Smart Operation Theatre: An AI-based System for Surgical Gauze Counting

Surgical gauze is an essential part of surgical procedures, primarily used for controlling bleeding and absorbing bodily fluids. The post-surgical retention of gauze can lead to serious complications and necessitate additional surgery for its removal. Despite the clinical significance, research on gauze segmentation using real-world surgical data remains underexplored, owing in part to the scarcity of annotated datasets. In this work, we investigate the use of deep learning methods for gauze segmentation in robot-assisted minimally invasive abdominal surgeries, utilizing an in-house surgical dataset prepared at a university hospital. The training data reflects realistic surgical settings and captures extensive diversity in spatial, morphological, and visual attributes across three different gauze categories. We evaluate several widely used segmentation architectures, including CNN-based, transformer-based, and hybrid architectures, to establish a proof-of-concept for gauze segmentation in a realistic clinical setting. In addition, we investigate the influence of sub-optimally annotated, auto-tracked segmentation masks as a strategy to address data scarcity and improve performance. Our results demonstrate the efficacy of real-world training data in countering the main challenge reported by prior works, the trade-off between blood presence and gauze detection. The incorporation of auto-tracked annotations yields performance enhancements, particularly in generic surgical scenarios. The integration of effective segmentation approaches can benefit robot-guided surgical procedures and various downstream applications by providing precise delineation of foreign objects, thereby enhancing patient safety and surgical outcomes.

Minimally invasive surgery has dramatically improved patient operative outcomes, yet identifying safe operative zones remains challenging in critical phases, requiring surgeons to integrate visual cues, procedural phase, and anatomical context under high cognitive load. Existing AI systems offer binary safety verification or static detection, ignoring the phase-dependent nature of intraoperative reasoning. We introduce ResGo, a benchmark of laparoscopic frames annotated with Go Zone bounding boxes and clinician-authored rationales covering phase, exposure quality reasoning, next action and risk reminder. We introduce evaluation metrics that treat correct grounding under incorrect phase as failures, revealing that most vision-language models cannot handle such tasks and perform poorly. We then present SurGo-R1, a model optimized via RLHF with a multi-turn phase-then-go architecture where the model first identifies the surgical phase, then generates reasoning and Go Zone coordinates conditioned on that context. On unseen procedures, SurGo-R1 achieves 76.6% phase accuracy, 32.7 mIoU, and 54.8% hardcore accuracy, a 6.6$\times$ improvement over the mainstream generalist VLMs. Code, model and benchmark will be available at https://github.com/jinlab-imvr/SurGo-R1

Purpose: Gaze-following, the task of inferring where individuals are looking, has been widely studied in computer vision, advancing research in visual attention modeling, social scene understanding, and human-robot interaction. However, gaze-following has never been explored in the operating room (OR), a complex, high-stakes environment where visual attention plays an important role in surgical workflow analysis. In this work, we introduce the concept of gaze-following to the surgical domain, and demonstrate its great potential for understanding clinical roles, surgical phases, and team communications in the OR. Methods: We extend the 4D-OR dataset with gaze-following annotations, and extend the Team-OR dataset with gaze-following and a new team communication activity annotations. Then, we propose novel approaches to address clinical role prediction, surgical phase recognition, and team communication detection using a gaze-following model. For role and phase recognition, we propose a gaze heatmap-based approach that uses gaze predictions solely; for team communication detection, we train a spatial-temporal model in a self-supervised way that encodes gaze-based clip features, and then feed the features into a temporal activity detection model. Results: Experimental results on the 4D-OR and Team-OR datasets demonstrate that our approach achieves state-of-the-art performance on all downstream tasks. Quantitatively, our approach obtains F1 scores of 0.92 for clinical role prediction and 0.95 for surgical phase recognition. Furthermore, it significantly outperforms existing baselines in team communication detection, improving previous best performances by over 30%. Conclusion: We introduce gaze-following in the OR as a novel research direction in surgical data science, highlighting its great potential to advance surgical workflow analysis in computer-assisted interventions.