Analysis of minimally invasive surgical videos is a powerful tool to drive new solutions for achieving reproducible training programs, objective and transparent assessment systems and navigation tools to assist surgeons and improve patient safety. This paper presents how video analysis contributes to the development of new cognitive and motor training and assessment programs as well as new paradigms for image-guided surgery

Gómez Aguilera, Enrique J.

Oropesa García, Ignacio

Sánchez González, Patricia

Archivo Digital UPM

Minimally invasive surgical video analysis: a powerful tool for surgical training and navigation

Analysis of minimally invasive surgical videos is a powerful tool to drive new solutions for achieving reproducible training programs, objective and transparent assessment systems and navigation tools to assist surgeons and 

improve patient safety. This paper presents how video analysis contributes to the development of new cognitive and motor training and assessment programs as well as new paradigms for image-guided surgery

Servicio de Coordinación de Bibliotecas de la Universidad Politécnica de Madrid

Minimally Invasive Surgical Video 
Analysis: a powerful tool for Surgical 
Training and Navigation  
P. Sánchez-González a,b,1, I. Oropesaa,b, E.J. Gómez a,b 
a
 Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, 
Universidad Politécnica de Madrid, Spain 
b
 Biomedical Research Networking center in Bioengineering, Biomaterials and 
Nanomedicine, Spain 
Abstract. Analysis of minimally invasive surgical videos is a powerful tool to 
drive new solutions for achieving reproducible training programs, objective and 
transparent assessment systems and navigation tools to assist surgeons and 
improve patient safety. This paper presents how video analysis contributes to the 
development of new cognitive and motor training and assessment programs as well 
as new paradigms for image-guided surgery. 
Keywords. Minimally invasive surgery, video analysis, training, navigation 
Introduction 
Automatic analysis of minimally invasive surgery (MIS) videos captured by the 
endoscope has the potential to drive new solutions for safer surgeries. Reproducible 
training programs, objective and transparent assessment systems and navigation tools 
to assist surgeons and improve patient safety can be developed by means of the 
analysis of video sequences [1]. Surgical video sequences provide useful information 
about the position of instruments and organs, surgical maneuvers, measurements of 
distances or even an approximate 3D reconstruction of the surgical scene. Endoscopic 
video images are an always available source of information and can be used without 
adding extra technological components in the operating room (OR). 
Cognitive and motor training can benefit from the use of video images captured by 
the endoscope since they can be useful multimedia didactic resources [2]. Early 
familiarization with the view present in the operating rooms can shorten learning 
curves of trainees. Existing video repositories appear bound to web technologies for 
cognitive on-line training, enabling anytime-anywhere education. 
Endoscopic video analysis can also be useful for assessment of surgeon’s skills. 
Motion analysis of the laparoscopic instruments’ movements has been proven to be a 
relevant source of information on psychomotor performance [3]. Video-based tracking 
can offer an alternative to sensor-based systems to this end, which are usually bulky 
and may modify the instruments’ ergonomics. 
                                                          
1 Biomedical Engineering and Telemedicine Centre. Avda. Complutense, 30. 28040. Madrid. Spain. 
   psanchez@gbt.tfo.upm.es 
Finally, video information can help surgeons during procedures providing surgical 
guidance, strongly relying in the information conveyed by the endoscope to track all 
elements (instruments, laparoscope, trocars and anatomic structures) in the surgical 
scene. In this research we compile our advances using video analysis for training and 
navigation fields. 
1. Surgical training 
The paradigm change from traditional surgery to minimally invasive procedures has 
brought forth a necessary change in education programs for new surgeons: because of 
the reduced time available for education, training based on mentor-apprentice 
relationship is no longer sufficiently efficient.  
In order to deal with cognitive training, a learning platform based on Technology 
Enhanced Learning for achieving a personalized learning experience while using 
pedagogically inspired solutions was implemented [4]. This platform is envisaged as a 
new cognitive learning concept to create, share and reuse scalable didactic content and 
to adapt content to learners’ individual needs according to pedagogical models. The 
proposed environment has a four-pillared architecture: (1) an authoring tool that allows 
the creation of video-based, structured, enhanced, didactic contents; (2) a learning 
content and knowledge management system that provides adaptive learning to users 
based on their progress and behaviors in the training platform as well as a modular and 
scalable system to capture, catalogue, search and retrieve multimedia content; (3) an 
evaluation module that provides both formative and summative feedback to the trainee; 
and (4) a professional network for collaborative learning. 
In this environment creation is not simply understood as a matter of digitalizing 
traditional materials; it also involves new approaches to constitute a well-designed 
surgical educational process. The environment incorporates a multimedia didactic 
authoring tool that offers the creation of formal learning content, the efficient use of 
surgical videos with enriched didactic value and the addition of multimedia objects to 
enhance surgical explanations.  
Moreover, a video-based method for tracking laparoscopic instruments, named 
EVA Tracking System, was implemented in order to deal with motor training [5]. The 
system exploits 2D information of the instruments on the screen and detects the 
instruments’ borders and tips. Analysis of geometrical properties of the instrument 
allows obtaining the 3D depth component.  
The first prototype was validated with offline recordings of a MIS assessment task 
in a box trainer environment. Several motion-related measurements were obtained for 
each participant, and statistical analysis on performance was carried out. The study 
reflected construct validation when comparing performance of students, residents and 
experts; and concurrent validation when comparing measurements with an optical-
based sensor system. 
2. Surgical navigation system 
Planning and navigation systems arise to aid surgeons during procedures. Navigation 
systems allow to transfer preoperative data, images and decisions from the planner 
directly into the OR, giving surgeons guidance during the procedure. Difficulties arise 
in soft-tissue surgeries where the lack of rigid landmarks makes harder to correlate 
intraoperative and preoperative data, due to anatomical alterations caused by organ-
shifting, tissue deformations, patient movement and surgeon’s manipulation. 
Analysis of minimally invasive surgical videos allows the creation of a new image 
and video guided surgery paradigm for soft-tissue navigation based on the intelligent 
exploitation of the information provided by the endoscopic video [6]. Three main 
motivations lie behind it: (1) enabling surgical guidance without modifications of the 
surgical workflow; (2) tracking surgical objects (instruments, anatomic structures and 
endoscope) without alterations of their ergonomic properties and (3) avoiding 
cluttering of equipment in the already overloaded space in the OR. A surgical 
navigation prototype for liver surgical treatment was implemented following the 
paradigm, with a flexible design to ease integration into the surgical work flow, using 
non-intrusive technologies to minimize disturbances to surgeons during procedures.  
As tracking presents even greater challenges due to pneumoperitoneum 
phenomena, and the use of markers and optical or electromagnetic systems to track 
deformations is not a feasible solution in many cases, automatic video processing 
provides information regarding position of instruments, organs, trocars and endoscope, 
surgical maneuvers, distances and 3D reconstructions of the surgical scene offering 
new information to surgeons when performing interventions.  
3. Conclusions 
Laparoscopic video, an ever-present resource in minimally invasive surgical 
techniques, may be further exploited to overcome some of the limitations of this type of 
surgery. Its analysis can be a powerful tool for surgeons. The use of endoscopic video 
images has several benefits: it is an always available information source that can be 
used without increasing surgeons’ workload does not add extra technology components 
in the OR. Several examples have been shown both for developing new training 
environments and for creating new navigation systems with intraoperative aids to the 
surgeons. 
References 
[1] P. Sánchez-González, A.M. Cano, I. Oropesa, F.M. Sánchez-Margallo, F. Del Pozo, P. Lamata, E.J. 
Gómez, Laparoscopic video analysis for training and image-guided surgery, Minimally Invasive 
Therapy & Allied Technologies 20(6) (2011), 311-20. 
[2] J.C. Rosser, M. Murayama, N.H. Gabriel, Minimally invasive surgical training solutions for the twenty-
first century, Surgical Clinics of North America 80(5) (2000), 1607-1624 
[3] G.M. Fried, L.S. Feldman, Objective assessment of technical performance, World Journal of Surgery 
32(2008),156–160 
[4] P. Sánchez-González, D. Burgos, I. Oropesa, V. Romero, A. Albacete, L. F. Sánchez-Peralta, J. Noguera, 
F. M. Sánchez-Margallo, E.J. Gómez, TELMA: Technology enhanced learning environment for 
minimally invasive surgery, Journal of Surgical Research (2012), [Epub ahead of print] 
[5] I. Oropesa, P. Sanchez-Gonzalez, M.K. Chmarra, A. Fernández, J.A. Sánchez-Margallo, F.W. Jansen, J. 
Dankelman, F.M. Sánchez-Margallo, E.J. Gómez. EVA – Laparoscopic Instrument Tracking Based On 
Endoscopic Video Analysis For Psychomotor Skills Assessment, Surgical Endoscopy, 27 (2013) 1029-
1039. 
[6] P. Sánchez-González, I. Oropesa, M. Doblaré, I. Morales, F. M. Sánchez-Margallo, E.J. Gómez, 
THEMIS: A new video and image guided navigation system, 24th International Conference of the 
Society for Medical Innovation and Technology, (2012) 


Minimally Invasive Surgical Video 
Analysis: a powerful tool for Surgical 
Training and Navigation  
P. Sánchez-González 
a,b,1
, I. Oropesa
a,b
, E.J. Gómez
 a,b
 
a
 Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, 
Universidad Politécnica de Madrid, Spain 
b
 Biomedical Research Networking center in Bioengineering, Biomaterials and 
Nanomedicine, Spain 
Abstract. Analysis of minimally invasive surgical videos is a powerful tool to 
drive new solutions for achieving reproducible training programs, objective and 
transparent assessment systems and navigation tools to assist surgeons and 
improve patient safety. This paper presents how video analysis contributes to the 
development of new cognitive and motor training and assessment programs as well 
as new paradigms for image-guided surgery. 
Keywords. Minimally invasive surgery, video analysis, training, navigation 
Introduction 
Automatic analysis of minimally invasive surgery (MIS) videos captured by the 
endoscope has the potential to drive new solutions for safer surgeries. Reproducible 
training programs, objective and transparent assessment systems and navigation tools 
to assist surgeons and improve patient safety can be developed by means of the 
analysis of video sequences [1]. Surgical video sequences provide useful information 
about the position of instruments and organs, surgical maneuvers, measurements of 
distances or even an approximate 3D reconstruction of the surgical scene. Endoscopic 
video images are an always available source of information and can be used without 
adding extra technological components in the operating room (OR). 
Cognitive and motor training can benefit from the use of video images captured by 
the endoscope since they can be useful multimedia didactic resources [2]. Early 
familiarization with the view present in the operating rooms can shorten learning 
curves of trainees. Existing video repositories appear bound to web technologies for 
cognitive on-line training, enabling anytime-anywhere education. 
Endoscopic video analysis can also be useful for assessment of surgeon’s skills. 
Motion analysis of the laparoscopic instruments’ movements has been proven to be a 
relevant source of information on psychomotor performance [3]. Video-based tracking 
can offer an alternative to sensor-based systems to this end, which are usually bulky 
and may modify the instruments’ ergonomics. 
                                                          
1
 Biomedical Engineering and Telemedicine Centre. Avda. Complutense, 30. 28040. Madrid. Spain. 
   psanchez@gbt.tfo.upm.es 
Finally, video information can help surgeons during procedures providing surgical 
guidance, strongly relying in the information conveyed by the endoscope to track all 
elements (instruments, laparoscope, trocars and anatomic structures) in the surgical 
scene. In this research we compile our advances using video analysis for training and 
navigation fields. 
1. Surgical training 
The paradigm change from traditional surgery to minimally invasive procedures has 
brought forth a necessary change in education programs for new surgeons: because of 
the reduced time available for education, training based on mentor-apprentice 
relationship is no longer sufficiently efficient.  
In order to deal with cognitive training, a learning platform based on Technology 
Enhanced Learning for achieving a personalized learning experience while using 
pedagogically inspired solutions was implemented [4]. This platform is envisaged as a 
new cognitive learning concept to create, share and reuse scalable didactic content and 
to adapt content to learners’ individual needs according to pedagogical models. The 
proposed environment has a four-pillared architecture: (1) an authoring tool that allows 
the creation of video-based, structured, enhanced, didactic contents; (2) a learning 
content and knowledge management system that provides adaptive learning to users 
based on their progress and behaviors in the training platform as well as a modular and 
scalable system to capture, catalogue, search and retrieve multimedia content; (3) an 
evaluation module that provides both formative and summative feedback to the trainee; 
and (4) a professional network for collaborative learning. 
In this environment creation is not simply understood as a matter of digitalizing 
traditional materials; it also involves new approaches to constitute a well-designed 
surgical educational process. The environment incorporates a multimedia didactic 
authoring tool that offers the creation of formal learning content, the efficient use of 
surgical videos with enriched didactic value and the addition of multimedia objects to 
enhance surgical explanations.  
Moreover, a video-based method for tracking laparoscopic instruments, named 
EVA Tracking System, was implemented in order to deal with motor training [5]. The 
system exploits 2D information of the instruments on the screen and detects the 
instruments’ borders and tips. Analysis of geometrical properties of the instrument 
allows obtaining the 3D depth component.  
The first prototype was validated with offline recordings of a MIS assessment task 
in a box trainer environment. Several motion-related measurements were obtained for 
each participant, and statistical analysis on performance was carried out. The study 
reflected construct validation when comparing performance of students, residents and 
experts; and concurrent validation when comparing measurements with an optical-
based sensor system. 
2. Surgical navigation system 
Planning and navigation systems arise to aid surgeons during procedures. Navigation 
systems allow to transfer preoperative data, images and decisions from the planner 
directly into the OR, giving surgeons guidance during the procedure. Difficulties arise 
in soft-tissue surgeries where the lack of rigid landmarks makes harder to correlate 
intraoperative and preoperative data, due to anatomical alterations caused by organ-
shifting, tissue deformations, patient movement and surgeon’s manipulation. 
Analysis of minimally invasive surgical videos allows the creation of a new image 
and video guided surgery paradigm for soft-tissue navigation based on the intelligent 
exploitation of the information provided by the endoscopic video [6]. Three main 
motivations lie behind it: (1) enabling surgical guidance without modifications of the 
surgical workflow; (2) tracking surgical objects (instruments, anatomic structures and 
endoscope) without alterations of their ergonomic properties and (3) avoiding 
cluttering of equipment in the already overloaded space in the OR. A surgical 
navigation prototype for liver surgical treatment was implemented following the 
paradigm, with a flexible design to ease integration into the surgical work flow, using 
non-intrusive technologies to minimize disturbances to surgeons during procedures.  
As tracking presents even greater challenges due to pneumoperitoneum 
phenomena, and the use of markers and optical or electromagnetic systems to track 
deformations is not a feasible solution in many cases, automatic video processing 
provides information regarding position of instruments, organs, trocars and endoscope, 
surgical maneuvers, distances and 3D reconstructions of the surgical scene offering 
new information to surgeons when performing interventions.  
3. Conclusions 
Laparoscopic video, an ever-present resource in minimally invasive surgical 
techniques, may be further exploited to overcome some of the limitations of this type of 
surgery. Its analysis can be a powerful tool for surgeons. The use of endoscopic video 
images has several benefits: it is an always available information source that can be 
used without increasing surgeons’ workload does not add extra technology components 
in the OR. Several examples have been shown both for developing new training 
environments and for creating new navigation systems with intraoperative aids to the 
surgeons. 
References 
[1] P. Sánchez-González, A.M. Cano, I. Oropesa, F.M. Sánchez-Margallo, F. Del Pozo, P. Lamata, E.J. 
Gómez, Laparoscopic video analysis for training and image-guided surgery, Minimally Invasive 
Therapy & Allied Technologies 20(6) (2011), 311-20. 
[2] J.C. Rosser, M. Murayama, N.H. Gabriel, Minimally invasive surgical training solutions for the twenty-
first century, Surgical Clinics of North America 80(5) (2000), 1607-1624 
[3] G.M. Fried, L.S. Feldman, Objective assessment of technical performance, World Journal of Surgery 
32(2008),156–160 
[4] P. Sánchez-González, D. Burgos, I. Oropesa, V. Romero, A. Albacete, L. F. Sánchez-Peralta, J. Noguera, 
F. M. Sánchez-Margallo, E.J. Gómez, TELMA: Technology enhanced learning environment for 
minimally invasive surgery, Journal of Surgical Research (2012), [Epub ahead of print] 
[5] I. Oropesa, P. Sanchez-Gonzalez, M.K. Chmarra, A. Fernández, J.A. Sánchez-Margallo, F.W. Jansen, J. 
Dankelman, F.M. Sánchez-Margallo, E.J. Gómez. EVA – Laparoscopic Instrument Tracking Based On 
Endoscopic Video Analysis For Psychomotor Skills Assessment, Surgical Endoscopy, 27 (2013) 1029-
1039. 
[6] P. Sánchez-González, I. Oropesa, M. Doblaré, I. Morales, F. M. Sánchez-Margallo, E.J. Gómez, 
THEMIS: A new video and image guided navigation system, 24th International Conference of the 
Society for Medical Innovation and Technology, (2012) 


Minimally invasive surgical video analysis: a powerful tool for surgical training and navigation

Abstract

Similar works

Full text

Available Versions

Archivo Digital UPM

Servicio de Coordinación de Bibliotecas de la Universidad Politécnica de Madrid

Servicio de Coordinación de Bibliotecas de la Universidad Politécnica de Madrid

Archivo Digital UPM