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Purpose: A stereoscopic surgical video stream consists of left-right image pairs provided by a stereo endoscope. While the surgical display shows these image pairs synchronised, most capture cards cause de-synchronisation. This means that the paired left and right images may not correspond once used in downstream tasks such as stereo depth computation. The stereo synchronisation problem is to recover the corresponding left-right images. This is particularly challenging in the surgical setting, owing to the moist tissues, rapid camera motion, quasi-staticity and real-time processing requirement. Existing methods exploit image cues from the diffuse reflection component and are defeated by the above challenges., Methods: We propose to exploit the specular reflection. Specifically, we propose a powerful left-right comparison score (LRCS) using the specular highlights commonly occurring on moist tissues. We detect the highlights using a neural network, characterise them with invariant descriptors, match them, and use the number of matches to form the proposed LRCS. We perform evaluation against 147 existing LRCS in 44 challenging robotic partial nephrectomy and robotic-assisted hepatic resection video sequences with simulated and real de-synchronisation., Results: The proposed LRCS outperforms, with an average and maximum offsets of 0.055 and 1 frames and 94.1±3.6% successfully synchronised frames. In contrast, the best existing LRCS achieves an average and maximum offsets of 0.3 and 3 frames and 81.2±6.4% successfully synchronised frames., Conclusion: The use of specular reflection brings a tremendous boost to the real-time surgical stereo synchronisation problem., (© 2024. CARS.)

Purpose: To detect specularities as elliptical blobs in endoscopy. The rationale is that in the endoscopic setting, specularities are generally small and that knowing the ellipse coefficients allows one to reconstruct the surface normal. In contrast, previous works detect specular masks as free-form shapes and consider the specular pixels as nuisance., Methods: A pipeline combining deep learning with handcrafted steps for specularity detection. This pipeline is general and accurate in the context of endoscopic applications involving multiple organs and moist tissues. A fully convolutional network produces an initial mask which specifically finds specular pixels, being mainly composed of sparsely distributed blobs. Standard ellipse fitting follows for local segmentation refinement in order to only keep the blobs fulfilling the conditions for successful normal reconstruction., Results: Convincing results in detection and reconstruction on synthetic and real images, showing that the elliptical shape prior improves the detection itself in both colonoscopy and kidney laparoscopy. The pipeline achieved a mean Dice of 84% and 87% respectively in test data for these two use cases, and allows one to exploit the specularities as useful information for inferring sparse surface geometry. The reconstructed normals are in good quantitative agreement with external learning-based depth reconstruction methods manifested, as shown by an average angular discrepancy of [Formula: see text] in colonoscopy., Conclusion: First fully automatic method to exploit specularities in endoscopic 3D reconstruction. Because the design of current reconstruction methods can vary considerably for different applications, our elliptical specularity detection could be of potential interest in clinical practice thanks to its simplicity and generalisability. In particular, the obtained results are promising towards future integration with learning-based depth inference and SfM methods., (© 2023. CARS.)

Introduction: Minimally invasive partial nephrectomy (MIPN) has become the standard of care for localized kidney tumors over the past decade. The characteristics of each tumor, in particular its size and relationship with the excretory tract and vessels, allow one to judge its complexity and to attempt predicting the risk of complications. The recent development of virtual 3D model reconstruction and computer vision has opened the way to image-guided surgery and augmented reality (AR)., Objective: Our objective was to perform a systematic review to list and describe the different AR techniques proposed to support PN., Materials and Methods: The systematic review of the literature was performed on 12/04/22, using the keywords "nephrectomy" and "augmented reality" on Embase and Medline. Articles were considered if they reported surgical outcomes when using AR with virtual image overlay on real vision, during ex vivo or in vivo MIPN. We classified them according to the registration technique they use., Results: We found 16 articles describing an AR technique during MIPN procedures that met the eligibility criteria. A moderate to high risk of bias was recorded for all the studies. We classified registration methods into three main families, of which the most promising one seems to be surface-based registration., Conclusion: Despite promising results, there do not exist studies showing an improvement in clinical outcomes using AR. The ideal AR technique is probably yet to be established, as several designs are still being actively explored. More clinical data will be required to establish the potential contribution of this technology to MIPN., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: We present a novel automatic system for markerless real-time augmented reality. Our system uses a dynamic keyframe database, which is required to track previously unseen or appearance-changing anatomical structures. Our main objective is to track the organ more accurately and over a longer time frame through the surgery., Methods: Our system works with an offline stage which constructs the initial keyframe database and an online stage which dynamically updates the database with new keyframes automatically selected from the video stream. We propose five keyframe selection criteria ensuring tracking stability and a database management scheme ensuring real-time performance., Results: Experimental results show that our automatic keyframe selection system based on a dynamic keyframe database outperforms the baseline system with a static keyframe database. An increase in number of tracked frames without requiring surgeon input is observed with an average improvement margin over the baseline of 11.9%. The frame rate is kept at the same values as the baseline, close to 50 FPS, and rendering remains smooth., Conclusion: Our software-based tracking system copes with new viewpoints and appearance changes during surgery. It improves surgical organ tracking performance. Its criterion-based architecture allows a high degree of flexibility in the implementation, hence compatibility with various use cases., (© 2022. CARS.)

Background: The advent of digital medical imaging, medical image analysis and computer vision has opened the surgeon horizons with the possibility to add virtual information to the real operative field. For oral and maxillofacial surgeons, overlaying anatomical structures to protect (such as teeth, sinus floors, inferior and superior alveolar nerves) or to remove (such as cysts, tumours, impacted teeth) presents a real clinical interest., Material and Methods: Through this work, we propose a proof-of-concept markerless augmented reality system for oral and maxillofacial surgery, where a virtual scene is generated preoperatively and mixed with reality to reveal the location of hidden anatomical structures intraoperatively. We devised a computer software to process still video frames of the operating field and to display them on the operating room screens., Results: Firstly, we give a description of the proposed system, where virtuality aligns with reality without artificial markers. The dental occlusion plan analysis and cusps detection allow us to initialise the alignment process. Secondly, we validate the feasibility with an experimental approach on a 3D printed jaw phantom and an ex-vivo pig jaw. Thirdly, we evaluate the potential clinical benefit on a patient., Conclusion: this proof-of-concept highlights the feasibility and the interest of augmented reality for hidden anatomical structures visualisation without artificial markers., Competing Interests: Declaration of Conflicting Interest The Authors declare that there is no conflict of interest, (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)