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A fully connected layer was trained on the intermediate feature representation to classify instrument-tissue interaction. RESULTS The perception study revealed that acoustic feedback has potential to improve the perception during MIS and to serve as a basis for further automated analysis. The proposed classification pipeline yielded excellent performance for four types of instrument-tissue interaction (muscle, fascia, liver and fatty tissue) and achieved top-1 accuracies of up to 89.9%. Moreover, our model is able to distinguish electrosurgical operation mo