Augmentation by generative modelling yields a promising alternative to the accumulation of surgical data, where ethical, organisational and regulatory aspects must be considered. Yet, the joint synthesis of (image, mask) pairs for segmentation, a major application in surgery, is rather unexplored. We propose to learn semantically comprehensive yet compact latent representations of the (image, mask) space, which we jointly model with a Latent Diffusion Model. We show that our approach can effectively synthesise unseen high-quality paired segmentation data of remarkable semantic coherence. Generative augmentation is typically applied pre-training by synthesising a fixed number of additional training samples to improve downstream task models. To enhance this approach, we further propose Generative Adaptive Uncertainty-guided Diffusion-based Augmentation (GAUDA), leveraging the epistemic uncertainty of a Bayesian downstream model for targeted online synthesis. We condition the generative model on classes with high estimated uncertainty during training to produce additional unseen samples for these classes. By adaptively utilising the generative model online, we can minimise the number of additional training samples and centre them around the currently most uncertain parts of the data distribution. GAUDA effectively improves downstream segmentation results over comparable methods by an average absolute IoU of 1.6% on CaDISv2 and 1.5% on CholecSeg8k, two prominent surgical datasets for semantic segmentation.

Machine learning systems produce biased results towards certain demographic groups, known as the fairness problem. Recent approaches to tackle this problem learn a latent code (i.e., representation) through disentangled representation learning and then discard the latent code dimensions correlated with sensitive attributes (e.g., gender). Nevertheless, these approaches may suffer from incomplete disentanglement and overlook proxy attributes (proxies for sensitive attributes) when processing real-world data, especially for unstructured data, causing performance degradation in fairness and loss of useful information for downstream tasks. In this paper, we propose a novel fairness framework that performs debiasing with regard to both sensitive attributes and proxy attributes, which boosts the prediction performance of downstream task models without complete disentanglement. The main idea is to, first, leverage gradient-based explanation to find two model focuses, 1) one focus for predicting sensitive attributes and 2) the other focus for predicting downstream task labels, and second, use them to perturb the latent code that guides the training of downstream task models towards fairness and utility goals. We show empirically that our framework works with both disentangled and non-disentangled representation learning methods and achieves better fairness-accuracy trade-off on unstructured and structured datasets than previous state-of-the-art approaches.