Deep-learned placental vessel segmentation for intraoperative video enhancement in fetoscopic surgery

  • Praneeth SaddaEmail author
  • Metehan Imamoglu
  • Michael Dombrowski
  • Xenophon Papademetris
  • Mert O. Bahtiyar
  • John Onofrey
Original Article



Twin-to-twin transfusion syndrome (TTTS) is a potentially lethal condition that affects pregnancies in which twins share a single placenta. The definitive treatment for TTTS is fetoscopic laser photocoagulation, a procedure in which placental blood vessels are selectively cauterized. Challenges in this procedure include difficulty in quickly identifying placental blood vessels due to the many artifacts in the endoscopic video that the surgeon uses for navigation. We propose using deep-learned segmentations of blood vessels to create masks that can be recombined with the original fetoscopic video frame in such a way that the location of placental blood vessels is discernable at a glance.


In a process approved by an institutional review board, intraoperative videos were acquired from ten fetoscopic laser photocoagulation surgeries performed at Yale New Haven Hospital. A total of 345 video frames were selected from these videos at regularly spaced time intervals. The video frames were segmented once by an expert human rater (a clinician) and once by a novice, but trained human rater (an undergraduate student). The segmentations were used to train a fully convolutional neural network of 25 layers.


The neural network was able to produce segmentations with a high similarity to ground truth segmentations produced by an expert human rater (sensitivity = 92.15% ± 10.69%) and produced segmentations that were significantly more accurate than those produced by a novice human rater (sensitivity = 56.87% ± 21.64%; p < 0.01).


A convolutional neural network can be trained to segment placental blood vessels with near-human accuracy and can exceed the accuracy of novice human raters. Recombining these segmentations with the original fetoscopic video frames can produced enhanced frames in which blood vessels are easily detectable. This has significant implications for aiding fetoscopic surgeons—especially trainees who are not yet at an expert level.


Segmentation Vessels Deep learning Convolutional neural network Fetoscopy Twin-to-twin transfusion syndrome 



This work was supported by the National Institutes of Health Grant Number T35DK104689 (NIDDK Medical Student Research Fellowship).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

11548_2018_1886_MOESM1_ESM.pptx (34 kb)
Supplementary material 1 (PPTX 34 kb)


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Copyright information

© CARS 2018

Authors and Affiliations

  1. 1.Yale University School of MedicineNew HavenUSA
  2. 2.Department of Obstetrics and GynecologyYale University School of MedicineNew HavenUSA
  3. 3.Department of Radiology and Biomedical ImagingYale University School of MedicineNew HavenUSA
  4. 4.Department of Biomedical EngineeringYale University School of MedicineNew HavenUSA
  5. 5.Yale Fetal Care CenterNew HavenUSA

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