Accurately determining the shape of deformable objects and the location of their internal structures is crucial for medical tasks that require precise targeting, such as robotic biopsies. We introduce LUDO, a method for accurate low-latency understanding of deformable objects. LUDO reconstructs objects in their deformed state, including their internal structures, from a single-view point cloud observation in under 30 ms using occupancy networks. LUDO provides uncertainty estimates for its predictions. Additionally, it provides explainability by highlighting key features in its input observations. Both uncertainty and explainability are important for safety-critical applications such as surgery. We evaluate LUDO in real-world robotic experiments, achieving a success rate of 98.9% for puncturing various regions of interest (ROIs) inside deformable objects. We compare LUDO to a popular baseline and show its superior ROI localization accuracy, training time, and memory requirements. LUDO demonstrates the potential to interact with deformable objects without the need for deformable registration methods.

Accurate geometric reconstruction of deformable tissues in monocular endoscopic video remains a fundamental challenge in robot-assisted minimally invasive surgery. Although recent volumetric and point primitive methods based on neural radiance fields (NeRF) and 3D Gaussian primitives have efficiently rendered surgical scenes, they still struggle with handling artifact-free tool occlusions and preserving fine anatomical details. These limitations stem from unrestricted Gaussian scaling and insufficient surface alignment constraints during reconstruction. To address these issues, we introduce Surgical Gaussian Surfels (SGS), which transform anisotropic point primitives into surface-aligned elliptical splats by constraining the scale component of the Gaussian covariance matrix along the view-aligned axis. We also introduce the Fully Fused Deformation Multilayer Perceptron (FFD-MLP), a lightweight Multi-Layer Perceptron (MLP) that predicts accurate surfel motion fields up to 5× faster than a standard MLP. This is coupled with locality constraints to handle complex tissue deformations. We use homodirectional view-space positional gradients to capture fine image details by splitting Gaussian Surfels in over-reconstructed regions. In addition, we define surface normals as the direction of the steepest density change within each Gaussian surfel primitive, enabling accurate normal estimation without requiring monocular normal priors. We evaluate our method on two in-vivo surgical datasets, where it outperforms current state-of-the-art methods in surface geometry, normal map quality, and rendering efficiency, while remaining competitive in real-time rendering performance. Code is available at https://git.new/NexyiHu.

Surgical automation requires precise guidance and understanding of the scene. Current methods in the literature rely on bulky depth cameras to create maps of the anatomy; however, this does not translate well to space-limited clinical applications. Monocular cameras are small and allow minimally invasive surgeries in tight spaces, but additional processing is required to generate 3D scene understanding. We propose a 3D mapping pipeline that uses only RGB images to create segmented point clouds of the target anatomy. To ensure the most accurate reconstruction, we compare different structure from motion algorithms’ performance on mapping the central airway obstructions, and test the pipeline on a downstream task of tumor resection. In several metrics, including post-procedure percentage tissue charring, our pipeline performs comparably to RGB-D cameras and, in some cases, even surpasses their downstream task performance. These promising results demonstrate that automation guidance can be achieved in minimally invasive procedures with monocular cameras. This study is a step toward the complete autonomy of surgical robots.

Imitation learning (IL) has shown immense promise in enabling autonomous dexterous manipulations, including in learning surgical tasks. To fully unlock the potential of IL for surgery, access to clinical datasets is needed, which unfortunately lack the kinematic data required for current IL approaches. A promising source of large-scale surgical demonstrations is monocular surgical videos available online, making monocular pose estimation a crucial step toward enabling large-scale robot learning. Towards this end, we propose SurgiPose, a differentiable rendering-based approach to estimate kinematic information from monocular surgical videos, eliminating the need for direct access to ground-truth kinematics. Our method infers tool trajectories and joint angles by optimizing tool pose parameters to minimize the discrepancy between rendered and real images. To evaluate the effectiveness of our approach, we conduct experiments on two robotic surgical tasks—tissue lifting and needle pickup—using the da Vinci Research Kit Si (dVRK Si). We train imitation learning policies with both ground-truth measured kinematics and with estimated kinematics from video and compare their performance. Our results show that policies trained on estimated kinematics achieve comparable success rates to those trained on ground-truth data, demonstrating the feasibility of using monocular video-based kinematic estimation for surgical robot learning. By enabling kinematic estimation from monocular surgical videos, our work lays the foundation for large-scale learning of autonomous surgical policies from online surgical data.

Accurately determining the shape of deformable objects and the location of their internal structures is crucial for medical tasks that require precise targeting, such as robotic biopsies. We introduce LUDO, a method for accurate low-latency understanding of deformable objects. LUDO reconstructs objects in their deformed state, including their internal structures, from a single-view point cloud observation in under 30 ms using occupancy networks. LUDO provides uncertainty estimates for its predictions. Additionally, it provides explainability by highlighting key features in its input observations. Both uncertainty and explainability are important for safety-critical applications such as surgery. We evaluate LUDO in real-world robotic experiments, achieving a success rate of 98.9% for puncturing various regions of interest (ROIs) inside deformable objects. We compare LUDO to a popular baseline and show its superior ROI localization accuracy, training time, and memory requirements. LUDO demonstrates the potential to interact with deformable objects without the need for deformable registration methods.

Cataract is the leading cause of blindness worldwide with an increasing number of patients due to changing demographics, making automation an important part in future surgical treatment. In this work, we focus on a substep of cataract surgery, the Continuous Curvilinear Capsulorhexis (CCC). With a high complexity, this task is an ideal candidate for Reinforcement Learning (RL) in simulation. First, we present an interactive and physically realistic simulation based on the Finite Element Method (FEM) that mimics the tearing behavior of soft tissue during CCC. Then, we train and evaluate RL models in simulation, demonstrating that the trained policies can complete the CCC in 85% of cases. We also show that applying domain randomization techniques make the policy more robust against changes in geometrical and biomechanical boundary conditions.

In deformable object manipulation, we often want to interact with specific segments of an object that are only defined in non-deformed models of the object. We thus require a system that can recognize and locate these segments in sensor data of deformed real world objects. This is normally done using deformable object registration, which is problem specific and complex to tune. Recent methods utilize neural occupancy functions to improve deformable object registration by registering to an object reconstruction. Going one step further, we propose a system that in addition to reconstruction learns segmentation of the reconstructed object. As the resulting output already contains the information about the segments, we can skip the registration process. Tested on a variety of deformable objects in simulation and the real world, we demonstrate that our method learns to robustly find these segments. We also introduce a simple sampling algorithm to generate better training data for occupancy learning.

Recent advances in reinforcement learning (RL) have increased the promise of introducing cognitive assistance and automation to robot-assisted laparoscopic surgery (RALS). However, progress in algorithms and methods depends on the availability of standardized learning environments that represent skills relevant to RALS. We present LapGym, a framework for building RL environments for RALS that models the challenges posed by surgical tasks, and sofaenv, a diverse suite of 12 environments. Motivated by surgical training, these environments are organized into 4 tracks: Spatial Reasoning, Deformable Object Manipulation & Grasping, Dissection, and Thread Manipulation. Each environment is highly parametrizable for increasing difficulty, resulting in a high performance ceiling for new algorithms. We use Proximal Policy Optimization (PPO) to establish a baseline for model-free RL algorithms, investigating the effect of several environment parameters on task difficulty. Finally, we show that many environments and parameter configurations reflect well-known, open problems in RL research, allowing researchers to continue exploring these fundamental problems in a surgical context. We aim to provide a challenging, standard environment suite for further development of RL for RALS, ultimately helping to realize the full potential of cognitive surgical robotics. LapGym is publicly accessible through GitHub (https://github.com/ScheiklP/lap_gym).

Cognitive cooperative assistance in robot-assisted surgery holds the potential to increase quality of care in minimally invasive interventions. Automation of surgical tasks promises to reduce the mental exertion and fatigue of surgeons. In this work, multi-agent reinforcement learning is demonstrated to be robust to the distribution shift introduced by pairing a learned policy with a human team member. Multi-agent policies are trained directly from images in simulation to control multiple instruments in a sub task of the minimally invasive removal of the gallbladder. These agents are evaluated individually and in cooperation with humans to demonstrate their suitability as autonomous assistants. Compared to human teams, the hybrid teams with artificial agents perform better considering completion time (44.4% to 71.2% shorter) as well as number of collisions (44.7% to 98.0% fewer). Path lengths, however, increase under control of an artificial agent (11.4% to 33.5% longer). A multi-agent formulation of the learning problem was favored over a single-agent formulation on this surgical sub task, due to the sequential learning of the two instruments. This approach may be extended to other tasks that are difficult to formulate within the standard reinforcement learning framework. Multi-agent reinforcement learning may shift the paradigm of cognitive robotic surgery towards seamless cooperation between surgeons and assistive technologies.