OSS: Open Suturing Skills Vision-Based Assessment Challenge 2024-2025

Achieving high levels of surgical skill through effective training is essential for optimal patient outcomes. Automated, data-driven skill assessment holds significant potential to improve surgical training. While machine learning-based methods are increasingly popular for assessing skills in minimally invasive surgery, their application to open surgery remains limited. We present the results of a dedicated MICCAI challenge designed to benchmark and advance vision-based skill assessment in open surgery. The challenge dataset comprises videos of an open suturing training task recorded with a static GoPro camera in a dry-lab setting, with instrument trajectories available in addition to the primary video modality. The OSS Challenge was hosted over two consecutive years, comprising two and three independent tasks, respectively: (1) classifying skill level into four classes, (2) predicting the full Objective Structured Assessment of Technical Skills across eight categories, and (3) tracking hands and surgical tools. Participants submitted diverse solutions including deep learning-based video models, tracking-driven methods, and hybrid approaches. General-purpose spatiotemporal video models consistently achieved the strongest performance, though conceptually diverse approaches reached competitive levels when well-executed. Predicting fine-grained OSATS scores remains challenging but benefits substantially from increased training data. Keypoint tracking proves difficult given frequent occlusions and out-of-frame instances, limiting current applicability for motion-based skill analysis. This work benchmarks innovative and diverse solutions for surgical skill assessment, highlighting both the promise and current limitations of video-based evaluation in open surgery and identifying critical directions for advancing automated skill assessment toward clinical impact.

HyKey: Hyperspectral Keypoint Detection and Matching in Minimally Invasive Surgery

Purpose: 3D reconstruction in minimally invasive surgery (MIS) enables enhanced surgical guidance through improved visualisation, tool tracking, and augmented reality. However, traditional RGB-based keypoint detection and matching pipelines struggle with surgical challenges, such as poor texture and complex illumination. We investigate whether using snapshot hyperspectral imaging (HSI) can provide improved results on keypoint detection and matching surgical scenes. Methods: We developed HyKey, a HYperspectral KEYpoint detection and description model made up of a hybrid 3D-2D convolutional neural network that jointly extracts spatial-spectral features from HSI. The model was trained using synthetic homographic augmentation and epipolar geometry constraints on a robotically-acquired dual-camera RGB-HSI laparoscopic dataset of ex-vivo organs with calibrated camera poses. We benchmarked performance against established RGB-based methods, including SuperPoint and ALIKE. Results: Our HSI-based model outperformed RGB baselines on registered RGB frames, achieving 96.62% mean matching accuracy and 67.18% mean average accuracy at 10 degree on pose estimation, demonstrating consistent improvements across multiple evaluation metrics. Conclusion: Integrating spectral information from an HSI cube offers a promising approach for robust monocular 3D reconstruction in MIS, addressing limitations of texture-poor surgical environments through enhanced spectral-spatial feature discrimination. Our model and dataset are available at https://github.com/alexsaikia/HyKey-Hyperspectral-Keypoint-Detection

Warm-Started Reinforcement Learning for Iterative 3D/2D Liver Registration

Registration between preoperative CT and intraoperative laparoscopic video plays a crucial role in augmented reality (AR) guidance for minimally invasive surgery. Learning-based methods have recently achieved registration errors comparable to optimization-based approaches while offering faster inference. However, many supervised methods produce coarse alignments that rely on additional optimization-based refinement, thereby increasing inference time. We present a discrete-action reinforcement learning (RL) framework that formulates CT-to-video registration as a sequential decision-making process. A shared feature encoder, warm-started from a supervised pose estimation network to provide stable geometric features and faster convergence, extracts representations from CT renderings and laparoscopic frames, while an RL policy head learns to choose rigid transformations along six degrees of freedom and to decide when to stop the iteration. Experiments on a public laparoscopic dataset demonstrated that our method achieved an average target registration error (TRE) of 15.70 mm, comparable to supervised approaches with optimization, while achieving faster convergence. The proposed RL-based formulation enables automated, efficient iterative registration without manually tuned step sizes or stopping criteria. This discrete framework provides a practical foundation for future continuous-action and deformable registration models in surgical AR applications.

CoRe-DA: Contrastive Regression for Unsupervised Domain Adaptation in Surgical Skill Assessment

Vision-based surgical skill assessment (SSA) enables objective and scalable evaluation of operative performance. Progress in this field is constrained by the high cost and time demands for manual annotation of quantitative skill scores, as well as the poor generalization of existing regression models to new surgical tasks and environments. Meanwhile, appreciable volumes of unlabeled video data are now available, motivating the development of unsupervised domain adaptation (UDA) methods for SSA. We introduce the first benchmark for UDA in SSA regression, spanning four datasets across dry-lab and clinical settings as well as open and robotic surgery. We evaluate eight representative models under challenging domain shifts and propose CoRe-DA, a novel contrastive regression-based adaptation framework. Our method learns domain-invariant representations through relative-score supervision and target-domain self-training. Comprehensive experiments across two UDA settings show that CoRe-DA is superior to state-of-the-art methods, achieving Spearman Correlation Coefficients of 0.46 and 0.41 on dry-lab and clinical target datasets, respectively, without using any labeled target data for training. Overall, CoRe-DA enables scalable SSA with reliable cross-domain generalization, where existing methods underperform. Our code and datasets will be released at https://github.com/anastadimi/CoRe-DA.

Design, Modelling and Characterisation of a Miniature Fibre-Reinforced Soft Bending Actuator for Endoluminal Interventions

Miniaturised soft pneumatic actuators are crucial for robotic intervention within highly constrained anatomical pathways. This work presents the design and validation of a fibre-reinforced soft actuator at the centimetre scale for inte- gration into an endoluminal robotic platform for natural-orifice interventional and diagnostic applications. A single-chamber geometry reinforced with embedded Kevlar fibre was de- signed to maximise curvature while preserving sealing integrity, fabricated using a multi-stage multi-stiffness silicone casting process, and validated against a high-fidelity Abaqus FEM using experimentally parametrised hyperelastic material models and embedded beam reinforcement. The semi-cylindrical actuator has an outer diameter of 18,mm and a length of 37.5,mm. Single and double helix winding configurations, fibre pitch, and fibre density were investigated. The optimal 100 SH configuration achieved a bending angle of 202.9° experimentally and 297.6° in simulation, with structural robustness maintained up to 100,kPa and radial expansion effectively constrained by the fibre reinforcement. Workspace evaluation confirmed suitability for integration into the target device envelope, demonstrating that fibre-reinforcement strategies can be effectively translated to the centimetre regime while retaining actuator performance.

TemporalDoRA: Temporal PEFT for Robust Surgical Video Question Answering

Surgical Video Question Answering (VideoQA) requires accurate temporal grounding while remaining robust to natural variation in how clinicians phrase questions, where linguistic bias can arise. Standard Parameter Efficient Fine Tuning (PEFT) methods adapt pretrained projections without explicitly modeling frame-to-frame interactions within the adaptation pathway, limiting their ability to exploit sparse temporal evidence. We introduce TemporalDoRA, a video-specific PEFT formulation that extends Weight-Decomposed Low-Rank Adaptation by (i) inserting lightweight temporal Multi-Head Attention (MHA) inside the low-rank bottleneck of the vision encoder and (ii) selectively applying weight decomposition only to the trainable low-rank branch rather than the full adapted weight. This design enables temporally-aware updates while preserving a frozen backbone and stable scaling. By mixing information across frames within the adaptation subspace, TemporalDoRA steers updates toward temporally consistent visual cues and improves robustness with minimal parameter overhead. To benchmark this setting, we present REAL-Colon-VQA, a colonoscopy VideoQA dataset with 6,424 clip--question pairs, including paired rephrased Out-of-Template questions to evaluate sensitivity to linguistic variation. TemporalDoRA improves Out-of-Template performance, and ablation studies confirm that temporal mixing inside the low-rank branch is the primary driver of these gains. We also validate on EndoVis18-VQA adapted to short clips and observe consistent improvements on the Out-of-Template split. Code and dataset available at~\href{https://anonymous.4open.science/r/TemporalDoRA-BFC8/}{Anonymous GitHub}.

Training-free Temporal Object Tracking in Surgical Videos

Purpose: In this paper, we present a novel approach for online object tracking in laparoscopic cholecystectomy (LC) surgical videos, targeting localisation and tracking of critical anatomical structures and instruments. Our method addresses the challenges of costly pixel-level annotations and label inconsistencies inherent in existing datasets. Methods: Leveraging the inherent object localisation capabilities of pre-trained text-to-image diffusion models, we extract representative features from surgical frames without any training or fine-tuning. Our tracking framework uses these features, along with cross-frame interactions via an affinity matrix inspired by query-key-value attention, to ensure temporal continuity in the tracking process. Results: Through a pilot study, we first demonstrate that diffusion features exhibit superior object localisation and consistent semantics across different decoder levels and temporal frames. Later, we perform extensive experiments to validate the effectiveness of our approach, showcasing its superiority over competitors for the task of temporal object tracking. Specifically, we achieve a per-pixel classification accuracy of 79.19%, mean Jaccard Score of 56.20%, and mean F-Score of 79.48% on the publicly available CholeSeg8K dataset. Conclusion: Our work not only introduces a novel application of text-to-image diffusion models but also contributes to advancing the field of surgical video analysis, offering a promising avenue for accurate and cost-effective temporal object tracking in minimally invasive surgery videos.

Confidence-aware Monocular Depth Estimation for Minimally Invasive Surgery

Purpose: Monocular depth estimation (MDE) is vital for scene understanding in minimally invasive surgery (MIS). However, endoscopic video sequences are often contaminated by smoke, specular reflections, blur, and occlusions, limiting the accuracy of MDE models. In addition, current MDE models do not output depth confidence, which could be a valuable tool for improving their clinical reliability. Methods: We propose a novel confidence-aware MDE framework featuring three significant contributions: (i) Calibrated confidence targets: an ensemble of fine-tuned stereo matching models is used to capture disparity variance into pixel-wise confidence probabilities; (ii) Confidence-aware loss: Baseline MDE models are optimized with confidence-aware loss functions, utilizing pixel-wise confidence probabilities such that reliable pixels dominate training; and (iii) Inference-time confidence: a confidence estimation head is proposed with two convolution layers to predict per-pixel confidence at inference, enabling assessment of depth reliability. Results: Comprehensive experimental validation across internal and public datasets demonstrates that our framework improves depth estimation accuracy and can robustly quantify the prediction's confidence. On the internal clinical endoscopic dataset (StereoKP), we improve dense depth estimation accuracy by ~8% as compared to the baseline model. Conclusion: Our confidence-aware framework enables improved accuracy of MDE models in MIS, addressing challenges posed by noise and artifacts in pre-clinical and clinical data, and allows MDE models to provide confidence maps that may be used to improve their reliability for clinical applications.

FoundationPose-Initialized 3D-2D Liver Registration for Surgical Augmented Reality

Augmented reality can improve tumor localization in laparoscopic liver surgery. Existing registration pipelines typically depend on organ contours; deformable (non-rigid) alignment is often handled with finite-element (FE) models coupled to dimensionality-reduction or machine-learning components. We integrate laparoscopic depth maps with a foundation pose estimator for camera-liver pose estimation and replace FE-based deformation with non-rigid iterative closest point (NICP) to lower engineering/modeling complexity and expertise requirements. On real patient data, the depth-augmented foundation pose approach achieved 9.91 mm mean registration error in 3 cases. Combined rigid-NICP registration outperformed rigid-only registration, demonstrating NICP as an efficient substitute for finite-element deformable models. This pipeline achieves clinically relevant accuracy while offering a lightweight, engineering-friendly alternative to FE-based deformation.

A multi-centre, multi-device benchmark dataset for landmark-based comprehensive fetal biometry

Accurate fetal growth assessment from ultrasound (US) relies on precise biometry measured by manually identifying anatomical landmarks in standard planes. Manual landmarking is time-consuming, operator-dependent, and sensitive to variability across scanners and sites, limiting the reproducibility of automated approaches. There is a need for multi-source annotated datasets to develop artificial intelligence-assisted fetal growth assessment methods. To address this bottleneck, we present an open, multi-centre, multi-device benchmark dataset of fetal US images with expert anatomical landmark annotations for clinically used fetal biometric measurements. These measurements include head bi-parietal and occipito-frontal diameters, abdominal transverse and antero-posterior diameters, and femoral length. The dataset comprises 4,513 de-identified US images from 1,904 subjects acquired at three clinical sites using seven different US devices. We provide standardised, subject-disjoint train/test splits, evaluation code, and baseline results to enable fair and reproducible comparison of methods. Using an automatic biometry model, we quantify domain shift and demonstrate that training and evaluation confined to a single centre substantially overestimate performance relative to multi-centre testing. To the best of our knowledge, this is the first publicly available multi-centre, multi-device, landmark-annotated dataset that covers all primary fetal biometry measures, providing a robust benchmark for domain adaptation and multi-centre generalisation in fetal biometry and enabling more reliable AI-assisted fetal growth assessment across centres. All data, annotations, training code, and evaluation pipelines are made publicly available.