Spatial-temporal attention for video-based assessment of intraoperative surgical skill.

Accurate, unbiased, and reproducible assessment of skill is a vital resource for surgeons throughout their career. The objective in this research is to develop and validate algorithms for video-based assessment of intraoperative surgical skill. Algorithms to classify surgical video into expert or novice categories provide a summative assessment of skill, which is useful for evaluating surgeons at discrete time points in their training or certification of surgeons.

OneSLAM to map them all: a generalized approach to SLAM for monocular endoscopic imaging based on tracking any point.

Purpose: Monocular SLAM algorithms are the key enabling technology for image-based surgical navigation systems for endoscopic procedures. Due to the visual feature scarcity and unique lighting conditions encountered in endoscopy, classical SLAM approaches perform inconsistently. Many of the recent approaches to endoscopic SLAM rely on deep learning models.

An endoscopic chisel: intraoperative imaging carves 3D anatomical models.

Purpose: Preoperative imaging plays a pivotal role in sinus surgery where CTs offer patient-specific insights of complex anatomy, enabling real-time intraoperative navigation to complement endoscopy imaging. However, surgery elicits anatomical changes not represented in the preoperative model, generating an inaccurate basis for navigation during surgery progression.

Methods: We propose a first vision-based approach to update the preoperative 3D anatomical model leveraging intraoperative endoscopic video for navigated sinus surgery where relative camera poses are known.

Correcting for Rater Effects in Operating Room Surgical Skills Assessment.

Objective: To estimate and adjust for rater effects in operating room surgical skills assessment performed using a structured rating scale for nasal septoplasty.

Methods: We analyzed survey responses from attending surgeons (raters) who supervised residents and fellows (trainees) performing nasal septoplasty in a prospective cohort study. We fit a structural equation model with the rubric item scores regressed on a latent component of skill and then fit a second model including the rating surgeon as a random effect to model a rater-effects-adjusted latent surgical skill.

Magnetic Resonance Imaging-Based Assessment of Pancreatic Fat Strongly Correlates With Histology-Based Assessment of Pancreas Composition.

Objective: The aim of the study is to assess the relationship between magnetic resonance imaging (MRI)-based estimation of pancreatic fat and histology-based measurement of pancreatic composition.

Materials And Methods: In this retrospective study, MRI was used to noninvasively estimate pancreatic fat content in preoperative images from high-risk individuals and disease controls having normal pancreata. A deep learning algorithm was used to label 11 tissue components at micron resolution in subsequent pancreatectomy histology.

Effect of pre-operative warm-up on trainee intraoperative performance during robot-assisted hysterectomy: a randomized controlled trial.

Introduction And Hypothesis: The objective was to study the effect of immediate pre-operative warm-up using virtual reality simulation on intraoperative robot-assisted laparoscopic hysterectomy (RALH) performance by gynecology trainees (residents and fellows).

Methods: We randomized the first, non-emergent RALH of the day that involved trainees warming up or not warming up. For cases assigned to warm-up, trainees performed a set of exercises on the da Vinci Skills Simulator immediately before the procedure.

Opportunity Cost to Attending Surgeons of Intraoperative Training for Residents in Cataract Surgery.

Purpose: To estimate the opportunity cost to attending surgeons of teaching residents cataract surgery in the operating room.

Patients And Methods: Operating room records at an academic teaching hospital from July 2016 to July 2020 were analyzed in this retrospective review of cases. Cases were identified using Current Procedural Terminology (CPT) codes 66982 and 66984 for cataract surgery.

Investigating keypoint descriptors for camera relocalization in endoscopy surgery.

Purpose: Recent advances in computer vision and machine learning have resulted in endoscopic video-based solutions for dense reconstruction of the anatomy. To effectively use these systems in surgical navigation, a reliable image-based technique is required to constantly track the endoscopic camera's position within the anatomy, despite frequent removal and re-insertion. In this work, we investigate the use of recent learning-based keypoint descriptors for six degree-of-freedom camera pose estimation in intraoperative endoscopic sequences and under changes in anatomy due to surgical resection.

Blood pressure control for diabetic retinopathy.

Background: Diabetic retinopathy is a common complication of diabetes and a leading cause of visual impairment and blindness. Research has established the importance of blood glucose control to prevent development and progression of the ocular complications of diabetes. Concurrent blood pressure control has been advocated for this purpose, but individual studies have reported varying conclusions regarding the effects of this intervention.

Artificial Intelligence Methods and Artificial Intelligence-Enabled Metrics for Surgical Education: A Multidisciplinary Consensus.

Background: Artificial intelligence (AI) methods and AI-enabled metrics hold tremendous potential to advance surgical education. Our objective was to generate consensus guidance on specific needs for AI methods and AI-enabled metrics for surgical education.

Study Design: The study included a systematic literature search, a virtual conference, and a 3-round Delphi survey of 40 representative multidisciplinary stakeholders with domain expertise selected through purposeful sampling.

Video-based assessment of intraoperative surgical skill.

Purpose: Surgeons' skill in the operating room is a major determinant of patient outcomes. Assessment of surgeons' skill is necessary to improve patient outcomes and quality of care through surgical training and coaching. Methods for video-based assessment of surgical skill can provide objective and efficient tools for surgeons.

A Unified Framework on Generalizability of Clinical Prediction Models.

To be useful, clinical prediction models (CPMs) must be generalizable to patients in new settings. Evaluating generalizability of CPMs helps identify spurious relationships in data, provides insights on when they fail, and thus, improves the explainability of the CPMs. There are discontinuities in concepts related to generalizability of CPMs in the clinical research and machine learning domains.

Eye Tracking and Motion Data Predict Endoscopic Sinus Surgery Skill.

Objective: Endoscopic surgery has a considerable learning curve due to dissociation of the visual-motor axes, coupled with decreased tactile feedback and mobility. In particular, endoscopic sinus surgery (ESS) lacks objective skill assessment metrics to provide specific feedback to trainees. This study aims to identify summary metrics from eye tracking, endoscope motion, and tool motion to objectively assess surgeons' ESS skill.

Do Attending and Trainee Surgeons Agree on What Happens in the Operating Room During Septoplasty?

Surgeons must select cases whose complexity aligns with their skill set. To determine how accurately trainees report involvement in procedures, judge case complexity, and assess their own skills. We recruited attendings and trainees from two otolaryngology departments.

Virtual Reality Simulation Has Weak Correlation with Overall Trainee Robot-Assisted Laparoscopic Hysterectomy Performance.

Study Objective: Both simulator practice and intraoperative performance serve to inform surgical trainee training, but the skill transfer from simulation to the intraoperative setting remains unclear. This study evaluates the correlation between trainee performance on virtual reality simulation and (1) overall intraoperative performance during robotic-assisted laparoscopic hysterectomy (RALH) procedures and (2) suturing performance during vaginal cuff closure portion of the case.

Design: Retrospective subgroup analysis of randomized controlled trial.

Surgical data science - from concepts toward clinical translation.

Recent developments in data science in general and machine learning in particular have transformed the way experts envision the future of surgery. Surgical Data Science (SDS) is a new research field that aims to improve the quality of interventional healthcare through the capture, organization, analysis and modeling of data. While an increasing number of data-driven approaches and clinical applications have been studied in the fields of radiological and clinical data science, translational success stories are still lacking in surgery.

Reconstructing the nasal septum from instrument motion during septoplasty surgery.

Surgery involves modifying anatomy to achieve a goal. Reconstructing anatomy can facilitate surgical care through surgical planning, real-time decision support, or anticipating outcomes. Tool motion is a rich source of data that can be used to quantify anatomy.

Effectiveness of simulation-based training for manual small incision cataract surgery among novice surgeons: a randomized controlled trial.

This study was designed to determine the effect of a novel simulation-based training curriculum for scleral tunnel construction in manual small incision cataract surgery (MSICS) compared with traditional training. In this multicenter, investigator-masked, randomized clinical trial, resident surgeons within 3 months of matriculation with minimal or no prior experience with MSICS were assigned either to simulation-based training, the Experimental Group (EG), or to conventional training, the Control Group (CG). EG residents were trained to perform scleral tunnel construction using a simulation-based curriculum (HelpMeSee Eye Surgery Simulator), while residents in the CG followed institution-specific curriculum before progressing to live surgery.

Lens extraction for chronic angle-closure glaucoma.

Background: Primary angle-closure glaucoma (PACG) is characterized by a rise in intraocular pressure (IOP) secondary to aqueous outflow obstruction, with relative pupillary block being the most common underlying mechanism. There is increasing evidence that lens extraction may relieve pupillary block and thereby improve IOP control. As such, comparing the effectiveness of lens extraction against other commonly used treatment modalities can help inform the decision-making process.

Interventions for preventing ophthalmia neonatorum.

Background: Ophthalmia neonatorum is an infection of the eyes in newborns that can lead to blindness, particularly if the infection is caused by Neisseria gonorrhoeae. Antiseptic or antibiotic medication is dispensed into the eyes of newborns, or dispensed systemically, soon after delivery to prevent neonatal conjunctivitis and potential vision impairment.

Objectives: 1.

Effect of real-time virtual reality-based teaching cues on learning needle passing for robot-assisted minimally invasive surgery: a randomized controlled trial.

Purpose: Current virtual reality-based (VR) simulators for robot-assisted minimally invasive surgery (RAMIS) training lack effective teaching and coaching. Our objective was to develop an automated teaching framework for VR training in RAMIS. Second, we wanted to study the effect of such real-time teaching cues on surgical technical skill acquisition.

Occlusion for stimulus deprivation amblyopia.

Background: Stimulus deprivation amblyopia (SDA) develops due to an obstruction to the passage of light secondary to a condition such as cataract. The obstruction prevents formation of a clear image on the retina. SDA can be resistant to treatment, leading to poor visual prognosis.