Motivation for the SAGES CVS Challenge
presented by former SAGES President Dr. Michael Brunt, MD.
What is the CVS Challenge?
The Critical View of Safety Challenge is the first biomedical data challenge organized by a consortium of surgeons and computer scientists on behalf of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). The Challenge targets the computational assessment of the Critical View of Safety (CVS) in Laparoscopic Cholecystectomy and aims to facilitate the clinical translation of AI. The CVS - one of the most meaningful, clinically validated, surgical safety measures - consists of three visually distinct criteria to be achieved throughout the procedure. Numerous AI models have been proposed to improve the safety of laparoscopic cholecystectomy by academic groups as well as MedTech companies. While these algorithms generally show promising results, thorough testing on large, diverse and representative datasets is necessary to better assess real-world performance and build trust prior to clinical translation. For this purpose the SAGES CVS challenge offers a uniquely large and diverse dataset of 1000 laparoscopic cholecystectomy videos from across the globe, meticulously annotated by clinical experts for the development AI algorithms targeting real-time CVS assessment.
The first CVS challenge 2024 was hosted at the Medical Image Computing and Computer Assisted Interventions (MICCAI) Conference 2024 in Marrakech. This first iteration of challenge has provided foundations for the development of clinically meaningful and effective AI solutions for the assessment of the CVS, focussing on accuracy, robustness across different clinical and technical data distributions and quantification of underlying uncertainty in assessing the CVS visually. We have received outstanding submissions from 13 different computational teams across the globe, offering promising AI models capable of automated visual identification of the CVS and its sub-criteria. The top performing models have the potential to augment surgeon’s visual perception and cognitive capacity during laparoscopic cholecystectomy and ultimately enhance surgical safety. The detailed results will be available in the form of scientific publications soon.
Given the success of the first CVS challenge at 2024, the project was selected for ‘Lighthouse Status’ at MICCAI 2025 in Daejeon, South Korea. The SAGES CVS Lighthouse challenge will focus on computational efficiency, to enable deployment of AI for CVS detection in low resource settings, and Image Segmentation of the individual CVS criteria to enable insights into model attention. For more information about the CVS Lighthouse Challenge at MICCAI 2025 click here.
Ultimately, the challenge provides foundations for the development of clinically meaningful and effective AI solutions for intraoperative assessment of the CVS to assist surgeons in critical decision making and enhance surgical safety worldwide. AI solutions to achieve automated visual identification of the CVS and its sub-criteria can augment surgeon’s visual perception and cognitive capacity during laparoscopic cholecystectomy.
For more information on how to become involved in the challenge, contribute data or participate please email info@cvschallenge.org and stay tuned for the Lighthouse Challenge 2025.
About the Critical View of Safety…
Laparoscopic cholecystectomy is one of the most frequently performed, highly standardized surgical procedures worldwide, to remove the gallbladder in case of inflammation or other pathologies. The Critical View of Safety (CVS) is an internationally recognized, clinically validated, intraoperative surgical safety measure during laparoscopic cholecystectomy. The CVS was first introduced by Dr. Steven Strasberg in 1995 to help prevent bile duct injuries, one of the most severe complications of laparoscopic cholecystectomy. The CVS is achieved by isolating three visually distinct anatomic structures, reflected by three CVS criteria (C1, C2 and C3), before proceeding to remove the gallbladder. The optical assessment and differentiation of these three anatomic structures can be deceiving. Therefore AI-driven automated assessment of the CVS criteria can enhance surgeons perception, decrease their cognitive workload, and improve surgical safety.
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The cystic duct and artery should be separated from other structures, with only their lower part still attached to the gallbladder. This ensures that the surgeon can clearly identify and dissect the correct structures.
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The hepatocystic triangle is the area bordered by the common hepatic duct, the cystic duct, and the liver. Surgeons must adequately expose and clear this area of surrounding fat and connective tissue to visualize the essential structures accurately.
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The lower part of the gallbladder must be separated from the liver bed, making the gallbladder-liver interface clearly visible. This ensures that the cystic duct and artery are the only structures connecting the gallbladder to the liver and other organs.
Two structures ✔️ + Hepatocystic Triangle ✔️ + Cystic Plate ✔️ = The Critical View of Safety ✅ ...............................................................
Two structures ✔️ + Hepatocystic Triangle ✔️ + Cystic Plate ✔️ = The Critical View of Safety ✅ ...............................................................