Surreal: Enhancing Surgical simulation Realism using style transfer

Surgical simulation is an increasingly important element of surgical education. Using simulation can be a means to address some of the significant challenges in developing surgical skills with limited time and resources. The photo-realistic fidelity of simulations is a key feature that can improve the experience and transfer ratio of trainees. In this paper, we demonstrate how we can enhance the visual fidelity of existing surgical simulation by performing style transfer of multi-class labels from real surgical video onto synthetic content. We demonstrate our approach on simulations of cataract surgery using real data labels from an existing public dataset. Our results highlight the feasibility of the approach and also the powerful possibility to extend this technique to incorporate additional temporal constraints and to different applications

Master manipulator designed for highly articulated robotic instruments in single access surgery

The performance of a master-slave robotic system depends significantly on the ergonomics and the capability of its master device to correctly interface the user with the slave robot. Master manipulators generating commands in task space represent a commonly adopted solution for controlling a range of slave robots while retaining an ergonomic design. However, these devices present several drawbacks, such as requiring the use of clutching mechanics to compensate for the mismatch between slave and master workspaces, and the lack of capability to intuitively transmit important information such as specific joint limits to the user. In this paper, a novel joint-space master manipulator is presented. This manipulator emulates the kinematic structure of highly flexible surgical instruments which it is designed to control. This system uses 6 active degrees of freedom to compensate for its own weight, as well as to provide force feedback corresponding to the slave robot's joint limits. A force/torque sensor integrated at the end effector is used to relay user-generated forces and torques directly to specific joints. This is performed to counteract the friction stemming from structural constraints imposed by the kinematic design of the instruments. Finally, a usability study is carried out to test the validity of the system, proving that the instruments can be intuitively controlled even at the extremities of the workspace

A spherical joint robotic end-effector for the Expanded Endoscopic Endonasal Approach

The endonasal transsphenoidal approach allows surgeons to access the pituitary gland through the natural orifice of the nose. Recently, surgeons have also described an Expanded Endoscopic Endonasal Approach (EEEA) for the treatment of other tumours around the base of the brain. However, operating in this way with nonarticulated tools is technically very difficult and not widely adopted. The goal of this study is to develop an articulated end-effector for a novel handheld robotic tool for the EEEA. We present a design and implementation of a 3.6mm diameter, three degrees-of-freedom, tendon-driven robotic end-effector that, contrary to rigid instruments which operate under fulcrum, will give the surgeon the ability to reach areas on the surface of the brain that were previously inaccessible. We model the end-effector kinematics in simulation to study the theoretical workspace it can achieve prior to implementing a test-bench device to validate the efficacy of the end-effector. We find promising repeatability of the proposed robotic end-effector of 0.42mm with an effective workspace with limits of ±30∘, which is greater than conventional neurosurgical tools. Additionally, although the tool’s end-effector has a small enough diameter to operate through the narrow nasal access path and the constrained workspace of EEEA, it showcased promising structural integrity and was able to support approximately a 6N load, despite a large deflection angle the limiting of which is scope of future work. These preliminary results indicate the end-effector is a promising first step towards developing appropriate handheld robotic instrumentation to drive EEEA adoption

Can surgical simulation be used to train detection and classification of neural networks?

Computer-assisted interventions (CAI) aim to increase the effectiveness, precision and repeatability of procedures to improve surgical outcomes. The presence and motion of surgical tools is a key information input for CAI surgical phase recognition algorithms. Vision-based tool detection and recognition approaches are an attractive solution and can be designed to take advantage of the powerful deep learning paradigm that is rapidly advancing image recognition and classification. The challenge for such algorithms is the availability and quality of labelled data used for training. In this Letter, surgical simulation is used to train tool detection and segmentation based on deep convolutional neural networks and generative adversarial networks. The authors experiment with two network architectures for image segmentation in tool classes commonly encountered during cataract surgery. A commercially-available simulator is used to create a simulated cataract dataset for training models prior to performing transfer learning on real surgical data. To the best of authors' knowledge, this is the first attempt to train deep learning models for surgical instrument detection on simulated data while demonstrating promising results to generalise on real data. Results indicate that simulated data does have some potential for training advanced classification methods for CAI systems

Towards video-based surgical workflow understanding in open orthopaedic surgery

Safe and efficient surgical training and workflow management play a critical role in clinical competency and ultimately, patient outcomes. Video data in minimally invasive surgery (MIS) have enabled opportunities for vision-based artificial intelligence (AI) systems to improve surgical skills training and assurance through post-operative video analysis and development of real-time computer-assisted interventions (CAI). Despite the availability of mounted cameras for the operating room (OR), similar capabilities are much more complex to develop for recording open surgery procedures, which has resulted in a shortage of exemplar video-based training materials. In this paper, we present a potential solution to record open surgical procedures using head-mounted cameras. Recorded videos were anonymised to remove patient and staff identifiable information using a machine learning algorithm that achieves state-of-the-art results on the OR Face dataset. We then propose a CNN-LSTM-based model to automatically segment videos into different surgical phases, which has never been previously demonstrated in open procedures. The redacted videos, along with the automatically predicted phases, are then available for surgeons and their teams for post-operative review and analysis. To our knowledge, this is the first demonstration of the feasibility of deploying camera recording systems and developing machine learning-based workflow analysis solutions for open surgery, particularly in orthopaedics

Probing strongly coupled anisotropic plasma

We calculate the static potential, the drag force and the jet quenching parameter in strongly coupled anisotropic N=4 super Yang-Mills plasma. We find that the jet quenching is in general enhanced in presence of anisotropy compared to the isotropic case and that its value depends strongly on the direction of the moving quark and the direction along which the momentum broadening occurs. The jet quenching is strongly enhanced for a quark moving along the anisotropic direction and momentum broadening happens along the transverse one. The parameter gets lower for a quark moving along the transverse direction and the momentum broadening considered along the anisotropic one. Finally, a weaker enhancement is observed when the quark moves in the transverse plane and the broadening occurs on the same plane. The drag force for quark motion parallel to the anisotropy is always enhanced. For motion in the transverse space the drag force is enhanced compared to the isotropic case only for quarks having velocity above a critical value. Below this critical value the force is decreased. Moreover, the drag force along the anisotropic direction is always stronger than the force in the transverse space. The diffusion time follows exactly the inverse relations of the drag forces. The static potential is decreased and stronger decrease observed for quark-antiquark pair aligned along the anisotropic direction than the transverse one. We finally comment on our results and elaborate on their similarities and differences with the weakly coupled plasmas.Comment: 1+44 pages, 18 Figures; Added results on static force; Added references; version published in JHE

On the pulsating strings in AdS_5 x T^{1,1}

We study the class of pulsating strings in AdS_5 x T^{1,1}. Using a generalized ansatz for pulsating string configurations we find new solutions of this class. Further we semiclassically quantize the theory and obtain the first correction to the energy. The latter, due to AdS/CFT correspondence, is supposed to give the anomalous dimensions of operators in the dual N=1 superconformal gauge field theory.Comment: 12 pages, improvements made, references adde

Energy loss in a strongly coupled anisotropic plasma

We study the energy loss of a rotating infinitely massive quark moving, at constant velocity, through an anisotropic strongly-coupled N=4 plasma from holography. It is shown that, similar to the isotropic plasma, the energy loss of the rotating quark is due to either the drag force or radiation with a continuous crossover from drag-dominated regime to the radiation dominated regime. We find that the anisotropy has a significant effect on the energy loss of the heavy quark, specially in the crossover regime. We argue that the energy loss due to radiation in anisotropic media is less than the isotropic case. Interestingly this is similar to analogous calculations for the energy loss in weakly coupled anisotropic plasma.Comment: 26+1 pages, 10 figures, typos fixe

Jet quenching in a strongly coupled anisotropic plasma

The jet quenching parameter of an anisotropic plasma depends on the relative orientation between the anisotropic direction, the direction of motion of the parton, and the direction along which the momentum broadening is measured. We calculate the jet quenching parameter of an anisotropic, strongly coupled N=4 plasma by means of its gravity dual. We present the results for arbitrary orientations and arbitrary values of the anisotropy. The anisotropic value can be larger or smaller than the isotropic one, and this depends on whether the comparison is made at equal temperatures or at equal entropy densities. We compare our results to analogous calculations for the real-world quark-gluon plasma and find agreement in some cases and disagreement in others.Comment: 22 pages, 10 figures; v2: minor changes, added reference. Extends arXiv:1202.369