Hasil untuk "Surgery"

Zheng Han, Zixin Yang, Yonghao Long et al.

Purpose: Precise port placement is a critical step in robot-assisted surgery, where port configuration influences both visual access to the operative field and instrument maneuverability. To bridge the gap between preoperative planning and intraoperative execution, we present ARport, an augmented reality (AR) system that automatically maps pre-planned trocar layouts onto the patient's body surface, providing intuitive spatial guidance during surgical preparation. Methods: ARport, implemented on an optical see-through head-mounted display (OST-HMD), operates without any external sensors or markers, simplifying setup and enhancing workflow integration. It reconstructs the operative scene from RGB, depth, and pose data captured by the OST-HMD, extracts the patient's body surface using a foundation model, and performs surface-based markerless registration to align preoperative anatomical models to the extracted patient's body surface, enabling in-situ visualization of planned trocar layouts. A demonstration video illustrating the overall workflow is available online. Results: In full-scale human-phantom experiments, ARport accurately overlaid pre-planned trocar sites onto the physical phantom, achieving consistent spatial correspondence between virtual plans and real anatomy. Conclusion: ARport provides a fully marker-free and hardware-minimal solution for visualizing preoperative trocar plans directly on the patient's body surface. The system facilitates efficient intraoperative setup and demonstrates potential for seamless integration into routine clinical workflows.

Yike Zhang, Eduardo Davalos, Dingjie Su et al.

Cochlear Implant (CI) surgery treats severe hearing loss by inserting an electrode array into the cochlea to stimulate the auditory nerve. An important step in this procedure is mastoidectomy, which removes part of the mastoid region of the temporal bone to provide surgical access. Accurate mastoidectomy shape prediction from preoperative imaging improves pre-surgical planning, reduces risks, and enhances surgical outcomes. Despite its importance, there are limited deep-learning-based studies regarding this topic due to the challenges of acquiring ground-truth labels. We address this gap by investigating self-supervised and weakly-supervised learning models to predict the mastoidectomy region without human annotations. We propose a hybrid self-supervised and weakly-supervised learning framework to predict the mastoidectomy region directly from preoperative CT scans, where the mastoid remains intact. Our hybrid method achieves a mean Dice score of 0.72 when predicting the complex and boundary-less mastoidectomy shape, surpassing state-of-the-art approaches and demonstrating strong performance. The method provides groundwork for constructing 3D postmastoidectomy surfaces directly from the corresponding preoperative CT scans. To our knowledge, this is the first work that integrating self-supervised and weakly-supervised learning for mastoidectomy shape prediction, offering a robust and efficient solution for CI surgical planning while leveraging 3D T-distribution loss in weakly-supervised medical imaging.

Valery Fischer, Alan Magdaleno, Anna-Katharina Calek et al.

Purpose: Accurate 3D hand pose estimation supports surgical applications such as skill assessment, robot-assisted interventions, and geometry-aware workflow analysis. However, surgical environments pose severe challenges, including intense and localized lighting, frequent occlusions by instruments or staff, and uniform hand appearance due to gloves, combined with a scarcity of annotated datasets for reliable model training. Method: We propose a robust multi-view pipeline for 3D hand pose estimation in surgical contexts that requires no domain-specific fine-tuning and relies solely on off-the-shelf pretrained models. The pipeline integrates reliable person detection, whole-body pose estimation, and state-of-the-art 2D hand keypoint prediction on tracked hand crops, followed by a constrained 3D optimization. In addition, we introduce a novel surgical benchmark dataset comprising over 68,000 frames and 3,000 manually annotated 2D hand poses with triangulated 3D ground truth, recorded in a replica operating room under varying levels of scene complexity. Results: Quantitative experiments demonstrate that our method consistently outperforms baselines, achieving a 31% reduction in 2D mean joint error and a 76% reduction in 3D mean per-joint position error. Conclusion: Our work establishes a strong baseline for 3D hand pose estimation in surgery, providing both a training-free pipeline and a comprehensive annotated dataset to facilitate future research in surgical computer vision.

Yan Meng, Jack Cook, X. Y. Han et al.

Accurate surgical phase recognition is essential for analyzing procedural workflows, supporting intraoperative decision-making, and enabling data-driven improvements in surgical education and performance evaluation. In this work, we present a comprehensive framework for phase recognition in pituitary tumor surgery (PTS) videos, combining self-supervised representation learning, robust temporal modeling, and scalable data annotation strategies. Our method achieves 90\% accuracy on a held-out test set, outperforming current state-of-the-art approaches and demonstrating strong generalization across variable surgical cases. A central contribution of this work is the integration of a collaborative online platform designed for surgeons to upload surgical videos, receive automated phase analysis, and contribute to a growing dataset. This platform not only facilitates large-scale data collection but also fosters knowledge sharing and continuous model improvement. To address the challenge of limited labeled data, we pretrain a ResNet-50 model using the self-supervised framework on 251 unlabeled PTS videos, enabling the extraction of high-quality feature representations. Fine-tuning is performed on a labeled dataset of 81 procedures using a modified training regime that incorporates focal loss, gradual layer unfreezing, and dynamic sampling to address class imbalance and procedural variability.

Zeqing Wang, Han Fang, Yihong Xu et al.

Minimally invasive procedures have been advanced rapidly by the robotic laparoscopic surgery. The latter greatly assists surgeons in sophisticated and precise operations with reduced invasiveness. Nevertheless, it is still safety critical to be aware of even the least tissue deformation during instrument-tissue interactions, especially in 3D space. To address this, recent works rely on NeRF to render 2D videos from different perspectives and eliminate occlusions. However, most of the methods fail to predict the accurate 3D shapes and associated deformation estimates robustly. Differently, we propose Tracking-Aware Deformation Field (TADF), a novel framework which reconstructs the 3D mesh along with the 3D tissue deformation simultaneously. It first tracks the key points of soft tissue by a foundation vision model, providing an accurate 2D deformation field. Then, the 2D deformation field is smoothly incorporated with a neural implicit reconstruction network to obtain tissue deformation in the 3D space. Finally, we experimentally demonstrate that the proposed method provides more accurate deformation estimation compared with other 3D neural reconstruction methods in two public datasets.

Gui Wang, Yang Wennuo, Xusen Ma et al.

MLLMs (Multimodal Large Language Models) have showcased remarkable capabilities, but their performance in high-stakes, domain-specific scenarios like surgical settings, remains largely under-explored. To address this gap, we develop \textbf{EyePCR}, a large-scale benchmark for ophthalmic surgery analysis, grounded in structured clinical knowledge to evaluate cognition across \textit{Perception}, \textit{Comprehension} and \textit{Reasoning}. EyePCR offers a richly annotated corpus with more than 210k VQAs, which cover 1048 fine-grained attributes for multi-view perception, medical knowledge graph of more than 25k triplets for comprehension, and four clinically grounded reasoning tasks. The rich annotations facilitate in-depth cognitive analysis, simulating how surgeons perceive visual cues and combine them with domain knowledge to make decisions, thus greatly improving models' cognitive ability. In particular, \textbf{EyePCR-MLLM}, a domain-adapted variant of Qwen2.5-VL-7B, achieves the highest accuracy on MCQs for \textit{Perception} among compared models and outperforms open-source models in \textit{Comprehension} and \textit{Reasoning}, rivalling commercial models like GPT-4.1. EyePCR reveals the limitations of existing MLLMs in surgical cognition and lays the foundation for benchmarking and enhancing clinical reliability of surgical video understanding models.

Marco Acerbis, Swarnadip Chatterjee, Christophe Avenel et al.

Computational cytology faces two major challenges: i) instance-level labels are unreliable and prohibitively costly to obtain, ii) witness rates are extremely low. We propose SLAM-AGS, a Slide-Label-Aware Multitask pretraining framework that jointly optimizes (i) a weakly supervised similarity objective on slide-negative patches and (ii) a self-supervised contrastive objective on slide-positive patches, yielding stronger performance on downstream tasks. To stabilize learning, we apply Adaptive Gradient Surgery to tackle conflicting task gradients and prevent model collapse. We integrate the pretrained encoder into an attention-based Multiple Instance Learning aggregator for bag-level prediction and attention-guided retrieval of the most abnormal instances in a bag. On a publicly available bone-marrow cytology dataset, with simulated witness rates from 10% down to 0.5%, SLAM-AGS improves bag-level F1-Score and Top 400 positive cell retrieval over other pretraining methods, with the largest gains at low witness rates, showing that resolving gradient interference enables stable pretraining and better performance on downstream tasks. To facilitate reproducibility, we share our complete implementation and evaluation framework as open source: https://github.com/Ace95/SLAM-AGS.

Yuhan Zheng, Jessie A Elliott, John V Reynolds et al.

Esophageal cancer is a major cause of cancer-related mortality internationally, with high recurrence rates and poor survival even among patients treated with curative-intent surgery. Investigating relevant prognostic factors and predicting prognosis can enhance post-operative clinical decision-making and potentially improve patients' outcomes. In this work, we assessed prognostic factor identification and discriminative performances of three models for Disease-Free Survival (DFS) and Overall Survival (OS) using a large multicenter international dataset from ENSURE study. We first employed Cox Proportional Hazards (CoxPH) model to assess the impact of each feature on outcomes. Subsequently, we utilised CoxPH and two deep neural network (DNN)-based models, DeepSurv and DeepHit, to predict DFS and OS. The significant prognostic factors identified by our models were consistent with clinical literature, with post-operative pathologic features showing higher significance than clinical stage features. DeepSurv and DeepHit demonstrated comparable discriminative accuracy to CoxPH, with DeepSurv slightly outperforming in both DFS and OS prediction tasks, achieving C-index of 0.735 and 0.74, respectively. While these results suggested the potential of DNNs as prognostic tools for improving predictive accuracy and providing personalised guidance with respect to risk stratification, CoxPH still remains an adequately good prediction model, with the data used in this study.

Fengming Lin, Yan Xia, Michael MacRaild et al.

The automated segmentation of cerebral aneurysms is pivotal for accurate diagnosis and treatment planning. Confronted with significant domain shifts and class imbalance in 3D Rotational Angiography (3DRA) data from various medical institutions, the task becomes challenging. These shifts include differences in image appearance, intensity distribution, resolution, and aneurysm size, all of which complicate the segmentation process. To tackle these issues, we propose a novel domain generalization strategy that employs gradient surgery exponential moving average (GS-EMA) optimization technique coupled with boundary-aware contrastive learning (BACL). Our approach is distinct in its ability to adapt to new, unseen domains by learning domain-invariant features, thereby improving the robustness and accuracy of aneurysm segmentation across diverse clinical datasets. The results demonstrate that our proposed approach can extract more domain-invariant features, minimizing over-segmentation and capturing more complete aneurysm structures.

Paul Maria Scheikl, Eleonora Tagliabue, Balázs Gyenes et al.

Automation holds the potential to assist surgeons in robotic interventions, shifting their mental work load from visuomotor control to high level decision making. Reinforcement learning has shown promising results in learning complex visuomotor policies, especially in simulation environments where many samples can be collected at low cost. A core challenge is learning policies in simulation that can be deployed in the real world, thereby overcoming the sim-to-real gap. In this work, we bridge the visual sim-to-real gap with an image-based reinforcement learning pipeline based on pixel-level domain adaptation and demonstrate its effectiveness on an image-based task in deformable object manipulation. We choose a tissue retraction task because of its importance in clinical reality of precise cancer surgery. After training in simulation on domain-translated images, our policy requires no retraining to perform tissue retraction with a 50% success rate on the real robotic system using raw RGB images. Furthermore, our sim-to-real transfer method makes no assumptions on the task itself and requires no paired images. This work introduces the first successful application of visual sim-to-real transfer for robotic manipulation of deformable objects in the surgical field, which represents a notable step towards the clinical translation of cognitive surgical robotics.

Cheng Gong, Yao Chen, Qiuyang Luo et al.

Multi-exit network is a promising architecture for efficient model inference by sharing backbone networks and weights among multiple exits. However, the gradient conflict of the shared weights results in sub-optimal accuracy. This paper introduces Deep Feature Surgery (\methodname), which consists of feature partitioning and feature referencing approaches to resolve gradient conflict issues during the training of multi-exit networks. The feature partitioning separates shared features along the depth axis among all exits to alleviate gradient conflict while simultaneously promoting joint optimization for each exit. Subsequently, feature referencing enhances multi-scale features for distinct exits across varying depths to improve the model accuracy. Furthermore, \methodname~reduces the training operations with the reduced complexity of backpropagation. Experimental results on Cifar100 and ImageNet datasets exhibit that \methodname~provides up to a \textbf{50.00\%} reduction in training time and attains up to a \textbf{6.94\%} enhancement in accuracy when contrasted with baseline methods across diverse models and tasks. Budgeted batch classification evaluation on MSDNet demonstrates that DFS uses about $\mathbf{2}\boldsymbol{\times}$ fewer average FLOPs per image to achieve the same classification accuracy as baseline methods on Cifar100. The code is available at https://github.com/GongCheng1919/dfs.

Rui Wang, Sophokles Ktistakis, Siwei Zhang et al.

The surgical usage of Mixed Reality (MR) has received growing attention in areas such as surgical navigation systems, skill assessment, and robot-assisted surgeries. For such applications, pose estimation for hand and surgical instruments from an egocentric perspective is a fundamental task and has been studied extensively in the computer vision field in recent years. However, the development of this field has been impeded by a lack of datasets, especially in the surgical field, where bloody gloves and reflective metallic tools make it hard to obtain 3D pose annotations for hands and objects using conventional methods. To address this issue, we propose POV-Surgery, a large-scale, synthetic, egocentric dataset focusing on pose estimation for hands with different surgical gloves and three orthopedic surgical instruments, namely scalpel, friem, and diskplacer. Our dataset consists of 53 sequences and 88,329 frames, featuring high-resolution RGB-D video streams with activity annotations, accurate 3D and 2D annotations for hand-object pose, and 2D hand-object segmentation masks. We fine-tune the current SOTA methods on POV-Surgery and further show the generalizability when applying to real-life cases with surgical gloves and tools by extensive evaluations. The code and the dataset are publicly available at batfacewayne.github.io/POV_Surgery_io/.

Jonathan D. Freedman, Ian A. Nappier

The Plastic Surgery In-Service Training Exam (PSITE) is an important indicator of resident proficiency and serves as a useful benchmark for evaluating OpenAI's GPT. Unlike many of the simulated tests or practice questions shown in the GPT-4 Technical Paper, the multiple-choice questions evaluated here are authentic PSITE questions. These questions offer realistic clinical vignettes that a plastic surgeon commonly encounters in practice and scores highly correlate with passing the written boards required to become a Board Certified Plastic Surgeon. Our evaluation shows dramatic improvement of GPT-4 (without vision) over GPT-3.5 with both the 2022 and 2021 exams respectively increasing the score from 8th to 88th percentile and 3rd to 99th percentile. The final results of the 2023 PSITE are set to be released on April 11, 2023, and this is an exciting moment to continue our research with a fresh exam. Our evaluation pipeline is ready for the moment that the exam is released so long as we have access via OpenAI to the GPT-4 API. With multimodal input, we may achieve superhuman performance on the 2023.

Joao Cartucho, Alistair Weld, Samyakh Tukra et al.

This paper introduces the ``SurgT: Surgical Tracking" challenge which was organised in conjunction with MICCAI 2022. There were two purposes for the creation of this challenge: (1) the establishment of the first standardised benchmark for the research community to assess soft-tissue trackers; and (2) to encourage the development of unsupervised deep learning methods, given the lack of annotated data in surgery. A dataset of 157 stereo endoscopic videos from 20 clinical cases, along with stereo camera calibration parameters, have been provided. Participants were assigned the task of developing algorithms to track the movement of soft tissues, represented by bounding boxes, in stereo endoscopic videos. At the end of the challenge, the developed methods were assessed on a previously hidden test subset. This assessment uses benchmarking metrics that were purposely developed for this challenge, to verify the efficacy of unsupervised deep learning algorithms in tracking soft-tissue. The metric used for ranking the methods was the Expected Average Overlap (EAO) score, which measures the average overlap between a tracker's and the ground truth bounding boxes. Coming first in the challenge was the deep learning submission by ICVS-2Ai with a superior EAO score of 0.617. This method employs ARFlow to estimate unsupervised dense optical flow from cropped images, using photometric and regularization losses. Second, Jmees with an EAO of 0.583, uses deep learning for surgical tool segmentation on top of a non-deep learning baseline method: CSRT. CSRT by itself scores a similar EAO of 0.563. The results from this challenge show that currently, non-deep learning methods are still competitive. The dataset and benchmarking tool created for this challenge have been made publicly available at https://surgt.grand-challenge.org/.

Przemysław Korzeniowski, Szymon Płotka, Robert Brawura-Biskupski-Samaha et al.

Spina Bifida (SB) is a birth defect developed during the early stage of pregnancy in which there is incomplete closing of the spine around the spinal cord. The growing interest in fetoscopic Spina-Bifida repair, which is performed in fetuses who are still in the pregnant uterus, prompts the need for appropriate training. The learning curve for such procedures is steep and requires excellent procedural skills. Computer-based virtual reality (VR) simulation systems offer a safe, cost-effective, and configurable training environment free from ethical and patient safety issues. However, to the best of our knowledge, there are currently no commercial or experimental VR training simulation systems available for fetoscopic SB-repair procedures. In this paper, we propose a novel VR simulator for core manual skills training for SB-repair. An initial simulation realism validation study was carried out by obtaining subjective feedback (face and content validity) from 14 clinicians. The overall simulation realism was on average marked 4.07 on a 5-point Likert scale (1 - very unrealistic, 5 - very realistic). Its usefulness as a training tool for SB-repair as well as in learning fundamental laparoscopic skills was marked 4.63 and 4.80, respectively. These results indicate that VR simulation of fetoscopic procedures may contribute to surgical training without putting fetuses and their mothers at risk. It could also facilitate wider adaptation of fetoscopic procedures in place of much more invasive open fetal surgeries.

Anh T. Tran

A rational number $r$ is called a left orderable slope of a knot $K \subset S^3$ if the 3-manifold obtained from $S^3$ by $r$-surgery along $K$ has left orderable fundamental group. In this paper we consider the double twist knots $C(k,l)$ in the Conway notation. For any positive integers $m$ and $n$, we show that if $K$ is a double twist knot of the form $C(2m,-2n)$, $C(2m+1, 2n)$ or $C(2m+1, -2n)$ then there is an explicit unbounded interval $I$ such that any rational number $r \in I$ is a left orderable slope of $K$.

Jingwei Song, Jun Wang, Liang Zhao et al.

Real-time simultaneously localization and dense mapping is very helpful for providing Virtual Reality and Augmented Reality for surgeons or even surgical robots. In this paper, we propose MIS-SLAM: a complete real-time large scale dense deformable SLAM system with stereoscope in Minimal Invasive Surgery based on heterogeneous computing by making full use of CPU and GPU. Idled CPU is used to perform ORB- SLAM for providing robust global pose. Strategies are taken to integrate modules from CPU and GPU. We solved the key problem raised in previous work, that is, fast movement of scope and blurry images make the scope tracking fail. Benefiting from improved localization, MIS-SLAM can achieve large scale scope localizing and dense mapping in real-time. It transforms and deforms current model and incrementally fuses new observation while keeping vivid texture. In-vivo experiments conducted on publicly available datasets presented in the form of videos demonstrate the feasibility and practicality of MIS-SLAM for potential clinical purpose.

Huygens C. Ravelomanana

We study small Seifert possibly chiral cosmetic surgeries on not necessarily null-homologous knot in rational homology spheres. Using $PSL_2(\mathbb{C})$-character variety theory we give a sharp bound on the number of slopes producing the same small Seifert manifold if the ambient manifold satisfies some representation theoretic conditions.

Alex Bartel, Aurel Page

If M is a manifold with an action of a group G, then the homology group H_1(M,Q) is naturally a Q[G]-module, where Q[G] denotes the rational group ring. We prove that for every finite group G, and for every Q[G]-module V, there exists a closed hyperbolic 3-manifold M with a free G-action such that the Q[G]-module H_1(M,Q) is isomorphic to V. We give an application to spectral geometry: for every finite set P of prime numbers, there exist hyperbolic 3-manifolds N and N' that are strongly isospectral such that for all p in P, the p-power torsion subgroups of H_1(N,Z) and of H_1(N',Z) have different orders. We also show that, in a certain precise sense, the rational homology of oriented Riemannian 3-manifolds with a G-action "knows" nothing about the fixed point structure under G, in contrast to the 2-dimensional case. The main geometric techniques are Dehn surgery and, for the spectral application, the Cheeger-Müller formula, but we also make use of tools from different branches of algebra, most notably of regulator constants, a representation theoretic tool that was originally developed in the context of elliptic curves.

Anh T. Tran

We show that the resulting manifold by $r$-surgery on the hyperbolic twist knot $K_m, \, m \ge 2$, has left-orderable fundamental group if the slope $r$ satisfies the condition $r \in (-4,2m)$ if $m$ is even, and $r \in [0,4] \cup (\frac{4m}ω+4, 2m+4)$ if $m$ is odd, where $ω>1$ is the unique real solution of the equation $x e^{x}=4m$.