Deep learning-based real-time intraoperative detection of thoracic duct

The thoracic duct (TD) is fragile in esophageal cancer surgery, and its injury may cause deadly chylothorax. Its identification is critical to prevent chylothorax and ensure patient safety. Deep learning-based image processing software may assist surgeons. This study aimed to develop and validate a deep learning-based system for real-time intraoperative detection of the thoracic duct.

From 30 thoracoscopic esophagectomy videos (prone position), 2,500 images (1,400 TD annotations; 1,100 background images) were extracted. The dataset was divided into training/validation (2,000/500 images) and 40 test images from 5 independent videos. The YOLOv5-seg model's performance was evaluated via dice coefficient & intersection over union and was statistically compared with resident and attending surgeons.

The artificial intelligence (AI) model's segmentation performance was superior to that of resident surgeons but inferior to that of attending surgeons. The AI system achieved a 92.5% accuracy, with a mean dice coefficient of 0.677 and an intersection over union (IoU) of 0.569. The AI system demonstrated significantly lower Dice performance than attending surgeons (0.677 vs. 0.797, P=0.01), but significantly higher performance than resident surgeons (0.677 vs. 0.577, P=0.02). However, the AI significantly outperformed the resident group (accuracy: 85.0%; dice: 0.577 vs. AI, P=0.02; IoU: 0.461 vs. AI, P=0.009), confirming its relative performance advantage over less-experienced surgeons.

This study demonstrates the technical feasibility of a deep learning-based real-time TD segmentation system. The model achieved segmentation performance superior to that of resident surgeons but inferior to that of attending surgeons and suggests its potential as a technical foundation for future AI-guided intraoperative applications.