Generalized Recognition of Basic Surgical Actions Enables Skill Assessment and Vision-Language-Model-based Surgical Planning

Artificial intelligence, imaging, and large language models have the potential to transform surgical practice, training, and automation. Understanding and modeling of basic surgical actions (BSA), the fundamental unit of operation in any surgery, is important to drive the evolution of this field. In this paper, we present a BSA dataset comprising 10 basic actions across 6 surgical specialties with over 11,000 video clips, which is the largest to date. Based on the BSA dataset, we developed a new foundation model that conducts general-purpose recognition of basic actions. Our approach demonstrates robust cross-specialist performance in experiments validated on datasets from different procedural types and various body parts. Furthermore, we demonstrate downstream applications enabled by the BAS foundation model through surgical skill assessment in prostatectomy using domain-specific knowledge, and action planning in cholecystectomy and nephrectomy using large vision-language models. Multinational surgeons' evaluation of the language model's output of the action planning explainable texts demonstrated clinical relevance. These findings indicate that basic surgical actions can be robustly recognized across scenarios, and an accurate BSA understanding model can essentially facilitate complex applications and speed up the realization of surgical superintelligence.

HoloPOCUS: Portable Mixed-Reality 3D Ultrasound Tracking, Reconstruction and Overlay

Ultrasound (US) imaging provides a safe and accessible solution to procedural guidance and diagnostic imaging. The effective usage of conventional 2D US for interventional guidance requires extensive experience to project the image plane onto the patient, and the interpretation of images in diagnostics suffers from high intra- and inter-user variability. 3D US reconstruction allows for more consistent diagnosis and interpretation, but existing solutions are limited in terms of equipment and applicability in real-time navigation. To address these issues, we propose HoloPOCUS - a mixed reality US system (MR-US) that overlays rich US information onto the user's vision in a point-of-care setting. HoloPOCUS extends existing MR-US methods beyond placing a US plane in the user's vision to include a 3D reconstruction and projection that can aid in procedural guidance using conventional probes. We validated a tracking pipeline that demonstrates higher accuracy compared to existing MR-US works. Furthermore, user studies conducted via a phantom task showed significant improvements in navigation duration when using our proposed methods.