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This paper presents an approach to enhanced endoscopic tool segmentation combining separate pathways utilizing input images in two different coordinate representations. The proposed method examines U-Net convolutional neural networks with input endoscopic images represented via (1) the original rectangular coordinate format alongside (2) a morphological polar coordinate transformation. To maximize information and the breadth of the endoscope frustrum, imaging sensors are oftentimes larger than the image circle. This results in unused border regions. Ideally, the region of interest is proximal to the image center. The above two observations formed the basis for the morphological polar transformation pathway as an augmentation to typical rectangular input image representations. Results indicate that neither of the two investigated coordinate representations consistently yielded better segmentation performance as compared to the other. Improved segmentation can be achieved with a hybrid approach that carefully selects which of the two pathways to be used for individual input images. Towards that end, two binary classifiers were trained to identify, given an input endoscopic image, which of the two coordinate representation segmentation pathways (rectangular or polar), would result in better segmentation performance. Results are promising and suggest marked improvements using a hybrid pathway selection approach compared to either alone. The experiment used to evaluate the proposed hybrid method utilized a dataset consisting of 8360 endoscopic images from real surgery and evaluated segmentation performance with Dice coefficient and Intersection over Union. The results suggest that on-the-fly polar transformation for tool segmentation is useful when paired with the proposed hybrid tool-segmentation approach. 

Accurate semantic image segmentation from medical imaging can enable intelligent vision-based assistance in robot-assisted minimally invasive surgery. The human body and surgical procedures are highly dynamic. While machine-vision presents a promising approach, sufficiently large training image sets for robust performance are either costly or unavailable. This work examines three novel generative adversarial network (GAN) methods of providing usable synthetic tool images using only surgical background images and a few real tool images. The best of these three novel approaches generates realistic tool textures while preserving local background content by incorporating both a style preservation and a content loss component into the proposed multi-level loss function. The approach is quantitatively evaluated, and results suggest that the synthetically generated training tool images enhance UNet tool segmentation performance. More specifically, with a random set of 100 cadaver and live endoscopic images from the University of Washington Sinus Dataset, the UNet trained with synthetically generated images using the presented method resulted in 35.7% and 30.6% improvement over using purely real images in mean Dice coefficient and Intersection over Union scores, respectively. This study is promising towards the use of more widely available and routine screening endoscopy to preoperatively generate synthetic training tool images for intraoperative UNet tool segmentation.