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Development of an artificial intelligence based virtual tool for measuring distances during image-guided surgery.

Raphael Kwok1, Takuto Yoshida1,2, Jaryd Hunter3

  • 1Surgical Artificial Intelligence Research Academy, University Health Network, Toronto, ON, Canada.

Surgical Endoscopy
|December 9, 2025
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Summary

Computer vision (CV) can objectively measure intraoperative distances, reducing subjectivity in image-guided surgery. This digital ruler prototype shows promise for enhancing surgical precision in procedures like gastric bypass.

Keywords:
Artificial intelligenceComputer visionMeasurementSurgery

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Area of Science:

  • Medical Imaging
  • Computer Vision
  • Surgical Technology

Background:

  • Image-guided surgery presents depth perception challenges, particularly for intracorporeal measurements in procedures like gastric bypass.
  • Conventional methods for intraoperative distance measurement are often subjective.
  • Computer vision (CV) offers potential for objective 3D distance prediction through tool identification.

Purpose of the Study:

  • To develop and validate a CV-based digital ruler for objective intraoperative distance measurement.
  • To address the subjectivity inherent in current intracorporeal measurement techniques.
  • To enhance precision in image-guided surgical procedures.

Main Methods:

  • Developed a CV instrument detection algorithm to identify surgical tools.
  • Created a computer program to calculate and display inter-grasper distances.
  • Trained the CV algorithm on laparoscopic surgery videos and validated its performance against ground truth.
  • Tested the system using a bench-box simulator and surgical video recordings.

Main Results:

  • The CV model achieved high performance metrics (AUC 0.89, accuracy 0.99, Dice Score 0.80).
  • The computer program demonstrated a mean error of estimation of 0.79 cm.
  • The prototype showed improved performance with a "human in the loop" system at larger distances (150 cm).
  • Video validation indicated low measurement variability for the prototype.

Conclusions:

  • CV-based techniques can effectively provide objective intracorporeal measurements.
  • This approach has the potential to significantly reduce subjectivity in image-guided surgery.
  • The developed digital ruler shows feasibility for clinical application.