Multi-Modal Gesture Recognition from Video and Surgical Tool Pose Information via Motion Invariants

Recognizing surgical gestures in real-time is a stepping stone towards automated activity recognition, skill assessment, intra-operative assistance, and eventually surgical automation. The current robotic surgical systems provide us with rich multi-modal data such as video and kinematics. While some recent works in multi-modal neural networks learn the relationships between vision and kinematics data, current approaches treat kinematics information as independent signals, with no underlying relation between tool-tip poses. However, instrument poses are geometrically related, and the underlying geometry can aid neural networks in learning gesture representation. Therefore, we propose combining motion invariant measures (curvature and torsion) with vision and kinematics data using a relational graph network to capture the underlying relations between different data streams. We show that gesture recognition improves when combining invariant signals with tool position, achieving 90.3\% frame-wise accuracy on the JIGSAWS suturing dataset. Our results show that motion invariant signals coupled with position are better representations of gesture motion compared to traditional position and quaternion representations. Our results highlight the need for geometric-aware modeling of kinematics for gesture recognition.

Zero-shot Prompt-based Video Encoder for Surgical Gesture Recognition

Purpose: Surgical video is an important data stream for gesture recognition. Thus, robust visual encoders for those data-streams is similarly important. Methods: Leveraging the Bridge-Prompt framework, we fine-tune a pre-trained vision-text model (CLIP) for gesture recognition in surgical videos. This can utilize extensive outside video data such as text, but also make use of label meta-data and weakly supervised contrastive losses. Results: Our experiments show that prompt-based video encoder outperforms standard encoders in surgical gesture recognition tasks. Notably, it displays strong performance in zero-shot scenarios, where gestures/tasks that were not provided during the encoder training phase are included in the prediction phase. Additionally, we measure the benefit of inclusion text descriptions in the feature extractor training schema. Conclusion: Bridge-Prompt and similar pre-trained+fine-tuned video encoder models present significant visual representation for surgical robotics, especially in gesture recognition tasks. Given the diverse range of surgical tasks (gestures), the ability of these models to zero-shot transfer without the need for any task (gesture) specific retraining makes them invaluable.

Multimodal Transformers for Real-Time Surgical Activity Prediction

Real-time recognition and prediction of surgical activities are fundamental to advancing safety and autonomy in robot-assisted surgery. This paper presents a multimodal transformer architecture for real-time recognition and prediction of surgical gestures and trajectories based on short segments of kinematic and video data. We conduct an ablation study to evaluate the impact of fusing different input modalities and their representations on gesture recognition and prediction performance. We perform an end-to-end assessment of the proposed architecture using the JHU-ISI Gesture and Skill Assessment Working Set (JIGSAWS) dataset. Our model outperforms the state-of-the-art (SOTA) with 89.5\% accuracy for gesture prediction through effective fusion of kinematic features with spatial and contextual video features. It achieves the real-time performance of 1.1-1.3ms for processing a 1-second input window by relying on a computationally efficient model.

Hierarchical Semi-Supervised Learning Framework for Surgical Gesture Segmentation and Recognition Based on Multi-Modality Data

Segmenting and recognizing surgical operation trajectories into distinct, meaningful gestures is a critical preliminary step in surgical workflow analysis for robot-assisted surgery. This step is necessary for facilitating learning from demonstrations for autonomous robotic surgery, evaluating surgical skills, and so on. In this work, we develop a hierarchical semi-supervised learning framework for surgical gesture segmentation using multi-modality data (i.e. kinematics and vision data). More specifically, surgical tasks are initially segmented based on distance characteristics-based profiles and variance characteristics-based profiles constructed using kinematics data. Subsequently, a Transformer-based network with a pre-trained `ResNet-18' backbone is used to extract visual features from the surgical operation videos. By combining the potential segmentation points obtained from both modalities, we can determine the final segmentation points. Furthermore, gesture recognition can be implemented based on supervised learning. The proposed approach has been evaluated using data from the publicly available JIGSAWS database, including Suturing, Needle Passing, and Knot Tying tasks. The results reveal an average F1 score of 0.623 for segmentation and an accuracy of 0.856 for recognition.

Evaluating the Task Generalization of Temporal Convolutional Networks for Surgical Gesture and Motion Recognition using Kinematic Data

Fine-grained activity recognition enables explainable analysis of procedures for skill assessment, autonomy, and error detection in robot-assisted surgery. However, existing recognition models suffer from the limited availability of annotated datasets with both kinematic and video data and an inability to generalize to unseen subjects and tasks. Kinematic data from the surgical robot is particularly critical for safety monitoring and autonomy, as it is unaffected by common camera issues such as occlusions and lens contamination. We leverage an aggregated dataset of six dry-lab surgical tasks from a total of 28 subjects to train activity recognition models at the gesture and motion primitive (MP) levels and for separate robotic arms using only kinematic data. The models are evaluated using the LOUO (Leave-One-User-Out) and our proposed LOTO (Leave-One-Task-Out) cross validation methods to assess their ability to generalize to unseen users and tasks respectively. Gesture recognition models achieve higher accuracies and edit scores than MP recognition models. But, using MPs enables the training of models that can generalize better to unseen tasks. Also, higher MP recognition accuracy can be achieved by training separate models for the left and right robot arms. For task-generalization, MP recognition models perform best if trained on similar tasks and/or tasks from the same dataset.

Towards Interpretable Motion-level Skill Assessment in Robotic Surgery

Purpose: We study the relationship between surgical gestures and motion primitives in dry-lab surgical exercises towards a deeper understanding of surgical activity at fine-grained levels and interpretable feedback in skill assessment. Methods: We analyze the motion primitive sequences of gestures in the JIGSAWS dataset and identify inverse motion primitives in those sequences. Inverse motion primitives are defined as sequential actions on the same object by the same tool that effectively negate each other. We also examine the correlation between surgical skills (measured by GRS scores) and the number and total durations of inverse motion primitives in the dry-lab trials of Suturing, Needle Passing, and Knot Tying tasks. Results: We find that the sequence of motion primitives used to perform gestures can help detect labeling errors in surgical gestures. Inverse motion primitives are often used as recovery actions to correct the position or orientation of objects or may be indicative of other issues such as with depth perception. The number and total durations of inverse motion primitives in trials are also strongly correlated with lower GRS scores in the Suturing and Knot Tying tasks. Conclusion: The sequence and pattern of motion primitives could be used to provide interpretable feedback in surgical skill assessment. Combined with an action recognition model, the explainability of automated skill assessment can be improved by showing video clips of the inverse motion primitives of inefficient or problematic movements.

Bounded Future MS-TCN++ for surgical gesture recognition

In recent times there is a growing development of video based applications for surgical purposes. Part of these applications can work offline after the end of the procedure, other applications must react immediately. However, there are cases where the response should be done during the procedure but some delay is acceptable. In the literature, the online-offline performance gap is known. Our goal in this study was to learn the performance-delay trade-off and design an MS-TCN++-based algorithm that can utilize this trade-off. To this aim, we used our open surgery simulation data-set containing 96 videos of 24 participants that perform a suturing task on a variable tissue simulator. In this study, we used video data captured from the side view. The Networks were trained to identify the performed surgical gestures. The naive approach is to reduce the MS-TCN++ depth, as a result, the receptive field is reduced, and also the number of required future frames is also reduced. We showed that this method is sub-optimal, mainly in the small delay cases. The second method was to limit the accessible future in each temporal convolution. This way, we have flexibility in the network design and as a result, we achieve significantly better performance than in the naive approach.

Recognition and Prediction of Surgical Gestures and Trajectories Using Transformer Models in Robot-Assisted Surgery

Surgical activity recognition and prediction can help provide important context in many Robot-Assisted Surgery (RAS) applications, for example, surgical progress monitoring and estimation, surgical skill evaluation, and shared control strategies during teleoperation. Transformer models were first developed for Natural Language Processing (NLP) to model word sequences and soon the method gained popularity for general sequence modeling tasks. In this paper, we propose the novel use of a Transformer model for three tasks: gesture recognition, gesture prediction, and trajectory prediction during RAS. We modify the original Transformer architecture to be able to generate the current gesture sequence, future gesture sequence, and future trajectory sequence estimations using only the current kinematic data of the surgical robot end-effectors. We evaluate our proposed models on the JHU-ISI Gesture and Skill Assessment Working Set (JIGSAWS) and use Leave-One-User-Out (LOUO) cross-validation to ensure the generalizability of our results. Our models achieve up to 89.3\% gesture recognition accuracy, 84.6\% gesture prediction accuracy (1 second ahead) and 2.71mm trajectory prediction error (1 second ahead). Our models are comparable to and able to outperform state-of-the-art methods while using only the kinematic data channel. This approach can enable near-real time surgical activity recognition and prediction.

COMPASS: A Formal Framework and Aggregate Dataset for Generalized Surgical Procedure Modeling

Objective: We propose a formal framework for modeling surgical tasks using a unified set of motion primitives (MPs) as the basic surgical actions to enable more objective labeling and aggregation of different datasets and training generalized models for surgical action recognition. Methods: We use our framework to create the COntext and Motion Primitive Aggregate Surgical Set (COMPASS), including six dry-lab surgical tasks from three publicly-available datasets (JIGSAWS, DESK, and ROSMA) with kinematic and video data and context and MP labels. Methods for labeling surgical context and automatic translation to MPs are presented. We propose the Leave-One-Task-Out (LOTO) cross validation method to evaluate a model's ability to generalize to an unseen task. Results: Our context labeling method achieves near-perfect agreement between consensus labels from crowd-sourcing and expert surgeons. Segmentation of tasks to MPs enables the generation of separate left and right transcripts and significantly improves LOTO performance. We find that MP segmentation models perform best if trained on tasks with the same context and/or tasks from the same dataset. Conclusion: The proposed framework enables high-quality labeling of surgical data based on context and fine-grained MPs. Modeling surgical tasks with MPs enables the aggregation of different datasets for training action recognition models that can generalize better to unseen tasks than models trained at the gesture level. Significance: Our formal framework and aggregate dataset can support the development of models and algorithms for surgical process analysis, skill assessment, error detection, and autonomy.

Quantification of Robotic Surgeries with Vision-Based Deep Learning

Surgery is a high-stakes domain where surgeons must navigate critical anatomical structures and actively avoid potential complications while achieving the main task at hand. Such surgical activity has been shown to affect long-term patient outcomes. To better understand this relationship, whose mechanics remain unknown for the majority of surgical procedures, we hypothesize that the core elements of surgery must first be quantified in a reliable, objective, and scalable manner. We believe this is a prerequisite for the provision of surgical feedback and modulation of surgeon performance in pursuit of improved patient outcomes. To holistically quantify surgeries, we propose a unified deep learning framework, entitled Roboformer, which operates exclusively on videos recorded during surgery to independently achieve multiple tasks: surgical phase recognition (the what of surgery), gesture classification and skills assessment (the how of surgery). We validated our framework on four video-based datasets of two commonly-encountered types of steps (dissection and suturing) within minimally-invasive robotic surgeries. We demonstrated that our framework can generalize well to unseen videos, surgeons, medical centres, and surgical procedures. We also found that our framework, which naturally lends itself to explainable findings, identified relevant information when achieving a particular task. These findings are likely to instill surgeons with more confidence in our framework's behaviour, increasing the likelihood of clinical adoption, and thus paving the way for more targeted surgical feedback.