Peer-Reviewed Publication
Surg Endosc2026;40(6):4514-4528.June 1, 2026Journal Article
Standardization of surgical gesture taxonomy: a SAGES Delphi consensus study.
Maria Clara Morais1, Aditya Amit Godbole2, Emaad Iqbal2, Mattia Ballo3, Anthony Jarc4, Beatrice Van Amsterdam5, Brent Matthews6, Christopher M Schlachta7, Daniel A Donoho8, Daniel A Hashimoto9,10, Jay A Redan11, Jayson Marwaha12, Jon Gould13, Liane S Feldman14, Ozanan Meireles15, Pieter De Backer16, Pietro Mascagni17,18, Simon LaPlante19, Ankit Sarin20, Anastasiya Shchatsko21, Danielle Walsh22, Danyal M Fer23, David Romero Funes24, Kimimasa Sasaki25, Nova Szoka26, Sara S Lazzaretti27, Sharona B Ross28, Thomas Schnelldorfer29, Axel Krieger30, Andrew J Hung31, Filippo Filicori2
1Intraoperative Performance Analytics Laboratory, Department of Surgery, Northwell Health, New York, NY, USA. drmariamorais@gmail.com.
2Intraoperative Performance Analytics Laboratory, Department of Surgery, Northwell Health, New York, NY, USA.
3Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy.
4Intuitive AI and Digital, Sunnyvale, CA, USA.
5Medtronic Digital Technologies, London, UK.
6Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
7Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
8Children's National Hospital, Washington, DC, USA.
9Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
10Department of Computer and Information Science, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA.
11Department of Surgery, Advent Health-Celebration, University of Central Florida College of Medicine, Celebration, FL, USA.
12Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
13Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
14Department of Surgery, McGill University, Montreal, QC, Canada.
15Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
16Orsi Academy and Department of Human Structure and Repair, Ghent University, Ghent, Belgium.
17Bioimage Analysis Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
18Institute of Image-Guided Surgery, IHU-Strasbourg, Strasbourg, France.
19Department of Surgery, Mayo Clinic, Rochester, MN, USA.
20Department of Surgery, University of CA - Davis, Davis, CA, USA.
21Piedmont Henry Hospital, Stockbridge, GA, USA.
22Department of Surgery, University of Kentucky, Lexington, KY, USA.
23Department of Surgery, David Grant Medical Center, Travis Air Force Base, Fairfield, CA, USA.
24Department of Surgery, Cleveland Clinic Florida, Weston, FL, USA.
25Department for the Promotion of Medical Device Innovation, National Cancer Center Hospital East, Tokyo, Japan.
26Department of Surgery, West Virginia University, Morgantown, WV, USA.
27Professional Affairs, Asensus Surgical, Milan, Italy.
28Department of Surgery, Advent Health-Tampa, University of Central Florida College of Medicine, Tampa, FL, USA.
29Surgical Imaging Lab, Tufts Medical Center, Boston, MA, USA.
30Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA.
31Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Abstract
INTRODUCTION: Artificial intelligence (AI) for surgical workflow analysis often fails to generalize because surgical actions lack a standardized, fine-grained representation. Gesture-level "tokenization" of surgery, capturing instrument-tissue interactions as the smallest intentional functional units, offers greater technical specificity than phase- or step-level labels and has demonstrated associ…
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