RAUL: Reference-Assisted Ureteroscopy Localization for Skill Assessment
Authors: Fangjie Li, Mai Bui, Charan Mohan, Michael Miga, Matthieu Chabanas, Nicholas Kavoussi, Jie Ying Wu
Organizations: Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37240 USA · Department of Computer Science, Vanderbilt University, Nashville, TN 37240 USA · Department of Urology, Vanderbilt University Medical Center, Nashville, TN 37232 USA
Objective: Incomplete navigation of anatomy during ureteroscopic kidney stone surgeries can contribute to repeat interventions. While skilled surgeons have lower reintervention rates, there are no objective metrics to quantify scope-navigation performance to evaluate when a trainee becomes skilled. This work aims to recover ureteroscope trajectories from endoscopic video and derive navigation metrics to quantify differences in skill. Methods: We propose RAUL, a reference-assisted reconstruction framework for recovering ureteroscope trajectories from ureteroscope videos only in phantoms. For each phantom, we use a slow, high-quality reference exploration video to generate a reference reconstruction. We localize subsequent exploration videos against this reference. We evaluate localization accuracy against electromagnetically tracked scope pose. We compute navigation metrics from phantom exploration trajectories to compare surgical residents across experience levels. Results: The proposed reference-assisted framework achieves a mean translation root mean square error of 0.5±0.1 mm across 9 phantoms. Compared to standard Structure-from-Motion (SfM), the proposed pipeline increases frame-wise localization coverage from 50.5±14.9% to 86.1±7.2% of all video frames. The reconstructed trajectories revealed significant differences between high- and low-experience trainees in established navigation metrics. Conclusion: RAUL enables substantially more complete recovery of ureteroscope trajectories from videos compared to standard SfM pipelines, enabling trajectory-based skill assessment without additional tracking equipment. Significance: To the best of our knowledge, this is the first use of video-only recovery of ureteroscope trajectories without external tracking sensors for skill assessment, supporting scalable automated assessment of ureteroscopy navigation skill.
Timely and transparent feedback is essential for effective surgical training, yet current assessment remains dependent on expert observation, limiting scalability and opportunities for autonomous practice. We present ExpOS, an explainable framework for data-driven assessment of open-surgery skills designed to enable automatic, feedback-oriented evaluation. Rather than relying on expert-defined metrics, ExpOS learns discriminative temporal patterns directly from motion data and identifies the segments and behaviors most predictive of skill level. We trained and evaluated the method on 221 videos of medical students performing three open-surgery tasks. Hand poses and tool detections were extracted from each frame to derive kinematic descriptors and global motion statistics. Spatiotemporal hand-tool dynamics were modeled using a temporal convolutional backbone with attention-based pooling to generate frame-level importance maps. These representations were fused with global motion statistics to predict skill level and to provide interpretable feedback. ExpOS provides multi-level explainability by identifying when informative events occur through attention weights and which motion characteristics most influence predictions through global feature analysis. Across tasks, the framework achieved strong correlation with expert ratings, with best performance on fascial closure (r = 0.778, R2 = 0.74). These results demonstrate that combining weakly-supervised temporal importance learning with interpretable motion statistics enables scalable and actionable surgical skill assessment.
Freehand 3-D ultrasound (US) imaging has attracted increasing attention owing to its intuitive volumetric visualization, ease of use, and low cost. However, accurate 3-D reconstruction critically depends on stable probe pose estimation, yet existing trackerless methods remain susceptible to accumulated pose errors, particularly over long scanning trajectories. To address this limitation, we propose a global-to-local pose estimation framework that exploits external camera observations for globally stable localization and B-mode US images for anatomy-aware local refinement. Specifically, the framework comprises a dual-camera branch that performs contextual feature aggregation across camera views and temporal observations to estimate a globally consistent probe trajectory, and a B-mode branch that performs anatomical feature aggregation from sequential US images to capture tissue-dependent local motion cues. A cross-modal fusion module subsequently integrates the contextual camera features and anatomical US features to predict pose residuals and refine the camera-derived estimates in the transformation space. Furthermore, a multi-scale pose loss constrains relative motion over multiple temporal horizons to suppress accumulated drift during extended scans. The proposed framework is validated on phantom and in vivo datasets. On two in-house datasets (FUSION-J and FUSION-L) collected using different machines, the proposed US + Dual-Cam model reduces average trajectory drift to 1.67 mm and 1.29 mm, representing improvement of 16.50% and 27.12%, respectively, over a strong dual-camera baseline, while substantially outperforming US-only pose estimation (>13 mm drift). In in vivo forearm arteries reconstruction, it achieves Hausdorff distances of 1.58 mm, demonstrating the effectiveness of the proposed method on real clinical scenarios.
Achieving high levels of surgical skill through effective training is essential for optimal patient outcomes. Automated, data-driven skill assessment holds significant potential to improve surgical training. While machine learning-based methods are increasingly popular for assessing skills in minimally invasive surgery, their application to open surgery remains limited. We present the results of a dedicated MICCAI challenge designed to benchmark and advance vision-based skill assessment in open surgery. The challenge dataset comprises videos of an open suturing training task recorded with a static GoPro camera in a dry-lab setting, with instrument trajectories available in addition to the primary video modality. The OSS Challenge was hosted over two consecutive years, comprising two and three independent tasks, respectively: (1) classifying skill level into four classes, (2) predicting the full Objective Structured Assessment of Technical Skills across eight categories, and (3) tracking hands and surgical tools. Participants submitted diverse solutions including deep learning-based video models, tracking-driven methods, and hybrid approaches. General-purpose spatiotemporal video models consistently achieved the strongest performance, though conceptually diverse approaches reached competitive levels when well-executed. Predicting fine-grained OSATS scores remains challenging but benefits substantially from increased training data. Keypoint tracking proves difficult given frequent occlusions and out-of-frame instances, limiting current applicability for motion-based skill analysis. This work benchmarks innovative and diverse solutions for surgical skill assessment, highlighting both the promise and current limitations of video-based evaluation in open surgery and identifying critical directions for advancing automated skill assessment toward clinical impact.