Machine Learning-Based Automated Assessment of Intracorporeal Suturing in Laparoscopic Fundoplication

Automated assessment of surgical skills using artificial intelligence (AI) provides trainees with instantaneous feedback. After bimanual tool motions are captured, derived kinematic metrics are reliable predictors of performance in laparoscopic tasks. Implementing automated tool tracking requires time-intensive human annotation. We developed AI-based tool tracking using the Segment Anything Model (SAM) to eliminate the need for human annotators. Here, we describe a study evaluating the usefulness of our tool tracking model in automated assessment during a laparoscopic suturing task in the fundoplication procedure. An automated tool tracking model was applied to recorded videos of Nissen fundoplication on porcine bowel. Surgeons were grouped as novices (PGY1-2) and experts (PGY3-5, attendings). The beginning and end of each suturing step were segmented, and motions of the left and right tools were extracted. A low-pass filter with a 24 Hz cut-off frequency removed noise. Performance was assessed using supervised and unsupervised models, and an ablation study compared results. Kinematic features--RMS velocity, RMS acceleration, RMS jerk, total path length, and Bimanual Dexterity--were extracted and analyzed using Logistic Regression, Random Forest, Support Vector Classifier, and XGBoost. PCA was performed for feature reduction. For unsupervised learning, a Denoising Autoencoder (DAE) model with classifiers, such as a 1-D CNN and traditional models, was trained. Data were extracted for 28 participants (9 novices, 19 experts). Supervised learning with PCA and Random Forest achieved an accuracy of 0.795 and an F1 score of 0.778. The unsupervised 1-D CNN achieved superior results with an accuracy of 0.817 and an F1 score of 0.806, eliminating the need for kinematic feature computation. We demonstrated an AI model capable of automated performance classification, independent of human annotation.