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Britty Baby

Publications and source records attributed to Britty Baby.

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Expert Consensus-based Video-Based Assessment Tool for Workflow Analysis in Minimally Invasive Colorectal Surgery: Development and Validation of ColoWorkflow

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 centres. The tool demonstrated broad applicability, with all but one label utilized. Inter-rater reliability was moderate, with mean Cohen's K of 0.71 for phases and 0.66 for steps. Most discrepancies arose at phase transitions and step boundary definitions. ColoWorkflow is the first consensus-based, validated VBA tool for comprehensive workflow analysis in minimally invasive CRS. It establishes a reproducible framework for video-based performance assessment, enabling benchmarking across institutions and supporting the development of artificial intelligence-driven workflow recognition. Its adoption may standardize training, accelerate competency acquisition, and advance data-informed surgical quality improvement.

cs.CV

Endoshare: A Publicly Available, Surgeons-Friendly Solution to De-Identify and Manage Surgical Videos

Video-based assessment and surgical data science can advance surgical training, research, and quality improvement, yet adoption remains limited by heterogeneous recording formats and privacy concerns linked to video sharing. This work develops, evaluates, and publicly releases Endoshare, a surgeon-friendly application that merges, standardizes, and de-identifies endoscopic videos. Development followed an iterative, user-centered software life cycle. In the analysis phase, an internal survey of four clinicians and four computer scientists, based on 10 usability heuristics, identified early requirements and guided a cross-platform, privacy-by-design architecture. Prototype testing reported high usability for clinicians (4.68 +/- 0.40 out of 5) and for computer scientists (4.03 +/- 0.51 out of 5), with the lowest score (4.00 +/- 0.93 out of 5) relating to label clarity, prompting interface refinement to streamline case selection, video merging, automated out-of-body removal, and filename pseudonymization. In the testing phase, ten surgeons completed an external survey combining the same heuristics with Technology Acceptance Model constructs, reporting high perceived usefulness (5.07 +/- 1.75 out of 7), ease of use (5.15 +/- 1.71 out of 7), heuristic usability (4.38 +/- 0.48 out of 5), and strong recommendation likelihood (9.20 +/- 0.79 out of 10). A performance assessment across different hardware and configurations showed that processing time increased proportionally with video duration and was consistently lower in fast mode. Endoshare is a publicly available solution to manage surgical videos, with potential to support training, research, and quality improvement. Compliance certification and broader interoperability validation are needed to establish it as a reliable tool for surgical video management. The software is available at https://camma-public.github.io/Endoshare

cs.CV

Multi-modal Representations for Fine-grained Multi-label Critical View of Safety Recognition

The Critical View of Safety (CVS) is crucial for safe laparoscopic cholecystectomy, yet assessing CVS criteria remains a complex and challenging task, even for experts. Traditional models for CVS recognition depend on vision-only models learning with costly, labor-intensive spatial annotations. This study investigates how text can be harnessed as a powerful tool for both training and inference in multi-modal surgical foundation models to automate CVS recognition. Unlike many existing multi-modal models, which are primarily adapted for multi-class classification, CVS recognition requires a multi-label framework. Zero-shot evaluation of existing multi-modal surgical models shows a significant performance gap for this task. To address this, we propose CVS-AdaptNet, a multi-label adaptation strategy that enhances fine-grained, binary classification across multiple labels by aligning image embeddings with textual descriptions of each CVS criterion using positive and negative prompts. By adapting PeskaVLP, a state-of-the-art surgical foundation model, on the Endoscapes-CVS201 dataset, CVS-AdaptNet achieves 57.6 mAP, improving over the ResNet50 image-only baseline (51.5 mAP) by 6 points. Our results show that CVS-AdaptNet's multi-label, multi-modal framework, enhanced by textual prompts, boosts CVS recognition over image-only methods. We also propose text-specific inference methods, that helps in analysing the image-text alignment. While further work is needed to match state-of-the-art spatial annotation-based methods, this approach highlights the potential of adapting generalist models to specialized surgical tasks. Code: https://github.com/CAMMA-public/CVS-AdaptNet

cs.CV

Adaptation of Multi-modal Representation Models for Multi-task Surgical Computer Vision

Surgical AI often involves multiple tasks within a single procedure, like phase recognition or assessing the Critical View of Safety in laparoscopic cholecystectomy. Traditional models, built for one task at a time, lack flexibility, requiring a separate model for each. To address this, we introduce MML-SurgAdapt, a unified multi-task framework with Vision-Language Models (VLMs), specifically CLIP, to handle diverse surgical tasks through natural language supervision. A key challenge in multi-task learning is the presence of partial annotations when integrating different tasks. To overcome this, we employ Single Positive Multi-Label (SPML) learning, which traditionally reduces annotation burden by training models with only one positive label per instance. Our framework extends this approach to integrate data from multiple surgical tasks within a single procedure, enabling effective learning despite incomplete or noisy annotations. We demonstrate the effectiveness of our model on a combined dataset consisting of Cholec80, Endoscapes2023, and CholecT50, utilizing custom prompts. Extensive evaluation shows that MML-SurgAdapt performs comparably to task-specific benchmarks, with the added advantage of handling noisy annotations. It also outperforms the existing SPML frameworks for the task. By reducing the required labels by 23%, our approach proposes a more scalable and efficient labeling process, significantly easing the annotation burden on clinicians. To our knowledge, this is the first application of SPML to integrate data from multiple surgical tasks, presenting a novel and generalizable solution for multi-task learning in surgical computer vision. Implementation is available at: https://github.com/CAMMA-public/MML-SurgAdapt

cs.CV

From Forks to Forceps: A New Framework for Instance Segmentation of Surgical Instruments

Minimally invasive surgeries and related applications demand surgical tool classification and segmentation at the instance level. Surgical tools are similar in appearance and are long, thin, and handled at an angle. The fine-tuning of state-of-the-art (SOTA) instance segmentation models trained on natural images for instrument segmentation has difficulty discriminating instrument classes. Our research demonstrates that while the bounding box and segmentation mask are often accurate, the classification head mis-classifies the class label of the surgical instrument. We present a new neural network framework that adds a classification module as a new stage to existing instance segmentation models. This module specializes in improving the classification of instrument masks generated by the existing model. The module comprises multi-scale mask attention, which attends to the instrument region and masks the distracting background features. We propose training our classifier module using metric learning with arc loss to handle low inter-class variance of surgical instruments. We conduct exhaustive experiments on the benchmark datasets EndoVis2017 and EndoVis2018. We demonstrate that our method outperforms all (more than 18) SOTA methods compared with, and improves the SOTA performance by at least 12 points (20%) on the EndoVis2017 benchmark challenge and generalizes effectively across the datasets.

cs.CV

Neuro-Endo-Trainer-Online Assessment System (NET-OAS) for Neuro-Endoscopic Skills Training

Neuro-endoscopy is a challenging minimally invasive neurosurgery that requires surgical skills to be acquired using training methods different from the existing apprenticeship model. There are various training systems developed for imparting fundamental technical skills in laparoscopy where as limited systems for neuro-endoscopy. Neuro-Endo-Trainer was a box-trainer developed for endo-nasal transsphenoidal surgical skills training with video based offline evaluation system. The objective of the current study was to develop a modified version (Neuro-Endo-Trainer-Online Assessment System (NET-OAS)) by providing a stand-alone system with online evaluation and real-time feedback. The validation study on a group of 15 novice participants shows the improvement in the technical skills for handling the neuro-endoscope and the tool while performing pick and place activity.

cs.CV