Spatiotemporal Recognition of Abdominal Wall Layers During Optical Trocar Entry

Objective. To evaluate whether spatial context and temporal modeling improve tissue recognition during optical trocar entry, where multiple abdominal-wall tissues may be visible simultaneously. Methods. We retrospectively analyzed 71 recordings with 1,516 annotated keyframes and 29,151 clinician-annotated sectors. Each frame was divided into 28 polar-grid sectors assigned to nine tissue classes. Color, neighboring-sector, and positional features were used by a gradient-boosted emission classifier. The full pipeline added learned temporal smoothing, spatial regularization, an anatomically ordered hidden Markov model, and posterior blending. Five-fold cross-validation was grouped by recording, with cross-fitting to prevent within-recording leakage. Primary evaluation used clinician-derived targets; ablations assessed classification, probability quality, spatial consistency, and peritoneum-or-deeper onset timing. Results. The complete pipeline achieved accuracy 0.646, macro-F1 0.507, and macro-AUROC 0.882, versus 0.600, 0.440, and 0.861 for emissions alone. Macro-F1 improved by 0.066 across all five folds. Label changes decreased from 66.2 to 19.5 per sector-minute, and median onset error decreased from 15.58 to 2.45 seconds. Frames with a tissue-depth-code span of at least three decreased from 53% to 26%, versus 22% for clinician annotations. Performance remained limited for preperitoneal fat and bowel, and the full model retained a 44% premature-onset proportion. Conclusions. Combining appearance, spatial context, and temporal constraints improved retrospective tissue recognition and onset localization. Tissue-specific limitations, residual timing errors, and reliance on future observations warrant external validation and prospective evaluation of causal models before clinical use.