Manual labeling of gestures in robot-assisted surgery is labor intensive, prone to errors, and requires expertise or training. We propose a method for automated and explainable generation of gesture transcripts that leverages the abundance of data for image segmentation. Surgical context is detected using segmentation masks by examining the distances and intersections between the tools and objects. Next, context labels are translated into gesture transcripts using knowledge-based Finite State Machine (FSM) and data-driven Long Short Term Memory (LSTM) models. We evaluate the performance of each stage of our method by comparing the results with the ground truth segmentation masks, the consensus context labels, and the gesture labels in the JIGSAWS dataset. Our results show that our segmentation models achieve state-of-the-art performance in recognizing needle and thread in Suturing and we can automatically detect important surgical states with high agreement with crowd-sourced labels (e.g., contact between graspers and objects in Suturing). We also find that the FSM models are more robust to poor segmentation and labeling performance than LSTMs. Our proposed method can significantly shorten the gesture labeling process (~2.8 times).

Surgical context inference has recently garnered significant attention in robot-assisted surgery as it can facilitate workflow analysis, skill assessment, and error detection. However, runtime context inference is challenging since it requires timely and accurate detection of the interactions among the tools and objects in the surgical scene based on the segmentation of video data. On the other hand, existing state-of-the-art video segmentation methods are often biased against infrequent classes and fail to provide temporal consistency for segmented masks. This can negatively impact the context inference and accurate detection of critical states. In this study, we propose a solution to these challenges using a Space-Time Correspondence Network (STCN). STCN is a memory network that performs binary segmentation and minimizes the effects of class imbalance. The use of a memory bank in STCN allows for the utilization of past image and segmentation information, thereby ensuring consistency of the masks. Our experiments using the publicly-available JIGSAWS dataset demonstrate that STCN achieves superior segmentation performance for objects that are difficult to segment, such as needle and thread, and improves context inference compared to the state-of-the-art. We also demonstrate that segmentation and context inference can be performed at runtime without compromising performance.