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This study evaluates Federated Learning in surgical vision, identifying temporal modeling as a key architectural factor for generalization across unseen clinical centers while highlighting significant performance gaps from clinical viability. The research underscores critical challenges like classifier collapse due to domain shift and data imbalance, establishing a methodological baseline for privacy-preserving AI in complex spatiotemporal video tasks.
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Federated Learning for Surgical Vision in Appendicitis Classification: Results of the FedSurg EndoVis 2024 Challenge

arXiv2 min read

arXiv:2510.04772v3 Announce Type: replace-cross Abstract: Developing generalizable surgical AI requires multi-institutional data, yet privacy constraints preclude direct data sharing, making Federated Learning (FL) a natural candidate. Its application to complex, spatiotemporal surgical video remains largely unbenchmarked. We present the FedSurg Challenge, the first international initiative dedicated to FL in surgical vision, as a proof-of-concept evaluation using a multi-center dataset of laparoscopic appendectomies (subset of Appendix300). Three participant submissions were evaluated on generalization to an unseen clinical center and center-specific local adaptation, alongside centralized, Swarm Learning, parameter-efficient fine-tuning baselines, and reference classifiers. Our analysis identifies temporal modeling as the architectural factor most consistently associated with generalization to the unseen center, although effects vary across metrics. Classifier collapse arises from both the global model's failure to transfer under domain shift and unconstrained fine-tuning on small, imbalanced local datasets, motivating structured personalized FL for center-specific adaptation. Absolute performance remains far from clinical viability: even with all data pooled centrally, the task reached a 26.31% F1-score on the unseen center. Paired permutation tests resolve only large differences, and no adaptation comparison reaches significance at this sample size. By characterizing these limitations, this work establishes a methodological reference point for privacy-preserving surgical video AI.

Authors:Max Kirchner, Hanna Hoffmann, Alexander C. Jenke, Oliver L. Saldanha, Kevin Pfeiffer, Weam Kanjo, Julia Alekseenko, Claas de Boer, Santhi Raj Kolamuri, Lorenzo Mazza, Nicolas Padoy, Sophia Bano, Annika Reinke, Lena Maier-Hein, Danail Stoyanov, Jakob N. Kather, Fiona R. Kolbinger, Sebastian Bodenstedt, Stefanie Speidel

Abstract:Developing generalizable surgical AI requires multi-institutional data, yet privacy constraints preclude direct data sharing, making Federated Learning (FL) a natural candidate. Its application to complex, spatiotemporal surgical video remains largely unbenchmarked. We present the FedSurg Challenge, the first international initiative dedicated to FL in surgical vision, as a proof-of-concept evaluation using a multi-center dataset of laparoscopic appendectomies (subset of Appendix300). Three participant submissions were evaluated on generalization to an unseen clinical center and center-specific local adaptation, alongside centralized, Swarm Learning, parameter-efficient fine-tuning baselines, and reference classifiers. Our analysis identifies temporal modeling as the architectural factor most consistently associated with generalization to the unseen center, although effects vary across metrics. Classifier collapse arises from both the global model's failure to transfer under domain shift and unconstrained fine-tuning on small, imbalanced local datasets, motivating structured personalized FL for center-specific adaptation. Absolute performance remains far from clinical viability: even with all data pooled centrally, the task reached a 26.31% F1-score on the unseen center. Paired permutation tests resolve only large differences, and no adaptation comparison reaches significance at this sample size. By characterizing these limitations, this work establishes a methodological reference point for privacy-preserving surgical video AI.

Computer Vision and Pattern Recognition (cs.CV); Artificial Intelligence (cs.AI); Machine Learning (cs.LG)

arXiv:2510.04772 [cs.CV]

(or arXiv:2510.04772v3 [cs.CV] for this version)

https://doi.org/10.1016/j.media.2026.104290 DOI(s) linking to related resources

Full text under the publisher's open licence · 264 words

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