Arthroscopy is a minimally invasive surgical procedure used to diagnose and treat joint problems. The clinical workflow of arthroscopy typically involves inserting an arthroscope into the joint through a small incision, during which surgeons navigate and operate largely by relying on their visual assessment through the arthroscope. However, the arthroscope's restricted field of view and lack of depth perception pose challenges in navigating complex articular structures and achieving surgical precision during procedures. Aiming at enhancing intraoperative awareness, we present a robust pipeline that incorporates simultaneous localization and mapping, depth estimation, and 3D Gaussian splatting to realistically reconstruct intra-articular structures solely based on monocular arthroscope video. Extending 3D reconstruction to Augmented Reality (AR) applications, our solution offers AR assistance for articular notch measurement and annotation anchoring in a human-in-the-loop manner. Compared to traditional Structure-from-Motion and Neural Radiance Field-based methods, our pipeline achieves dense 3D reconstruction and competitive rendering fidelity with explicit 3D representation in 7 minutes on average. When evaluated on four phantom datasets, our method achieves RMSE = 2.21mm reconstruction error, PSNR = 32.86 and SSIM = 0.89 on average. Because our pipeline enables AR reconstruction and guidance directly from monocular arthroscopy without any additional data and/or hardware, our solution may hold the potential for enhancing intraoperative awareness and facilitating surgical precision in arthroscopy. Our AR measurement tool achieves accuracy within 1.59 +/- 1.81mm and the AR annotation tool achieves a mIoU of 0.721.

Large language model-based (LLM) agents are emerging as a powerful enabler of robust embodied intelligence due to their capability of planning complex action sequences. Sound planning ability is necessary for robust automation in many task domains, but especially in surgical automation. These agents rely on a highly detailed natural language representation of the scene. Thus, to leverage the emergent capabilities of LLM agents for surgical task planning, developing similarly powerful and robust perception algorithms is necessary to derive a detailed scene representation of the environment from visual input. Previous research has focused primarily on enabling LLM-based task planning while adopting simple yet severely limited perception solutions to meet the needs for bench-top experiments but lack the critical flexibility to scale to less constrained settings. In this work, we propose an alternate perception approach -- a digital twin-based machine perception approach that capitalizes on the convincing performance and out-of-the-box generalization of recent vision foundation models. Integrating our digital twin-based scene representation and LLM agent for planning with the dVRK platform, we develop an embodied intelligence system and evaluate its robustness in performing peg transfer and gauze retrieval tasks. Our approach shows strong task performance and generalizability to varied environment settings. Despite convincing performance, this work is merely a first step towards the integration of digital twin-based scene representations. Future studies are necessary for the realization of a comprehensive digital twin framework to improve the interpretability and generalizability of embodied intelligence in surgery.

Accurate segmentation of tools in robot-assisted surgery is critical for machine perception, as it facilitates numerous downstream tasks including augmented reality feedback. While current feed-forward neural network-based methods exhibit excellent segmentation performance under ideal conditions, these models have proven susceptible to even minor corruptions, significantly impairing the model's performance. This vulnerability is especially problematic in surgical settings where predictions might be used to inform high-stakes decisions. To better understand model behavior under non-adversarial corruptions, prior work has explored introducing artificial corruptions, like Gaussian noise or contrast perturbation to test set images, to assess model robustness. However, these corruptions are either not photo-realistic or model/task agnostic. Thus, these investigations provide limited insights into model deterioration under realistic surgical corruptions. To address this limitation, we introduce the SegSTRONG-C challenge that aims to promote the development of algorithms robust to unforeseen but plausible image corruptions of surgery, like smoke, bleeding, and low brightness. We collect and release corruption-free mock endoscopic video sequences for the challenge participants to train their algorithms and benchmark them on video sequences with photo-realistic non-adversarial corruptions for a binary robot tool segmentation task. This new benchmark will allow us to carefully study neural network robustness to non-adversarial corruptions of surgery, thus constituting an important first step towards more robust models for surgical computer vision. In this paper, we describe the data collection and annotation protocol, baseline evaluations of established segmentation models, and data augmentation-based techniques to enhance model robustness.

Purpose: Tracking the 3D motion of the surgical tool and the patient anatomy is a fundamental requirement for computer-assisted skull-base surgery. The estimated motion can be used both for intra-operative guidance and for downstream skill analysis. Recovering such motion solely from surgical videos is desirable, as it is compliant with current clinical workflows and instrumentation. Methods: We present Tracker of Anatomy and Tool (TAToo). TAToo jointly tracks the rigid 3D motion of patient skull and surgical drill from stereo microscopic videos. TAToo estimates motion via an iterative optimization process in an end-to-end differentiable form. For robust tracking performance, TAToo adopts a probabilistic formulation and enforces geometric constraints on the object level. Results: We validate TAToo on both simulation data, where ground truth motion is available, as well as on anthropomorphic phantom data, where optical tracking provides a strong baseline. We report sub-millimeter and millimeter inter-frame tracking accuracy for skull and drill, respectively, with rotation errors below 1{\deg}. We further illustrate how TAToo may be used in a surgical navigation setting. Conclusion: We present TAToo, which simultaneously tracks the surgical tool and the patient anatomy in skull-base surgery. TAToo directly predicts the motion from surgical videos, without the need of any markers. Our results show that the performance of TAToo compares favorably to competing approaches. Future work will include fine-tuning of our depth network to reach a 1 mm clinical accuracy goal desired for surgical applications in the skull base.

Purpose: Digital twins are virtual interactive models of the real world, exhibiting identical behavior and properties. In surgical applications, computational analysis from digital twins can be used, for example, to enhance situational awareness. Methods: We present a digital twin framework for skull-base surgeries, named Twin-S, which can be integrated within various image-guided interventions seamlessly. Twin-S combines high-precision optical tracking and real-time simulation. We rely on rigorous calibration routines to ensure that the digital twin representation precisely mimics all real-world processes. Twin-S models and tracks the critical components of skull-base surgery, including the surgical tool, patient anatomy, and surgical camera. Significantly, Twin-S updates and reflects real-world drilling of the anatomical model in frame rate. Results: We extensively evaluate the accuracy of Twin-S, which achieves an average 1.39 mm error during the drilling process. We further illustrate how segmentation masks derived from the continuously updated digital twin can augment the surgical microscope view in a mixed reality setting, where bone requiring ablation is highlighted to provide surgeons additional situational awareness. Conclusion: We present Twin-S, a digital twin environment for skull-base surgery. Twin-S tracks and updates the virtual model in real-time given measurements from modern tracking technologies. Future research on complementing optical tracking with higher-precision vision-based approaches may further increase the accuracy of Twin-S.

With careful manipulation, malicious agents can reverse engineer private information encoded in pre-trained language models. Security concerns motivate the development of quantum pre-training. In this work, we propose a highly Portable Quantum Language Model (PQLM) that can easily transmit information to downstream tasks on classical machines. The framework consists of a cloud PQLM built with random Variational Quantum Classifiers (VQC) and local models for downstream applications. We demonstrate the ad hoc portability of the quantum model by extracting only the word embeddings and effectively applying them to downstream tasks on classical machines. Our PQLM exhibits comparable performance to its classical counterpart on both intrinsic evaluation (loss, perplexity) and extrinsic evaluation (multilingual sentiment analysis accuracy) metrics. We also perform ablation studies on the factors affecting PQLM performance to analyze model stability. Our work establishes a theoretical foundation for a portable quantum pre-trained language model that could be trained on private data and made available for public use with privacy protection guarantees.