Cancer remains a significant health challenge worldwide, with a new diagnosis occurring every two minutes in the UK. Surgery is one of the main treatment options for cancer. However, surgeons rely on the sense of touch and naked eye with limited use of pre-operative image data to directly guide the excision of cancerous tissues and metastases due to the lack of reliable intraoperative visualisation tools. This leads to increased costs and harm to the patient where the cancer is removed with positive margins, or where other critical structures are unintentionally impacted. There is therefore a pressing need for more reliable and accurate intraoperative visualisation tools for minimally invasive surgery to improve surgical outcomes and enhance patient care. A recent miniaturised cancer detection probe (i.e., SENSEI developed by Lightpoint Medical Ltd.) leverages the cancer-targeting ability of nuclear agents to more accurately identify cancer intra-operatively using the emitted gamma signal. However, the use of this probe presents a visualisation challenge as the probe is non-imaging and is air-gapped from the tissue, making it challenging for the surgeon to locate the probe-sensing
This paper focuses on the design of a parallel robot designed for robotic assisted minimally invasive pancreatic surgery. Two alternative architectures, called ATHENA-1 and ATHENA-2, each with 4 degrees of freedom (DOF) are proposed. Their kinematic schemes are presented, and the conceptual 3D CAD models are illustrated. Based on these, two Finite Element Method (FEM) simulations were performed to determine which architecture has the higher stiffness. A workspace quantitative analysis is performed to further assess the usability of the two proposed parallel architectures related to the medical tasks. The obtained results are used to select the architecture which fit the required design criteria and will be used to develop the experimental model of the surgical robot.
Minimally invasive colorectal surgery is characterized by procedural variability, a difficult learning curve, and complications that impact quality and outcomes. Video-based assessment (VBA) offers an opportunity to generate data-driven insights to reduce variability, optimize training, and improve surgical performance. However, existing tools for workflow analysis remain difficult to standardize and implement. This study aims to develop and validate a VBA tool for workflow analysis across minimally invasive colorectal procedures. A Delphi process was conducted to achieve consensus on generalizable workflow descriptors. The resulting framework informed the development of a new VBA tool, ColoWorkflow. Independent raters then applied ColoWorkflow to a multicentre video dataset of laparoscopic and robotic colorectal surgery (CRS). Applicability and inter-rater reliability were evaluated. Consensus was achieved for 10 procedure-agnostic phases and 34 procedure-specific steps describing CRS workflows. ColoWorkflow was developed and applied to 54 colorectal operative videos (left and right hemicolectomies, sigmoid and rectosigmoid resections, and total proctocolectomies) from five centre
Effective force modulation during tissue manipulation is important for ensuring safe robot-assisted minimally invasive surgery (RMIS). Strict requirements for in-vivo distal force sensing have led to prior sensor designs that trade off ease of manufacture and integration against force measurement accuracy along the tool axis. These limitations have made collecting high-quality 3-degree-of-freedom (3-DoF) bimanual force data in RMIS inaccessible to researchers. We present a modular and manufacturable 3-DoF force sensor that integrates easily with an existing RMIS tool. We achieve this by relaxing biocompatibility and sterilizability requirements while utilizing commercial load cells and common electromechanical fabrication techniques. The sensor has a range of +-5 N axially and +-3 N laterally with average root mean square errors(RMSEs) of below 0.15 N in all directions. During teleoperated mock tissue manipulation tasks, a pair of jaw-mounted sensors achieved average RMSEs of below 0.15 N in all directions. For grip force, it achieved an RMSE of 0.156 N. The sensor has sufficient accuracy within the range of forces found in delicate manipulation tasks, with potential use in bimanua
Precisely determining the contact force during safe interaction in Minimally Invasive Robotic Surgery (MIRS) is still an open research challenge. Inspired by post-operative qualitative analysis from surgical videos, the use of cross-modality data driven deep neural network models has been one of the newest approaches to predict sensorless force trends. However, these methods required for large and variable datasets which are not currently available. In this paper, we present a new vision-haptic dataset (DaFoEs) with variable soft environments for the training of deep neural models. In order to reduce the bias from a single dataset, we present a pipeline to generalize different vision and state data inputs for mixed dataset training, using a previously validated dataset with different setup. Finally, we present a variable encoder-decoder architecture to predict the forces done by the laparoscopic tool using single input or sequence of inputs. For input sequence, we use a recurrent decoder, named with the prefix R, and a new temporal sampling to represent the acceleration of the tool. During our training, we demonstrate that single dataset training tends to overfit to the training da
We investigate grasping of rigid objects in unilateral robot-assisted minimally invasive surgery (RAMIS) in this paper. We define a human-centered transparency that quantifies natural action and perception in RAMIS. We demonstrate this human-centered transparency analysis for different values of gripper scaling - the scaling between the grasp aperture of the surgeon-side manipulator and the aperture of the surgical instrument grasper. Thirty-one participants performed teleoperated grasping and perceptual assessment of rigid objects in one of three gripper scaling conditions (fine, normal, and quick, trading off precision and responsiveness). Psychophysical analysis of the variability of maximal grasping aperture during prehension and of the reported size of the object revealed that in normal and quick (but not in the fine) gripper scaling conditions, teleoperated grasping with our system was similar to natural grasping, and therefore, human-centered transparent. We anticipate that using motor control and psychophysics for human-centered optimizing of teleoperation control will eventually improve the usability of RAMIS.
Control systems used in Minimally Invasive Surgery (MIS) play a crucial role in ensuring preci-sion and safety throughout procedures. This paper presents a control architecture developed for a robotic system designed for MIS operations. The modular structure of the control system allows for compatibility with a range of procedures in abdominal and thoracic regions. The proposed control system, employing the master-slave concept, is presented alongside the experimental model. Functional validation is obtained by performing a Siemens NX simulation and comparing the results with several experimental runs using the experimental model of the robot. With its compact size and stiffness, the system holds promise for integration with other robotic systems. Future efforts will be dedicated to exploring and optimizing this potential collaboration to enhance the overall capabilities of robotic-assisted surgery.
We compare the network of aggregated journal-journal citation relations provided by the Journal Citation Reports (JCR) 2012 of the Science and Social Science Citation Indexes (SCI and SSCI) with similar data based on Scopus 2012. First, global maps were developed for the two sets separately; sets of documents can then be compared using overlays to both maps. Using fuzzy-string matching and ISSN numbers, we were able to match 10,524 journal names between the two sets; that is, 96.4% of the 10,936 journals contained in JCR or 51.2% of the 20,554 journals covered by Scopus. Network analysis was then pursued on the set of journals shared between the two databases and the two sets of unique journals. Citations among the shared journals are more comprehensively covered in JCR than Scopus, so the network in JCR is denser and more connected than in Scopus. The ranking of shared journals in terms of indegree (that is, numbers of citing journals) or total citations is similar in both databases overall (Spearman's \r{ho} > 0.97), but some individual journals rank very differently. Journals that are unique to Scopus seem to be less important--they are citing shared journals rather than bein
Intraoperative segmentation and tracking of minimally invasive instruments is a prerequisite for computer- and robotic-assisted surgery. Since additional hardware like tracking systems or the robot encoders are cumbersome and lack accuracy, surgical vision is evolving as promising techniques to segment and track the instruments using only the endoscopic images. However, what is missing so far are common image data sets for consistent evaluation and benchmarking of algorithms against each other. The paper presents a comparative validation study of different vision-based methods for instrument segmentation and tracking in the context of robotic as well as conventional laparoscopic surgery. The contribution of the paper is twofold: we introduce a comprehensive validation data set that was provided to the study participants and present the results of the comparative validation study. Based on the results of the validation study, we arrive at the conclusion that modern deep learning approaches outperform other methods in instrument segmentation tasks, but the results are still not perfect. Furthermore, we show that merging results from different methods actually significantly increases
In this paper, we report our discovery of a gaze behavior called Quiet Eye (QE) in minimally invasive surgery. The QE behavior has been extensively studied in sports training and has been associated with higher level of expertise in multiple sports. We investigated the QE behavior in two independently collected data sets of surgeons performing tasks in a sinus surgery setting and a robotic surgery setting, respectively. Our results show that the QE behavior is more likely to occur in successful task executions and in performances of surgeons of high level of expertise. These results open the door to use the QE behavior in both training and skill assessment in minimally invasive surgery.
Flexible robots hold great promise for enhancing minimally invasive surgery (MIS) by providing superior dexterity, precise control, and safe tissue interaction. Yet, translating these advantages into endoscopic interventions within open cavities remains challenging. The lack of anatomical constraints and the inherent flexibility of such devices complicate their control, while the limited field of view of endoscopes restricts situational awareness. We present a robotic platform designed to overcome these challenges and demonstrate its potential in fetoscopic laser coagulation, a complex MIS procedure typically performed only by highly experienced surgeons. Our system combines a magnetically actuated flexible endoscope with teleoperated and semi-autonomous navigation capabilities for performing targeted laser ablations. To enhance surgical awareness, the platform reconstructs real-time mosaics of the endoscopic scene, providing an extended and continuous visual context. The ability of this system to address the key limitations of MIS in open spaces is validated in vivo in an ovine model.
Rankings of scholarly journals based on citation data are often met with skepticism by the scientific community. Part of the skepticism is due to disparity between the common perception of journals' prestige and their ranking based on citation counts. A more serious concern is the inappropriate use of journal rankings to evaluate the scientific influence of authors. This paper focuses on analysis of the table of cross-citations among a selection of Statistics journals. Data are collected from the Web of Science database published by Thomson Reuters. Our results suggest that modelling the exchange of citations between journals is useful to highlight the most prestigious journals, but also that journal citation data are characterized by considerable heterogeneity, which needs to be properly summarized. Inferential conclusions require care in order to avoid potential over-interpretation of insignificant differences between journal ratings. Comparison with published ratings of institutions from the UK's Research Assessment Exercise shows strong correlation at aggregate level between assessed research quality and journal citation `export scores' within the discipline of Statistics.
Purpose: Monocular depth estimation (MDE) is vital for scene understanding in minimally invasive surgery (MIS). However, endoscopic video sequences are often contaminated by smoke, specular reflections, blur, and occlusions, limiting the accuracy of MDE models. In addition, current MDE models do not output depth confidence, which could be a valuable tool for improving their clinical reliability. Methods: We propose a novel confidence-aware MDE framework featuring three significant contributions: (i) Calibrated confidence targets: an ensemble of fine-tuned stereo matching models is used to capture disparity variance into pixel-wise confidence probabilities; (ii) Confidence-aware loss: Baseline MDE models are optimized with confidence-aware loss functions, utilizing pixel-wise confidence probabilities such that reliable pixels dominate training; and (iii) Inference-time confidence: a confidence estimation head is proposed with two convolution layers to predict per-pixel confidence at inference, enabling assessment of depth reliability. Results: Comprehensive experimental validation across internal and public datasets demonstrates that our framework improves depth estimation accuracy
Objective: The computation of anatomical information and laparoscope position is a fundamental block of surgical navigation in Minimally Invasive Surgery (MIS). Recovering a dense 3D structure of surgical scene using visual cues remains a challenge, and the online laparoscopic tracking primarily relies on external sensors, which increases system complexity. Methods: Here, we propose a learning-driven framework, in which an image-guided laparoscopic localization with 3D reconstructions of complex anatomical structures is obtained. To reconstruct the 3D structure of the whole surgical environment, we first fine-tune a learning-based stereoscopic depth perception method, which is robust to the texture-less and variant soft tissues, for depth estimation. Then, we develop a dense visual reconstruction algorithm to represent the scene by surfels, estimate the laparoscope poses and fuse the depth maps into a unified reference coordinate for tissue reconstruction. To estimate poses of new laparoscope views, we achieve a coarse-to-fine localization method, which incorporates our reconstructed 3D model. Results: We evaluate the reconstruction method and the localization module on three datas
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.
A common limitation of autonomous tissue manipulation in robotic minimally invasive surgery (MIS) is the absence of force sensing and control at the tool level. Recently, our team has developed miniature force-sensing forceps that can simultaneously measure the grasping and pulling forces during tissue manipulation. Based on this design, here we further present a method to automate tissue traction that comprises grasping and pulling stages. During this process, the grasping and pulling forces can be controlled either separately or simultaneously through force decoupling. The force controller is built upon a static model of tissue manipulation, considering the interaction between the force-sensing forceps and soft tissue. The efficacy of this force control approach is validated through a series of experiments comparing targeted, estimated, and actual reference forces. To verify the feasibility of the proposed method in surgical applications, various tissue resections are conducted on ex vivo tissues employing a dual-arm robotic setup. Finally, we discuss the benefits of multi-force control in tissue traction, evidenced through comparative analyses of various ex vivo tissue resection
Background: Robot-assisted minimally invasive surgery (RMIS) research increasingly relies on multimodal data, yet access to proprietary robot telemetry remains a major barrier. We introduce MiDAS, an open-source, platform-agnostic system enabling time-synchronized, non-invasive multimodal data acquisition across surgical robotic platforms. Methods: MiDAS integrates electromagnetic and RGB-D hand tracking, foot pedal sensing, and surgical video capturing without requiring proprietary robot interfaces. We validated MiDAS on the open-source Raven-II and the clinical da Vinci Xi by collecting multimodal datasets of peg transfer and hernia repair suturing tasks performed by surgical residents. Correlation analysis and downstream gesture recognition experiments were conducted. Results: External hand and foot sensing closely approximated internal robot kinematics and non-invasive motion signals achieved gesture recognition performance comparable to proprietary telemetry. Conclusion: MiDAS enables reproducible multimodal RMIS data collection and is released with annotated datasets, including the first multimodal dataset capturing hernia repair suturing on high-fidelity simulation models.
We propose a new method for six-degree-of-freedom (6-DoF) autonomous camera movement for minimally invasive surgery, which, unlike previous methods, takes into account both the position and orientation information from structures in the surgical scene. In addition to locating the camera for a good view of the manipulated object, our autonomous camera takes into account workspace constraints, including the horizon and safety constraints. We developed a simulation environment to test our method on the "wire chaser" surgical training task from validated training curricula in conventional laparoscopy and robot-assisted surgery. Furthermore, we propose, for the first time, the application of the proposed autonomous camera method in video-based surgical skill assessment, an area where videos are typically recorded using fixed cameras. In a study with N=30 human subjects, we show that video examination of the autonomous camera view as it tracks the ring motion over the wire leads to more accurate user error (ring touching the wire) detection than when using a fixed camera view, or camera movement with a fixed orientation. Our preliminary work suggests that there are potential benefits to
Purpose: 3D reconstruction in minimally invasive surgery (MIS) enables enhanced surgical guidance through improved visualisation, tool tracking, and augmented reality. However, traditional RGB-based keypoint detection and matching pipelines struggle with surgical challenges, such as poor texture and complex illumination. We investigate whether using snapshot hyperspectral imaging (HSI) can provide improved results on keypoint detection and matching surgical scenes. Methods: We developed HyKey, a HYperspectral KEYpoint detection and description model made up of a hybrid 3D-2D convolutional neural network that jointly extracts spatial-spectral features from HSI. The model was trained using synthetic homographic augmentation and epipolar geometry constraints on a robotically-acquired dual-camera RGB-HSI laparoscopic dataset of ex-vivo organs with calibrated camera poses. We benchmarked performance against established RGB-based methods, including SuperPoint and ALIKE. Results: Our HSI-based model outperformed RGB baselines on registered RGB frames, achieving 96.62% mean matching accuracy and 67.18% mean average accuracy at 10 degree on pose estimation, demonstrating consistent improvem
Purpose: The facial recess is a delicate structure that must be protected in minimally invasive cochlear implant surgery. Current research estimates the drill trajectory by using endoscopy of the unique mastoid patterns. However, missing depth information limits available features for a registration to preoperative CT data. Therefore, this paper evaluates OCT for enhanced imaging of drill holes in mastoid bone and compares OCT data to original endoscopic images. Methods: A catheter-based OCT probe is inserted into a drill trajectory of a mastoid phantom in a translation-rotation manner to acquire the inner surface state. The images are undistorted and stitched to create volumentric data of the drill hole. The mastoid cell pattern is segmented automatically and compared to ground truth. Results: The mastoid pattern segmented on images acquired with OCT show a similarity of J = 73.6 % to ground truth based on endoscopic images and measured with the Jaccard metric. Leveraged by additional depth information, automated segmentation tends to be more robust and fail-safe compared to endoscopic images. Conclusion: The feasibility of using a clinically approved OCT probe for imaging the dri