Temporal Segmentation of Surgical Sub-tasks through Deep Learning with Multiple Data Sources

Many tasks in robot-assisted surgeries (RAS) can be represented by finite-state machines (FSMs), where each state represents either an action (such as picking up a needle) or an observation (such as bleeding). A crucial step towards the automation of such surgical tasks is the temporal perception of the current surgical scene, which requires a real-time estimation of the states in the FSMs. The objective of this work is to estimate the current state of the surgical task based on the actions performed or events occurred as the task progresses. We propose Fusion-KVE, a unified surgical state estimation model that incorporates multiple data sources including the Kinematics, Vision, and system Events. Additionally, we examine the strengths and weaknesses of different state estimation models in segmenting states with different representative features or levels of granularity. We evaluate our model on the JHU-ISI Gesture and Skill Assessment Working Set (JIGSAWS), as well as a more complex dataset involving robotic intra-operative ultrasound (RIOUS) imaging, created using the da Vinci® Xi surgical system. Our model achieves a superior frame-wise state estimation accuracy up to 89.4%, which improves the state-of-the-art surgical state estimation models in both JIGSAWS suturing dataset and our RIOUS dataset

Computerized Evaluatution of Microsurgery Skills Training

The style of imparting medical training has evolved, over the years. The traditional methods of teaching and practicing basic surgical skills under apprenticeship model, no longer occupy the first place in modern technically demanding advanced surgical disciplines like neurosurgery. Furthermore, the legal and ethical concerns for patient safety as well as cost-effectiveness have forced neurosurgeons to master the necessary microsurgical techniques to accomplish desired results. This has lead to increased emphasis on assessment of clinical and surgical techniques of the neurosurgeons. However, the subjective assessment of microsurgical techniques like micro-suturing under the apprenticeship model cannot be completely unbiased. A few initiatives using computer-based techniques, have been made to introduce objective evaluation of surgical skills. This thesis presents a novel approach involving computerized evaluation of different components of micro-suturing techniques, to eliminate the bias of subjective assessment. The work involved acquisition of cine clips of micro-suturing activity on synthetic material. Image processing and computer vision based techniques were then applied to these videos to assess different characteristics of micro-suturing viz. speed, dexterity and effectualness. In parallel subjective grading on these was done by a senior neurosurgeon. Further correlation and comparative study of both the assessments was done to analyze the efficacy of objective and subjective evaluation

Who's Better? Who's Best? Pairwise Deep Ranking for Skill Determination

We present a method for assessing skill from video, applicable to a variety of tasks, ranging from surgery to drawing and rolling pizza dough. We formulate the problem as pairwise (who's better?) and overall (who's best?) ranking of video collections, using supervised deep ranking. We propose a novel loss function that learns discriminative features when a pair of videos exhibit variance in skill, and learns shared features when a pair of videos exhibit comparable skill levels. Results demonstrate our method is applicable across tasks, with the percentage of correctly ordered pairs of videos ranging from 70% to 83% for four datasets. We demonstrate the robustness of our approach via sensitivity analysis of its parameters. We see this work as effort toward the automated organization of how-to video collections and overall, generic skill determination in video.Comment: CVPR 201

Computational Modeling Approaches For Task Analysis In Robotic-Assisted Surgery

Surgery is continuously subject to technological innovations including the introduction of robotic surgical devices. The ultimate goal is to program the surgical robot to perform certain difficult or complex surgical tasks in an autonomous manner. The feasibility of current robotic surgery systems to record quantitative motion and video data motivates developing descriptive mathematical models to recognize, classify and analyze surgical tasks. Recent advances in machine learning research for uncovering concealed patterns in huge data sets, like kinematic and video data, offer a possibility to better understand surgical procedures from a system point of view. This dissertation focuses on bridging the gap between these two lines of the research by developing computational models for task analysis in robotic-assisted surgery. The key step for advance study in robotic-assisted surgery and autonomous skill assessment is to develop techniques that are capable of recognizing fundamental surgical tasks intelligently. Surgical tasks and at a more granular level, surgical gestures, need to be quantified to make them amenable for further study. To answer to this query, we introduce a new framework, namely DTW-kNN, to recognize and classify three important surgical tasks including suturing, needle passing and knot tying based on kinematic data captured using da Vinci robotic surgery system. Our proposed method needs minimum preprocessing that results in simple, straightforward and accurate framework which can be applied for any autonomous control system. We also propose an unsupervised gesture segmentation and recognition (UGSR) method which has the ability to automatically segment and recognize temporal sequence of gestures in RMIS task. We also extent our model by applying soft boundary segmentation (Soft-UGSR) to address some of the challenges that exist in the surgical motion segmentation. The proposed algorithm can effectively model gradual transitions between surgical activities. Additionally, surgical training is undergoing a paradigm shift with more emphasis on the development of technical skills earlier in training. Thus metrics for the skills, especially objective metrics, become crucial. One field of surgery where such techniques can be developed is robotic surgery, as here all movements are already digitalized and therefore easily susceptible to analysis. Robotic surgery requires surgeons to perform a much longer and difficult training process which create numerous new challenges for surgical training. Hence, a new method of surgical skill assessment is required to ensure that surgeons have adequate skill level to be allowed to operate freely on patients. Among many possible approaches, those that provide noninvasive monitoring of expert surgeon and have the ability to automatically evaluate surgeon\u27s skill are of increased interest. Therefore, in this dissertation we develop a predictive framework for surgical skill assessment to automatically evaluate performance of surgeon in RMIS. Our classification framework is based on the Global Movement Features (GMFs) which extracted from kinematic movement data. The proposed method addresses some of the limitations in previous work and gives more insight about underlying patterns of surgical skill levels

A Suture Training System with Synchronized Force, Motion and Video Data Collection

Suturing is a common surgical task where surgeons stitch a particular tissue. There is an increasing demand for a tool to objectively quantify and train surgical skills. Suturing is particularly difficult to teach due to various multi-modal aspects involved in the task including applied forces, hand motion and optimal time for suturing. Towards quantifying the task of suturing, a platform is required to capture force, motion and video data while performing surgical suturing. This objective data can potentially be used to evaluate performance of a trainee and provide feedback regarding improving suturing skill. In the previous prototype of the platform, 3 key issues faced were synchronization of the three sensors, inadequate construction of the platform and the lack of a framework for image processing towards real-time assessment of suturing skill. In order to improve the platform, the aforementioned issues have been addressed in specific ways. The data collected in the system is synchronized in real-time along with a video recording for image processing and the noise due to the platform is considerably reduced by making modification to the platform construction. Data was collected on the platform with 15 novice participants. Initial analysis validates the synchronization of the sensor data. In the future, the suture skill of experts and novices will be analyzed using meaningful metrics and machine learning algorithms. This work has the potential of enabling objective and structured training and evaluation for next generation surgeons

Artificial intelligence and automation in endoscopy and surgery

Modern endoscopy relies on digital technology, from high-resolution imaging sensors and displays to electronics connecting configurable illumination and actuation systems for robotic articulation. In addition to enabling more effective diagnostic and therapeutic interventions, the digitization of the procedural toolset enables video data capture of the internal human anatomy at unprecedented levels. Interventional video data encapsulate functional and structural information about a patient’s anatomy as well as events, activity and action logs about the surgical process. This detailed but difficult-to-interpret record from endoscopic procedures can be linked to preoperative and postoperative records or patient imaging information. Rapid advances in artificial intelligence, especially in supervised deep learning, can utilize data from endoscopic procedures to develop systems for assisting procedures leading to computer-assisted interventions that can enable better navigation during procedures, automation of image interpretation and robotically assisted tool manipulation. In this Perspective, we summarize state-of-the-art artificial intelligence for computer-assisted interventions in gastroenterology and surgery

Real-time 3D tracking of laparoscopy training instruments for assessment and feedback

Assessment of minimally invasive surgical skills is a non-trivial task, usually requiring the presence and time of expert observers, including subjectivity and requiring special and expensive equipment and software. Although there are virtual simulators that provide self-assessment features, they are limited as the trainee loses the immediate feedback from realistic physical interaction. The physical training boxes, on the other hand, preserve the immediate physical feedback, but lack the automated self-assessment facilities. This study develops an algorithm for real-time tracking of laparoscopy instruments in the video cues of a standard physical laparoscopy training box with a single fisheye camera. The developed visual tracking algorithm recovers the 3D positions of the laparoscopic instrument tips, to which simple colored tapes (markers) are attached. With such system, the extracted instrument trajectories can be digitally processed, and automated self-assessment feedback can be provided. In this way, both the physical interaction feedback would be preserved and the need for the observance of an expert would be overcome. Real-time instrument tracking with a suitable assessment criterion would constitute a significant step towards provision of real-time (immediate) feedback to correct trainee actions and show them how the action should be performed. This study is a step towards achieving this with a low cost, automated, and widely applicable laparoscopy training and assessment system using a standard physical training box equipped with a fisheye camera