From Monocular Vision to Autonomous Action: Guiding Tumor Resection via 3D Reconstruction

Surgical automation requires precise guidance and understanding of the scene. Current methods in the literature rely on bulky depth cameras to create maps of the anatomy, however this does not translate well to space-limited clinical applications. Monocular cameras are small and allow minimally invasive surgeries in tight spaces but additional processing is required to generate 3D scene understanding. We propose a 3D mapping pipeline that uses only RGB images to create segmented point clouds of the target anatomy. To ensure the most precise reconstruction, we compare different structure from motion algorithms' performance on mapping the central airway obstructions, and test the pipeline on a downstream task of tumor resection. In several metrics, including post-procedure tissue model evaluation, our pipeline performs comparably to RGB-D cameras and, in some cases, even surpasses their performance. These promising results demonstrate that automation guidance can be achieved in minimally invasive procedures with monocular cameras. This study is a step toward the complete autonomy of surgical robots.

Surgical Gaussian Surfels: Highly Accurate Real-time Surgical Scene Rendering

Accurate geometric reconstruction of deformable tissues in monocular endoscopic video remains a fundamental challenge in robot-assisted minimally invasive surgery. Although recent volumetric and point primitive methods based on neural radiance fields (NeRF) and 3D Gaussian primitives have efficiently rendered surgical scenes, they still struggle with handling artifact-free tool occlusions and preserving fine anatomical details. These limitations stem from unrestricted Gaussian scaling and insufficient surface alignment constraints during reconstruction. To address these issues, we introduce Surgical Gaussian Surfels (SGS), which transforms anisotropic point primitives into surface-aligned elliptical splats by constraining the scale component of the Gaussian covariance matrix along the view-aligned axis. We predict accurate surfel motion fields using a lightweight Multi-Layer Perceptron (MLP) coupled with locality constraints to handle complex tissue deformations. We use homodirectional view-space positional gradients to capture fine image details by splitting Gaussian Surfels in over-reconstructed regions. In addition, we define surface normals as the direction of the steepest density change within each Gaussian surfel primitive, enabling accurate normal estimation without requiring monocular normal priors. We evaluate our method on two in-vivo surgical datasets, where it outperforms current state-of-the-art methods in surface geometry, normal map quality, and rendering efficiency, while remaining competitive in real-time rendering performance. We make our code available at https://github.com/aloma85/SurgicalGaussianSurfels

Towards Fluorescence-Guided Autonomous Robotic Partial Nephrectomy on Novel Tissue-Mimicking Hydrogel Phantoms

Autonomous robotic systems hold potential for improving renal tumor resection accuracy and patient outcomes. We present a fluorescence-guided robotic system capable of planning and executing incision paths around exophytic renal tumors with a clinically relevant resection margin. Leveraging point cloud observations, the system handles irregular tumor shapes and distinguishes healthy from tumorous tissue based on near-infrared imaging, akin to indocyanine green staining in partial nephrectomy. Tissue-mimicking phantoms are crucial for the development of autonomous robotic surgical systems for interventions where acquiring ex-vivo animal tissue is infeasible, such as cancer of the kidney and renal pelvis. To this end, we propose novel hydrogel-based kidney phantoms with exophytic tumors that mimic the physical and visual behavior of tissue, and are compatible with electrosurgical instruments, a common limitation of silicone-based phantoms. In contrast to previous hydrogel phantoms, we mix the material with near-infrared dye to enable fluorescence-guided tumor segmentation. Autonomous real-world robotic experiments validate our system and phantoms, achieving an average margin accuracy of 1.44 mm in a completion time of 69 sec.

LUDO: Low-Latency Understanding of Highly Deformable Objects using Point Cloud Occupancy Functions

Accurately determining the shape and location of internal structures within deformable objects is crucial for medical tasks that require precise targeting, such as robotic biopsies. We introduce LUDO, a method for accurate low-latency understanding of deformable objects. LUDO reconstructs objects in their deformed state, including their internal structures, from a single-view point cloud observation in under 30 ms using occupancy networks. We demonstrate LUDO's abilities for autonomous targeting of internal regions of interest (ROIs) in highly deformable objects. Additionally, LUDO provides uncertainty estimates and explainability for its predictions, both of which are important in safety-critical applications such as surgical interventions. We evaluate LUDO in real-world robotic experiments, achieving a success rate of 98.9% for puncturing various ROIs inside highly deformable objects. LUDO demonstrates the potential to interact with deformable objects without the need for deformable registration methods.

Sim-To-Real Transfer for Visual Reinforcement Learning of Deformable Object Manipulation for Robot-Assisted Surgery

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.

Movement Primitive Diffusion: Learning Gentle Robotic Manipulation of Deformable Objects

Policy learning in robot-assisted surgery (RAS) lacks data efficient and versatile methods that exhibit the desired motion quality for delicate surgical interventions. To this end, we introduce Movement Primitive Diffusion (MPD), a novel method for imitation learning (IL) in RAS that focuses on gentle manipulation of deformable objects. The approach combines the versatility of diffusion-based imitation learning (DIL) with the high-quality motion generation capabilities of Probabilistic Dynamic Movement Primitives (ProDMPs). This combination enables MPD to achieve gentle manipulation of deformable objects, while maintaining data efficiency critical for RAS applications where demonstration data is scarce. We evaluate MPD across various simulated tasks and a real world robotic setup on both state and image observations. MPD outperforms state-of-the-art DIL methods in success rate, motion quality, and data efficiency.

Registered and Segmented Deformable Object Reconstruction from a Single View Point Cloud

In deformable object manipulation, we often want to interact with specific segments of an object that are only defined in non-deformed models of the object. We thus require a system that can recognize and locate these segments in sensor data of deformed real world objects. This is normally done using deformable object registration, which is problem specific and complex to tune. Recent methods utilize neural occupancy functions to improve deformable object registration by registering to an object reconstruction. Going one step further, we propose a system that in addition to reconstruction learns segmentation of the reconstructed object. As the resulting output already contains the information about the segments, we can skip the registration process. Tested on a variety of deformable objects in simulation and the real world, we demonstrate that our method learns to robustly find these segments. We also introduce a simple sampling algorithm to generate better training data for occupancy learning.

Grounding Graph Network Simulators using Physical Sensor Observations

Physical simulations that accurately model reality are crucial for many engineering disciplines such as mechanical engineering and robotic motion planning. In recent years, learned Graph Network Simulators produced accurate mesh-based simulations while requiring only a fraction of the computational cost of traditional simulators. Yet, the resulting predictors are confined to learning from data generated by existing mesh-based simulators and thus cannot include real world sensory information such as point cloud data. As these predictors have to simulate complex physical systems from only an initial state, they exhibit a high error accumulation for long-term predictions. In this work, we integrate sensory information to ground Graph Network Simulators on real world observations. In particular, we predict the mesh state of deformable objects by utilizing point cloud data. The resulting model allows for accurate predictions over longer time horizons, even under uncertainties in the simulation, such as unknown material properties. Since point clouds are usually not available for every time step, especially in online settings, we employ an imputation-based model. The model can make use of such additional information only when provided, and resorts to a standard Graph Network Simulator, otherwise. We experimentally validate our approach on a suite of prediction tasks for mesh-based interactions between soft and rigid bodies. Our method results in utilization of additional point cloud information to accurately predict stable simulations where existing Graph Network Simulators fail.

LapGym -- An Open Source Framework for Reinforcement Learning in Robot-Assisted Laparoscopic Surgery

Recent advances in reinforcement learning (RL) have increased the promise of introducing cognitive assistance and automation to robot-assisted laparoscopic surgery (RALS). However, progress in algorithms and methods depends on the availability of standardized learning environments that represent skills relevant to RALS. We present LapGym, a framework for building RL environments for RALS that models the challenges posed by surgical tasks, and sofa_env, a diverse suite of 12 environments. Motivated by surgical training, these environments are organized into 4 tracks: Spatial Reasoning, Deformable Object Manipulation & Grasping, Dissection, and Thread Manipulation. Each environment is highly parametrizable for increasing difficulty, resulting in a high performance ceiling for new algorithms. We use Proximal Policy Optimization (PPO) to establish a baseline for model-free RL algorithms, investigating the effect of several environment parameters on task difficulty. Finally, we show that many environments and parameter configurations reflect well-known, open problems in RL research, allowing researchers to continue exploring these fundamental problems in a surgical context. We aim to provide a challenging, standard environment suite for further development of RL for RALS, ultimately helping to realize the full potential of cognitive surgical robotics. LapGym is publicly accessible through GitHub (https://github.com/ScheiklP/lap_gym).

Cooperative Assistance in Robotic Surgery through Multi-Agent Reinforcement Learning

Cognitive cooperative assistance in robot-assisted surgery holds the potential to increase quality of care in minimally invasive interventions. Automation of surgical tasks promises to reduce the mental exertion and fatigue of surgeons. In this work, multi-agent reinforcement learning is demonstrated to be robust to the distribution shift introduced by pairing a learned policy with a human team member. Multi-agent policies are trained directly from images in simulation to control multiple instruments in a sub task of the minimally invasive removal of the gallbladder. These agents are evaluated individually and in cooperation with humans to demonstrate their suitability as autonomous assistants. Compared to human teams, the hybrid teams with artificial agents perform better considering completion time (44.4% to 71.2% shorter) as well as number of collisions (44.7% to 98.0% fewer). Path lengths, however, increase under control of an artificial agent (11.4% to 33.5% longer). A multi-agent formulation of the learning problem was favored over a single-agent formulation on this surgical sub task, due to the sequential learning of the two instruments. This approach may be extended to other tasks that are difficult to formulate within the standard reinforcement learning framework. Multi-agent reinforcement learning may shift the paradigm of cognitive robotic surgery towards seamless cooperation between surgeons and assistive technologies.