Federated Learning for Surgical Vision in Appendicitis Classification: Results of the FedSurg EndoVis 2024 Challenge

Purpose: The FedSurg challenge was designed to benchmark the state of the art in federated learning for surgical video classification. Its goal was to assess how well current methods generalize to unseen clinical centers and adapt through local fine-tuning while enabling collaborative model development without sharing patient data. Methods: Participants developed strategies to classify inflammation stages in appendicitis using a preliminary version of the multi-center Appendix300 video dataset. The challenge evaluated two tasks: generalization to an unseen center and center-specific adaptation after fine-tuning. Submitted approaches included foundation models with linear probing, metric learning with triplet loss, and various FL aggregation schemes (FedAvg, FedMedian, FedSAM). Performance was assessed using F1-score and Expected Cost, with ranking robustness evaluated via bootstrapping and statistical testing. Results: In the generalization task, performance across centers was limited. In the adaptation task, all teams improved after fine-tuning, though ranking stability was low. The ViViT-based submission achieved the strongest overall performance. The challenge highlighted limitations in generalization, sensitivity to class imbalance, and difficulties in hyperparameter tuning in decentralized training, while spatiotemporal modeling and context-aware preprocessing emerged as promising strategies. Conclusion: The FedSurg Challenge establishes the first benchmark for evaluating FL strategies in surgical video classification. Findings highlight the trade-off between local personalization and global robustness, and underscore the importance of architecture choice, preprocessing, and loss design. This benchmarking offers a reference point for future development of imbalance-aware, adaptive, and robust FL methods in clinical surgical AI.

Clinnova Federated Learning Proof of Concept: Key Takeaways from a Cross-border Collaboration

Clinnova, a collaborative initiative involving France, Germany, Switzerland, and Luxembourg, is dedicated to unlocking the power of precision medicine through data federation, standardization, and interoperability. This European Greater Region initiative seeks to create an interoperable European standard using artificial intelligence (AI) and data science to enhance healthcare outcomes and efficiency. Key components include multidisciplinary research centers, a federated biobanking strategy, a digital health innovation platform, and a federated AI strategy. It targets inflammatory bowel disease, rheumatoid diseases, and multiple sclerosis (MS), emphasizing data quality to develop AI algorithms for personalized treatment and translational research. The IHU Strasbourg (Institute of Minimal-invasive Surgery) has the lead in this initiative to develop the federated learning (FL) proof of concept (POC) that will serve as a foundation for advancing AI in healthcare. At its core, Clinnova-MS aims to enhance MS patient care by using FL to develop more accurate models that detect disease progression, guide interventions, and validate digital biomarkers across multiple sites. This technical report presents insights and key takeaways from the first cross-border federated POC on MS segmentation of MRI images within the Clinnova framework. While our work marks a significant milestone in advancing MS segmentation through cross-border collaboration, it also underscores the importance of addressing technical, logistical, and ethical considerations to realize the full potential of FL in healthcare settings.