset for gynecologic laparoscopic surgery to date. GynSurg provides rich annotations across multiple tasks, supporting applications in action recognition, semantic segmentation, surgical documentation, and discovery of novel procedural insights. We demonstrate the dataset quality and versatility by benchmarking state-of-the-art models under a standardized training protocol. To accelerate progress in the field, we publicly release the GynSurg dataset and its annotations

Negin Ghamsarian, Sahar Nasirihaghighi, Klaus Schoeffmann et al.

Semi-supervised learning leverages unlabeled data to enhance model performance, addressing the limitations of fully supervised approaches. Among its strategies, pseudo-supervision has proven highly effective, typically relying on one or multiple teacher networks to refine pseudo-labels before training a student network. A common practice in pseudo-supervision is filtering pseudo-labels based on pre-defined confidence thresholds or entropy. However, selecting optimal thresholds requires large labeled datasets, which are often scarce in real-world semi-supervised scenarios. To overcome this challenge, we propose Ensemble-of-Confidence Reinforcement (ENCORE), a dynamic feedback-driven thresholding strategy for pseudo-label selection. Instead of relying on static confidence thresholds, ENCORE estimates class-wise true-positive confidence within the unlabeled dataset and continuously adjusts thresholds based on the model's response to different levels of pseudo-label filtering. This feedback-driven mechanism ensures the retention of informative pseudo-labels while filtering unreliable ones, enhancing model training without manual threshold tuning. Our method seamlessly integrates into existing pseudo-supervision frameworks and significantly improves segmentation performance, particularly in data-scarce conditions. Extensive experiments demonstrate that integrating ENCORE with existing pseudo-supervision frameworks enhances performance across multiple datasets and network architectures, validating its effectiveness in semi-supervised learning.

Andreas Leibetseder, Klaus Schoeffmann, Jörg Keckstein et al.

Endometriosis is a common women's condition exhibiting a manifold visual appearance in various body-internal locations. Having such properties makes its identification very difficult and error-prone, at least for laymen and non-specialized medical practitioners. In an attempt to provide assistance to gynecologic physicians treating endometriosis, this demo paper describes a system that is trained to segment one frequently occurring visual appearance of endometriosis, namely dark endometrial implants. The system is capable of analyzing laparoscopic surgery videos, annotating identified implant regions with multi-colored overlays and displaying a detection summary for improved video browsing.

Sahar Nasirihaghighi, Negin Ghamsarian, Yiping Li et al.

Medical image segmentation is clinically important, yet data privacy and the cost of expert annotation limit the availability of labeled data. Federated semi-supervised learning (FSSL) offers a solution but faces two challenges: pseudo-label reliability depends on the strength of local models, and client devices often require compact or heterogeneous architectures due to limited computational resources. These constraints reduce the quality and stability of pseudo-labels, while large models, though more accurate, cannot be trained or used for routine inference on client devices. We propose SAM-Fed, a federated semi-supervised framework that leverages a high-capacity segmentation foundation model to guide lightweight clients during training. SAM-Fed combines dual knowledge distillation with an adaptive agreement mechanism to refine pixel-level supervision. Experiments on skin lesion and polyp segmentation across homogeneous and heterogeneous settings show that SAM-Fed consistently outperforms state-of-the-art FSSL methods.

Negin Ghamsarian, Raphael Sznitman, Klaus Schoeffmann et al.

To meet the growing demand for systematic surgical training, wet-lab environments have become indispensable platforms for hands-on practice in ophthalmology. Yet, traditional wet-lab training depends heavily on manual performance evaluations, which are labor-intensive, time-consuming, and often subject to variability. Recent advances in computer vision offer promising avenues for automated skill assessment, enhancing both the efficiency and objectivity of surgical education. Despite notable progress in ophthalmic surgical datasets, existing resources predominantly focus on real surgeries or isolated tasks, falling short of supporting comprehensive skill evaluation in controlled wet-lab settings. To address these limitations, we introduce WetCat, the first dataset of wet-lab cataract surgery videos specifically curated for automated skill assessment. WetCat comprises high-resolution recordings of surgeries performed by trainees on artificial eyes, featuring comprehensive phase annotations and semantic segmentations of key anatomical structures. These annotations are meticulously designed to facilitate skill assessment during the critical capsulorhexis and phacoemulsification phases, adhering to standardized surgical skill assessment frameworks. By focusing on these essential phases, WetCat enables the development of interpretable, AI-driven evaluation tools aligned with established clinical metrics. This dataset lays a strong foundation for advancing objective, scalable surgical education and sets a new benchmark for automated workflow analysis and skill assessment in ophthalmology training. The dataset and annotations are publicly available in Synapse.

Negin Ghamsarian, Mario Taschwer, Doris Putzgruber-Adamitsch et al.

Semantic segmentation in surgical videos is a prerequisite for a broad range of applications towards improving surgical outcomes and surgical video analysis. However, semantic segmentation in surgical videos involves many challenges. In particular, in cataract surgery, various features of the relevant objects such as blunt edges, color and context variation, reflection, transparency, and motion blur pose a challenge for semantic segmentation. In this paper, we propose a novel convolutional module termed as \textit{ReCal} module, which can calibrate the feature maps by employing region intra-and-inter-dependencies and channel-region cross-dependencies. This calibration strategy can effectively enhance semantic representation by correlating different representations of the same semantic label, considering a multi-angle local view centering around each pixel. Thus the proposed module can deal with distant visual characteristics of unique objects as well as cross-similarities in the visual characteristics of different objects. Moreover, we propose a novel network architecture based on the proposed module termed as ReCal-Net. Experimental results confirm the superiority of ReCal-Net compared to rival state-of-the-art approaches for all relevant objects in cataract surgery. Moreover, ablation studies reveal the effectiveness of the ReCal module in boosting semantic segmentation accuracy.

Negin Ghamsarian, Mario Taschwer, klaus Schoeffmann

Semantic segmentation in cataract surgery has a wide range of applications contributing to surgical outcome enhancement and clinical risk reduction. However, the varying issues in segmenting the different relevant instances make the designation of a unique network quite challenging. This paper proposes a semantic segmentation network termed as DeepPyram that can achieve superior performance in segmenting relevant objects in cataract surgery videos with varying issues. This superiority mainly originates from three modules: (i) Pyramid View Fusion, which provides a varying-angle global view of the surrounding region centering at each pixel position in the input convolutional feature map; (ii) Deformable Pyramid Reception, which enables a wide deformable receptive field that can adapt to geometric transformations in the object of interest; and (iii) Pyramid Loss that adaptively supervises multi-scale semantic feature maps. These modules can effectively boost semantic segmentation performance, especially in the case of transparency, deformability, scalability, and blunt edges in objects. The proposed approach is evaluated using four datasets of cataract surgery for objects with different contextual features and compared with thirteen state-of-the-art segmentation networks. The experimental results confirm that DeepPyram outperforms the rival approaches without imposing additional trainable parameters. Our comprehensive ablation study further proves the effectiveness of the proposed modules.

Negin Ghamsarian, Mario Taschwer, Doris Putzgruber-Adamitsch et al.

A critical complication after cataract surgery is the dislocation of the lens implant leading to vision deterioration and eye trauma. In order to reduce the risk of this complication, it is vital to discover the risk factors during the surgery. However, studying the relationship between lens dislocation and its suspicious risk factors using numerous videos is a time-extensive procedure. Hence, the surgeons demand an automatic approach to enable a larger-scale and, accordingly, more reliable study. In this paper, we propose a novel framework as the major step towards lens irregularity detection. In particular, we propose (I) an end-to-end recurrent neural network to recognize the lens-implantation phase and (II) a novel semantic segmentation network to segment the lens and pupil after the implantation phase. The phase recognition results reveal the effectiveness of the proposed surgical phase recognition approach. Moreover, the segmentation results confirm the proposed segmentation network's effectiveness compared to state-of-the-art rival approaches.

Luca Rossetto, Klaus Schoeffmann, Abraham Bernstein

For research results to be comparable, it is important to have common datasets for experimentation and evaluation. The size of such datasets, however, can be an obstacle to their use. The Vimeo Creative Commons Collection (V3C) is a video dataset designed to be representative of video content found on the web, containing roughly 3800 hours of video in total, split into three shards. In this paper, we present insights on the second of these shards (V3C2) and discuss their implications for research areas, such as video retrieval, for which the dataset might be particularly useful. We also provide all the extracted data in order to simplify the use of the dataset.

Negin Ghamsarian, Mario Taschwer, Doris Putzgruber-Adamitsch et al.

In cataract surgery, the operation is performed with the help of a microscope. Since the microscope enables watching real-time surgery by up to two people only, a major part of surgical training is conducted using the recorded videos. To optimize the training procedure with the video content, the surgeons require an automatic relevance detection approach. In addition to relevance-based retrieval, these results can be further used for skill assessment and irregularity detection in cataract surgery videos. In this paper, a three-module framework is proposed to detect and classify the relevant phase segments in cataract videos. Taking advantage of an idle frame recognition network, the video is divided into idle and action segments. To boost the performance in relevance detection, the cornea where the relevant surgical actions are conducted is detected in all frames using Mask R-CNN. The spatiotemporally localized segments containing higher-resolution information about the pupil texture and actions, and complementary temporal information from the same phase are fed into the relevance detection module. This module consists of four parallel recurrent CNNs being responsible to detect four relevant phases that have been defined with medical experts. The results will then be integrated to classify the action phases as irrelevant or one of four relevant phases. Experimental results reveal that the proposed approach outperforms static CNNs and different configurations of feature-based and end-to-end recurrent networks.

Tobias Ross, Annika Reinke, Peter M. Full et al.

Intraoperative tracking of laparoscopic instruments is often a prerequisite for computer and robotic-assisted interventions. While numerous methods for detecting, segmenting and tracking of medical instruments based on endoscopic video images have been proposed in the literature, key limitations remain to be addressed: Firstly, robustness, that is, the reliable performance of state-of-the-art methods when run on challenging images (e.g. in the presence of blood, smoke or motion artifacts). Secondly, generalization; algorithms trained for a specific intervention in a specific hospital should generalize to other interventions or institutions. In an effort to promote solutions for these limitations, we organized the Robust Medical Instrument Segmentation (ROBUST-MIS) challenge as an international benchmarking competition with a specific focus on the robustness and generalization capabilities of algorithms. For the first time in the field of endoscopic image processing, our challenge included a task on binary segmentation and also addressed multi-instance detection and segmentation. The challenge was based on a surgical data set comprising 10,040 annotated images acquired from a total of 30 surgical procedures from three different types of surgery. The validation of the competing methods for the three tasks (binary segmentation, multi-instance detection and multi-instance segmentation) was performed in three different stages with an increasing domain gap between the training and the test data. The results confirm the initial hypothesis, namely that algorithm performance degrades with an increasing domain gap. While the average detection and segmentation quality of the best-performing algorithms is high, future research should concentrate on detection and segmentation of small, crossing, moving and transparent instrument(s) (parts).

Klaus Schoeffmann, Bernd Münzer, Jürgen Primus et al.

This short paper provides further details of the diveXplore system (formerly known as CoViSS), which has been used by team ITEC1 for the Video Browser Showdown (VBS) 2018. In particular, it gives a short overview of search features and some details of final system changes, not included in the corresponding VBS2018 paper, as well as a basic analysis of how the system has been used for VBS2018 (from a user perspective).