Unsupervised Desmoking of Laparoscopy

Author Proof

Images Using Multi-scale DesmokeNet

V. Vishal1 , Varun Venkatesh2 , Kshetrimayum Lochan1 , Neeraj Sharma3 ,

and Munendra Singh1(B)
1
Department of Mechatronics Engineering, Manipal Institute of Technology,
Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
vishalv7197@gmail.com, lochan.nits@gmail.com, munendra107@gmail.com
2
Sapthagiri Institute of Medical Sciences & Research Center,
Bangalore 560090, India
drvarunv0103@gmail.com
3
School of Biomedical Engineering,
Indian Institute of Technology (Banaras Hindu University),
Varanasi 221005, India
neeraj.bme@iitbhu.ac.in

Abstract. The presence of surgical smoke in laparoscopic surgery

reduces the visibility of the operative field. In order to ensure better
visualization, the present paper proposes an unsupervised deep learn-
ing approach for the task of desmoking of the laparoscopic images. This AQ1

network builds upon generative adversarial networks (GANs) and con-

verts laparoscopic images from smoke domain to smoke-free domain. The
network comprises a new generator architecture that has an encoder-
decoder structure composed of multi-scale feature extraction (MSFE)
blocks at each encoder block. The MSFE blocks of the generator cap-
ture features at multiple scales to obtain a robust deep representation
map and help to reduce the smoke component in the image. Further,
a structure-consistency loss has been introduced to preserve the struc-
ture in the desmoked images. The proposed network is called Multi-
scale DesmokeNet, which has been evaluated on the laparoscopic images
obtain from Cholec80dataset. The quantitative and qualitative results
shows the efficacy of the proposed Multi-scale DesmokeNet in compari-
son with other state-of-the-art desmoking methods.

Keywords: Smoke removal · Image enhancement · Laparoscopic

surgery

1 Introduction
In laparoscopic surgery, the generation of artefacts like specular reflections, sur-
gical smoke [2], blood and inadequate illumination degrades the image quality,
which affects the efficiency of the computer vision algorithms for assistive help
at tasks like tracking and detection [14]. The robust performance of the track-
ing and detection algorithms cannot be realized without removing the artefacts
c Springer Nature Switzerland AG 2020
J. Blanc-Talon et al. (Eds.): ACIVS 2020, LNCS 12002, pp. 1–12, 2020.
https://doi.org/10.1007/978-3-030-40605-9_37
 2 V. Vishal et al.

from the images. This study particularly discusses the smoke in the laparoscopic
Author Proof

surgery, which blocks surgeon’s operative field and affects his ability to carry out
various procedures specially in case of image-guided surgical systems. Hence, the
removal of the smoke is an essential task in order to realize the full potential
and benefits of laparoscopic surgery. Hardware based techniques [23] and other
computer vision methods [13,24] have been developed to remove the smoke,
which are bound by certain limitations. A digital solution can serve as a use-
ful tool to better visualize the operative field and produce high quality images
for the computer vision pipeline of the system. In recent times, the advance-
ments in computer vision has been greatly influenced by Deep learning. The rise
of new deep learning networks, objective functions and strategies has enabled
to achieve impressive results and breakthroughs with problems that were dif-
ficult to be solved by traditional and non-learning based approaches. Further,
Goodfellow et al. formulated the Generative Adversarial networks (GANs) [8],
which has shown significant progress in the field of image synthesis. The com-
petitive learning between the generator and discriminator networks drives the
GANs to realise an implicit loss function that helps produce images that are
more sharper and of higher perceptual quality. The generator and discriminator
networks both learn the distribution of the training images. The generator tries
to produces fake images, while the discriminator network tries to distinguish
the fake images from the real images from the training dataset. The min-max
optimization between the generator and the discriminator networks, i.e genera-
tor minimizes the discriminator’s ability to distinguish the fake images from real
images and discriminator maximizes its ability to identify real images. GANs has
also depicted outstanding results at task of Image-to-Image translation, which
requires either paired or unpaired data.
Previously, Isola et al. proposed the Pix2Pix framework [10] that utilizes
a conditional generative adversarial network to learn a mapping between the
input and output images using paired data. Various tasks like generation of
photographs from semantic layouts [11], sketches [21] and edges can be seen
using similar approach. The extended work of the Pix2Pix framework resulted in
CycleGAN [31] that aimed to tackle the task of image translation using unpaired
data. It learns a mapping between two data domains: X and Y rather than just
pair of images. This enables it to be unsupervised and allows the generation of
images even in the absence of ground truth. Similar work can be seen in case of
UNIT [17], DiscoGAN [12] and DualGAN [30].
In the present study, we focus on the task of smoke removal as a single
image desmoking that translates a smoke image to an image resembling smoke-
free images. The translation of the image from the smoke domain to smoke-free
domain depicts considerable decrease in the smoke component and results in the
enhancement of the image. The main contributions of the paper are as follows:

1. An unsupervised method that translates smoke images to desmoke images

without the need for synthetic ground truths in an unpaired manner. This
method helps to remove the need for paired data and simulation to real world
domain adaptation.
 Unsupervised Desmoking of Laparoscopy Images Using DesmokeNet 3

2. A new generator architecture that consists of multi-scale feature extraction

Author Proof

(MSFE) blocks. The MSFE blocks perform robust feature extraction and help
capture the smoke features at multiple scales at each encoder level.
3. A new loss function called structure-consistency loss has been proposed. This
loss ensures the structure in the image is maintained in the translation frame-
work, hence resulting in the reconstruction of the desmoked images with struc-
ture and edges identical to the smoke image.

2 Related Work

2.1 Conventional Methods

Previously, Tchaka et al. [24] utilized the dark channel prior dehazing method
(DCP) [9] for the task of smoke removal. They have improved upon the DCP
by performing two modifications: decreasing the emphasis on pixel values in the
range where smoke is expected to be present and thresholding the dark chan-
nel by a constant value. Further, to enhance the contrast they have performed
histogram equalization. In [13], Kotwal et al. framed the problem as Bayesian
inference problem and performed joint de-smoking and de-noising using a prob-
abilistic graphical, where the uncorrupted image is represented as a Markov
random field (MRF) and maximum-a-posteriori (MAP) is used to obtain the
enhanced images. The method was extended in [1] to perform specular removal,
along with de-smoking and de-noising. Previously proposed methods for desmok-
ing also focused on applying solutions relevant to the problem of dehazing. The
mathematical model for the atmospheric scattering is given as follows:

I(x) = J(x)t(x) + A(1 − t(x)) (1)

where I(x) represents the hazy image, J(x) is the haze-free image, t(x) is the
transmission map and A is the global atmospheric light on each x pixel coordi-
nates.
Wang et al. in [27], devised a variational method to estimate the smoke
veil for smoke removal assuming smoke component to have low contrast and
low inter-channel differences. The results of the method yielded considerable
enhancement in the image and higher visual quality. On the other hand, Luo
et al. [18] introduced a visibility-driven defogging framework that recovers the
atmospheric veil solution as bilateral of bilateral grid and finally obtains the
defogged image by Eq. 1. The work also proposed no-reference image quality
assessment metrics to quantify the naturalness and sharpness in an image.

2.2 Deep Learning Methods

Recently, Sabri et al. produced a synthetic smoke images dataset using Perlin
noise and utilized AOD-net model to transfer learn the task of smoke removal [4].
In [28], Wang et al. trained a encoder-decoder architecture with Laplacian image
 4 V. Vishal et al.

pyramid decomposition input strategy on a synthetic smoke images and evalu-

Author Proof

ated the performance on real smoke. An improvement of the CycleGAN frame-

work called the Cycle-Desmoke was proposed in [26] for desmoking of laparo-
scopic images, this work on relied on atrous convolutions to perform multi-scale
feature extraction and consisted of a new loss function called the guided-unsharp
upsample loss to help the network at the operation of upsampling.

3 Method
This section describes the proposed method for single image desmoking of laparo-
scopic images. Figure 1 depicts the overview of the Image-to-Image translation
framework, which consists of two generator networks GDS and GS that help gen-
erate synthetic desmoked and smoke images respectively, two discriminator net-
works DDS and DS that help distinguish the synthesized desmoked images from
real smoke-free images and synthesized smoke images from real smoke images.
The two mapping functions are desmoking (DS) and re-smoking (RS) that map
smoke to desmoke images and smoke-free to smoke images respectively. In addi-
tion to the adversarial and cycle-consistency losses, we include structure consis-
tency loss as well, this enables to maintain and preserve the structure and edge
information during the mapping operations.

3.1 Adversarial Loss

For both the mapping functions DS and RS, the adversarial loss has been
applied. The generator minimizes the discriminator’s ability to distinguish the
synthetic images from the real images, while the discriminator maximizes its
ability to identify the real images. This min-max optimization follows the game
theoretic approach and helps realize a loss function. The adversarial losses for
the two mapping functions are given as follows:
minGDS maxDDS LGAN (GDS , DDS , S, SF ) = Esf ∼pdata (sf ) [logDDS (sf )]
(2)
+ Es∼pdata (s) [log(1 − DDS (GDS (s)))]
minGS maxDS LGAN (GS , DS , SF, S) = Es∼pdata (s) [logDS (s)]
(3)
+ Esf ∼pdata (sf ) [log(1 − DS (GS (sf )))]

3.2 Cycle Consistency Loss

Only adversarial loss cannot ensure the learned mapping function to map an
image from input domain to the target domain. The addition of cycle-consistency
loss helps to learn mapping functions more accurately. Given an input smoke
image s, GDS is the desmoked image and GS (GDS (s)) ≈ s the forward cycle
consistency and similarly in the backward cycle consistency: given an input
smoke-free image sf, GS (sf ) is the smoke image and GDS (GS (sf )) ≈ sf . This
loss is applicable only to the generator networks. The loss is given as follows:
Lcyclic (GDS , GS ) = ||GDS (GS (sf )) − sf || + ||GS (GDS (s)) − s|| (4)
 Unsupervised Desmoking of Laparoscopy Images Using DesmokeNet 5
Author Proof

Fig. 1. Representation of the framework of the proposed method.

3.3 Structure Consistency Loss

In order to ensure the structure between the images of the mapping operations
is preserved, we include the structure consistency loss. Such a loss is essential at
reconstructing the structure and edges in an image similar to the input images.
We make use of the Canny edge detection to obtain edge information in the
image. The image gradients of the input image serve as the ground truth and
through L1 norm we try to generate the image gradients of the translated images
to be similar to the input image. This forces the generator networks to produce
images that resemble the input images in both edge and structural information
and also helps in reduction of artefacts, distortions etc. The structure consistency
loss is given as follows:

LSC (GDS .GS ) = LSF + LSB (5)


LSF = α1 ||Icanny (s) − Icanny (GDS (s))||
 (6)
+ α2 ||Icanny (s) − Icanny (GS (GDS (s)))||

LSB = α1 ||Icanny (sf ) − Icanny (GS (sf ))||
 (7)
+ α2 ||Icanny (sf ) − Icanny (GD S(GS (sf )))||
 6 V. Vishal et al.
Author Proof

Fig. 2. The structure of the multi-scale feature extraction block.

where LSF and LSB are losses for the forward and backward translations respec-
tively. The terms α1 and α2 are set as 0.5 and 1 respectively in order to control
the amount of edge information reconstructed. α1 is set lower than α2 as the edge
information in the input image approximately resembles the translated image,
while the edge information of the reconstructed input image has complete resem-
blance with respect to that of input image.

3.4 Complete Objective Function

The combination of adversarial, cycle-consistency and structure-consistency loss
forms the complete objective function is given as follows:
L(GDS , GS , DDS , DS ) = LGAN (GDS , GS ) + LGAN (GS , DS )
(8)
+ λ1 Lcyclic (GDS , GS ) + λ2 LSC (GDS , GS )
The terms λ1 and λ2 are positive weighted terms that help control the train-
ing procedure.

3.5 Network Architecture

Multi-scale Feature Extraction Blocks: The detection of features at mul-
tiple scales is useful for a wide range of computer vision problems like seman-
tic segmentation [7], object detection [6] and image super-resolution [16]. We
 Unsupervised Desmoking of Laparoscopy Images Using DesmokeNet 7

propose similar technique for the task of desmoking. Our multi-scale feature
Author Proof

extraction blocks consists of different kernel sizes. The input feature map passes
sequentially through conv 3 × 3, conv 5 × 5, conv 7 × 7 branch in an incremental
kernel dimension pattern and conv 7 × 7, conv 5 × 5, conv 3 × 3 branch in a
decremental kernel dimension pattern respectively. By doing so, we are able to
vary the receptive field effectively and capture distinctive features from the input
feature map. The output feature maps from each convolution operation is con-
catenated, as depicted in Fig. 2. The concatenated blocks are further convolved
by particular kernel sizes and the output feature maps are concatenated and
later convolved by 1 × 1 kernel to maintain the desired channel dimension. If the
channel dimension in the input feature map is M, then the channel dimension
after every convolution operation is maintained as M. We also include residual
learning in order making the learning more efficient and allow the information
to flow from the input layer to the output layer. This is brought about a skip
connection and element-wise addition.
Generator Architecture: We adopt an encoder-decoder architecture design
for the generator. Each encoder layer consists of a multi-scale feature extraction
block and is downsampled by a convolution operation with stride 2. The bottle-
neck consists of 6 residual blocks similar to [31]. Each decoder layer consists of a
pixel shuffle [22] operation that receives input feature maps from the respective
encoder and decoder layers as depicted in Fig. 3. Once the desired spatial resolu-
tion is realized, convolution operations are performed to obtain the output image
with same dimensions of that of the input image. This architectural design for
the generator network allows it reconstruct the images.

Fig. 3. Representation of the generator architecture. It consists of MSFE blocks at

each encoder block and pixel shuffle at each decoder block for upsampling along the
corresponding encoder-decoder levels. The C XX denotes the channel dimension of
the output feature map of the particular layer.
 8 V. Vishal et al.

Discriminator Architecture: The discriminator DDS and DS adopt the archi-

Author Proof

tecture as in [31]. They consist of five convolutional layers that identify whether
the 70 × 70 overlapping image patches are synthetic or real.

3.6 Experimental Results

This section evaluates the proposed approach on the ITEC Smoke Cholec80 real
laparoscopic image dataset, which is composed of 80 different cholecystectomy
procedures. The present study first introduces the dataset and discusses the
implementation details. Each component of the proposed approach is evaluated
and the results are analyzed. Finally, the study provides the comparison results
with other state-of-the-art de-smoking methods.
ITEC Smoke Cholec80 Image Dataset: The public dataset [15] consists of
100K smoke/non-smoke images extracted from the Cholec80 dataset [25]. We
have selected 1200 images each for smoke domain and smoke-free domain as
our training set, random 100 images from the training set as the validation
set and 200 images as the test set. As there is black corners due to the camera
arrangement, the images have been center cropped to 240×320, which will avoid
network to learn unnecessary information. The selected images have varying
levels of smoke at different depths, to ensure the network is to learn on a diverse
set of images.

Fig. 4. Ablation study on the utility of the MSFE blocks and the structure consistency
loss. a: input smoke images, b: images generated without MSFE blocks but just con-
volution blocks, c: images generated without structure consistency loss in the overall
objective function, d: images from the proposed method

Implementation Details: In order to stabilize the training procedure, the

least-squared loss is used instead of the log likelihood loss [19] network is trained
with a learning rate of 0.0001 and is linearly decayed to zero for the next 100
 Unsupervised Desmoking of Laparoscopy Images Using DesmokeNet 9

Table 1. Quantitative evaluation of ablation study on the validation dataset. The

Author Proof

terms a, b, c, d are denoted in Fig. 4.

Method a b c d
Image quality BRISQE CEIQ BRISQE CEIQ BRISQE CEIQ BRISQE CEIQ
Mean 19.14 3.345 17.95 3.350 17.50 3.317 17.43 3.352

epochs with ADAM as the optimizer. The batch size is fixed to one. Experimen-
tally, the λ1 and λ2 terms in the complete objective function are set to 10 and
0.1 respectively. Tensorflow was used to train the network on the NVidia K80
GPU.
Experimental Results: The use of multi-scale feature extraction block in com-
parison to just convolution layers help to capture features at different scales and
this is essential at detecting and reducing the smoke component in the image and
also leads to better contrast. The addition of the structure-consistency loss along
with adversarial and cycle-consistency loss results in images that are sharper and
with enhanced structural information as shown in Fig. 4. Further, the quantita-
tive analysis of ablation study on the validation dataset in terms of image quality
measures (i) Blind/Referenceless Image Spatial Quality Evaluator (BRISQE)
[20] and (ii) Quality Assessment of Contrast-Distorted Images (CEIQ) [29] is
shown in Table 1. The lower values for BRISQE and higher values for CEIQ
indicates better perceptual quality.

Fig. 5. Qualitative evaluation of smoke removal on randomly selected images from test
set. a: input smoke images, b: Non-local Dehaze, c: DehazeNet, d: DCP, e: CycleGAN,
f: Proposed Multi-scale DesmokeNet
 10 V. Vishal et al.

The proposed method is compared with state-of-the-art methods i.e. Non-

Author Proof

local Dehaze [3], Single image haze removal using dark channel prior (DCP)
[9], Dehazenet [5] and CycleGAN [31]. Figure 5 shows the qualitative results on
random four images. It is quite evident that the desmoked images generated
from other comparison methods are low in contrast, dark and result in lesser
smoke removal in comparison to the proposed method. The images from proposed
method looks more promising and of higher quality. Further, the quantitative
results in Table 2 also suggest the better performance of the proposed method
over the other state-of-the-art methods.

Table 2. Quantitative evaluation on the test dataset. The values denote the mean of
the image quality.

Method Image quality

BRISQE CEIQ
Test Input 21.14 3.302
Non-local Dehaze 19.05 3.148
DehazeNet 22.04 3.101
DCP 20.949 2.948
CycleGAN 17.12 3.373
Proposed method 15.39 3.382

3.7 Conclusion

This paper introduced a new unsupervised learning method for removal of smoke
in laparoscopic images. The proposed method consists of a new generator archi-
tecture of comprising of novel multi-scale feature extraction blocks that help to
alleviate the smoke component at different scales. Further, the new structure-
consistency loss in addition with the adversarial and cycle-consistency losses
results in preserving the structure of the image effectively. The proposed method
is qualitatively and quantitatively compared and has shown the edge over other
state-of-the-art desmoking methods.
As the surgical smoke removal relies on mechanical solutions that still have
lag time, having a digital visualization of the frames that automatically removes
smoke will be of great use for the practitioners and surgeons, we plan to extend
this work to develop an algorithm that performs in real time. Further, looking at
the spatial-temporal consistency between the sequences of frames and we would
try to ensure that the level of smoke removal is not dependent on its amount
but just on its presence in that frame.
 Unsupervised Desmoking of Laparoscopy Images Using DesmokeNet 11

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