Real-time Surgical Instrument Segmentation in Video Using Point Tracking and Segment Anything

The Segment Anything Model (SAM) is a powerful vision foundation model that is revolutionizing the traditional paradigm of segmentation. Despite this, a reliance on prompting each frame and large computational cost limit its usage in robotically assisted surgery. Applications, such as augmented reality guidance, require little user intervention along with efficient inference to be usable clinically. In this study, we address these limitations by adopting lightweight SAM variants to meet the speed requirement and employing fine-tuning techniques to enhance their generalization in surgical scenes. Recent advancements in Tracking Any Point (TAP) have shown promising results in both accuracy and efficiency, particularly when points are occluded or leave the field of view. Inspired by this progress, we present a novel framework that combines an online point tracker with a lightweight SAM model that is fine-tuned for surgical instrument segmentation. Sparse points within the region of interest are tracked and used to prompt SAM throughout the video sequence, providing temporal consistency. The quantitative results surpass the state-of-the-art semi-supervised video object segmentation method on the EndoVis 2015 dataset, with an over 25 FPS inference speed running on a single GeForce RTX 4060 GPU.

Suturing Tasks Automation Based on Skills Learned From Demonstrations: A Simulation Study

In this work, we develop an open-source surgical simulation environment that includes a realistic model obtained by MRI-scanning a physical phantom, for the purpose of training and evaluating a Learning from Demonstration (LfD) algorithm for autonomous suturing. The LfD algorithm utilizes Dynamic Movement Primitives (DMP) and Locally Weighted Regression (LWR), but focuses on the needle trajectory, rather than the instruments, to obtain better generality with respect to needle grasps. We conduct a user study to collect multiple suturing demonstrations and perform a comprehensive analysis of the ability of the LfD algorithm to generalize from a demonstration at one location in one phantom to different locations in the same phantom and to a different phantom. Our results indicate good generalization, on the order of 91.5%, when learning from more experienced subjects, indicating the need to integrate skill assessment in the future.

Beyond the Manual Touch: Situational-aware Force Control for Increased Safety in Robot-assisted Skullbase Surgery

Purpose - Skullbase surgery demands exceptional precision when removing bone in the lateral skull base. Robotic assistance can alleviate the effect of human sensory-motor limitations. However, the stiffness and inertia of the robot can significantly impact the surgeon's perception and control of the tool-to-tissue interaction forces. Methods - We present a situational-aware, force control technique aimed at regulating interaction forces during robot-assisted skullbase drilling. The contextual interaction information derived from the digital twin environment is used to enhance sensory perception and suppress undesired high forces. Results - To validate our approach, we conducted initial feasibility experiments involving a medical and two engineering students. The experiment focused on further drilling around critical structures following cortical mastoidectomy. The experiment results demonstrate that robotic assistance coupled with our proposed control scheme effectively limited undesired interaction forces when compared to robotic assistance without the proposed force control. Conclusions - The proposed force control techniques show promise in significantly reducing undesired interaction forces during robot-assisted skullbase surgery. These findings contribute to the ongoing efforts to enhance surgical precision and safety in complex procedures involving the lateral skull base.

Integrating 3D Slicer with a Dynamic Simulator for Situational Aware Robotic Interventions

Image-guided robotic interventions represent a transformative frontier in surgery, blending advanced imaging and robotics for improved precision and outcomes. This paper addresses the critical need for integrating open-source platforms to enhance situational awareness in image-guided robotic research. We present an open-source toolset that seamlessly combines a physics-based constraint formulation framework, AMBF, with a state-of-the-art imaging platform application, 3D Slicer. Our toolset facilitates the creation of highly customizable interactive digital twins, that incorporates processing and visualization of medical imaging, robot kinematics, and scene dynamics for real-time robot control. Through a feasibility study, we showcase real-time synchronization of a physical robotic interventional environment in both 3D Slicer and AMBF, highlighting low-latency updates and improved visualization.

Haptic-Assisted Collaborative Robot Framework for Improved Situational Awareness in Skull Base Surgery

Skull base surgery is a demanding field in which surgeons operate in and around the skull while avoiding critical anatomical structures including nerves and vasculature. While image-guided surgical navigation is the prevailing standard, limitation still exists requiring personalized planning and recognizing the irreplaceable role of a skilled surgeon. This paper presents a collaboratively controlled robotic system tailored for assisted drilling in skull base surgery. Our central hypothesis posits that this collaborative system, enriched with haptic assistive modes to enforce virtual fixtures, holds the potential to significantly enhance surgical safety, streamline efficiency, and alleviate the physical demands on the surgeon. The paper describes the intricate system development work required to enable these virtual fixtures through haptic assistive modes. To validate our system's performance and effectiveness, we conducted initial feasibility experiments involving a medical student and two experienced surgeons. The experiment focused on drilling around critical structures following cortical mastoidectomy, utilizing dental stone phantom and cadaveric models. Our experimental results demonstrate that our proposed haptic feedback mechanism enhances the safety of drilling around critical structures compared to systems lacking haptic assistance. With the aid of our system, surgeons were able to safely skeletonize the critical structures without breaching any critical structure even under obstructed view of the surgical site.

Evaluation of a motion measurement system for PET imaging studies

Positron Emission Tomography (PET) enables functional imaging of deep brain structures, but the bulk and weight of current systems preclude their use during many natural human activities, such as locomotion. The proposed long-term solution is to construct a robotic system that can support an imaging system surrounding the subject's head, and then move the system to accommodate natural motion. This requires a system to measure the motion of the head with respect to the imaging ring, for use by both the robotic system and the image reconstruction software. We report here the design and experimental evaluation of a parallel string encoder mechanism for sensing this motion. Our preliminary results indicate that the measurement system may achieve accuracy within 0.5 mm, especially for small motions, with improved accuracy possible through kinematic calibration.

Calibration and evaluation of a motion measurement system for PET imaging studies

Positron Emission Tomography (PET) enables functional imaging of deep brain structures, but the bulk and weight of current systems preclude their use during many natural human activities, such as locomotion. The proposed long-term solution is to construct a robotic system that can support an imaging system surrounding the subject's head, and then move the system to accommodate natural motion. This requires a system to measure the motion of the head with respect to the imaging ring, for use by both the robotic system and the image reconstruction software. We report here the design, calibration, and experimental evaluation of a parallel string encoder mechanism for sensing this motion. Our results indicate that with kinematic calibration, the measurement system can achieve accuracy within 0.5mm, especially for small motions.

Evaluation of a measurement system for PET imaging studies

Positron Emission Tomography (PET) enables functional imaging of deep brain structures, but the bulk and weight of current systems preclude their use during many natural human activities, such as locomotion. The proposed long-term solution is to construct a robotic system that can support an imaging system surrounding the subject's head, and then move the system to accommodate natural motion. This requires a system to measure the motion of the head with respect to the imaging ring, for use by both the robotic system and the image reconstruction software. We report here the design and experimental evaluation of a parallel string encoder mechanism for sensing this motion. Our preliminary results indicate that the measurement system may achieve accuracy within 0.5 mm, especially for small motions, with improved accuracy possible through kinematic calibration.

Method for robotic motion compensation during PET imaging of mobile subjects

Studies of the human brain during natural activities, such as locomotion, would benefit from the ability to image deep brain structures during these activities. While Positron Emission Tomography (PET) can image these structures, the bulk and weight of current scanners are not compatible with the desire for a wearable device. This has motivated the design of a robotic system to support a PET imaging system around the subject's head and to move the system to accommodate natural motion. We report here the design and experimental evaluation of a prototype robotic system that senses motion of a subject's head, using parallel string encoders connected between the robot-supported imaging ring and a helmet worn by the subject. This measurement is used to robotically move the imaging ring (coarse motion correction) and to compensate for residual motion during image reconstruction (fine motion correction). Minimization of latency and measurement error are the key design goals, respectively, for coarse and fine motion correction. The system is evaluated using recorded human head motions during locomotion, with a mock imaging system consisting of lasers and cameras, and is shown to provide an overall system latency of about 80 ms, which is sufficient for coarse motion correction and collision avoidance, as well as a measurement accuracy of about 0.5 mm for fine motion correction.

Improving Surgical Situational Awareness with Signed Distance Field: A Pilot Study in Virtual Reality

The introduction of image-guided surgical navigation (IGSN) has greatly benefited technically demanding surgical procedures by providing real-time support and guidance to the surgeon during surgery. To develop effective IGSN, a careful selection of the information provided to the surgeon is needed. However, identifying optimal feedback modalities is challenging due to the broad array of available options. To address this problem, we have developed an open-source library that facilitates the development of multimodal navigation systems in a wide range of surgical procedures relying on medical imaging data. To provide guidance, our system calculates the minimum distance between the surgical instrument and the anatomy and then presents this information to the user through different mechanisms. The real-time performance of our approach is achieved by calculating Signed Distance Fields at initialization from segmented anatomical volumes. Using this framework, we developed a multimodal surgical navigation system to help surgeons navigate anatomical variability in a skull-base surgery simulation environment. Three different feedback modalities were explored: visual, auditory, and haptic. To evaluate the proposed system, a pilot user study was conducted in which four clinicians performed mastoidectomy procedures with and without guidance. Each condition was assessed using objective performance and subjective workload metrics. This pilot user study showed improvements in procedural safety without additional time or workload. These results demonstrate our pipeline's successful use case in the context of mastoidectomy.