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Precise placement of the Veress needle is still a challenge for the surgeon. In this study, a computer\u2010aided endoscopic optical coherence tomography (OCT) system was developed to effectively and safely guide Veress needle insertion. This endoscopic system was tested by imaging subcutaneous fat, muscle, abdominal space, and the small intestine from swine samples to simulate the surgical process, including the situation with small intestine injury. Each tissue layer was visualized in OCT images with unique features and subsequently used to develop a system for automatic localization of the Veress needle tip by identifying tissue layers (or spaces) and estimating the needle\u2010to\u2010tissue distance. We used convolutional neural networks (CNNs) in automatic tissue classification and distance estimation. The average testing accuracy in tissue classification was 98.53\u2009\u00b1\u20090.39%, and the average testing relative error in distance estimation reached 4.42\u2009\u00b1\u20090.56% (36.09\u2009\u00b1\u20094.92\u2009\u03bcm).<jats:inline-graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"graphic\/jbio202100347-gra-0001.png\" xlink:title=\"image\"\/><\/jats:p>","DOI":"10.1002\/jbio.202100347","type":"journal-article","created":{"date-parts":[[2022,2,1]],"date-time":"2022-02-01T13:13:33Z","timestamp":1643721213000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Computer\u2010aided Veress needle guidance using endoscopic optical coherence tomography and convolutional neural networks"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4645-3227","authenticated-orcid":false,"given":"Chen","family":"Wang","sequence":"first","affiliation":[{"name":"Stephenson School of Biomedical Engineering University of Oklahoma  Norman OK USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin C.","family":"Reynolds","sequence":"additional","affiliation":[{"name":"School of Computer Science University of Oklahoma  Norman OK USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Calle","sequence":"additional","affiliation":[{"name":"School of Computer Science University of Oklahoma  Norman OK USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avery D.","family":"Ladymon","sequence":"additional","affiliation":[{"name":"Stephenson School of Biomedical Engineering University of Oklahoma  Norman OK USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Yan","sequence":"additional","affiliation":[{"name":"Stephenson School of Biomedical Engineering University of Oklahoma  Norman OK USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuyang","family":"Yan","sequence":"additional","affiliation":[{"name":"Stephenson School of Biomedical Engineering University of Oklahoma  Norman OK USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"Ton","sequence":"additional","affiliation":[{"name":"Stephenson School of Biomedical Engineering University of Oklahoma  Norman OK USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kar\u2010ming","family":"Fung","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Oklahoma Health Sciences Center  Oklahoma City OK USA"},{"name":"Stephenson Cancer Center University of Oklahoma Health Sciences Center  Oklahoma City OK USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay G.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Urology University of Oklahoma Health Sciences Center  Oklahoma City OK USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongxin","family":"Yu","sequence":"additional","affiliation":[{"name":"Children's Hospital University of Oklahoma Health Sciences Center  Oklahoma City OK USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2860-0334","authenticated-orcid":false,"given":"Chongle","family":"Pan","sequence":"additional","affiliation":[{"name":"School of Computer Science University of Oklahoma  Norman OK USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinggong","family":"Tang","sequence":"additional","affiliation":[{"name":"Stephenson School of Biomedical Engineering University of Oklahoma  Norman OK USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,2,11]]},"reference":[{"issue":"5","key":"e_1_2_8_2_1","first-page":"763","volume":"96","author":"Hasson H. 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