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This paper addresses automatic skill assessment in robotic minimally invasive surgery. Hidden Markov models (HMMs) are developed for individual surgical gestures (or surgemes) that comprise a typical bench-top surgical training task. It is known that such HMMs can be used to recognize and segment surgemes in previously unseen trials. Here, the topology of each surgeme HMM is designed in a data-driven manner, mixing trials from multiple surgeons with varying skill levels, resulting in HMM states that model skill-specific sub-gestures. The sequence of HMM states visited while performing a surgeme are therefore indicative of the surgeon's skill level. This expectation is confirmed by the average edit distance between the state-level "transcripts" of the same surgeme performed by two surgeons with different expertise levels. Some surgemes are further shown to be more indicative of skill than others.

Data-Derived Models for Segmentation with Application to Surgical Assessment and Training