Surgical Skill Assessment on In-Vivo Clinical Data via the Clearness of Operating Field

Surgical skill assessment is important for surgery training and quality control. Prior works on this task largely focus on basic surgical tasks such as suturing and knot tying performed in simulation settings. In contrast, surgical skill assessment is studied in this paper on a real clinical dataset, which consists of fifty-seven in-vivo laparoscopic surgeries and corresponding skill scores annotated by six surgeons. From analyses on this dataset, the clearness of operating field (COF) is identified as a good proxy for overall surgical skills, given its strong correlation with overall skills and high inter-annotator consistency. Then an objective and automated framework based on neural network is proposed to predict surgical skills through the proxy of COF. The neural network is jointly trained with a supervised regression loss and an unsupervised rank loss. In experiments, the proposed method achieves 0.55 Spearman's correlation with the ground truth of overall technical skill, which is even comparable with the human performance of junior surgeons.Comment: MICCAI 201

Automated operative workflow analysis of endoscopic pituitary surgery using machine learning: development and preclinical evaluation (IDEAL stage 0)

OBJECTIVE: Surgical workflow analysis involves systematically breaking down operations into key phases and steps. Automatic analysis of this workflow has potential uses for surgical training, preoperative planning, and outcome prediction. Recent advances in machine learning (ML) and computer vision have allowed accurate automated workflow analysis of operative videos. In this Idea, Development, Exploration, Assessment, Long-term study (IDEAL) stage 0 study, the authors sought to use Touch Surgery for the development and validation of an ML-powered analysis of phases and steps in the endoscopic transsphenoidal approach (eTSA) for pituitary adenoma resection, a first for neurosurgery. METHODS: The surgical phases and steps of 50 anonymized eTSA operative videos were labeled by expert surgeons. Forty videos were used to train a combined convolutional and recurrent neural network model by Touch Surgery. Ten videos were used for model evaluation (accuracy, F1 score), comparing the phase and step recognition of surgeons to the automatic detection of the ML model. RESULTS: The longest phase was the sellar phase (median 28 minutes), followed by the nasal phase (median 22 minutes) and the closure phase (median 14 minutes). The longest steps were step 5 (tumor identification and excision, median 17 minutes); step 3 (posterior septectomy and removal of sphenoid septations, median 14 minutes); and step 4 (anterior sellar wall removal, median 10 minutes). There were substantial variations within the recorded procedures in terms of video appearances, step duration, and step order, with only 50% of videos containing all 7 steps performed sequentially in numerical order. Despite this, the model was able to output accurate recognition of surgical phases (91% accuracy, 90% F1 score) and steps (76% accuracy, 75% F1 score). CONCLUSIONS: In this IDEAL stage 0 study, ML techniques have been developed to automatically analyze operative videos of eTSA pituitary surgery. This technology has previously been shown to be acceptable to neurosurgical teams and patients. ML-based surgical workflow analysis has numerous potential uses-such as education (e.g., automatic indexing of contemporary operative videos for teaching), improved operative efficiency (e.g., orchestrating the entire surgical team to a common workflow), and improved patient outcomes (e.g., comparison of surgical techniques or early detection of adverse events). Future directions include the real-time integration of Touch Surgery into the live operative environment as an IDEAL stage 1 (first-in-human) study, and further development of underpinning ML models using larger data sets

The Pros and Cons: Rank-aware Temporal Attention for Skill Determination in Long Videos

We present a new model to determine relative skill from long videos, through learnable temporal attention modules. Skill determination is formulated as a ranking problem, making it suitable for common and generic tasks. However, for long videos, parts of the video are irrelevant for assessing skill, and there may be variability in the skill exhibited throughout a video. We therefore propose a method which assesses the relative overall level of skill in a long video by attending to its skill-relevant parts. Our approach trains temporal attention modules, learned with only video-level supervision, using a novel rank-aware loss function. In addition to attending to task relevant video parts, our proposed loss jointly trains two attention modules to separately attend to video parts which are indicative of higher (pros) and lower (cons) skill. We evaluate our approach on the EPIC-Skills dataset and additionally annotate a larger dataset from YouTube videos for skill determination with five previously unexplored tasks. Our method outperforms previous approaches and classic softmax attention on both datasets by over 4% pairwise accuracy, and as much as 12% on individual tasks. We also demonstrate our model's ability to attend to rank-aware parts of the video.Comment: CVPR 201

CEPS: An Open Access MATLAB Graphical User Interface (GUI) for the Analysis of Complexity and Entropy in Physiological Signals

Background: We developed CEPS as an open access MATLAB® GUI (graphical user interface) for the analysis of Complexity and Entropy in Physiological Signals (CEPS), and demonstrate its use with an example data set that shows the effects of paced breathing (PB) on variability of heart, pulse and respiration rates. CEPS is also sufficiently adaptable to be used for other time series physiological data such as EEG (electroencephalography), postural sway or temperature measurements. Methods: Data were collected from a convenience sample of nine healthy adults in a pilot for a larger study investigating the effects on vagal tone of breathing paced at various different rates, part of a development programme for a home training stress reduction system. Results: The current version of CEPS focuses on those complexity and entropy measures that appear most frequently in the literature, together with some recently introduced entropy measures which may have advantages over those that are more established. Ten methods of estimating data complexity are currently included, and some 28 entropy measures. The GUI also includes a section for data pre-processing and standard ancillary methods to enable parameter estimation of embedding dimension m and time delay τ (‘tau’) where required. The software is freely available under version 3 of the GNU Lesser General Public License (LGPLv3) for non-commercial users. CEPS can be downloaded at https://bitbucket.org/deepak_panday/ceps/src/pipeline_v2/. In our illustration on PB, most complexity and entropy measures decreased significantly in response to breathing at 7 breaths per minute, differentiating more clearly than conventional linear, time- and frequency-domain measures between breathing states. In contrast, Higuchi fractal dimension increased during paced breathing. Conclusions: We have developed CEPS software as a physiological data visualiser able to integrate state of the art techniques. The interface is designed for clinical research and has a structure designed for integrating new tools. The aim is to strengthen collaboration between clinicians and the biomedical community, as demonstrated here by using CEPS to analyse various physiological responses to paced breathing

Advances in automated surgery skills evaluation

Training a surgeon to be skilled and competent to perform a given surgical procedure, is an important step in providing a high quality of care and reducing the risk of complications. Traditional surgical training is carried out by expert surgeons who observe and assess the trainees directly during a given procedure. However, these traditional training methods are time-consuming, subjective, costly, and do not offer an overall surgical expertise evaluation criterion. The solution for these subjective evaluation methods is a sensor-based methodology able to objectively assess the surgeon's skill level. The development and advances in sensor technologies enable capturing and studying the information obtained from complex surgery procedures. If the surgical activities that occur during a procedure are captured using a set of sensors, then the skill evaluation methodology can be defined as a motion and time series analysis problem. This work aims at developing machine learning approaches for automated surgical skill assessment based on hand motion analysis. Specifically, this work presents several contributions to the field of objective surgical techniques using multi-dimensional time series, such as 1) introduce a new distance measure for the surgical activities based on the alignment of two multi-dimensional time series, 2) develop an automated classification framework to identify the surgeon proficiency level using wrist worn sensors, 3) develop a classification technique to identify elementary surgical tasks: suturing, needle passing, and knot tying , 4) introduce a new surgemes mean feature reduction technique which help improve the machine learning algorithms, 5) develop a framework for surgical gesture classification by employing the mean feature reduction method, 6) design an unsupervised method to identify the surgemes in a given procedure.Includes bibliographical references