Surgical Tool Segmentation Research Articles

Toward Intraoperative Visual Intelligence: Real-Time Surgical Instrument Segmentation for Enhanced Surgical Monitoring.

Open surgery relies heavily on the surgeon's visual acuity and spatial awareness to track instruments within a dynamic and often cluttered surgical field. This system utilizes a head-mounted depth camera to monitor surgical scenes, providing both image data and depth information. The video captured from this camera is scaled down, compressed using MPEG, and transmitted to a high-performance workstation via the RTSP (Real-Time Streaming Protocol), a reliable protocol designed for real-time media transmission. To segment surgical instruments, we utilize the enhanced U-Net with GridMask (EUGNet) for its proven effectiveness in surgical tool segmentation. For rigorous validation, the system's performance reliability and accuracy are evaluated using prerecorded RGB-D surgical videos. This work demonstrates the potential of this system to improve situational awareness, surgical efficiency, and generate data-driven insights within the operating room. In a simulated surgical environment, the system achieves a high accuracy of 85.5% in identifying and segmenting surgical instruments. Furthermore, the wireless video transmission proves reliable with a latency of 200 ms, suitable for real-time processing. These findings represent a promising step towards the development of assistive technologies with the potential to significantly enhance surgical practice.

Enhanced U-Net with GridMask (EUGNet): A Novel Approach for Robotic Surgical Tool Segmentation.

This study proposed enhanced U-Net with GridMask (EUGNet) image augmentation techniques focused on pixel manipulation, emphasizing GridMask augmentation. This study introduces EUGNet, which incorporates GridMask augmentation to address U-Net's limitations. EUGNet features a deep contextual encoder, residual connections, class-balancing loss, adaptive feature fusion, GridMask augmentation module, efficient implementation, and multi-modal fusion. These innovations enhance segmentation accuracy and robustness, making it well-suited for medical image analysis. The GridMask algorithm is detailed, demonstrating its distinct approach to pixel elimination, enhancing model adaptability to occlusions and local features. A comprehensive dataset of robotic surgical scenarios and instruments is used for evaluation, showcasing the framework's robustness. Specifically, there are improvements of 1.6 percentage points in balanced accuracy for the foreground, 1.7 points in intersection over union (IoU), and 1.7 points in mean Dice similarity coefficient (DSC). These improvements are highly significant and have a substantial impact on inference speed. The inference speed, which is a critical factor in real-time applications, has seen a noteworthy reduction. It decreased from 0.163 milliseconds for the U-Net without GridMask to 0.097 milliseconds for the U-Net with GridMask.

SurgT challenge: Benchmark of soft-tissue trackers for robotic surgery

This paper introduces the “SurgT: Surgical Tracking” challenge which was organized in conjunction with the 25th International Conference on Medical Image Computing and Computer-Assisted Intervention (MICCAI 2022). There were two purposes for the creation of this challenge: (1) the establishment of the first standardized 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/. This challenge is expected to contribute to the development of autonomous robotic surgery and other digital surgical technologies.

Min-Max Similarity: A Contrastive Semi-Supervised Deep Learning Network for Surgical Tools Segmentation.

A common problem with segmentation of medical images using neural networks is the difficulty to obtain a significant number of pixel-level annotated data for training. To address this issue, we proposed a semi-supervised segmentation network based on contrastive learning. In contrast to the previous state-of-the-art, we introduce Min-Max Similarity (MMS), a contrastive learning form of dual-view training by employing classifiers and projectors to build all-negative, and positive and negative feature pairs, respectively, to formulate the learning as solving a MMS problem. The all-negative pairs are used to supervise the networks learning from different views and to capture general features, and the consistency of unlabeled predictions is measured by pixel-wise contrastive loss between positive and negative pairs. To quantitatively and qualitatively evaluate our proposed method, we test it on four public endoscopy surgical tool segmentation datasets and one cochlear implant surgery dataset, which we manually annotated. Results indicate that our proposed method consistently outperforms state-of-the-art semi-supervised and fully supervised segmentation algorithms. And our semi-supervised segmentation algorithm can successfully recognize unknown surgical tools and provide good predictions. Also, our MMS approach could achieve inference speeds of about 40 frames per second (fps) and is suitable to deal with the real-time video segmentation.

Surgical Tool Segmentation with Pose-Informed Morphological Polar Transform of Endoscopic Images

This paper presents a tool-pose-informed variable center morphological polar transform to enhance segmentation of endoscopic images. The representation, while not loss-less, transforms rigid tool shapes into morphologies consistently more rectangular that may be more amenable to image segmentation networks. The proposed method was evaluated using the U-Net convolutional neural network, and the input images from endoscopy were represented in one of the four different coordinate formats (1) the original rectangular image representation, (2) the morphological polar coordinate transform, (3) the proposed variable center transform about the tool-tip pixel and (4) the proposed variable center transform about the tool vanishing point pixel. Previous work relied on the observations that endoscopic images typically exhibit unused border regions with content in the shape of a circle (since the image sensor is designed to be larger than the image circle to maximize available visual information in the constrained environment) and that the region of interest (ROI) was most ideally near the endoscopic image center. That work sought an intelligent method for, given an input image, carefully selecting between methods (1) and (2) for best image segmentation prediction. In this extension, the image center reference constraint for polar transformation in method (2) is relaxed via the development of a variable center morphological transformation. Transform center selection leads to different spatial distributions of image loss, and the transform-center location can be informed by robot kinematic model and endoscopic image data. In particular, this work is examined using the tool-tip and tool vanishing point on the image plane as candidate centers. The experiments were conducted for each of the four image representations using a data set of 8360 endoscopic images from real sinus surgery. The segmentation performance was evaluated with standard metrics, and some insight about loss and tool location effects on performance are provided. Overall, the results are promising, showing that selecting a transform center based on tool shape features using the proposed method can improve segmentation performance.

Simultaneous Depth Estimation and Surgical Tool Segmentation in Laparoscopic Images.

Surgical instrument segmentation and depth estimation are crucial steps to improve autonomy in robotic surgery. Most recent works treat these problems separately, making the deployment challenging. In this paper, we propose a unified framework for depth estimation and surgical tool segmentation in laparoscopic images. The network has an encoder-decoder architecture and comprises two branches for simultaneously performing depth estimation and segmentation. To train the network end to end, we propose a new multi-task loss function that effectively learns to estimate depth in an unsupervised manner, while requiring only semi-ground truth for surgical tool segmentation. We conducted extensive experiments on different datasets to validate these findings. The results showed that the end-to-end network successfully improved the state-of-the-art for both tasks while reducing the complexity during their deployment.

Robotic Endoscope Control Via Autonomous Instrument Tracking

Many keyhole interventions rely on bi-manual handling of surgical instruments, forcing the main surgeon to rely on a second surgeon to act as a camera assistant. In addition to the burden of excessively involving surgical staff, this may lead to reduced image stability, increased task completion time and sometimes errors due to the monotony of the task. Robotic endoscope holders, controlled by a set of basic instructions, have been proposed as an alternative, but their unnatural handling may increase the cognitive load of the (solo) surgeon, which hinders their clinical acceptance. More seamless integration in the surgical workflow would be achieved if robotic endoscope holders collaborated with the operating surgeon via semantically rich instructions that closely resemble instructions that would otherwise be issued to a human camera assistant, such as “focus on my right-hand instrument.” As a proof of concept, this paper presents a novel system that paves the way towards a synergistic interaction between surgeons and robotic endoscope holders. The proposed platform allows the surgeon to perform a bimanual coordination and navigation task, while a robotic arm autonomously performs the endoscope positioning tasks. Within our system, we propose a novel tooltip localization method based on surgical tool segmentation and a novel visual servoing approach that ensures smooth and appropriate motion of the endoscope camera. We validate our vision pipeline and run a user study of this system. The clinical relevance of the study is ensured through the use of a laparoscopic exercise validated by the European Academy of Gynaecological Surgery which involves bi-manual coordination and navigation. Successful application of our proposed system provides a promising starting point towards broader clinical adoption of robotic endoscope holders.

Surgical Tool Segmentation Using Generative Adversarial Networks With Unpaired Training Data

Surgical tool segmentation is a challenging and crucial task for computer and robot-assisted surgery. Supervised learning approaches have shown great success for this task. However, they need a large number of paired training data. Based on Generative Adversarial Networks (GAN), unpaired image-to-image translation (I2I) techniques (like CycleGAN and dualGAN) have been proposed to avoid the requirement of paired data and have been employed for surgical tool segmentation. The unpaired I2I methods avoid annotating images for domain changes. Instead of using them directly for the segmentation task, we propose new GAN-based methods for unpaired I2I by embedding a specific constraint for segmentation, namely each pixel of input image belongs to either background or surgical tool. Our methods simplify the architectures of existing unpaired I2I with a reduced number of generators and discriminators. Compared with dualGAN, the proposed strategies have a faster training process without reducing the accuracy of the segmentation. Besides, we show that, using textured tool images as annotated samples to train discriminators, unpaired I2I (including our methods) can achieve simultaneous tool image segmentation and repair (such as reflection removal and tool inpainting). The proposed strategies are validated for image segmentation of a flexible tool and for in vivo images from the EndoVis dataset.

Video recognition of simple mastoidectomy using convolutional neural networks: Detection and segmentation of surgical tools and anatomical regions

A simple mastoidectomy is used to remove inflammation of the mastoid cavity and to create a route to the skull base and middle ear. However, due to the complexity and difficulty of the simple mastoidectomy, implementing robot vision for assisted surgery is a challenge. To overcome this issue using a convolutional neural network architecture in a surgical environment, each surgical instrument and anatomical region must be distinguishable in real time. To meet this condition, we used the latest instance segmentation architecture, YOLACT. In this study, a data set comprising 5,319 extracted frames from 70 simple mastoidectomy surgery videos were used. Six surgical tools and five anatomic regions were identified for the training. The YOLACT-based model in the surgical environment was trained and evaluated for real-time object detection and semantic segmentation. Detection accuracies of surgical tools and anatomic regions were 91.2% and 56.5% in mean average precision, respectively. Additionally, the dice similarity coefficient metric for segmentation of the five anatomic regions was 48.2%. The mean frames per second of this model was 32.3, which is sufficient for real-time robotic applications.

Segmentation and Removal of Surgical Instruments for Background Scene Visualization from Endoscopic / Laparoscopic Video.

Surgical tool segmentation is becoming imperative to provide detailed information during intra-operative execution. These tools can obscure surgeons' dexterity control due to narrow working space and visual field-of-view, which increases the risk of complications resulting from tissue injuries (e.g. tissue scars and tears). This paper demonstrates a novel application of segmenting and removing surgical instruments from laparoscopic/endoscopic video using digital inpainting algorithms. To segment the surgical instruments, we use a modified U-Net architecture (U-NetPlus) composed of a pre-trained VGG11 or VGG16 encoder and redesigned decoder. The decoder is modified by replacing the transposed convolution operation with an up-sampling operation based on nearest-neighbor (NN) interpolation. This modification removes the artifacts generated by the transposed convolution, and, furthermore, these new interpolation weights require no learning for the upsampling operation. The tool removal algorithms use the tool segmentation mask and either the instrument-free reference frames or previous instrument-containing frames to fill-in (i.e., inpaint) the instrument segmentation mask with the background tissue underneath. We have demonstrated the performance of the proposed surgical tool segmentation/removal algorithms on a robotic instrument dataset from the MICCAI 2015 EndoVis Challenge. We also showed successful performance of the tool removal algorithm from synthetically generated surgical instruments-containing videos obtained by embedding a moving surgical tool into surgical tool-free videos. Our application successfully segments and removes the surgical tool to unveil the background tissue view otherwise obstructed by the tool, producing visually comparable results to the ground truth.

Image Compositing for Segmentation of Surgical Tools Without Manual Annotations.

Producing manual, pixel-accurate, image segmentation labels is tedious and time-consuming. This is often a rate-limiting factor when large amounts of labeled images are required, such as for training deep convolutional networks for instrument-background segmentation in surgical scenes. No large datasets comparable to industry standards in the computer vision community are available for this task. To circumvent this problem, we propose to automate the creation of a realistic training dataset by exploiting techniques stemming from special effects and harnessing them to target training performance rather than visual appeal. Foreground data is captured by placing sample surgical instruments over a chroma key (a.k.a. green screen) in a controlled environment, thereby making extraction of the relevant image segment straightforward. Multiple lighting conditions and viewpoints can be captured and introduced in the simulation by moving the instruments and camera and modulating the light source. Background data is captured by collecting videos that do not contain instruments. In the absence of pre-existing instrument-free background videos, minimal labeling effort is required, just to select frames that do not contain surgical instruments from videos of surgical interventions freely available online. We compare different methods to blend instruments over tissue and propose a novel data augmentation approach that takes advantage of the plurality of options. We show that by training a vanilla U-Net on semi-synthetic data only and applying a simple post-processing, we are able to match the results of the same network trained on a publicly available manually labeled real dataset.

Weakly supervised segmentation for real-time surgical tool tracking.

Surgical tool tracking has a variety of applications in different surgical scenarios. Electromagnetic (EM) tracking can be utilised for tool tracking, but the accuracy is often limited by magnetic interference. Vision-based methods have also been suggested; however, tracking robustness is limited by specular reflection, occlusions, and blurriness observed in the endoscopic image. Recently, deep learning-based methods have shown competitive performance on segmentation and tracking of surgical tools. The main bottleneck of these methods lies in acquiring a sufficient amount of pixel-wise, annotated training data, which demands substantial labour costs. To tackle this issue, the authors propose a weakly supervised method for surgical tool segmentation and tracking based on hybrid sensor systems. They first generate semantic labellings using EM tracking and laparoscopic image processing concurrently. They then train a light-weight deep segmentation network to obtain a binary segmentation mask that enables tool tracking. To the authors’ knowledge, the proposed method is the first to integrate EM tracking and laparoscopic image processing for generation of training labels. They demonstrate that their framework achieves accurate, automatic tool segmentation (i.e. without any manual labelling of the surgical tool to be tracked) and robust tool tracking in laparoscopic image sequences.

Robot-Assisted Training in Laparoscopy Using Deep Reinforcement Learning

Minimally invasive surgery (MIS) is increasingly becoming a vital method of reducing surgical trauma and significantly improving postoperative recovery. However, skillful handling of surgical instruments used in MIS, especially for laparoscopy, requires a long period of training and depends highly on the experience of surgeons. This letter presents a new robot-assisted surgical training system which is designed to improve the practical skills of surgeons through intrapractice feedback and demonstration from both human experts and reinforcement learning (RL) agents. This system utilizes proximal policy optimization to learn the control policy in simulation. Subsequently, a generative adversarial imitation learning agent is trained based on both expert demonstrations and learned policies in simulation. This agent then generates demonstration policies on the robot-assisted device for trainees and produces feedback scores during practice. To further acquire surgical tools coordinates and encourage self-oriented practice, a mask region-based convolution neural network is trained to perform the semantic segmentation of surgical tools and targets. To the best of our knowledge, this system is the first robot-assisted laparoscopy training system which utilizes actual surgical tools and leverages deep reinforcement learning to provide demonstration training from both human expert perspectives and RL criterion.

Detection and correction of specular reflections for automatic surgical tool segmentation in thoracoscopic images

This paper presents an algorithm that automatically detects and corrects specular reflections in thoracoscopic images and its application in the context of automatic segmentation of surgical tools. The detection is done by isolating the spike component of the specular reflection which is characterized by a bump at the end of the histogram of thoracoscopic images. The specular lobe is then extracted in the neighborhood of the spike component of the reflection. The result is a mask of the reflections positions in the image. Thereafter, the image is corrected using Oliveira et al.’s digital inpainting method. The automatic segmentation of surgical tools using the corrected images is then demonstrated. Results of the segmentation with and without the specular reflection elimination technique are compared. Moreover, 108 images extracted from 5 different surgeries performed under various conditions were considered to demonstrate the effectiveness of the proposed technique.