Phase-Specific Augmented Reality Guidance for Microscopic Cataract Surgery Using Long-Short Spatiotemporal Aggregation Transformer

Phacoemulsification cataract surgery (PCS) is a routine procedure conducted using a surgical microscope, heavily reliant on the skill of the ophthalmologist. While existing PCS guidance systems extract valuable information from surgical microscopic videos to enhance intraoperative proficiency, they suffer from non-phasespecific guidance, leading to redundant visual information. In this study, our major contribution is the development of a novel phase-specific augmented reality (AR) guidance system, which offers tailored AR information corresponding to the recognized surgical phase. Leveraging the inherent quasi-standardized nature of PCS procedures, we propose a two-stage surgical microscopic video recognition network. In the first stage, we implement a multi-task learning structure to segment the surgical limbus region and extract limbus region-focused spatial feature for each frame. In the second stage, we propose the long-short spatiotemporal aggregation transformer (LS-SAT) network to model local fine-grained and global temporal relationships, and combine the extracted spatial features to recognize the current surgical phase. Additionally, we collaborate closely with ophthalmologists to design AR visual cues by utilizing techniques such as limbus ellipse fitting and regional restricted normal cross-correlation rotation computation. We evaluated the network on publicly available and in-house datasets, with comparison results demonstrating its superior performance compared to related works. Ablation results further validated the effectiveness of the limbus region-focused spatial feature extractor and the combination of temporal features. Furthermore, the developed system was evaluated in a clinical setup, with results indicating remarkable accuracy and real-time performance. underscoring its potential for clinical applications.