Bayesian Retraction Optimization for Tissue Attachment Mapping in Surgical Dissection
Authors: Shing-Hei Ho, Bao Thach, Toan Vo, James M. Ferguson, Alan Kuntz
Abstract
With growing surgeon shortages, automating surgical sub-tasks such as tissue dissection offers a promising step toward reducing workload and expanding patient access. Prior work has relied on hand-crafted incision policies that cannot quantify uncertainty or has relied on simulation-based methods that require strong modeling assumptions. We instead view tissue attachment identification as an inherently probabilistic problem and propose a Bayesian approach that avoids explicit tissue modeling. Our method uses a Sequential Bayesian Hilbert Map (SBHM) to represent the likelihood that each tissue point is attached to the underlying resection surface. An ensemble of learned classifiers predicts attachment likelihoods from spatial data acquired during robotic tissue retraction, with each classifier serving as a noisy information source to update the SBHM. To plan the next retraction, we devise Bayesian Retraction Optimization (BRO) to select the most informative action under safety constraints. As the SBHM refines over time, regions with high attachment likelihood are selectively incised. We validate our method in simulation across diverse tissue geometries and acquisition strategies, and demonstrate zero-shot transfer to real robotic dissection experiments.
Surgical tissue retraction requires effective manipulation planning under partial and noisy perception. We study state estimation for deformable tissue retraction, where only sparse observations of the tissue surface are available at decision time. We propose a learned state estimator that reconstructs the full deformable mesh state from 40 noisy vertex observations. The estimator combines a multilayer perceptron with a low-dimensional PCA latent representation and is trained using geometry-aware regularization that encourages smooth and physically plausible deformations. We evaluate the approach in a 2D deformable sheet simulation using single-step and multi-step retraction planning. Results show that the learned estimator achieves 98.1% of oracle performance in multi-step retraction while supporting efficient inference. These results demonstrate that learned, geometry-regularized state estimation can support effective deformable manipulation under realistic perception constraints.
In various surgical procedures, regions of interest (ROIs) such as organs or lesions are often occluded by overlying tissues, requiring surgeons to achieve adequate exposure for precise intervention. However, the irregular geometry, nonlinear biomechanical properties of overlying tissues, and limited intraoperative visibility of the ROI pose significant challenges to the autonomous execution of tissue retraction. To address this, we formulate a realistic model of the tissue retraction task and propose a learning-based adaptive control framework for achieving ROI exposure. The method optimizes control inputs online by monitoring changes in the visual boundary of the tissue, while leveraging a deep deformation estimation model trained on simulation data to identify the optimal grasping point and ensure the convergence and safety of the adaptive controller. Through simulations and real-world experiments on different deformable materials, it has been demonstrated that this framework exhibits zero-shot adaptation to similar tasks and can complete the autonomous retraction process, from initial grasp selection to full ROI exposure. Therefore, it has the potential to be applied in actual surgical assistance scenarios.
Surgical automation is being increasingly studied, yet bridging visual scene understanding with autonomous action planning remains a fundamental challenge. While much research effort has been made on scene perception (e.g., tool recognition and scene segmentation), understanding and predicting actionable possibilities for surgical automation is still underexplored. In this paper, we introduce surgical affordance prediction, which identifies actionable regions for fundamental surgical actions from visual data. Specifically, a novel adaptive feature fusion framework is proposed that leverages the complementary strengths of a self-supervised vision transformer encoder for its superior semantic understanding and a large-scale generative model encoder for its spatially-aware capability. Furthermore, we introduce a hierarchical prompt learning mechanism to adapt to varying procedural contexts. Finally, a scene-guided attention decoder is proposed to focus on critical surgical areas while suppressing background distractions. To validate the effectiveness, we established a new dataset, derived from publicly available surgical datasets with affordance annotations for three basic surgical actions: aspiration, clipping, and retraction. Extensive experiments demonstrate that our approach achieves state-of-the-art performance. Moreover, we validate our framework's applicability for downstream automation on a realistic lung and prostate phantom, and results show that the predicted affordance maps successfully enable autonomous surgical actions.