Skip to main content
Top
Published in: International Journal of Computer Assisted Radiology and Surgery 9/2019

30-07-2019 | Original Article

Accurate and interpretable evaluation of surgical skills from kinematic data using fully convolutional neural networks

Authors: Hassan Ismail Fawaz, Germain Forestier, Jonathan Weber, Lhassane Idoumghar, Pierre-Alain Muller

Published in: International Journal of Computer Assisted Radiology and Surgery | Issue 9/2019

Log in

Activate our intelligent search to find suitable subject content or patents.

search-config
loading …

Abstract

Purpose

Manual feedback from senior surgeons observing less experienced trainees is a laborious task that is very expensive, time-consuming and prone to subjectivity. With the number of surgical procedures increasing annually, there is an unprecedented need to provide an accurate, objective and automatic evaluation of trainees’ surgical skills in order to improve surgical practice.

Methods

In this paper, we designed a convolutional neural network (CNN) to classify surgical skills by extracting latent patterns in the trainees’ motions performed during robotic surgery. The method is validated on the JIGSAWS dataset for two surgical skills evaluation tasks: classification and regression.

Results

Our results show that deep neural networks constitute robust machine learning models that are able to reach new competitive state-of-the-art performance on the JIGSAWS dataset. While we leveraged from CNNs’ efficiency, we were able to minimize its black-box effect using the class activation map technique.

Conclusions

This characteristic allowed our method to automatically pinpoint which parts of the surgery influenced the skill evaluation the most, thus allowing us to explain a surgical skill classification and provide surgeons with a novel personalized feedback technique. We believe this type of interpretable machine learning model could integrate within “Operation Room 2.0” and support novice surgeons in improving their skills to eventually become experts.

Dont have a licence yet? Then find out more about our products and how to get one now:

Springer Professional "Wirtschaft+Technik"

Online-Abonnement

Mit Springer Professional "Wirtschaft+Technik" erhalten Sie Zugriff auf:

  • über 102.000 Bücher
  • über 537 Zeitschriften

aus folgenden Fachgebieten:

  • Automobil + Motoren
  • Bauwesen + Immobilien
  • Business IT + Informatik
  • Elektrotechnik + Elektronik
  • Energie + Nachhaltigkeit
  • Finance + Banking
  • Management + Führung
  • Marketing + Vertrieb
  • Maschinenbau + Werkstoffe
  • Versicherung + Risiko

Jetzt Wissensvorsprung sichern!

Springer Professional "Wirtschaft"

Online-Abonnement

Mit Springer Professional "Wirtschaft" erhalten Sie Zugriff auf:

  • über 67.000 Bücher
  • über 340 Zeitschriften

aus folgenden Fachgebieten:

  • Bauwesen + Immobilien
  • Business IT + Informatik
  • Finance + Banking
  • Management + Führung
  • Marketing + Vertrieb
  • Versicherung + Risiko




Jetzt Wissensvorsprung sichern!

Springer Professional "Technik"

Online-Abonnement

Mit Springer Professional "Technik" erhalten Sie Zugriff auf:

  • über 67.000 Bücher
  • über 390 Zeitschriften

aus folgenden Fachgebieten:

  • Automobil + Motoren
  • Bauwesen + Immobilien
  • Business IT + Informatik
  • Elektrotechnik + Elektronik
  • Energie + Nachhaltigkeit
  • Maschinenbau + Werkstoffe




 

Jetzt Wissensvorsprung sichern!

Footnotes
1
Our source code will be publicly available upon the acceptance of the paper.
 
Literature
1.
go back to reference Ahmidi N, Tao L, Sefati S, Gao Y, Lea C, Haro BB, Zappella L, Khudanpur S, Vidal R, Hager GD (2017) A dataset and benchmarks for segmentation and recognition of gestures in robotic surgery. IEEE Trans Biomed Eng 64(9):2025–2041CrossRefPubMedPubMedCentral Ahmidi N, Tao L, Sefati S, Gao Y, Lea C, Haro BB, Zappella L, Khudanpur S, Vidal R, Hager GD (2017) A dataset and benchmarks for segmentation and recognition of gestures in robotic surgery. IEEE Trans Biomed Eng 64(9):2025–2041CrossRefPubMedPubMedCentral
2.
go back to reference Bridgewater B, Grayson AD, Jackson M, Brooks N, Grotte GJ, Keenan DJ, Millner R, Fabri BM, Mark J (2003) Surgeon specific mortality in adult cardiac surgery: comparison between crude and risk stratified data. BMJ 327(7405):13–17CrossRefPubMedPubMedCentral Bridgewater B, Grayson AD, Jackson M, Brooks N, Grotte GJ, Keenan DJ, Millner R, Fabri BM, Mark J (2003) Surgeon specific mortality in adult cardiac surgery: comparison between crude and risk stratified data. BMJ 327(7405):13–17CrossRefPubMedPubMedCentral
4.
go back to reference Forestier G, Petitjean F, Senin P, Despinoy F, Jannin P (2017) Discovering discriminative and interpretable patterns for surgical motion analysis. In: Artificial intelligence in medicine, pp 136–145CrossRef Forestier G, Petitjean F, Senin P, Despinoy F, Jannin P (2017) Discovering discriminative and interpretable patterns for surgical motion analysis. In: Artificial intelligence in medicine, pp 136–145CrossRef
5.
go back to reference Forestier G, Petitjean F, Senin P, Despinoy F, Huaulmé A, Ismail Fawaz H, Weber J, Idoumghar L, Muller PA, Jannin P (2018) Surgical motion analysis using discriminative interpretable patterns. Artif Intell Med 91:3–11CrossRefPubMed Forestier G, Petitjean F, Senin P, Despinoy F, Huaulmé A, Ismail Fawaz H, Weber J, Idoumghar L, Muller PA, Jannin P (2018) Surgical motion analysis using discriminative interpretable patterns. Artif Intell Med 91:3–11CrossRefPubMed
6.
go back to reference Gao Y, Vedula SS, Reiley CE, Ahmidi N, Varadarajan B, Lin HC, Tao L, Zappella L, Béjar B, Yuh DD, Chen CCG, Vidal R, Khudanpur S, Hager GD (2014) The JHU-ISI gesture and skill assessment working set (JIGSAWS): a surgical activity dataset for human motion modeling. In: Modeling and monitoring of computer assisted interventions—MICCAI workshop Gao Y, Vedula SS, Reiley CE, Ahmidi N, Varadarajan B, Lin HC, Tao L, Zappella L, Béjar B, Yuh DD, Chen CCG, Vidal R, Khudanpur S, Hager GD (2014) The JHU-ISI gesture and skill assessment working set (JIGSAWS): a surgical activity dataset for human motion modeling. In: Modeling and monitoring of computer assisted interventions—MICCAI workshop
7.
go back to reference Glorot X, Bengio Y (2010) Understanding the difficulty of training deep feedforward neural networks. Int Conf Artif Intell Stat 9:249–256 Glorot X, Bengio Y (2010) Understanding the difficulty of training deep feedforward neural networks. Int Conf Artif Intell Stat 9:249–256
8.
go back to reference Hatala R, Cook DA, Brydges R, Hawkins R (2015) Constructing a validity argument for the objective structured assessment of technical skills (OSATS): a systematic review of validity evidence. Adv Health Sci Educ 20(5):1149–1175CrossRef Hatala R, Cook DA, Brydges R, Hawkins R (2015) Constructing a validity argument for the objective structured assessment of technical skills (OSATS): a systematic review of validity evidence. Adv Health Sci Educ 20(5):1149–1175CrossRef
9.
go back to reference Intuitive Surgical Sunnyvale CA (2018) The Da Vinci Surgical System Intuitive Surgical Sunnyvale CA (2018) The Da Vinci Surgical System
10.
go back to reference Islam G, Kahol K, Li B, Smith M, Patel VL (2016) Affordable, web-based surgical skill training and evaluation tool. J Biomed Inf 59:102–114CrossRef Islam G, Kahol K, Li B, Smith M, Patel VL (2016) Affordable, web-based surgical skill training and evaluation tool. J Biomed Inf 59:102–114CrossRef
11.
go back to reference Ismail Fawaz H, Forestier G, Weber J, Idoumghar L, Muller PA (2018) Evaluating surgical skills from kinematic data using convolutional neural networks. In: International conference on medical image computing and computer assisted intervention, pp 214–221 Ismail Fawaz H, Forestier G, Weber J, Idoumghar L, Muller PA (2018) Evaluating surgical skills from kinematic data using convolutional neural networks. In: International conference on medical image computing and computer assisted intervention, pp 214–221
12.
go back to reference Ismail Fawaz H, Forestier G, Weber J, Idoumghar L, Muller PA (2018) Transfer learning for time series classification. In: IEEE international conference on big data, pp 1367–1376 Ismail Fawaz H, Forestier G, Weber J, Idoumghar L, Muller PA (2018) Transfer learning for time series classification. In: IEEE international conference on big data, pp 1367–1376
13.
go back to reference Ismail Fawaz H, Forestier G, Weber J, Idoumghar L, Muller PA (2019) Deep learning for time series classification: a review. Data Mining and Knowledge Discovery Ismail Fawaz H, Forestier G, Weber J, Idoumghar L, Muller PA (2019) Deep learning for time series classification: a review. Data Mining and Knowledge Discovery
14.
go back to reference Kassahun Y, Yu B, Tibebu AT, Stoyanov D, Giannarou S, Metzen JH, Vander Poorten E (2016) Surgical robotics beyond enhanced dexterity instrumentation: a survey of machine learning techniques and their role in intelligent and autonomous surgical actions. Int J Comput Assist Radiol Surg 11(4):553–568CrossRefPubMed Kassahun Y, Yu B, Tibebu AT, Stoyanov D, Giannarou S, Metzen JH, Vander Poorten E (2016) Surgical robotics beyond enhanced dexterity instrumentation: a survey of machine learning techniques and their role in intelligent and autonomous surgical actions. Int J Comput Assist Radiol Surg 11(4):553–568CrossRefPubMed
15.
go back to reference Kingma DP, Ba J (2015) Adam: a method for stochastic optimization. In: International conference on learning representations Kingma DP, Ba J (2015) Adam: a method for stochastic optimization. In: International conference on learning representations
16.
go back to reference Maier-Hein L, Vedula SS, Speidel S, Navab N, Kikinis R, Park A, Eisenmann M, Feussner H, Forestier G, Giannarou S, Hashizume M, Katic D, Kenngott H, Kranzfelder M, Malpani A, März K, Neumuth T, Padoy N, Pugh C, Schoch N, Stoyanov D, Taylor R, Wagner M, Hager GD, Jannin P (2017) Surgical data science for next-generation interventions. Nat Biomed Eng 1(9):691–696CrossRefPubMed Maier-Hein L, Vedula SS, Speidel S, Navab N, Kikinis R, Park A, Eisenmann M, Feussner H, Forestier G, Giannarou S, Hashizume M, Katic D, Kenngott H, Kranzfelder M, Malpani A, März K, Neumuth T, Padoy N, Pugh C, Schoch N, Stoyanov D, Taylor R, Wagner M, Hager GD, Jannin P (2017) Surgical data science for next-generation interventions. Nat Biomed Eng 1(9):691–696CrossRefPubMed
17.
go back to reference Niitsu H, Hirabayashi N, Yoshimitsu M, Mimura T, Taomoto J, Sugiyama Y, Murakami S, Saeki S, Mukaida H, Takiyama W (2013) Using the objective structured assessment of technical skills (OSATS) global rating scale to evaluate the skills of surgical trainees in the operating room. Surg Today 43(3):271–275CrossRefPubMed Niitsu H, Hirabayashi N, Yoshimitsu M, Mimura T, Taomoto J, Sugiyama Y, Murakami S, Saeki S, Mukaida H, Takiyama W (2013) Using the objective structured assessment of technical skills (OSATS) global rating scale to evaluate the skills of surgical trainees in the operating room. Surg Today 43(3):271–275CrossRefPubMed
18.
go back to reference Polavarapu HV, Kulaylat A, Sun S, Hamed O (2013) 100 years of surgical education: the past, present, and future. Bull Am Coll Surg 98(7):22–29PubMed Polavarapu HV, Kulaylat A, Sun S, Hamed O (2013) 100 years of surgical education: the past, present, and future. Bull Am Coll Surg 98(7):22–29PubMed
19.
go back to reference Tao L, Elhamifar E, Khudanpur S, Hager GD, Vidal R (2012) Sparse hidden Markov models for surgical gesture classification and skill evaluation. In: Information processing in computer-assisted interventions, pp 167–177CrossRef Tao L, Elhamifar E, Khudanpur S, Hager GD, Vidal R (2012) Sparse hidden Markov models for surgical gesture classification and skill evaluation. In: Information processing in computer-assisted interventions, pp 167–177CrossRef
20.
go back to reference Vedula SS, Malpani AO, Tao L, Chen G, Gao Y, Poddar P, Ahmidi N, Paxton C, Vidal R, Khudanpur S, Hager GD, Chen CCG (2016) Analysis of the structure of surgical activity for a suturing and knot-tying task. Public Libr Sci One 11(3):1–14 Vedula SS, Malpani AO, Tao L, Chen G, Gao Y, Poddar P, Ahmidi N, Paxton C, Vidal R, Khudanpur S, Hager GD, Chen CCG (2016) Analysis of the structure of surgical activity for a suturing and knot-tying task. Public Libr Sci One 11(3):1–14
21.
go back to reference Wang Z, Majewicz Fey A (2018) Deep learning with convolutional neural network for objective skill evaluation in robot-assisted surgery. Int J Comput Assist Radiol Surg 13(12):1959–1970CrossRefPubMed Wang Z, Majewicz Fey A (2018) Deep learning with convolutional neural network for objective skill evaluation in robot-assisted surgery. Int J Comput Assist Radiol Surg 13(12):1959–1970CrossRefPubMed
22.
go back to reference Wang Z, Yan W, Oates T (2017) Time series classification from scratch with deep neural networks: a strong baseline. In: International joint conference on neural networks, pp 1578–1585 Wang Z, Yan W, Oates T (2017) Time series classification from scratch with deep neural networks: a strong baseline. In: International joint conference on neural networks, pp 1578–1585
23.
go back to reference Zhou B, Khosla A, Lapedriza A, Oliva A, Torralba A (2016) Learning deep features for discriminative localization. In: IEEE conference on computer vision and pattern recognition, pp 2921–2929 Zhou B, Khosla A, Lapedriza A, Oliva A, Torralba A (2016) Learning deep features for discriminative localization. In: IEEE conference on computer vision and pattern recognition, pp 2921–2929
24.
go back to reference Zia A, Essa I (2018) Automated surgical skill assessment in RMIS training. Int J Comput Assist Radiol Surg 13(5):731–739CrossRefPubMed Zia A, Essa I (2018) Automated surgical skill assessment in RMIS training. Int J Comput Assist Radiol Surg 13(5):731–739CrossRefPubMed
Metadata
Title
Accurate and interpretable evaluation of surgical skills from kinematic data using fully convolutional neural networks
Authors
Hassan Ismail Fawaz
Germain Forestier
Jonathan Weber
Lhassane Idoumghar
Pierre-Alain Muller
Publication date
30-07-2019
Publisher
Springer International Publishing
Published in
International Journal of Computer Assisted Radiology and Surgery / Issue 9/2019
Print ISSN: 1861-6410
Electronic ISSN: 1861-6429
DOI
https://doi.org/10.1007/s11548-019-02039-4

Other articles of this Issue 9/2019

International Journal of Computer Assisted Radiology and Surgery 9/2019 Go to the issue

Premium Partner