Learning from Single Timestamps: Complexity Estimation in Laparoscopic Cholecystectomy

Purpose: Accurate assessment of surgical complexity is essential in Laparoscopic Cholecystectomy (LC), where severe inflammation is associated with longer operative times and increased risk of postoperative complications. The Parkland Grading Scale (PGS) provides a clinically validated framework for stratifying inflammation severity; however, its automation in surgical videos remains largely unexplored, particularly in realistic scenarios where complete videos must be analyzed without prior manual curation. Methods: In this work, we introduce STC-Net, a novel framework for SingleTimestamp-based Complexity estimation in LC via the PGS, designed to operate under weak temporal supervision. Unlike prior methods limited to static images or manually trimmed clips, STC-Net operates directly on full videos. It jointly performs temporal localization and grading through a localization, window proposal, and grading module. We introduce a novel loss formulation combining hard and soft localization objectives and background-aware grading supervision. Results: Evaluated on a private dataset of 1,859 LC videos, STC-Net achieves an accuracy of 62.11% and an F1-score of 61.42%, outperforming non-localized baselines by over 10% in both metrics and highlighting the effectiveness of weak supervision for surgical complexity assessment. Conclusion: STC-Net demonstrates a scalable and effective approach for automated PGS-based surgical complexity estimation from full LC videos, making it promising for post-operative analysis and surgical training.

Exploring Pre-training Across Domains for Few-Shot Surgical Skill Assessment

Automated surgical skill assessment (SSA) is a central task in surgical computer vision. Developing robust SSA models is challenging due to the scarcity of skill annotations, which are time-consuming to produce and require expert consensus. Few-shot learning (FSL) offers a scalable alternative enabling model development with minimal supervision, though its success critically depends on effective pre-training. While widely studied for several surgical downstream tasks, pre-training has remained largely unexplored in SSA. In this work, we formulate SSA as a few-shot task and investigate how self-supervised pre-training strategies affect downstream few-shot SSA performance. We annotate a publicly available robotic surgery dataset with Objective Structured Assessment of Technical Skill (OSATS) scores, and evaluate various pre-training sources across three few-shot settings. We quantify domain similarity and analyze how domain gap and the inclusion of procedure-specific data into pre-training influence transferability. Our results show that small but domain-relevant datasets can outperform large scale, less aligned ones, achieving accuracies of 60.16%, 66.03%, and 73.65% in the 1-, 2-, and 5-shot settings, respectively. Moreover, incorporating procedure-specific data into pre-training with a domain-relevant external dataset significantly boosts downstream performance, with an average gain of +1.22% in accuracy and +2.28% in F1-score; however, applying the same strategy with less similar but large-scale sources can instead lead to performance degradation. Code and models are available at https://github.com/anastadimi/ssa-fsl.