A Kinematic Bottleneck Approach For Pose Regression of Flexible Surgical Instruments directly from Images

3-D pose estimation of instruments is a crucial step towards automatic scene understanding in robotic minimally invasive surgery. Although robotic systems can potentially directly provide joint values, this information is not commonly exploited inside the operating room, due to its possible unreliability, limited access and the time-consuming calibration required, especially for continuum robots. For this reason, standard approaches for 3-D pose estimation involve the use of external tracking systems. Recently, image-based methods have emerged as promising, non-invasive alternatives. While many image-based approaches in the literature have shown accurate results, they generally require either a complex iterative optimization for each processed image, making them unsuitable for real-time applications, or a large number of manually-annotated images for efficient learning. In this paper we propose a self-supervised image-based method, exploiting, at training time only, the imprecise kinematic information provided by the robot. In order to avoid introducing time-consuming manual annotations, the problem is formulated as an auto-encoder, smartly bottlenecked by the presence of a physical model of the robotic instruments and surgical camera, forcing a separation between image background and kinematic content. Validation of the method was performed on semi-synthetic, phantom and in-vivo datasets, obtained using a flexible robotized endoscope, showing promising results for real-time image-based 3-D pose estimation of surgical instruments.

Multi-Task Temporal Convolutional Networks for Joint Recognition of Surgical Phases and Steps in Gastric Bypass Procedures

Purpose: Automatic segmentation and classification of surgical activity is crucial for providing advanced support in computer-assisted interventions and autonomous functionalities in robot-assisted surgeries. Prior works have focused on recognizing either coarse activities, such as phases, or fine-grained activities, such as gestures. This work aims at jointly recognizing two complementary levels of granularity directly from videos, namely phases and steps. Method: We introduce two correlated surgical activities, phases and steps, for the laparoscopic gastric bypass procedure. We propose a Multi-task Multi-Stage Temporal Convolutional Network (MTMS-TCN) along with a multi-task Convolutional Neural Network (CNN) training setup to jointly predict the phases and steps and benefit from their complementarity to better evaluate the execution of the procedure. We evaluate the proposed method on a large video dataset consisting of 40 surgical procedures (Bypass40). Results: We present experimental results from several baseline models for both phase and step recognition on the Bypass40 dataset. The proposed MTMS-TCN method outperforms in both phase and step recognition by 1-2% in accuracy, precision and recall, compared to single-task methods. Furthermore, for step recognition, MTMS-TCN achieves a superior performance of 3-6% compared to LSTM based models in accuracy, precision, and recall. Conclusion: In this work, we present a multi-task multi-stage temporal convolutional network for surgical activity recognition, which shows improved results compared to single-task models on the Bypass40 gastric bypass dataset with multi-level annotations. The proposed method shows that the joint modeling of phases and steps is beneficial to improve the overall recognition of each type of activity.

Surgical Data Science -- from Concepts to Clinical Translation

Recent developments in data science in general and machine learning in particular have transformed the way experts envision the future of surgery. Surgical data science is a new research field that aims to improve the quality of interventional healthcare through the capture, organization, analysis and modeling of data. While an increasing number of data-driven approaches and clinical applications have been studied in the fields of radiological and clinical data science, translational success stories are still lacking in surgery. In this publication, we shed light on the underlying reasons and provide a roadmap for future advances in the field. Based on an international workshop involving leading researchers in the field of surgical data science, we review current practice, key achievements and initiatives as well as available standards and tools for a number of topics relevant to the field, namely (1) technical infrastructure for data acquisition, storage and access in the presence of regulatory constraints, (2) data annotation and sharing and (3) data analytics. Drawing from this extensive review, we present current challenges for technology development and (4) describe a roadmap for faster clinical translation and exploitation of the full potential of surgical data science.

Encode the Unseen: Predictive Video Hashing for Scalable Mid-Stream Retrieval

This paper tackles a new problem in computer vision: mid-stream video-to-video retrieval. This task, which consists in searching a database for content similar to a video right as it is playing, e.g. from a live stream, exhibits challenging characteristics. Only the beginning part of the video is available as query and new frames are constantly added as the video plays out. To perform retrieval in this demanding situation, we propose an approach based on a binary encoder that is both predictive and incremental in order to (1) account for the missing video content at query time and (2) keep up with repeated, continuously evolving queries throughout the streaming. In particular, we present the first hashing framework that infers the unseen future content of a currently playing video. Experiments on FCVID and ActivityNet demonstrate the feasibility of this task. Our approach also yields a significant mAP@20 performance increase compared to a baseline adapted from the literature for this task, for instance 7.4% (2.6%) increase at 20% (50%) of elapsed runtime on FCVID using bitcodes of size 192 bits.

Artificial Intelligence in Surgery: Neural Networks and Deep Learning

Deep neural networks power most recent successes of artificial intelligence, spanning from self-driving cars to computer aided diagnosis in radiology and pathology. The high-stake data intensive process of surgery could highly benefit from such computational methods. However, surgeons and computer scientists should partner to develop and assess deep learning applications of value to patients and healthcare systems. This chapter and the accompanying hands-on material were designed for surgeons willing to understand the intuitions behind neural networks, become familiar with deep learning concepts and tasks, grasp what implementing a deep learning model in surgery means, and finally appreciate the specific challenges and limitations of deep neural networks in surgery. For the associated hands-on material, please see https://github.com/CAMMA-public/ai4surgery.

Self-supervision on Unlabelled OR Data for Multi-person 2D/3D Human Pose Estimation

2D/3D human pose estimation is needed to develop novel intelligent tools for the operating room that can analyze and support the clinical activities. The lack of annotated data and the complexity of state-of-the-art pose estimation approaches limit, however, the deployment of such techniques inside the OR. In this work, we propose to use knowledge distillation in a teacher/student framework to harness the knowledge present in a large-scale non-annotated dataset and in an accurate but complex multi-stage teacher network to train a lightweight network for joint 2D/3D pose estimation. The teacher network also exploits the unlabeled data to generate both hard and soft labels useful in improving the student predictions. The easily deployable network trained using this effective self-supervision strategy performs on par with the teacher network on \emph{MVOR+}, an extension of the public MVOR dataset where all persons have been fully annotated, thus providing a viable solution for real-time 2D/3D human pose estimation in the OR.

Human Pose Estimation on Privacy-Preserving Low-Resolution Depth Images

Human pose estimation (HPE) is a key building block for developing AI-based context-aware systems inside the operating room (OR). The 24/7 use of images coming from cameras mounted on the OR ceiling can however raise concerns for privacy, even in the case of depth images captured by RGB-D sensors. Being able to solely use low-resolution privacy-preserving images would address these concerns and help scale up the computer-assisted approaches that rely on such data to a larger number of ORs. In this paper, we introduce the problem of HPE on low-resolution depth images and propose an end-to-end solution that integrates a multi-scale super-resolution network with a 2D human pose estimation network. By exploiting intermediate feature-maps generated at different super-resolution, our approach achieves body pose results on low-resolution images (of size 64x48) that are on par with those of an approach trained and tested on full resolution images (of size 640x480).

Recognition of Instrument-Tissue Interactions in Endoscopic Videos via Action Triplets

Recognition of surgical activity is an essential component to develop context-aware decision support for the operating room. In this work, we tackle the recognition of fine-grained activities, modeled as action triplets <instrument, verb, target> representing the tool activity. To this end, we introduce a new laparoscopic dataset, CholecT40, consisting of 40 videos from the public dataset Cholec80 in which all frames have been annotated using 128 triplet classes. Furthermore, we present an approach to recognize these triplets directly from the video data. It relies on a module called Class Activation Guide (CAG), which uses the instrument activation maps to guide the verb and target recognition. To model the recognition of multiple triplets in the same frame, we also propose a trainable 3D Interaction Space, which captures the associations between the triplet components. Finally, we demonstrate the significance of these contributions via several ablation studies and comparisons to baselines on CholecT40.

CAI4CAI: The Rise of Contextual Artificial Intelligence in Computer Assisted Interventions

Data-driven computational approaches have evolved to enable extraction of information from medical images with a reliability, accuracy and speed which is already transforming their interpretation and exploitation in clinical practice. While similar benefits are longed for in the field of interventional imaging, this ambition is challenged by a much higher heterogeneity. Clinical workflows within interventional suites and operating theatres are extremely complex and typically rely on poorly integrated intra-operative devices, sensors, and support infrastructures. Taking stock of some of the most exciting developments in machine learning and artificial intelligence for computer assisted interventions, we highlight the crucial need to take context and human factors into account in order to address these challenges. Contextual artificial intelligence for computer assisted intervention, or CAI4CAI, arises as an emerging opportunity feeding into the broader field of surgical data science. Central challenges being addressed in CAI4CAI include how to integrate the ensemble of prior knowledge and instantaneous sensory information from experts, sensors and actuators; how to create and communicate a faithful and actionable shared representation of the surgery among a mixed human-AI actor team; how to design interventional systems and associated cognitive shared control schemes for online uncertainty-aware collaborative decision making ultimately producing more precise and reliable interventions.