arXiv subjects

Alejandro Granados

Publications and source records attributed to Alejandro Granados.

At least 19 recordsLinked to original sources

arXiv2026

Progressive Experience Fusion for Multi-Task World Model Control in Endovascular Navigation

Autonomous endovascular navigation could support the delivery of mechanical thrombectomy to underserved areas, but controllers must navigate long, multi-stage paths across varying vascular anatomies. This study investigates Progressive Experience Fusion (PEF) to train a multi-task TD-MPC2 controller. We additionally evaluate a heuristic that changes the Model Predictive Path Integral planning horizon using residual action-sequence dispersion, and fine-tuning in a patient-specific simulation. Across five subtasks in ten known training anatomies with held-out targets, PEF achieved a mean success rate of 74%, compared with 37% for Soft Actor-Critic (p < 0.001) and 65% for base TD-MPC2 (p = 0.053). A PEF controller with adaptive-horizon planning trained on 30 vasculatures achieved a mean success rate of 90% in ten held-out vasculatures. The PEF agent successfully transferred to an unseen in vitro stroke patient vasculature under fluoroscopy, achieving a mean path ratio improvement from 63% to 80% with fine-tuning (p < 0.001), following 40x103 fine-tuning steps (corresponding to approximately 107 min of clinical inter-hospital transfer time). This work represents a proof of concept for multi-vasculature training and patient-specific adaptation, while further validation is required before clinical deployment.

cs.RO↗

arXiv2026

Vascular Geometry Characterization for AI-Based Endovascular Navigation

Mechanical thrombectomy (MT) is a time-critical intervention for acute ischemic stroke; however, access remains limited due to a shortage of neuroradiologists and specialized centers. Reinforcement learning (RL) offers potential to automate endovascular navigation and improve accessibility, yet current models lack standardized frameworks to assess navigation difficulty for model training and evaluation. This study aims to identify vascular metrics associated with navigation difficulty and to develop an automated pipeline for quantitative vascular feature extraction, enabling future complexity grading. Vascular trees were segmented from computed tomography angiograms from 61 patients, and vascular metrics including aortic arch type, presence of bovine arch, vessel length, tortuosity, take-off angle, number of reverse curves, were measured using a custom pipeline. A Soft Actor-Critic RL algorithm was used for 120 s autonomous navigation. Outcomes were analyzed using both mixed effects linear and logistic regression. On the left side, the presence of a bovine arch and aortic arch type II/III increased navigation time by 30.19 s and 37.92 s, respectively, while greater tortuosity (\b{eta} = 118.20) further prolonged the procedure and reduced success probability. On the right side, type II/III arches extended procedure time by 45.94 s, while each additional reverse curve was associated with 3.96 s longer navigation time and lower probability of success. These findings demonstrate for the first time that MT agent navigation difficulty is strongly influenced by vascular geometry. The proposed automated pipeline enables objective and quantitative characterization of vascular features, providing a foundation for future development of standardized complexity grading and RL model evaluation, without aiming to demonstrate clinically generalizable autonomous navigation.

cs.RO↗

arXiv2026

Manual, Joystick, or Haptic Control? An In Vitro Comparison of Navigation Strategies for Robotic Interventional Neuroradiology Procedures

Objective: To evaluate robotic controller interfaces for interventional neuroradiology procedures in-vitro incorporating a force-sensing platform to assess safety. Methods: A custom endovascular robot, device-mimicking controller, and sensorized neurovascular phantom were developed. Ten interventional neuroradiologists (4 novices, 6 experts) performed simulated navigations using four control modalities: device-mimicking controllers with and without haptic feedback, joystick-based input, and manual navigation. Navigation time, peak vessel-wall forces, incorrect catheterisations, and prolapse events were assessed, alongside user analyses. Results: Manual navigation was fastest (mean 47.7 s) compared to haptic-on (248.7 s), haptic-off (314.7 s), and joystick (392.6 s) modalities (p<0.001). Regardless of controller type, vessel-wall forces were below the 0.70 N puncture threshold; therefore all modalities were considered safe. Joystick produced significantly more prolapse events than manual control (1.56 vs 0.13; p=0.018). Operator experience was relevant to performance: experts made fewer incorrect catheterisations than novices (0.25 vs 0.62; p=0.035) and applied less vessel-wall force (p<0.0005); these effects were sustained across controllers but accentuated when haptics were on. Users perceived haptic on and haptic off as similarly intuitive, and more intuitive than joystick (p=0.033). Conclusion: Device-mimicking robotic controllers outperform joystick interfaces on most metrics; haptic feedback shows promising but non-significant performance benefits.

cs.RO↗

arXiv2026

Developing a novel Comorbidities Index for predicting 10-year mortality in Prostate Cancer patients: A computational data-driven approach

The Charlson Comorbidities Index (CCI) is a weighted additive index widely used to estimate ten-year mortality risk, but its original weights may not reflect contemporary prognoses. This limitation is critical in Prostate Cancer (PCa), where radical treatment is recommended only for patients with a life expectancy of at least ten years. For candidates eligible for Radical Prostatectomy (RP), accurate estimation of ten-year other-cause mortality is essential to balance oncological benefit against competing risks and avoid overtreatment. We propose a data-driven framework to derive a comorbidity index tailored to PCa patients considered for RP. Using a retrospective single-institution cohort, we apply Population-Based Bio-Inspired Algorithms (PBBIAs) to recalibrate comorbidity weights and evolve alternative symbolic formulations optimized for ten-year survival discrimination. We compared six optimization strategies, including symbolic regression approaches based on Genetic Programming (GP), population-based metaheuristics, clinically validated baselines, and survival prediction models. Results show that GA, FST-PSO, and SLIM outperform both the original CCI and the PCCI, particularly when PCa-specific variables are included, improving the Concordance Index by up to 0.1. GPLearn yields compact and interpretable models with competitive performance. Overall, the proposed approach provides an updated and interpretable tool to improve patient selection for RP.

cs.NE↗

arXiv2026

Towards Real-Time Autonomous Navigation: Transformer-Based Catheter Tip Tracking in Fluoroscopy

Purpose: Mechanical thrombectomy (MT) improves stroke outcomes, but is limited by a lack of local treatment access. Widespread distribution of reinforcement learning (RL)-based robotic systems can be used to alleviate this challenge through autonomous navigation, but current RL methods require live device tip coordinate tracking to function. This paper aims to develop and evaluate a real-time catheter tip tracking pipeline under fluoroscopy, addressing challenges such as low contrast, noise, and device occlusion. Methods: A multi-threaded pipeline was designed, incorporating frame reading, preprocessing, inference, and post-processing. Deep learning segmentation models, including U-Net, U-Net+Transformer, and SegFormer, were trained and benchmarked using two-class and three-class formulations. Post-processing involved two-step component filtering, one-pixel medial skeletonization, and greedy arc-length path following with contour fall-back. Results: On manually-labeled moderate complexity fluoroscopic video data, the two-class SegFormer achieved a mean absolute error of 4.44 mm, outperforming U-Net (4.60 mm), U-Net+Transformer (6.20 mm) and all three-class models (5.19-7.74 mm). On segmentation benchmarks, the system exceeded state-of-the-art CathAction results with improvements of up to +5% in Dice scores for three-segmentation. Conclusion: The results demonstrate that the proposed multi-threaded tracking framework maintains stable performance under challenging imaging conditions, outperforming prior benchmarks, while providing a reliable and efficient foundation for RL-based autonomous MT navigation.

cs.CV↗

arXiv2026

Stabilizing Temporal Inference Dynamics for Online Surgical Phase Recognition

Online Surgical Phase Recognition (SPR) models can reach high frame-wise accuracy, yet their predictions often lack temporal stability, fragmenting workflow understanding and reducing the reliability of downstream assistance. We show that this instability is not random noise but arises from two mechanisms: early misclassifications corrupt temporal feature states and propagate forward to form error cascades, and phase transitions follow evidence-accumulation dynamics whereas most online SPR systems rely on memoryless frame-wise decisions, making them sensitive to transient confidence fluctuations. We propose a unified Train-Inference-Evaluation framework that explicitly stabilizes temporal inference dynamics using model-agnostic, plug-and-play components. For training, the Temporal Error-Cascade (TEC) loss suppresses error onset and mitigates forward error propagation by stabilizing temporal feature evolution. For inference, the Evidence-Gated Transition Predictor (EGTP) enforces evidence-driven state transitions, allowing phase changes only when accumulated evidence exceeds a confidence boundary. For evaluation, we introduce the Temporal Fragmentation Index (TFI), a reliability-aware metric that quantifies instability-induced temporal disagreement beyond conventional frame-wise and token-based measures. Experiments on Cholec80 and AutoLaparo across three representative backbones show that the proposed framework substantially improves temporal stability and reduces prediction fragmentation, while maintaining or modestly improving frame-wise performance.

cs.CV↗

arXiv2026

Toward Safe Autonomous Robotic Endovascular Interventions using World Models

Autonomous mechanical thrombectomy (MT) presents substantial challenges due to highly variable vascular geometries and the requirements for accurate, real-time control. While reinforcement learning (RL) has emerged as a promising paradigm for the automation of endovascular navigation, existing approaches often show limited robustness when faced with diverse patient anatomies or extended navigation horizons. In this work, we investigate a world-model-based framework for autonomous endovascular navigation built on TD-MPC2, a model-based RL method that integrates planning and learned dynamics. We evaluate a TD-MPC2 agent trained on multiple navigation tasks across hold out patient-specific vasculatures and benchmark its performance against the state-of-the-art Soft Actor-Critic (SAC) algorithm agent. Both approaches are further validated in vitro using patient-specific vascular phantoms under fluoroscopic guidance. In simulation, TD-MPC2 demonstrates a significantly higher mean success rate than SAC (58% vs. 36%, p < 0.001), and mean tip contact forces of 0.15 N, well below the proposed 1.5 N vessel rupture threshold. Mean success rates for TD-MPC2 (68%) were comparable to SAC (60%) in vitro, but TD-MPC2 achieved superior path ratios (p = 0.017) at the cost of longer procedure times (p < 0.001). Together, these results provide the first demonstration of autonomous MT navigation validated across both hold out in silico data and fluoroscopy-guided in vitro experiments, highlighting the promise of world models for safe and generalizable AI-assisted endovascular interventions.

cs.RO↗

arXiv2026

A Position Statement on Endovascular Models and Effectiveness Metrics for Mechanical Thrombectomy Navigation, on behalf of the Stakeholder Taskforce for AI-assisted Robotic Thrombectomy (START)

While we are making progress in overcoming infectious diseases and cancer; one of the major medical challenges of the mid-21st century will be the rising prevalence of stroke. Large vessels occlusions are especially debilitating, yet effective treatment (needed within hours to achieve best outcomes) remains limited due to geography. One solution for improving timely access to mechanical thrombectomy in geographically diverse populations is the deployment of robotic surgical systems. Artificial intelligence (AI) assistance may enable the upskilling of operators in this emerging therapeutic delivery approach. Our aim was to establish consensus frameworks for developing and validating AI-assisted robots for thrombectomy. Objectives included standardizing effectiveness metrics and defining reference testbeds across in silico, in vitro, ex vivo, and in vivo environments. To achieve this, we convened experts in neurointervention, robotics, data science, health economics, policy, statistics, and patient advocacy. Consensus was built through an incubator day, a Delphi process, and a final Position Statement. We identified that the four essential testbed environments each had distinct validation roles. Realism requirements vary: simpler testbeds should include realistic vessel anatomy compatible with guidewire and catheter use, while standard testbeds should incorporate deformable vessels. More advanced testbeds should include blood flow, pulsatility, and disease features. There are two macro-classes of effectiveness metrics: one for in silico, in vitro, and ex vivo stages focusing on technical navigation, and another for in vivo stages, focused on clinical outcomes. Patient safety is central to this technology's development. One requisite patient safety task needed now is to correlate in vitro measurements to in vivo complications.

cs.RO↗

arXiv2026

Toward AI Autonomous Navigation for Mechanical Thrombectomy using Hierarchical Modular Multi-agent Reinforcement Learning (HM-MARL)

Mechanical thrombectomy (MT) is typically the optimal treatment for acute ischemic stroke involving large vessel occlusions, but access is limited due to geographic and logistical barriers. Reinforcement learning (RL) shows promise in autonomous endovascular navigation, but generalization across 'long' navigation tasks remains challenging. We propose a Hierarchical Modular Multi-Agent Reinforcement Learning (HM-MARL) framework for autonomous two-device navigation in vitro, enabling efficient and generalizable navigation. HM-MARL was developed to autonomously navigate a guide catheter and guidewire from the femoral artery to the internal carotid artery (ICA). A modular multi-agent approach was used to decompose the complex navigation task into specialized subtasks, each trained using Soft Actor-Critic RL. The framework was validated in both in silico and in vitro testbeds to assess generalization and real-world feasibility. In silico, a single-vasculature model achieved 92-100% success rates on individual anatomies, while a multi-vasculature model achieved 56-80% across multiple patient anatomies. In vitro, both HM-MARL models successfully navigated 100% of trials from the femoral artery to the right common carotid artery and 80% to the right ICA but failed on the left-side vessel superhuman challenge due to the anatomy and catheter type used in navigation. This study presents the first demonstration of in vitro autonomous navigation in MT vasculature. While HM-MARL enables generalization across anatomies, the simulation-to-real transition introduces challenges. Future work will refine RL strategies using world models and validate performance on unseen in vitro data, advancing autonomous MT towards clinical translation.

cs.RO↗

arXiv2026

From Pre- to Intra-operative MRI: Predicting Brain Shift in Temporal Lobe Resection for Epilepsy Surgery

Introduction: In neurosurgery, image-guided Neurosurgery Systems (IGNS) highly rely on preoperative brain magnetic resonance images (MRI) to assist surgeons in locating surgical targets and determining surgical paths. However, brain shift invalidates the preoperative MRI after dural opening. Updated intraoperative brain MRI with brain shift compensation is crucial for enhancing the precision of neuronavigation systems and ensuring the optimal outcome of surgical interventions. Methodology: We propose NeuralShift, a U-Net-based model that predicts brain shift entirely from pre-operative MRI for patients undergoing temporal lobe resection. We evaluated our results using Target Registration Errors (TREs) computed on anatomical landmarks located on the resection side and along the midline, and DICE scores comparing predicted intraoperative masks with masks derived from intraoperative MRI. Results: Our experimental results show that our model can predict the global deformation of the brain (DICE of 0.97) with accurate local displacements (achieve landmark TRE as low as 1.12 mm), compensating for large brain shifts during temporal lobe removal neurosurgery. Conclusion: Our proposed model is capable of predicting the global deformation of the brain during temporal lobe resection using only preoperative images, providing potential opportunities to the surgical team to increase safety and efficiency of neurosurgery and better outcomes to patients. Our contributions will be publicly available after acceptance in https://github.com/SurgicalDataScienceKCL/NeuralShift.

cs.CV↗

arXiv2025

World Model for AI Autonomous Navigation in Mechanical Thrombectomy

Autonomous navigation for mechanical thrombectomy (MT) remains a critical challenge due to the complexity of vascular anatomy and the need for precise, real-time decision-making. Reinforcement learning (RL)-based approaches have demonstrated potential in automating endovascular navigation, but current methods often struggle with generalization across multiple patient vasculatures and long-horizon tasks. We propose a world model for autonomous endovascular navigation using TD-MPC2, a model-based RL algorithm. We trained a single RL agent across multiple endovascular navigation tasks in ten real patient vasculatures, comparing performance against the state-of-the-art Soft Actor-Critic (SAC) method. Results indicate that TD-MPC2 significantly outperforms SAC in multi-task learning, achieving a 65% mean success rate compared to SAC's 37%, with notable improvements in path ratio. TD-MPC2 exhibited increased procedure times, suggesting a trade-off between success rate and execution speed. These findings highlight the potential of world models for improving autonomous endovascular navigation and lay the foundation for future research in generalizable AI-driven robotic interventions.

cs.LG↗

arXiv2025

DARIL: When Imitation Learning outperforms Reinforcement Learning in Surgical Action Planning

Surgical action planning requires predicting future instrument-verb-target triplets for real-time assistance. While teleoperated robotic surgery provides natural expert demonstrations for imitation learning (IL), reinforcement learning (RL) could potentially discover superior strategies through self-exploration. We present the first comprehensive comparison of IL versus RL for surgical action planning on CholecT50. Our Dual-task Autoregressive Imitation Learning (DARIL) baseline achieves 34.6% action triplet recognition mAP and 33.6% next frame prediction mAP with smooth planning degradation to 29.2% at 10-second horizons. We evaluated three RL variants: world model-based RL, direct video RL, and inverse RL enhancement. Surprisingly, all RL approaches underperformed DARIL--world model RL dropped to 3.1% mAP at 10s while direct video RL achieved only 15.9%. Our analysis reveals that distribution matching on expert-annotated test sets systematically favors IL over potentially valid RL policies that differ from training demonstrations. This challenges assumptions about RL superiority in sequential decision making and provides crucial insights for surgical AI development.

cs.AI↗

arXiv2025

Reinforcement Learning for Safe Autonomous Two Device Navigation of Cerebral Vessels in Mechanical Thrombectomy

Purpose: Autonomous systems in mechanical thrombectomy (MT) hold promise for reducing procedure times, minimizing radiation exposure, and enhancing patient safety. However, current reinforcement learning (RL) methods only reach the carotid arteries, are not generalizable to other patient vasculatures, and do not consider safety. We propose a safe dual-device RL algorithm that can navigate beyond the carotid arteries to cerebral vessels. Methods: We used the Simulation Open Framework Architecture to represent the intricacies of cerebral vessels, and a modified Soft Actor-Critic RL algorithm to learn, for the first time, the navigation of micro-catheters and micro-guidewires. We incorporate patient safety metrics into our reward function by integrating guidewire tip forces. Inverse RL is used with demonstrator data on 12 patient-specific vascular cases. Results: Our simulation demonstrates successful autonomous navigation within unseen cerebral vessels, achieving a 96% success rate, 7.0s procedure time, and 0.24 N mean forces, well below the proposed 1.5 N vessel rupture threshold. Conclusion: To the best of our knowledge, our proposed autonomous system for MT two-device navigation reaches cerebral vessels, considers safety, and is generalizable to unseen patient-specific cases for the first time. We envisage future work will extend the validation to vasculatures of different complexity and on in vitro models. While our contributions pave the way towards deploying agents in clinical settings, safety and trustworthiness will be crucial elements to consider when proposing new methodology.

cs.LG↗

arXiv2025

UltraFlwr -- An Efficient Federated Surgical Object Detection Framework

Surgical object detection in laparoscopic videos enables real-time instrument identification for workflow analysis and skills assessment, but training robust models such as You Only Look Once (YOLO) is challenged by limited data, privacy constraints, and inter-institutional variability. Federated learning (FL) enables collaborative training without sharing raw data, yet practical support for modern YOLO pipelines under heterogeneous surgical data remains limited. We present UltraFlwr, an open-source, communication-efficient, and edge-deployable framework that integrates Ultralytics YOLO with the Flower FL platform and supports native Partial Aggregation (PA) of YOLO components (backbone, neck, head). Using two public laparoscopic surgical tool detection datasets, we conduct a systematic empirical study of federated YOLO training under Independent and Identically Distributed (IID) and multiple clinically motivated heterogeneous scenarios, including differences in data curation, video length, and label availability. Results show that standard FL aggregators (e.g., FedAvg) do not consistently match centralized training per client, but reduce inter-client performance variability. Aggregating both backbone and neck components achieves performance comparable to full aggregation with lower communication costs. Also, improving within-client data consistency can benefit FL even when it increases distribution shift across clients. These findings provide practical guidance for deploying federated YOLO-based object detection in heterogeneous surgical environments. UltraFlwr is publicly available at https://github.com/KCL-BMEIS/UltraFlwr.

cs.CV↗

arXiv2024

SWAG: Long-term Surgical Workflow Prediction with Generative-based Anticipation

While existing approaches excel at recognising current surgical phases, they provide limited foresight and intraoperative guidance into future procedural steps. Similarly, current anticipation methods are constrained to predicting short-term and single events, neglecting the dense, repetitive, and long sequential nature of surgical workflows. To address these needs and limitations, we propose SWAG (Surgical Workflow Anticipative Generation), a framework that combines phase recognition and anticipation using a generative approach. This paper investigates two distinct decoding methods - single-pass (SP) and auto-regressive (AR) - to generate sequences of future surgical phases at minute intervals over long horizons. We propose a novel embedding approach using class transition probabilities to enhance the accuracy of phase anticipation. Additionally, we propose a generative framework using remaining time regression to classification (R2C). SWAG was evaluated on two publicly available datasets, Cholec80 and AutoLaparo21. Our single-pass model with class transition probability embeddings (SP*) achieves 32.1% and 41.3% F1 scores over 20 and 30 minutes on Cholec80 and AutoLaparo21, respectively. Moreover, our approach competes with existing methods on phase remaining time regression, achieving weighted mean absolute errors of 0.32 and 0.48 minutes for 2- and 3-minute horizons. SWAG demonstrates versatility across generative decoding frame works and classification and regression tasks to create temporal continuity between surgical workflow recognition and anticipation. Our method provides steps towards intraoperative surgical workflow generation for anticipation. Project: https://maxboels.com/research/swag.

cs.CV↗

arXiv2024

Autonomous navigation of catheters and guidewires in mechanical thrombectomy using inverse reinforcement learning

Purpose: Autonomous navigation of catheters and guidewires can enhance endovascular surgery safety and efficacy, reducing procedure times and operator radiation exposure. Integrating tele-operated robotics could widen access to time-sensitive emergency procedures like mechanical thrombectomy (MT). Reinforcement learning (RL) shows potential in endovascular navigation, yet its application encounters challenges without a reward signal. This study explores the viability of autonomous navigation in MT vasculature using inverse RL (IRL) to leverage expert demonstrations. Methods: This study established a simulation-based training and evaluation environment for MT navigation. We used IRL to infer reward functions from expert behaviour when navigating a guidewire and catheter. We utilized soft actor-critic to train models with various reward functions and compared their performance in silico. Results: We demonstrated feasibility of navigation using IRL. When evaluating single versus dual device (i.e. guidewire versus catheter and guidewire) tracking, both methods achieved high success rates of 95% and 96%, respectively. Dual-tracking, however, utilized both devices mimicking an expert. A success rate of 100% and procedure time of 22.6 s were obtained when training with a reward function obtained through reward shaping. This outperformed a dense reward function (96%, 24.9 s) and an IRL-derived reward function (48%, 59.2 s). Conclusions: We have contributed to the advancement of autonomous endovascular intervention navigation, particularly MT, by employing IRL. The results underscore the potential of using reward shaping to train models, offering a promising avenue for enhancing the accessibility and precision of MT. We envisage that future research can extend our methodology to diverse anatomical structures to enhance generalizability.

cs.LG↗

arXiv2024

Artificial Intelligence in the Autonomous Navigation of Endovascular Interventions: A Systematic Review

Purpose: Autonomous navigation of devices in endovascular interventions can decrease operation times, improve decision-making during surgery, and reduce operator radiation exposure while increasing access to treatment. This systematic review explores recent literature to assess the impact, challenges, and opportunities artificial intelligence (AI) has for the autonomous endovascular intervention navigation. Methods: PubMed and IEEEXplore databases were queried. Eligibility criteria included studies investigating the use of AI in enabling the autonomous navigation of catheters/guidewires in endovascular interventions. Following PRISMA, articles were assessed using QUADAS-2. PROSPERO: CRD42023392259. Results: Among 462 studies, fourteen met inclusion criteria. Reinforcement learning (9/14, 64%) and learning from demonstration (7/14, 50%) were used as data-driven models for autonomous navigation. Studies predominantly utilised physical phantoms (10/14, 71%) and in silico (4/14, 29%) models. Experiments within or around the blood vessels of the heart were reported by the majority of studies (10/14, 71%), while simple non-anatomical vessel platforms were used in three studies (3/14, 21%), and the porcine liver venous system in one study. We observed that risk of bias and poor generalisability were present across studies. No procedures were performed on patients in any of the studies reviewed. Studies lacked patient selection criteria, reference standards, and reproducibility, resulting in low clinical evidence levels. Conclusions: AI's potential in autonomous endovascular navigation is promising, but in an experimental proof-of-concept stage, with a technology readiness level of 3. We highlight that reference standards with well-identified performance metrics are crucial to allow for comparisons of data-driven algorithms proposed in the years to come.

cs.AI↗

arXiv2024

ReCAP: Recursive Cross Attention Network for Pseudo-Label Generation in Robotic Surgical Skill Assessment

In surgical skill assessment, the Objective Structured Assessments of Technical Skills (OSATS) and Global Rating Scale (GRS) are well-established tools for evaluating surgeons during training. These metrics, along with performance feedback, help surgeons improve and reach practice standards. Recent research on the open-source JIGSAWS dataset, which includes both GRS and OSATS labels, has focused on regressing GRS scores from kinematic data, video, or their combination. However, we argue that regressing GRS alone is limiting, as it aggregates OSATS scores and overlooks clinically meaningful variations during a surgical trial. To address this, we developed a weakly-supervised recurrent transformer model that tracks a surgeon's performance throughout a session by mapping hidden states to six OSATS, derived from kinematic data. These OSATS scores are averaged to predict GRS, allowing us to compare our model's performance against state-of-the-art (SOTA) methods. We report Spearman's Correlation Coefficients (SCC) demonstrating that our model outperforms SOTA using kinematic data (SCC 0.83-0.88), and matches performance with video-based models. Our model also surpasses SOTA in most tasks for average OSATS predictions (SCC 0.46-0.70) and specific OSATS (SCC 0.56-0.95). The generation of pseudo-labels at the segment level translates quantitative predictions into qualitative feedback, vital for automated surgical skill assessment pipelines. A senior surgeon validated our model's outputs, agreeing with 77\% of the weakly-supervised predictions \(p=0.006\).

cs.CV↗