The persistent gap between the growing global surgical demand and the trained surgical workforce [1] highlights the need to develop scalable solutions that can enhance training paradigms and optimize workflow management [2]. Computer-assisted surgery (CAS) systems are one approach to address this challenge, with applications in preoperative planning [3], intraoperative guidance [4], and standardized postoperative assessment [5, 6]. The development and validation of these advanced CAS capabilities fundamentally depend on access to large-scale, deeply annotated surgical video datasets that capture procedural phases, instrument-tissue interactions, and technical skill cues [7, 8]. Phacoemulsification cataract surgery is the most common ophthalmic procedure worldwide and the primary intervention for avoidable blindness [9, 10]. This makes it a critical domain for developing data-driven CAS with potential applications in clinical workflows and training [11, 12]. Publicly available datasets for developing CAS in cataract surgery, such as Cataract-1K [13] and CaDIS [14], are limited by their single-center origin and limited annotation scopes [15]. The absence of a multi-source dataset with comprehensive and multi-layered annotations, including objective skill assessments, has limited the development of generalizable multi-task deep learning models [11]. To address this gap, we present the Cataract-LMM (Large-scale, Multi-source, Multi-task) Dataset, a dataset of 3,000 phacoemulsification procedures recorded at two distinct clinical centers (Farabi and Noor Eye Hospitals, Tehran, Iran) between December 2021 and March 2025. The dataset is enriched with four complementary layers of annotations on subsets of the data: 1. Temporal Phase Labels (Phase): Frame-wise annotations for 13 surgical phases across 150 videos to support automated workflow recognition.

Automated surgical skill assessment (SSA) is a central task in surgical computer vision. Developing robust SSA models is challenging due to the scarcity of skill annotations, which are time-consuming to produce and require expert consensus. Few-shot learning (FSL) offers a scalable alternative enabling model development with minimal supervision, though its success critically depends on effective pre-training. While widely studied for several surgical downstream tasks, pre-training has remained largely unexplored in SSA. In this work, we formulate SSA as a few-shot task and investigate how self-supervised pre-training strategies affect downstream few-shot SSA performance. We annotate a publicly available robotic surgery dataset with Objective Structured Assessment of Technical Skill (OSATS) scores, and evaluate various pre-training sources across three few-shot settings. We quantify domain similarity and analyze how domain gap and the inclusion of procedure-specific data into pre-training influence transferability. Our results show that small but domain-relevant datasets can outperform large scale, less aligned ones, achieving accuracies of 60.16%, 66.03%, and 73.65% in the 1-, 2-, and 5-shot settings, respectively. Moreover, incorporating procedure-specific data into pre-training with a domain-relevant external dataset significantly boosts downstream performance, with an average gain of +1.22% in accuracy and +2.28% in F1-score; however, applying the same strategy with less similar but large-scale sources can instead lead to performance degradation. Code and models are available at https://github.com/anastadimi/ssa-fsl.

Traditional surgical skill acquisition relies heavily on expert feedback, yet direct access is limited by faculty availability and variability in subjective assessments. While trainees can practice independently, the lack of personalized, objective, and quantitative feedback reduces the effectiveness of self-directed learning. Recent advances in computer vision and machine learning have enabled automated surgical skill assessment, demonstrating the feasibility of automatic competency evaluation. However, it is unclear whether such Artificial Intelligence (AI)-driven feedback can contribute to skill acquisition. Here, we examine the effectiveness of explainable AI (XAI)-generated feedback in surgical training through a human-AI study. We create a simulation-based training framework that utilizes XAI to analyze videos and extract surgical skill proxies related to primitive actions. Our intervention provides automated, user-specific feedback by comparing trainee performance to expert benchmarks and highlighting deviations from optimal execution through understandable proxies for actionable guidance. In a prospective user study with medical students, we compare the impact of XAI-guided feedback against traditional video-based coaching on task outcomes, cognitive load, and trainees' perceptions of AI-assisted learning. Results showed improved cognitive load and confidence post-intervention. While no differences emerged between the two feedback types in reducing performance gaps or practice adjustments, trends in the XAI group revealed desirable effects where participants more closely mimicked expert practice. This work encourages the study of explainable AI in surgical education and the development of data-driven, adaptive feedback mechanisms that could transform learning experiences and competency assessment.

Objective motor skill assessment plays a critical role in fields such as surgery, where proficiency is vital for certification and patient safety. Existing assessment methods, however, rely heavily on subjective human judgment, which introduces bias and limits reproducibility. While recent efforts have leveraged kinematic data and neural imaging to provide more objective evaluations, these approaches often overlook the dynamic neural mechanisms that differentiate expert and novice performance. This study proposes a novel method for motor skill assessment based on dynamic directed functional connectivity (dFC) as a neural biomarker. By using electroencephalography (EEG) to capture brain dynamics and employing an attention-based Long Short-Term Memory (LSTM) model for non-linear Granger causality analysis, we compute dFC among key brain regions involved in psychomotor tasks. Coupled with hierarchical task analysis (HTA), our approach enables subtask-level evaluation of motor skills, offering detailed insights into neural coordination that underpins expert proficiency. A convolutional neural network (CNN) is then used to classify skill levels, achieving greater accuracy and specificity than established performance metrics in laparoscopic surgery. This methodology provides a reliable, objective framework for assessing motor skills, contributing to the development of tailored training protocols and enhancing the certification process.

Automated assessment of surgical skills using artificial intelligence (AI) provides trainees with instantaneous feedback. After bimanual tool motions are captured, derived kinematic metrics are reliable predictors of performance in laparoscopic tasks. Implementing automated tool tracking requires time-intensive human annotation. We developed AI-based tool tracking using the Segment Anything Model (SAM) to eliminate the need for human annotators. Here, we describe a study evaluating the usefulness of our tool tracking model in automated assessment during a laparoscopic suturing task in the fundoplication procedure. An automated tool tracking model was applied to recorded videos of Nissen fundoplication on porcine bowel. Surgeons were grouped as novices (PGY1-2) and experts (PGY3-5, attendings). The beginning and end of each suturing step were segmented, and motions of the left and right tools were extracted. A low-pass filter with a 24 Hz cut-off frequency removed noise. Performance was assessed using supervised and unsupervised models, and an ablation study compared results. Kinematic features--RMS velocity, RMS acceleration, RMS jerk, total path length, and Bimanual Dexterity--were extracted and analyzed using Logistic Regression, Random Forest, Support Vector Classifier, and XGBoost. PCA was performed for feature reduction. For unsupervised learning, a Denoising Autoencoder (DAE) model with classifiers, such as a 1-D CNN and traditional models, was trained. Data were extracted for 28 participants (9 novices, 19 experts). Supervised learning with PCA and Random Forest achieved an accuracy of 0.795 and an F1 score of 0.778. The unsupervised 1-D CNN achieved superior results with an accuracy of 0.817 and an F1 score of 0.806, eliminating the need for kinematic feature computation. We demonstrated an AI model capable of automated performance classification, independent of human annotation.

In surgical skill assessment, Objective Structured Assessments of Technical Skills (OSATS scores) and the Global Rating Scale (GRS) are established tools for evaluating the performance of surgeons during training. These metrics, coupled with feedback on their performance, enable surgeons to improve and achieve standards of practice. Recent studies on the open-source dataset JIGSAW, which contains both GRS and OSATS labels, have focused on regressing GRS scores from kinematic signals, video data, or a combination of both. In this paper, we argue that regressing the GRS score, a unitless value, by itself is too restrictive, and variations throughout the surgical trial do not hold significant clinical meaning. To address this gap, we developed a recurrent transformer model that outputs the surgeon's performance throughout their training session by relating the model's hidden states to five OSATS scores derived from kinematic signals. These scores are averaged and aggregated to produce a GRS prediction, enabling assessment of the model's performance against the state-of-the-art (SOTA). We report Spearman's Correlation Coefficient (SCC), demonstrating that our model outperforms SOTA models for all tasks, except for Suturing under the leave-one-subject-out (LOSO) scheme (SCC 0.68-0.89), while achieving comparable performance for suturing and across tasks under the leave-one-user-out (LOUO) scheme (SCC 0.45-0.68) and beating SOTA for Needle Passing (0.69). We argue that relating final OSATS scores to short instances throughout a surgeon's procedure is more clinically meaningful than a single GRS score. This approach also allows us to translate quantitative predictions into qualitative feedback, which is crucial for any automated surgical skill assessment pipeline. A senior surgeon validated our model's behaviour and agreed with the semi-supervised predictions 77 \% (p = 0.006) of the time.

Biomedical Engineering Department, Rensselaer Polytechnic Institute, NY, USA Accurate assessment of bimanual motor skills is essential across various professions, yet, traditional methods often rely on subjective assessments or focus solely on motor actions, overlooking the integral role of cognitive processes. This study introduces a novel approach by leveraging deep neural networks (DNNs) to analyze and integrate both cognitive decision-making and motor execution. We tested this methodology by assessing laparoscopic surgery skills within the Fundamentals of Laparoscopic Surgery program, which is a prerequisite for general surgery certification. Utilizing video capture of motor actions and non-invasive functional near-infrared spectroscopy (fNIRS) for measuring neural activations, our approach precisely classifies subjects by expertise level and predicts FLS behavioral performance scores, significantly surpassing traditional single-modality assessments. In this study, we introduce a novel approach by conducting a direct statistical comparative analysis between neural activations and motor actions for assessing bimanual motor skills using DNNs. We explore the synergy of these modalities in multimodal analysis, applied to precision and cognitive-demanding tasks, particularly within the Fundamentals of Laparoscopic Surgery (FLS) program (Figure 1).

Deep Learning (DL) has achieved automatic and objective assessment of surgical skills. However, the applicability of DL models is often hampered by their substantial data requirements and confinement to specific training domains. This prevents them from transitioning to new tasks with scarce data. Therefore, domain adaptation emerges as a critical element for the practical implementation of DL in real-world scenarios. Herein, we introduce A-VBANet, a novel meta-learning model capable of delivering domain-agnostic surgical skill classification via one-shot learning. A-VBANet has been rigorously developed and tested on five diverse laparoscopic and robotic surgical simulators. Furthermore, we extend its validation to operating room (OR) videos of laparoscopic cholecystectomy. Our model successfully adapts with accuracies up to 99.5% in one-shot and 99.9% in few-shot settings for simulated tasks and 89.7% for laparoscopic cholecystectomy. This research marks the first instance of a domain-agnostic methodology for surgical skill assessment, paving the way for more precise and accessible training evaluation across diverse high-stakes environments such as real-life surgery where data is scarce.

Image processing techniques have huge impact on most fields of robotics and industrial automation. Real time methods are usually employed in complex automation tasks, assisting with decision making or directly guiding robots and machinery, while post-processing is usually used for retrospective assessment of systems and processes. While artificial intelligence based image processing algorithms (usually neural networks) are more common nowadays, classical methods can also be used effectively even in modern applications. This paper focuses on optical flow based image processing, proving its efficiency by presenting optical flow based solutions for modern challenges in different fields of robotics such as robotic surgery and food industry automation. The main subject of the paper is a smart robotic gripper designed for automated robot cells in the meat industry, that is capable of slip detection and secure gripping of soft, slippery tissues with the help of the implemented optical flow based algorithm.

Objective technical skill assessment is crucial for effective training of new surgeons in robot-assisted surgery. With advancements in surgical training programs in both physical and virtual environments, it is imperative to develop generalizable methods for automatically assessing skills. In this paper, we propose a novel approach for skill assessment by transferring domain knowledge from labeled kinematic data to unlabeled data. Our approach leverages labeled data from common surgical training tasks such as Suturing, Needle Passing, and Knot Tying to jointly train a model with both labeled and unlabeled data. Pseudo labels are generated for the unlabeled data through an iterative manner that incorporates uncertainty estimation to ensure accurate labeling. We evaluate our method on a virtual reality simulated training task (Ring Transfer) using data from the da Vinci Research Kit (dVRK). The results show that trainees with robotic assistance have significantly higher expert probability compared to these without any assistance, p < 0.05, which aligns with previous studies showing the benefits of robotic assistance in improving training proficiency. Our method offers a significant advantage over other existing works as it does not require manual labeling or prior knowledge of the surgical training task for robot-assisted surgery.