  Current `dry lab' surgical phantom simulators are a valuable tool for
surgeons which allows them to improve their dexterity and skill with surgical
instruments. These phantoms mimic the haptic and shape of organs of interest,
but lack a realistic visual appearance. In this work, we present an innovative
application in which representations learned from real intraoperative
endoscopic sequences are transferred to a surgical phantom scenario. The term
hyperrealism is introduced in this field, which we regard as a novel subform of
surgical augmented reality for approaches that involve real-time object
transfigurations. For related tasks in the computer vision community, unpaired
cycle-consistent Generative Adversarial Networks (GANs) have shown excellent
results on still RGB images. Though, application of this approach to continuous
video frames can result in flickering, which turned out to be especially
prominent for this application. Therefore, we propose an extension of
cycle-consistent GANs, named tempCycleGAN, to improve temporal consistency.The
novel method is evaluated on captures of a silicone phantom for training
endoscopic reconstructive mitral valve procedures. Synthesized videos show
highly realistic results with regard to 1) replacement of the silicone
appearance of the phantom valve by intraoperative tissue texture, while 2)
explicitly keeping crucial features in the scene, such as instruments, sutures
and prostheses. Compared to the original CycleGAN approach, tempCycleGAN
efficiently removes flickering between frames. The overall approach is expected
to change the future design of surgical training simulators since the generated
sequences clearly demonstrate the feasibility to enable a considerably more
realistic training experience for minimally-invasive procedures.
