(Abridged) Stroke and SCI are conditions that can significantly impact the QoL of survivors in both the physical and psychosocial domains. Both diseases often result in significant motor and sensory impairments that are not fully reversible despite current available therapies. Invasive BCIs have emerged as a promising means to bypass the site of injury and potentially restore motor and sensory function. However, to maximize the utility and participant satisfaction with such technology, participants' willingness to embrace BCIs must be assessed, and placed in context with functional goals and rehabilitative priorities. Hence, we conducted a survey of a cohort of stroke (n=33), SCI (n=37), and both (n=1) participants regarding their receptiveness to invasive ECoG-based BCIs as well as to assess their goals for functional rehabilitation. Overall, participants indicated a high level of willingness to undergo surgery to implant ECoG grids for BCI technology if basic motor functions, including upper extremity, gait, bowel/bladder, and sensory function were restored. There was no correlation between participant willingness to undergo a prospective BCI implantation and the level of functional recovery offered by the BCI. Similarly, there was no correlation between willingness to undergo surgery and the participants' perceived rehabilitative priorities and level of disability. These findings indicate that participants were interested in invasive BCI technology even if only basic functions can be restored, regardless of their level of disability and their rehabilitative priorities. Such observations imply that first generation commercial invasive BCIs may not need extensive functions to garner adoption. Conversely, it also raises a concern that participants from the stroke and SCI cohort may be overly enthusiastic about such technology, which poses potential risks for medical exploitation.
Ureteroscopy is the standard of care for diagnosing and treating kidney stones and tumors. However, current ureteroscopes have a limited field of view, requiring significant experience to adequately navigate the renal collecting system. This is evidenced by the fact that inexperienced surgeons have higher rates of missed stones. One-third of patients with residual stones require re-operation within 20 months. In order to aid surgeons to fully explore the kidney, this study presents the Navigated Augmented Reality Visualization for Ureteroscopic Surgery (NAVIUS) system. NAVIUS assists surgeons by providing 3D maps of the target anatomy, real-time scope positions, and preoperative imaging overlays. To enable real-time navigation and visualization, we integrate an electromagnetic tracker-based navigation pipeline with augmented reality visualizations. NAVIUS connects to 3D Slicer and Unity with OpenIGTLink, and uses HoloLens 2 as a holographic interface. We evaluate NAVIUS through a user study where surgeons conducted ureteroscopy on kidney phantoms with and without visual guidance. With our proposed system, we observed that surgeons explored more areas within the collecting system with NAVIUS (average 23.73% increase), and NASA-TLX metrics were improved (up to 27.27%). NAVIUS acts as a step towards better surgical outcomes and surgeons' experience. The codebase for the system will be available at: https://github.com/vu-maple-lab/NAVIUS.
Scene graphs (SGs) provide structured relational representations crucial for decoding complex, dynamic surgical environments. This PRISMA-ScR-guided scoping review systematically maps the evolving landscape of SG research in surgery, charting its applications, methodological advancements, and future directions. Our analysis reveals rapid growth, yet uncovers a critical 'data divide': internal-view research (e.g., triplet recognition) almost exclusively uses real-world 2D video, while external-view 4D modeling relies heavily on simulated data, exposing a key translational research gap. Methodologically, the field has advanced from foundational graph neural networks to specialized foundation models that now significantly outperform generalist large vision-language models in surgical contexts. This progress has established SGs as a cornerstone technology for both analysis, such as workflow recognition and automated safety monitoring, and generative tasks like controllable surgical simulation. Although challenges in data annotation and real-time implementation persist, they are actively being addressed through emerging techniques. Surgical SGs are maturing into an essential semantic bridge, enabling a new generation of intelligent systems to improve surgical safety, efficiency, and training.
The surgical intervention is crucial to patient healthcare, and many studies have developed advanced algorithms to provide understanding and decision-making assistance for surgeons. Despite great progress, these algorithms are developed for a single specific task and scenario, and in practice require the manual combination of different functions, thus limiting the applicability. Thus, an intelligent and versatile surgical assistant is expected to accurately understand the surgeon's intentions and accordingly conduct the specific tasks to support the surgical process. In this work, by leveraging advanced multimodal large language models (MLLMs), we propose a Versatile Surgery Assistant (VS-Assistant) that can accurately understand the surgeon's intention and complete a series of surgical understanding tasks, e.g., surgical scene analysis, surgical instrument detection, and segmentation on demand. Specifically, to achieve superior surgical multimodal understanding, we devise a mixture of projectors (MOP) module to align the surgical MLLM in VS-Assistant to balance the natural and surgical knowledge. Moreover, we devise a surgical Function-Calling Tuning strategy to enable the VS-Assistant to understand surgical intentions, and thus make a series of surgical function calls on demand to meet the needs of the surgeons. Extensive experiments on neurosurgery data confirm that our VS-Assistant can understand the surgeon's intention more accurately than the existing MLLM, resulting in overwhelming performance in textual analysis and visual tasks. Source code and models will be made public.
Kristina Mach, Hessam Roodaki, Michael Sommersperger
et al.
This paper presents an innovative approach to intraoperative Optical Coherence Tomography (iOCT) image segmentation in ophthalmic surgery, leveraging statistical analysis of speckle patterns to incorporate statistical pathology-specific prior knowledge. Our findings indicate statistically different speckle patterns within the retina and between retinal layers and surgical tools, facilitating the segmentation of previously unseen data without the necessity for manual labeling. The research involves fitting various statistical distributions to iOCT data, enabling the differentiation of different ocular structures and surgical tools. The proposed segmentation model aims to refine the statistical findings based on prior tissue understanding to leverage statistical and biological knowledge. Incorporating statistical parameters, physical analysis of light-tissue interaction, and deep learning informed by biological structures enhance segmentation accuracy, offering potential benefits to real-time applications in ophthalmic surgical procedures. The study demonstrates the adaptability and precision of using Gamma distribution parameters and the derived binary maps as sole inputs for segmentation, notably enhancing the model's inference performance on unseen data.
Surgical tool detection is essential for analyzing and evaluating minimally invasive surgery videos. Current approaches are mostly based on supervised methods that require large, fully instance-level labels (i.e., bounding boxes). However, large image datasets with instance-level labels are often limited because of the burden of annotation. Thus, surgical tool detection is important when providing image-level labels instead of instance-level labels since image-level annotations are considerably more time-efficient than instance-level annotations. In this work, we propose to strike a balance between the extremely costly annotation burden and detection performance. We further propose a co-occurrence loss, which considers a characteristic that some tool pairs often co-occur together in an image to leverage image-level labels. Encapsulating the knowledge of co-occurrence using the co-occurrence loss helps to overcome the difficulty in classification that originates from the fact that some tools have similar shapes and textures. Extensive experiments conducted on the Endovis2018 dataset in various data settings show the effectiveness of our method.
We prove that a positive two-bridge knot other than the $(2,k)$ torus knot does not admit chirally cosmetic surgeries, a pair of Dehn surgeries along distinct slopes yielding orientation-reversingly homeomorphic 3-manifolds.
Danial Khorsandi, Amir Fahimipour, Payam Abasian
et al.
3D and 4D printing are cutting-edge technologies for precise and expedited manufacturing of objects ranging from plastic to metal. Recent advances in 3D and 4D printing technologies in dentistry and maxillofacial surgery enable dentists to custom design and print surgical drill guides, temporary and permanent crowns and bridges, orthodontic appliances and orthotics, implants, mouthguards for drug delivery. In the present review, different 3D printing technologies available for use in dentistry are highlighted together with a critique on the materials available for printing. Recent reports of the application of these printed platformed are highlighted to enable readers appreciate the progress in 3D/4D printing in dentistry.
Robotic-assisted surgeries benefit both surgeons and patients, however, surgeons frequently need to adjust the endoscopic camera to achieve good viewpoints. Simultaneously controlling the camera and the surgical instruments is impossible, and consequentially, these camera adjustments repeatedly interrupt the surgery. Autonomous camera control could help overcome this challenge, but most existing systems are reactive, e.g., by having the camera follow the surgical instruments. We propose a predictive approach for anticipating when camera movements will occur using artificial neural networks. We used the kinematic data of the surgical instruments, which were recorded during robotic-assisted surgical training on porcine models. We split the data into segments, and labeled each either as a segment that immediately precedes a camera movement, or one that does not. Due to the large class imbalance, we trained an ensemble of networks, each on a balanced sub-set of the training data. We found that the instruments' kinematic data can be used to predict when camera movements will occur, and evaluated the performance on different segment durations and ensemble sizes. We also studied how much in advance an upcoming camera movement can be predicted, and found that predicting a camera movement 0.25, 0.5, and 1 second before they occurred achieved 98%, 94%, and 84% accuracy relative to the prediction of an imminent camera movement. This indicates that camera movement events can be predicted early enough to leave time for computing and executing an autonomous camera movement and suggests that an autonomous camera controller for RAMIS may one day be feasible.
Segmentation of surgical instruments is an important problem in robot-assisted surgery: it is a crucial step towards full instrument pose estimation and is directly used for masking of augmented reality overlays during surgical procedures. Most applications rely on accurate real-time segmentation of high-resolution surgical images. While previous research focused primarily on methods that deliver high accuracy segmentation masks, majority of them can not be used for real-time applications due to their computational cost. In this work, we design a light-weight and highly-efficient deep residual architecture which is tuned to perform real-time inference of high-resolution images. To account for reduced accuracy of the discovered light-weight deep residual network and avoid adding any additional computational burden, we perform a differentiable search over dilation rates for residual units of our network. We test our discovered architecture on the EndoVis 2017 Robotic Instruments dataset and verify that our model is the state-of-the-art in terms of speed and accuracy tradeoff with a speed of up to 125 FPS on high resolution images.
Surgical scene understanding and multi-tasking learning are crucial for image-guided robotic surgery. Training a real-time robotic system for the detection and segmentation of high-resolution images provides a challenging problem with the limited computational resource. The perception drawn can be applied in effective real-time feedback, surgical skill assessment, and human-robot collaborative surgeries to enhance surgical outcomes. For this purpose, we develop a novel end-to-end trainable real-time Multi-Task Learning (MTL) model with weight-shared encoder and task-aware detection and segmentation decoders. Optimization of multiple tasks at the same convergence point is vital and presents a complex problem. Thus, we propose an asynchronous task-aware optimization (ATO) technique to calculate task-oriented gradients and train the decoders independently. Moreover, MTL models are always computationally expensive, which hinder real-time applications. To address this challenge, we introduce a global attention dynamic pruning (GADP) by removing less significant and sparse parameters. We further design a skip squeeze and excitation (SE) module, which suppresses weak features, excites significant features and performs dynamic spatial and channel-wise feature re-calibration. Validating on the robotic instrument segmentation dataset of MICCAI endoscopic vision challenge, our model significantly outperforms state-of-the-art segmentation and detection models, including best-performed models in the challenge.
Ngoc Duy Nguyen, Thanh Nguyen, Saeid Nahavandi
et al.
In robotic surgery, pattern cutting through a deformable material is a challenging research field. The cutting procedure requires a robot to concurrently manipulate a scissor and a gripper to cut through a predefined contour trajectory on the deformable sheet. The gripper ensures the cutting accuracy by nailing a point on the sheet and continuously tensioning the pinch point to different directions while the scissor is in action. The goal is to find a pinch point and a corresponding tensioning policy to minimize damage to the material and increase cutting accuracy measured by the symmetric difference between the predefined contour and the cut contour. Previous study considers finding one fixed pinch point during the course of cutting, which is inaccurate and unsafe when the contour trajectory is complex. In this paper, we examine the soft tissue cutting task by using multiple pinch points, which imitates human operations while cutting. This approach, however, does not require the use of a multi-gripper robot. We use a deep reinforcement learning algorithm to find an optimal tensioning policy of a pinch point. Simulation results show that the multi-point approach outperforms the state-of-the-art method in soft pattern cutting task with respect to both accuracy and reliability.
Hamilton's Ricci flow (RF) equations were recently expressed in terms of a sparsely-coupled system of autonomous first-order nonlinear differential equations for the edge lengths of a d-dimensional piecewise linear (PL) simplicial geometry. More recently, this system of discrete Ricci flow (DRF) equations was further simplified by explicitly constructing the Forman-Ricci tensor associated to each edge, thereby diagonalizing the first-order differential operator and avoiding the need to invert large sparse matrices at each time step. We recently showed analytically and numerically that these equations converge for axisymmetric 3-geometries to the corresponding continuum RF equations. We demonstrate here that these DRF equations yield an explicit numerical realization of Thurston's geometrization procedure for a discrete 3D axially-symmetric neckpinch geometry by using surgery to explicitly integrate through its Type-1 neck pinch singularity. A cubic-spline-based adaptive mesh was required to complete the evolution. Our numerically efficient simulations yield the expected Thurston decomposition of the sufficiently pinched axially symmetric geometry into its unique geometric structure -- a direct product of two lobes, each collapsing toward a 3-sphere geometry. The structure of our curvature may be used to better inform one of the vertex and edge weighting factors that appear in the Forman's expression of Ricci curvature on graphs.
In the orthognathic surgery, dental splints are important and necessary to help the surgeon reposition the maxilla or mandible. However, the traditional methods of manual design of dental splints are difficult and time-consuming. The research on computer-aided design software for dental splints is rarely reported. Our purpose is to develop a novel special software named EasySplint to design the dental splints conveniently and efficiently. The design can be divided into two steps, which are the generation of initial splint base and the Boolean operation between it and the maxilla-mandibular model. The initial splint base is formed by ruled surfaces reconstructed using the manually picked points. Then, a method to accomplish Boolean operation based on the distance filed of two meshes is proposed. The interference elimination can be conducted on the basis of marching cubes algorithm and Boolean operation. The accuracy of the dental splint can be guaranteed since the original mesh is utilized to form the result surface. Using EasySplint, the dental splints can be designed in about 10 minutes and saved as a stereo lithography (STL) file for 3D printing in clinical applications. Three phantom experiments were conducted and the efficiency of our method was demonstrated.
We suggest a method to construct new examples of partially hyperbolic diffeomorphisms. We begin with a partially hyperbolic diffeomorphism $f\colon M\to M$ which leaves invariant a submanifold $N\subset M$. We assume that $N$ is an Anosov submanifold for $f$, that is, the restriction $f|_N$ is an Anosov diffeomorphism and the center distribution is transverse to $TN\subset TM$. By replacing each point in $N$ with the projective space (real or complex) of lines normal to $N$ we obtain the blow-up $\hat M$. Replacing $M$ with $\hat M$ amounts to a surgery on the neighborhood of $N$ which alters the topology of the manifold. The diffeomorphism $f$ induces a canonical diffeomorphism $\hat f\colon \hat M\to \hat M$. We prove that under certain assumptions on the local dynamics of $f$ at $N$ the diffeomorphism $\hat f$ is also partially hyperbolic. We also present some modifications such as the connected sum construction which allows to "paste together" two partially hyperbolic diffeomorphisms to obtain a new one. Finally, we present several examples to which our results apply.
We show that all positive contact surgeries on every Legendrian figure-eight knot in $(S^3, ξ_{\rm{std}})$ result in an overtwisted contact structure. The proof uses convex surface theory and invariants from Heegaard Floer homology.
Let $M_n$ be a homology 3-sphere obtained by $\frac1n$-Dehn surgery along a $(p,q)$-torus knot. We consider a polynomial $σ_{(p,q,n)}(t)$ whose zeros are the inverses of the Reideimeister torsion of $M_n$ for $\mathit{SL}(2;\mathbb{C})$-irreducible representations. We give an explicit formula of this polynomial by using Tchebychev polynomials of the first kind. Further we also give a 3-term relations of these polynomials.
Philippe Merloz, Jocelyne Troccaz, Hervé Vouaillat
et al.
The variability in width, height, and spatial orientation of a spinal pedicle makes pedicle screw insertion a delicate operation. The aim of the current paper is to describe a computer-assisted surgical navigation system based on fluoroscopic X-ray image calibration and three-dimensional optical localizers in order to reduce radiation exposure while increasing accuracy and reliability of the surgical procedure for pedicle screw insertion. Instrumentation using transpedicular screw fixation was performed: in a first group, a conventional surgical procedure was carried out with 26 patients (138 screws); in a second group, a navigated surgical procedure (virtual fluoroscopy) was performed with 26 patients (140 screws). Evaluation of screw placement in every case was done by using plain X-rays and post-operative computer tomography scan. A 5 per cent cortex penetration (7 of 140 pedicle screws) occurred for the computer-assisted group. A 13 per cent penetration (18 of 138 pedicle screws) occurred for the non computer-assisted group. The radiation running time for each vertebra level (two screws) reached 3.5 s on average in the computer-assisted group and 11.5 s on average in the non computer-assisted group. The operative time for two screws on the same vertebra level reaches 10 min on average in the non computer-assisted group and 11.9 min on average in the computer-assisted group. The fluoroscopy-based (two-dimensional) navigation system for pedicle screw insertion is a safe and reliable procedure for surgery in the lower thoracic and lumbar spine.