Multi-view Video-Pose Pretraining for Operating Room Surgical Activity Recognition

Understanding the workflow of surgical procedures in complex operating rooms requires a deep understanding of the interactions between clinicians and their environment. Surgical activity recognition (SAR) is a key computer vision task that detects activities or phases from multi-view camera recordings. Existing SAR models often fail to account for fine-grained clinician movements and multi-view knowledge, or they require calibrated multi-view camera setups and advanced point-cloud processing to obtain better results. In this work, we propose a novel calibration-free multi-view multi-modal pretraining framework called Multiview Pretraining for Video-Pose Surgical Activity Recognition PreViPS, which aligns 2D pose and vision embeddings across camera views. Our model follows CLIP-style dual-encoder architecture: one encoder processes visual features, while the other encodes human pose embeddings. To handle the continuous 2D human pose coordinates, we introduce a tokenized discrete representation to convert the continuous 2D pose coordinates into discrete pose embeddings, thereby enabling efficient integration within the dual-encoder framework. To bridge the gap between these two modalities, we propose several pretraining objectives using cross- and in-modality geometric constraints within the embedding space and incorporating masked pose token prediction strategy to enhance representation learning. Extensive experiments and ablation studies demonstrate improvements over the strong baselines, while data-efficiency experiments on two distinct operating room datasets further highlight the effectiveness of our approach. We highlight the benefits of our approach for surgical activity recognition in both multi-view and single-view settings, showcasing its practical applicability in complex surgical environments. Code will be made available at: https://github.com/CAMMA-public/PreViPS.

When do they StOP?: A First Step Towards Automatically Identifying Team Communication in the Operating Room

Purpose: Surgical performance depends not only on surgeons' technical skills but also on team communication within and across the different professional groups present during the operation. Therefore, automatically identifying team communication in the OR is crucial for patient safety and advances in the development of computer-assisted surgical workflow analysis and intra-operative support systems. To take the first step, we propose a new task of detecting communication briefings involving all OR team members, i.e. the team Time-out and the StOP?-protocol, by localizing their start and end times in video recordings of surgical operations. Methods: We generate an OR dataset of real surgeries, called Team-OR, with more than one hundred hours of surgical videos captured by the multi-view camera system in the OR. The dataset contains temporal annotations of 33 Time-out and 22 StOP?-protocol activities in total. We then propose a novel group activity detection approach, where we encode both scene context and action features, and use an efficient neural network model to output the results. Results: The experimental results on the Team-OR dataset show that our approach outperforms existing state-of-the-art temporal action detection approaches. It also demonstrates the lack of research on group activities in the OR, proving the significance of our dataset. Conclusion: We investigate the Team Time-Out and the StOP?-protocol in the OR, by presenting the first OR dataset with temporal annotations of group activities protocols, and introducing a novel group activity detection approach that outperforms existing approaches. Code is available at https://github.com/CAMMA-public/Team-OR .

Early Operative Difficulty Assessment in Laparoscopic Cholecystectomy via Snapshot-Centric Video Analysis

Purpose: Laparoscopic cholecystectomy (LC) operative difficulty (LCOD) is highly variable and influences outcomes. Despite extensive LC studies in surgical workflow analysis, limited efforts explore LCOD using intraoperative video data. Early recog- nition of LCOD could allow prompt review by expert surgeons, enhance operating room (OR) planning, and improve surgical outcomes. Methods: We propose the clinical task of early LCOD assessment using limited video observations. We design SurgPrOD, a deep learning model to assess LCOD by analyzing features from global and local temporal resolutions (snapshots) of the observed LC video. Also, we propose a novel snapshot-centric attention (SCA) module, acting across snapshots, to enhance LCOD prediction. We introduce the CholeScore dataset, featuring video-level LCOD labels to validate our method. Results: We evaluate SurgPrOD on 3 LCOD assessment scales in the CholeScore dataset. On our new metric assessing early and stable correct predictions, SurgPrOD surpasses baselines by at least 0.22 points. SurgPrOD improves over baselines by at least 9 and 5 percentage points in F1 score and top1-accuracy, respectively, demonstrating its effectiveness in correct predictions. Conclusion: We propose a new task for early LCOD assessment and a novel model, SurgPrOD analyzing surgical video from global and local perspectives. Our results on the CholeScore dataset establishes a new benchmark to study LCOD using intraoperative video data.

UltraSam: A Foundation Model for Ultrasound using Large Open-Access Segmentation Datasets

Purpose: Automated ultrasound image analysis is challenging due to anatomical complexity and limited annotated data. To tackle this, we take a data-centric approach, assembling the largest public ultrasound segmentation dataset and training a versatile visual foundation model tailored for ultrasound. Methods: We compile US-43d, a large-scale collection of 43 open-access ultrasound datasets with over 280,000 images and segmentation masks for more than 50 anatomical structures. We then introduce UltraSam, an adaptation of the Segment Anything Model (SAM) that is trained on US-43d and supports both point- and box-prompts. Finally, we introduce a new use case for SAM-style models by using UltraSam as a model initialization that can be fine-tuned for various downstream analysis tasks, demonstrating UltraSam's foundational capabilities. Results: UltraSam achieves vastly improved performance over existing SAM-style models for prompt-based segmentation on three diverse public datasets. Moreover, an UltraSam-initialized Vision Transformer surpasses ImageNet-, SAM-, and MedSAM-initialized models in various downstream segmentation and classification tasks, highlighting UltraSam's effectiveness as a foundation model. Conclusion: We compile US-43d, a large-scale unified ultrasound dataset, and introduce UltraSam, a powerful multi-purpose SAM-style model for ultrasound images. We release our code and pretrained models at https://github.com/CAMMA-public/UltraSam and invite the community to further this effort by contributing high-quality datasets.

CycleSAM: One-Shot Surgical Scene Segmentation using Cycle-Consistent Feature Matching to Prompt SAM

The recently introduced Segment-Anything Model (SAM) has the potential to greatly accelerate the development of segmentation models. However, directly applying SAM to surgical images has key limitations including (1) the requirement of image-specific prompts at test-time, thereby preventing fully automated segmentation, and (2) ineffectiveness due to substantial domain gap between natural and surgical images. In this work, we propose CycleSAM, an approach for one-shot surgical scene segmentation that uses the training image-mask pair at test-time to automatically identify points in the test images that correspond to each object class, which can then be used to prompt SAM to produce object masks. To produce high-fidelity matches, we introduce a novel spatial cycle-consistency constraint that enforces point proposals in the test image to rematch to points within the object foreground region in the training image. Then, to address the domain gap, rather than directly using the visual features from SAM, we employ a ResNet50 encoder pretrained on surgical images in a self-supervised fashion, thereby maintaining high label-efficiency. We evaluate CycleSAM for one-shot segmentation on two diverse surgical semantic segmentation datasets, comprehensively outperforming baseline approaches and reaching up to 50% of fully-supervised performance.

Overcoming Dimensional Collapse in Self-supervised Contrastive Learning for Medical Image Segmentation

Self-supervised learning (SSL) approaches have achieved great success when the amount of labeled data is limited. Within SSL, models learn robust feature representations by solving pretext tasks. One such pretext task is contrastive learning, which involves forming pairs of similar and dissimilar input samples, guiding the model to distinguish between them. In this work, we investigate the application of contrastive learning to the domain of medical image analysis. Our findings reveal that MoCo v2, a state-of-the-art contrastive learning method, encounters dimensional collapse when applied to medical images. This is attributed to the high degree of inter-image similarity shared between the medical images. To address this, we propose two key contributions: local feature learning and feature decorrelation. Local feature learning improves the ability of the model to focus on the local regions of the image, while feature decorrelation removes the linear dependence among the features. Our experimental findings demonstrate that our contributions significantly enhance the model's performance in the downstream task of medical segmentation, both in the linear evaluation and full fine-tuning settings. This work illustrates the importance of effectively adapting SSL techniques to the characteristics of medical imaging tasks. The source code will be made publicly available at: https://github.com/CAMMA-public/med-moco

The Endoscapes Dataset for Surgical Scene Segmentation, Object Detection, and Critical View of Safety Assessment: Official Splits and Benchmark

This technical report provides a detailed overview of Endoscapes, a dataset of laparoscopic cholecystectomy (LC) videos with highly intricate annotations targeted at automated assessment of the Critical View of Safety (CVS). Endoscapes comprises 201 LC videos with frames annotated sparsely but regularly with segmentation masks, bounding boxes, and CVS assessment by three different clinical experts. Altogether, there are 11090 frames annotated with CVS and 1933 frames annotated with tool and anatomy bounding boxes from the 201 videos, as well as an additional 422 frames from 50 of the 201 videos annotated with tool and anatomy segmentation masks. In this report, we provide detailed dataset statistics (size, class distribution, dataset splits, etc.) and a comprehensive performance benchmark for instance segmentation, object detection, and CVS prediction. The dataset and model checkpoints are publically available at https://github.com/CAMMA-public/Endoscapes.

ST(OR)2: Spatio-Temporal Object Level Reasoning for Activity Recognition in the Operating Room

Surgical robotics holds much promise for improving patient safety and clinician experience in the Operating Room (OR). However, it also comes with new challenges, requiring strong team coordination and effective OR management. Automatic detection of surgical activities is a key requirement for developing AI-based intelligent tools to tackle these challenges. The current state-of-the-art surgical activity recognition methods however operate on image-based representations and depend on large-scale labeled datasets whose collection is time-consuming and resource-expensive. This work proposes a new sample-efficient and object-based approach for surgical activity recognition in the OR. Our method focuses on the geometric arrangements between clinicians and surgical devices, thus utilizing the significant object interaction dynamics in the OR. We conduct experiments in a low-data regime study for long video activity recognition. We also benchmark our method againstother object-centric approaches on clip-level action classification and show superior performance.

Challenges in Multi-centric Generalization: Phase and Step Recognition in Roux-en-Y Gastric Bypass Surgery

Most studies on surgical activity recognition utilizing Artificial intelligence (AI) have focused mainly on recognizing one type of activity from small and mono-centric surgical video datasets. It remains speculative whether those models would generalize to other centers. In this work, we introduce a large multi-centric multi-activity dataset consisting of 140 videos (MultiBypass140) of laparoscopic Roux-en-Y gastric bypass (LRYGB) surgeries performed at two medical centers: the University Hospital of Strasbourg (StrasBypass70) and Inselspital, Bern University Hospital (BernBypass70). The dataset has been fully annotated with phases and steps. Furthermore, we assess the generalizability and benchmark different deep learning models in 7 experimental studies: 1) Training and evaluation on BernBypass70; 2) Training and evaluation on StrasBypass70; 3) Training and evaluation on the MultiBypass140; 4) Training on BernBypass70, evaluation on StrasBypass70; 5) Training on StrasBypass70, evaluation on BernBypass70; Training on MultiBypass140, evaluation 6) on BernBypass70 and 7) on StrasBypass70. The model's performance is markedly influenced by the training data. The worst results were obtained in experiments 4) and 5) confirming the limited generalization capabilities of models trained on mono-centric data. The use of multi-centric training data, experiments 6) and 7), improves the generalization capabilities of the models, bringing them beyond the level of independent mono-centric training and validation (experiments 1) and 2)). MultiBypass140 shows considerable variation in surgical technique and workflow of LRYGB procedures between centers. Therefore, generalization experiments demonstrate a remarkable difference in model performance. These results highlight the importance of multi-centric datasets for AI model generalization to account for variance in surgical technique and workflows.

Encoding Surgical Videos as Latent Spatiotemporal Graphs for Object and Anatomy-Driven Reasoning

Recently, spatiotemporal graphs have emerged as a concise and elegant manner of representing video clips in an object-centric fashion, and have shown to be useful for downstream tasks such as action recognition. In this work, we investigate the use of latent spatiotemporal graphs to represent a surgical video in terms of the constituent anatomical structures and tools and their evolving properties over time. To build the graphs, we first predict frame-wise graphs using a pre-trained model, then add temporal edges between nodes based on spatial coherence and visual and semantic similarity. Unlike previous approaches, we incorporate long-term temporal edges in our graphs to better model the evolution of the surgical scene and increase robustness to temporary occlusions. We also introduce a novel graph-editing module that incorporates prior knowledge and temporal coherence to correct errors in the graph, enabling improved downstream task performance. Using our graph representations, we evaluate two downstream tasks, critical view of safety prediction and surgical phase recognition, obtaining strong results that demonstrate the quality and flexibility of the learned representations. Code is available at github.com/CAMMA-public/SurgLatentGraph.