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

Computer Vision in the Surgical Operating Room

Background: Multiple types of surgical cameras are used in modern surgical practice and provide a rich visual signal that is used by surgeons to visualize the clinical site and make clinical decisions. This signal can also be used by artificial intelligence (AI) methods to provide support in identifying instruments, structures, or activities both in real-time during procedures and postoperatively for analytics and understanding of surgical processes. Summary: In this paper, we provide a succinct perspective on the use of AI and especially computer vision to power solutions for the surgical operating room (OR). The synergy between data availability and technical advances in computational power and AI methodology has led to rapid developments in the field and promising advances. Key Messages: With the increasing availability of surgical video sources and the convergence of technologiesaround video storage, processing, and understanding, we believe clinical solutions and products leveraging vision are going to become an important component of modern surgical capabilities. However, both technical and clinical challenges remain to be overcome to efficiently make use of vision-based approaches into the clinic

Refractive Structure-From-Motion Through a Flat Refractive Interface

Recovering 3D scene geometry from underwater images involves the Refractive Structure-from-Motion (RSfM) problem, where the image distortions caused by light refraction at the interface between different propagation media invalidates the single view point assumption. Direct use of the pinhole camera model in RSfM leads to inaccurate camera pose estimation and consequently drift. RSfM methods have been thoroughly studied for the case of a thick glass interface that assumes two refractive interfaces between the camera and the viewed scene. On the other hand, when the camera lens is in direct contact with the water, there is only one refractive interface. By explicitly considering a refractive interface, we develop a succinct derivation of the refractive fundamental matrix in the form of the generalised epipolar constraint for an axial camera. We use the refractive fundamental matrix to refine initial pose estimates obtained by assuming the pinhole model. This strategy allows us to robustly estimate underwater camera poses, where other methods suffer from poor noise-sensitivity. We also formulate a new four view constraint enforcing camera pose consistency along a video which leads us to a novel RSfM framework. For validation we use synthetic data to show the numerical properties of our method and we provide results on real data to demonstrate performance within laboratory settings and for applications in endoscopy

Identifying key mechanisms leading to visual recognition errors for missed colorectal polyps using eye-tracking technology

Background and Aim Lack of visual recognition of colorectal polyps may lead to interval cancers. The mechanisms contributing to perceptual variation, particularly for subtle and advanced colorectal neoplasia, have scarcely been investigated. We aimed to evaluate visual recognition errors and provide novel mechanistic insights. Methods Eleven participants (seven trainees and four medical students) evaluated images from the UCL polyp perception dataset, containing 25 polyps, using eye-tracking equipment. Gaze errors were defined as those where the lesion was not observed according to eye-tracking technology. Cognitive errors occurred when lesions were observed but not recognized as polyps by participants. A video study was also performed including 39 subtle polyps, where polyp recognition performance was compared with a convolutional neural network. Results Cognitive errors occurred more frequently than gaze errors overall (65.6%), with a significantly higher proportion in trainees (P = 0.0264). In the video validation, the convolutional neural network detected significantly more polyps than trainees and medical students, with per-polyp sensitivities of 79.5%, 30.0%, and 15.4%, respectively. Conclusions Cognitive errors were the most common reason for visual recognition errors. The impact of interventions such as artificial intelligence, particularly on different types of perceptual errors, needs further investigation including potential effects on learning curves. To facilitate future research, a publicly accessible visual perception colonoscopy polyp database was created

Adjoint Transformation Algorithm for Hand-Eye Calibration with Applications in Robotic Assisted Surgery

Hand-eye calibration aims at determining the unknown rigid transformation between the coordinate systems of a robot arm and a camera. Existing hand-eye algorithms using closed-form solutions followed by iterative non-linear refinement provide accurate calibration results within a broad range of robotic applications. However, in the context of surgical robotics hand-eye calibration is still a challenging problem due to the required accuracy within the millimetre range, coupled with a large displacement between endoscopic cameras and the robot end-effector. This paper presents a new method for hand-eye calibration based on the adjoint transformation of twist motions that solves the problem iteratively through alternating estimations of rotation and translation. We show that this approach converges to a solution with a higher accuracy than closed form initializations within a broad range of synthetic and real experiments. We also propose a stereo hand-eye formulation that can be used in the context of both our proposed method and previous state-of-the-art closed form solutions. Experiments with real data are conducted with a stereo laparoscope, the KUKA robot arm manipulator, and the da Vinci surgical robot, showing that both our new alternating solution and the explicit representation of stereo camera hand-eye relations contribute to a higher calibration accuracy

Corner-Based Geometric Calibration of Multi-focus Plenoptic Cameras

We propose a method for geometric calibration of multi-focus plenoptic cameras using raw images. Multi-focus plenoptic cameras feature several types of micro-lenses spatially aligned in front of the camera sensor to generate micro-images at different magnifications. This multi-lens arrangement provides computational-photography benefits but complicates calibration. Our methodology achieves the detection of the type of micro-lenses, the retrieval of their spatial arrangement, and the estimation of intrinsic and extrinsic camera parameters therefore fully characterising this specialised camera class. Motivated from classic pinhole camera calibration, our algorithm operates on a checker-board's corners, retrieved by a custom micro-image corner detector. This approach enables the introduction of a reprojection error that is used in a minimisation framework. Our algorithm compares favourably to the state-of-the-art, as demonstrated by controlled and freehand experiments, making it a first step towards accurate 3D reconstruction and Structure-from-Motion

A Combined EM and Visual Tracking Probabilistic Model for Robust Mosaicking: Application to Fetoscopy

Twin-to-Twin Transfusion Syndrome (TTTS) is a progressive pregnancy complication in which inter-twin vascular connections in the shared placenta result in a blood flow imbalance between the twins. The most effective therapy is to sever these connections by laser photo-coagulation. However, the limited field of view of the fetoscope hinders their identification. A potential solution is to augment the surgeon’s view by creating a mosaic image of the placenta. State-of-the-art mosaicking methods use feature-based ap- proaches, which have three main limitations: (i) they are not robust against corrupt data e.g. blurred frames, (ii) tem- poral information is not used, (iii) the resulting mosaic suf- fers from drift. We introduce a probabilistic temporal model that incorporates electromagnetic and visual tracking data to achieve a robust mosaic with reduced drift. By assuming planarity of the imaged object, the nRT decomposition can be used to parametrize the state vector. Finally, we tackle the non-linear nature of the problem in a numerically stable manner by using the Square Root Unscented Kalman Filter. We show an improvement in performance in terms of robustness as well as a reduction of the drift in comparison to state-of-the-art methods in synthetic, phantom and ex vivo datasets

Automated pick-up of suturing needles for robotic surgical assistance

Robot-assisted laparoscopic prostatectomy (RALP) is a treatment for prostate cancer that involves complete or nerve sparing removal prostate tissue that contains cancer. After removal the bladder neck is successively sutured directly with the urethra. The procedure is called urethrovesical anastomosis and is one of the most dexterity demanding tasks during RALP. Two suturing instruments and a pair of needles are used in combination to perform a running stitch during urethrovesical anastomosis. While robotic instruments provide enhanced dexterity to perform the anastomosis, it is still highly challenging and difficult to learn. In this paper, we presents a vision-guided needle grasping method for automatically grasping the needle that has been inserted into the patient prior to anastomosis. We aim to automatically grasp the suturing needle in a position that avoids hand-offs and immediately enables the start of suturing. The full grasping process can be broken down into: a needle detection algorithm; an approach phase where the surgical tool moves closer to the needle based on visual feedback; and a grasping phase through path planning based on observed surgical practice. Our experimental results show examples of successful autonomous grasping that has the potential to simplify and decrease the operational time in RALP by assisting a small component of urethrovesical anastomosis

A Continuum Robot and Control Interface for Surgical Assist in Fetoscopic Interventions

Twin-twin transfusion syndrome requires interventional treatment using a fetoscopically introduced laser to sever the shared blood supply between the fetuses. This is a delicate procedure relying on small instrumentation with limited articulation to guide the laser tip and a narrow field of view to visualize all relevant vascular connections. In this letter, we report on a mechatronic design for a comanipulated instrument that combines concentric tube actuation to a larger manipulator constrained by a remote centre of motion. A stereoscopic camera is mounted at the distal tip and used for imaging. Our mechanism provides enhanced dexterity and stability of the imaging device. We demonstrate that the imaging system can be used for computing geometry and enhancing the view at the operating site. Results using electromagnetic sensors for verification and comparison to visual odometry from the distal sensor show that our system is promising and can be developed further for multiple clinical needs in fetoscopic procedures

Deep Placental Vessel Segmentation for Fetoscopic Mosaicking

During fetoscopic laser photocoagulation, a treatment for twin-to-twin transfusion syndrome (TTTS), the clinician first identifies abnormal placental vascular connections and laser ablates them to regulate blood flow in both fetuses. The procedure is challenging due to the mobility of the environment, poor visibility in amniotic fluid, occasional bleeding, and limitations in the fetoscopic field-of-view and image quality. Ideally, anastomotic placental vessels would be automatically identified, segmented and registered to create expanded vessel maps to guide laser ablation, however, such methods have yet to be clinically adopted. We propose a solution utilising the U-Net architecture for performing placental vessel segmentation in fetoscopic videos. The obtained vessel probability maps provide sufficient cues for mosaicking alignment by registering consecutive vessel maps using the direct intensity-based technique. Experiments on 6 different in vivo fetoscopic videos demonstrate that the vessel intensity-based registration outperformed image intensity-based registration approaches showing better robustness in qualitative and quantitative comparison. We additionally reduce drift accumulation to negligible even for sequences with up to 400 frames and we incorporate a scheme for quantifying drift error in the absence of the ground-truth. Our paper provides a benchmark for fetoscopy placental vessel segmentation and registration by contributing the first in vivo vessel segmentation and fetoscopic videos dataset.Comment: Accepted at MICCAI 202