Active Learning for Efficient Annotation of Surgical Videos with Weak Supervision
Authors: Manasa Dendukuri, Matjaz Jogan, Daniel A. Hashimoto, Guiqiu Liao
Organizations: 1*GRASP Laboratory, University of Pennsylvania, 3330 Walnut Street, Philadelphia, PA, 19104, USA. · 2PCASO Laboratory, Dept. of Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA. · 3Dept. of Computer and Information Science, University of Pennsylvania, 3330 Walnut Street, Philadelphia, PA, 19104, USA.
Abstract
Precise spatial-temporal annotation of laparoscopic videos is time-consuming and requires expert knowledge. We propose a human-in-the-loop knowledge acquisition framework that combines active learning with dual-loss optimization to significantly reduce the annotation effort needed for automatic localization and segmentation of objects in the surgical field. Our method employs a foundation model to generate temporally consistent class activation maps (CAMs) from video using two complementary training objectives: a weak supervision loss on video-level tool presence labels for weakly annotated data, and an image-level mask loss on human-corrected annotations obtained through active learning. Rather than requiring dense pixel-level annotation upfront, our pipeline iteratively proposes pseudo-masks that guide the expert annotator to refine the knowledge previously captured by the model. We demonstrate that our framework reduces the effort of surgical video annotation by 50% by the end of training in comparison to fully manual annotation. Through eliminating the need for large, fully annotated datasets from the start, this framework enables scalability to the development of surgical tool segmentation models. This iterative human-in-the-loop refinement supports efficient knowledge acquisition with minimal expert input, providing a practical and deployable strategy for expanding tool segmentation to larger, more diverse datasets and real-world clinical settings.
Effective multi-task learning for surgical scene understanding is fundamentally hindered by annotation granularity mismatch; temporal workflow tasks such as phase recognition, step recognition and anticipation benefit from dense frame-level supervision, whereas pixel-level spatial tasks including instrument segmentation and action recognition are only sparsely annotated on selected keyframes due to prohibitive labeling costs. This supervision imbalance undermines shared representation learning and limits joint optimization across heterogeneous surgical tasks. To address this, we propose Flow-guided Annotation for Robust Operating Scenes (FAROS), a flow-guided label interpolation framework, that combines zero-shot segmentation-based mask propagation with optical flow estimation to overcome the limitations of appearance-based propagation under challenging surgical conditions such as occlusion, smoke, and motion blur, generating temporally consistent dense pseudo labels from sparse keyframe annotations. The densified instrument masks and action labels are integrated into a unified Transformer-based multi-task framework that jointly learns surgical phase recognition, step recognition, anticipation, instrument segmentation, and action recognition, enabling balanced optimization between dense temporal supervision and sparse spatial supervision. The label interpolation quality of FAROS is first validated on the DAVIS 2017 benchmark under a sparse ground-truth protocol, confirming robust propagation beyond the surgical domain. Extensive experiments on GraSP, MISAW, and AutoLaparo benchmarks further demonstrate that FAROS significantly improves cross-task representation learning and enhances holistic surgical scene understanding performance across spatio-temporal tasks.
Artificial Intelligence is increasingly applied to surgical video analysis for phase segmentation, skill assessment, and workflow optimization. A key challenge is the length of surgical recordings, often one to several hours, creating substantial computational burden. We previously developed Kinematics-Adaptive Frame Recognition (KAFR) for robotic surgery, showing that tracking tool motion effectively identifies informative frames while filtering redundant content. However, laparoscopic surgery introduces additional challenges: manual camera control causes frequent motion artifacts, and image quality is generally lower than robotic systems. This study evaluates whether KAFR generalizes to laparoscopic surgery using the Cholec80 benchmark, comprising 80 laparoscopic cholecystectomy procedures annotated for seven surgical phases. KAFR operates in three stages: a fine-tuned YOLO model detects and segments surgical tools; frames are adaptively selected based on tool displacement or velocity variation; and an X3D model classifies selected frames into surgical phases. KAFR achieved a 91.0% F1 score using only 0.58% of frames for phase classification, representing an approximately seven-fold reduction compared to typical 4% frame sampling, while maintaining performance comparable to LoViT (90.2%) and Trans-SVNet (89.7%). These results demonstrate that kinematics-based frame selection transfers effectively to the challenging laparoscopic environment.
Huu Phong Nguyen, Shekhar Madhav Khairnar, Ganesh Sankaranarayanan
Temporal action segmentation (TAS) in untrimmed videos requires dense temporal supervision. However, most of the annotation cost is spent identifying action transitions where segmentation errors concentrate and small temporal shifts can disproportionately degrade segment-level metrics. We introduce B-ACT, a clip-budgeted active learning framework that explicitly allocates supervision to these error-prone boundary regions. B-ACT operates in a hierarchical two-stage loop: (i) it ranks and queries unlabeled videos using predictive uncertainty, and (ii) within each selected video, it detects candidate transitions from the current model predictions and selects the top-K boundaries via a novel boundary score. The boundary score fuses neighborhood uncertainty, class ambiguity, and temporal prediction dynamics to reveal the underlying importance of each frame. Importantly, our annotation protocol requests labels only at the boundary frames while still training on boundary-centered clips to exploit temporal context through the model's receptive field. Extensive experiments on GTEA, 50Salads, and Breakfast demonstrate that boundary-centric supervision delivers strong label efficiency and consistently surpasses representative TAS active learning baselines and prior state of the art under sparse budgets. Gains are largest on datasets where performance is highly sensitive to boundary placement, as measured by edit and overlap-based F1 metrics.