Daily Papers

Surgical scene perception via videos are critical for advancing robotic surgery, telesurgery, and AI-assisted surgery, particularly in ophthalmology. However, the scarcity of diverse and richly annotated video datasets has hindered the development of intelligent systems for surgical workflow analysis. Existing datasets for surgical workflow analysis, which typically face challenges such as small scale, a lack of diversity in surgery and phase categories, and the absence of time-localized annotations, limit the requirements for action understanding and model generalization validation in complex and diverse real-world surgical scenarios. To address this gap, we introduce OphNet, a large-scale, expert-annotated video benchmark for ophthalmic surgical workflow understanding. OphNet features: 1) A diverse collection of 2,278 surgical videos spanning 66 types of cataract, glaucoma, and corneal surgeries, with detailed annotations for 102 unique surgical phases and 150 granular operations; 2) It offers sequential and hierarchical annotations for each surgery, phase, and operation, enabling comprehensive understanding and improved interpretability; 3) Moreover, OphNet provides time-localized annotations, facilitating temporal localization and prediction tasks within surgical workflows. With approximately 205 hours of surgical videos, OphNet is about 20 times larger than the largest existing surgical workflow analysis benchmark. Our dataset and code have been made available at: https://github.com/minghu0830/OphNet-benchmark.

In ophthalmic surgery, developing an AI system capable of interpreting surgical videos and predicting subsequent operations requires numerous ophthalmic surgical videos with high-quality annotations, which are difficult to collect due to privacy concerns and labor consumption. Text-guided video generation (T2V) emerges as a promising solution to overcome this issue by generating ophthalmic surgical videos based on surgeon instructions. In this paper, we present Ophora, a pioneering model that can generate ophthalmic surgical videos following natural language instructions. To construct Ophora, we first propose a Comprehensive Data Curation pipeline to convert narrative ophthalmic surgical videos into a large-scale, high-quality dataset comprising over 160K video-instruction pairs, Ophora-160K. Then, we propose a Progressive Video-Instruction Tuning scheme to transfer rich spatial-temporal knowledge from a T2V model pre-trained on natural video-text datasets for privacy-preserved ophthalmic surgical video generation based on Ophora-160K. Experiments on video quality evaluation via quantitative analysis and ophthalmologist feedback demonstrate that Ophora can generate realistic and reliable ophthalmic surgical videos based on surgeon instructions. We also validate the capability of Ophora for empowering downstream tasks of ophthalmic surgical workflow understanding. Code is available at https://github.com/mar-cry/Ophora.

Surgical practice involves complex visual interpretation, procedural skills, and advanced medical knowledge, making surgical vision-language pretraining (VLP) particularly challenging due to this complexity and the limited availability of annotated data. To address the gap, we propose OphCLIP, a hierarchical retrieval-augmented vision-language pretraining framework specifically designed for ophthalmic surgical workflow understanding. OphCLIP leverages the OphVL dataset we constructed, a large-scale and comprehensive collection of over 375K hierarchically structured video-text pairs with tens of thousands of different combinations of attributes (surgeries, phases/operations/actions, instruments, medications, as well as more advanced aspects like the causes of eye diseases, surgical objectives, and postoperative recovery recommendations, etc). These hierarchical video-text correspondences enable OphCLIP to learn both fine-grained and long-term visual representations by aligning short video clips with detailed narrative descriptions and full videos with structured titles, capturing intricate surgical details and high-level procedural insights, respectively. Our OphCLIP also designs a retrieval-augmented pretraining framework to leverage the underexplored large-scale silent surgical procedure videos, automatically retrieving semantically relevant content to enhance the representation learning of narrative videos. Evaluation across 11 datasets for phase recognition and multi-instrument identification shows OphCLIP's robust generalization and superior performance.

Recent advancements in surgical computer vision have been driven by vision-only models, which lack language semantics, relying on manually annotated videos to predict fixed object categories. This limits their generalizability to unseen surgical procedures and tasks. We propose leveraging surgical video lectures from e-learning platforms to provide effective vision and language supervisory signals for multi-modal representation learning, bypassing manual annotations. We address surgery-specific linguistic challenges using multiple automatic speech recognition systems for text transcriptions. We introduce SurgVLP - Surgical Vision Language Pre-training - a novel method for multi-modal representation learning. SurgVLP employs a new contrastive learning objective, aligning video clip embeddings with corresponding multiple text embeddings in a joint latent space. We demonstrate the representational capability of this space through several vision-and-language surgical tasks and vision-only tasks specific to surgery. Unlike current fully supervised approaches, SurgVLP adapts to different surgical procedures and tasks without specific fine-tuning, achieving zero-shot adaptation to tasks such as surgical tool, phase, and triplet recognition without manual annotation. These results highlight the transferability and versatility of the learned multi-modal representations in surgical video analysis. The code is available at https://github.com/CAMMA-public/SurgVLP

In recent years, the landscape of computer-assisted interventions and post-operative surgical video analysis has been dramatically reshaped by deep-learning techniques, resulting in significant advancements in surgeons' skills, operation room management, and overall surgical outcomes. However, the progression of deep-learning-powered surgical technologies is profoundly reliant on large-scale datasets and annotations. Particularly, surgical scene understanding and phase recognition stand as pivotal pillars within the realm of computer-assisted surgery and post-operative assessment of cataract surgery videos. In this context, we present the largest cataract surgery video dataset that addresses diverse requisites for constructing computerized surgical workflow analysis and detecting post-operative irregularities in cataract surgery. We validate the quality of annotations by benchmarking the performance of several state-of-the-art neural network architectures for phase recognition and surgical scene segmentation. Besides, we initiate the research on domain adaptation for instrument segmentation in cataract surgery by evaluating cross-domain instrument segmentation performance in cataract surgery videos. The dataset and annotations will be publicly available upon acceptance of the paper.

The field of computer vision applied to videos of minimally invasive surgery is ever-growing. Workflow recognition pertains to the automated recognition of various aspects of a surgery: including which surgical steps are performed; and which surgical instruments are used. This information can later be used to assist clinicians when learning the surgery; during live surgery; and when writing operation notes. The Pituitary Vision (PitVis) 2023 Challenge tasks the community to step and instrument recognition in videos of endoscopic pituitary surgery. This is a unique task when compared to other minimally invasive surgeries due to the smaller working space, which limits and distorts vision; and higher frequency of instrument and step switching, which requires more precise model predictions. Participants were provided with 25-videos, with results presented at the MICCAI-2023 conference as part of the Endoscopic Vision 2023 Challenge in Vancouver, Canada, on 08-Oct-2023. There were 18-submissions from 9-teams across 6-countries, using a variety of deep learning models. A commonality between the top performing models was incorporating spatio-temporal and multi-task methods, with greater than 50% and 10% macro-F1-score improvement over purely spacial single-task models in step and instrument recognition respectively. The PitVis-2023 Challenge therefore demonstrates state-of-the-art computer vision models in minimally invasive surgery are transferable to a new dataset, with surgery specific techniques used to enhance performance, progressing the field further. Benchmark results are provided in the paper, and the dataset is publicly available at: https://doi.org/10.5522/04/26531686.

The prevalence of vision-threatening eye diseases is a significant global burden, with many cases remaining undiagnosed or diagnosed too late for effective treatment. Large vision-language models (LVLMs) have the potential to assist in understanding anatomical information, diagnosing eye diseases, and drafting interpretations and follow-up plans, thereby reducing the burden on clinicians and improving access to eye care. However, limited benchmarks are available to assess LVLMs' performance in ophthalmology-specific applications. In this study, we introduce LMOD, a large-scale multimodal ophthalmology benchmark consisting of 21,993 instances across (1) five ophthalmic imaging modalities: optical coherence tomography, color fundus photographs, scanning laser ophthalmoscopy, lens photographs, and surgical scenes; (2) free-text, demographic, and disease biomarker information; and (3) primary ophthalmology-specific applications such as anatomical information understanding, disease diagnosis, and subgroup analysis. In addition, we benchmarked 13 state-of-the-art LVLM representatives from closed-source, open-source, and medical domains. The results demonstrate a significant performance drop for LVLMs in ophthalmology compared to other domains. Systematic error analysis further identified six major failure modes: misclassification, failure to abstain, inconsistent reasoning, hallucination, assertions without justification, and lack of domain-specific knowledge. In contrast, supervised neural networks specifically trained on these tasks as baselines demonstrated high accuracy. These findings underscore the pressing need for benchmarks in the development and validation of ophthalmology-specific LVLMs.

With the advent of smartphone indirect ophthalmoscopy, teleophthalmology - the use of specialist ophthalmology assets at a distance from the patient - has experienced a breakthrough, promising enormous benefits especially for healthcare in distant, inaccessible or opthalmologically underserved areas, where specialists are either unavailable or too few in number. However, accurate teleophthalmology requires high-quality ophthalmoscopic imagery. This paper considers three feature families - statistical metrics, gradient-based metrics and wavelet transform coefficient derived indicators - as possible metrics to identify unsharp or blurry images. By using standard machine learning techniques, the suitability of these features for image quality assessment is confirmed, albeit on a rather small data set. With the increased availability and decreasing cost of digital ophthalmoscopy on one hand and the increased prevalence of diabetic retinopathy worldwide on the other, creating tools that can determine whether an image is likely to be diagnostically suitable can play a significant role in accelerating and streamlining the teleophthalmology process. This paper highlights the need for more research in this area, including the compilation of a diverse database of ophthalmoscopic imagery, annotated with quality markers, to train the Point of Acquisition error detection algorithms of the future.

Vision-language pre-training (VLP) offers unique advantages for surgery by aligning language with surgical videos, enabling workflow understanding and transfer across tasks without relying on expert-labeled datasets. However, progress in surgical VLP remains constrained by the limited scale, procedural diversity, semantic quality, and hierarchical structure of existing datasets. In this work, we present SurgLaVi, the largest and most diverse surgical vision-language dataset to date, comprising nearly 240k clip-caption pairs from more than 200 procedures, and comprising hierarchical levels at phase-, step-, and task-level. At the core of SurgLaVi lies a fully automated pipeline that systematically generates fine-grained transcriptions of surgical videos and segments them into coherent procedural units. To ensure high-quality annotations, it applies dual-modality filtering to remove irrelevant and noisy samples. Within this framework, the resulting captions are enriched with contextual detail, producing annotations that are both semantically rich and easy to interpret. To ensure accessibility, we release SurgLaVi-eta, an open-source derivative of 113k clip-caption pairs constructed entirely from public data, which is over four times larger than existing surgical VLP datasets. To demonstrate the value of SurgLaVi datasets, we introduce SurgCLIP, a CLIP-style video-text contrastive framework with dual encoders, as a representative base model. SurgCLIP achieves consistent improvements across phase, step, action, and tool recognition, surpassing prior state-of-the-art methods, often by large margins. These results validate that large-scale, semantically rich, and hierarchically structured datasets directly translate into stronger and more generalizable representations, establishing SurgLaVi as a key resource for developing surgical foundation models.

Advancements in computer-assisted surgical procedures heavily rely on accurate visual data interpretation from camera systems used during surgeries. Traditional open-access datasets focusing on surgical procedures are often limited by their small size, typically consisting of fewer than 100 videos with less than 100K images. To address these constraints, a new dataset called Surg-3M has been compiled using a novel aggregation pipeline that collects high-resolution videos from online sources. Featuring an extensive collection of over 4K surgical videos and more than 3 million high-quality images from multiple procedure types, Surg-3M offers a comprehensive resource surpassing existing alternatives in size and scope, including two novel tasks. To demonstrate the effectiveness of this dataset, we present SurgFM, a self-supervised foundation model pretrained on Surg-3M that achieves impressive results in downstream tasks such as surgical phase recognition, action recognition, and tool presence detection. Combining key components from ConvNeXt, DINO, and an innovative augmented distillation method, SurgFM exhibits exceptional performance compared to specialist architectures across various benchmarks. Our experimental results show that SurgFM outperforms state-of-the-art models in multiple downstream tasks, including significant gains in surgical phase recognition (+8.9pp, +4.7pp, and +3.9pp of Jaccard in AutoLaparo, M2CAI16, and Cholec80), action recognition (+3.1pp of mAP in CholecT50) and tool presence detection (+4.6pp of mAP in Cholec80). Moreover, even when using only half of the data, SurgFM outperforms state-of-the-art models in AutoLaparo and achieves state-of-the-art performance in Cholec80. Both Surg-3M and SurgFM have significant potential to accelerate progress towards developing autonomous robotic surgery systems.

Purpose: Foundation models, trained on multitudes of public datasets, often require additional fine-tuning or re-prompting mechanisms to be applied to visually distinct target domains such as surgical videos. Further, without domain knowledge, they cannot model the specific semantics of the target domain. Hence, when applied to surgical video segmentation, they fail to generalise to sections where previously tracked objects leave the scene or new objects enter. Methods: We propose SASVi, a novel re-prompting mechanism based on a frame-wise Mask R-CNN Overseer model, which is trained on a minimal amount of scarcely available annotations for the target domain. This model automatically re-prompts the foundation model SAM2 when the scene constellation changes, allowing for temporally smooth and complete segmentation of full surgical videos. Results: Re-prompting based on our Overseer model significantly improves the temporal consistency of surgical video segmentation compared to similar prompting techniques and especially frame-wise segmentation, which neglects temporal information, by at least 1.5%. Our proposed approach allows us to successfully deploy SAM2 to surgical videos, which we quantitatively and qualitatively demonstrate for three different cholecystectomy and cataract surgery datasets. Conclusion: SASVi can serve as a new baseline for smooth and temporally consistent segmentation of surgical videos with scarcely available annotation data. Our method allows us to leverage scarce annotations and obtain complete annotations for full videos of the large-scale counterpart datasets. We make those annotations publicly available, providing extensive annotation data for the future development of surgical data science models.

Automatically recognizing surgical gestures is a crucial step towards a thorough understanding of surgical skill. Possible areas of application include automatic skill assessment, intra-operative monitoring of critical surgical steps, and semi-automation of surgical tasks. Solutions that rely only on the laparoscopic video and do not require additional sensor hardware are especially attractive as they can be implemented at low cost in many scenarios. However, surgical gesture recognition based only on video is a challenging problem that requires effective means to extract both visual and temporal information from the video. Previous approaches mainly rely on frame-wise feature extractors, either handcrafted or learned, which fail to capture the dynamics in surgical video. To address this issue, we propose to use a 3D Convolutional Neural Network (CNN) to learn spatiotemporal features from consecutive video frames. We evaluate our approach on recordings of robot-assisted suturing on a bench-top model, which are taken from the publicly available JIGSAWS dataset. Our approach achieves high frame-wise surgical gesture recognition accuracies of more than 84%, outperforming comparable models that either extract only spatial features or model spatial and low-level temporal information separately. For the first time, these results demonstrate the benefit of spatiotemporal CNNs for video-based surgical gesture recognition.

Surgical simulation plays a pivotal role in training novice surgeons, accelerating their learning curve and reducing intra-operative errors. However, conventional simulation tools fall short in providing the necessary photorealism and the variability of human anatomy. In response, current methods are shifting towards generative model-based simulators. Yet, these approaches primarily focus on using increasingly complex conditioning for precise synthesis while neglecting the fine-grained human control aspect. To address this gap, we introduce SG2VID, the first diffusion-based video model that leverages Scene Graphs for both precise video synthesis and fine-grained human control. We demonstrate SG2VID's capabilities across three public datasets featuring cataract and cholecystectomy surgery. While SG2VID outperforms previous methods both qualitatively and quantitatively, it also enables precise synthesis, providing accurate control over tool and anatomy's size and movement, entrance of new tools, as well as the overall scene layout. We qualitatively motivate how SG2VID can be used for generative augmentation and present an experiment demonstrating its ability to improve a downstream phase detection task when the training set is extended with our synthetic videos. Finally, to showcase SG2VID's ability to retain human control, we interact with the Scene Graphs to generate new video samples depicting major yet rare intra-operative irregularities.

Surgical workflow recognition has numerous potential medical applications, such as the automatic indexing of surgical video databases and the optimization of real-time operating room scheduling, among others. As a result, phase recognition has been studied in the context of several kinds of surgeries, such as cataract, neurological, and laparoscopic surgeries. In the literature, two types of features are typically used to perform this task: visual features and tool usage signals. However, the visual features used are mostly handcrafted. Furthermore, the tool usage signals are usually collected via a manual annotation process or by using additional equipment. In this paper, we propose a novel method for phase recognition that uses a convolutional neural network (CNN) to automatically learn features from cholecystectomy videos and that relies uniquely on visual information. In previous studies, it has been shown that the tool signals can provide valuable information in performing the phase recognition task. Thus, we present a novel CNN architecture, called EndoNet, that is designed to carry out the phase recognition and tool presence detection tasks in a multi-task manner. To the best of our knowledge, this is the first work proposing to use a CNN for multiple recognition tasks on laparoscopic videos. Extensive experimental comparisons to other methods show that EndoNet yields state-of-the-art results for both tasks.

Surgical video-language pretraining (VLP) faces unique challenges due to the knowledge domain gap and the scarcity of multi-modal data. This study aims to bridge the gap by addressing issues regarding textual information loss in surgical lecture videos and the spatial-temporal challenges of surgical VLP. We propose a hierarchical knowledge augmentation approach and a novel Procedure-Encoded Surgical Knowledge-Augmented Video-Language Pretraining (PeskaVLP) framework to tackle these issues. The knowledge augmentation uses large language models (LLM) for refining and enriching surgical concepts, thus providing comprehensive language supervision and reducing the risk of overfitting. PeskaVLP combines language supervision with visual self-supervision, constructing hard negative samples and employing a Dynamic Time Warping (DTW) based loss function to effectively comprehend the cross-modal procedural alignment. Extensive experiments on multiple public surgical scene understanding and cross-modal retrieval datasets show that our proposed method significantly improves zero-shot transferring performance and offers a generalist visual representation for further advancements in surgical scene understanding.The code is available at https://github.com/CAMMA-public/SurgVLP

A major obstacle to building models for effective semantic segmentation, and particularly video semantic segmentation, is a lack of large and well annotated datasets. This bottleneck is particularly prohibitive in highly specialized and regulated fields such as medicine and surgery, where video semantic segmentation could have important applications but data and expert annotations are scarce. In these settings, temporal clues and anatomical constraints could be leveraged during training to improve performance. Here, we present Temporally Constrained Neural Networks (TCNN), a semi-supervised framework used for video semantic segmentation of surgical videos. In this work, we show that autoencoder networks can be used to efficiently provide both spatial and temporal supervisory signals to train deep learning models. We test our method on a newly introduced video dataset of laparoscopic cholecystectomy procedures, Endoscapes, and an adaptation of a public dataset of cataract surgeries, CaDIS. We demonstrate that lower-dimensional representations of predicted masks can be leveraged to provide a consistent improvement on both sparsely labeled datasets with no additional computational cost at inference time. Further, the TCNN framework is model-agnostic and can be used in conjunction with other model design choices with minimal additional complexity.

Artificial intelligence (AI) is vital in ophthalmology, tackling tasks like diagnosis, classification, and visual question answering (VQA). However, existing AI models in this domain often require extensive annotation and are task-specific, limiting their clinical utility. While recent developments have brought about foundation models for ophthalmology, they are limited by the need to train separate weights for each imaging modality, preventing a comprehensive representation of multi-modal features. This highlights the need for versatile foundation models capable of handling various tasks and modalities in ophthalmology. To address this gap, we present EyeFound, a multimodal foundation model for ophthalmic images. Unlike existing models, EyeFound learns generalizable representations from unlabeled multimodal retinal images, enabling efficient model adaptation across multiple applications. Trained on 2.78 million images from 227 hospitals across 11 ophthalmic modalities, EyeFound facilitates generalist representations and diverse multimodal downstream tasks, even for detecting challenging rare diseases. It outperforms previous work RETFound in diagnosing eye diseases, predicting systemic disease incidents, and zero-shot multimodal VQA. EyeFound provides a generalizable solution to improve model performance and lessen the annotation burden on experts, facilitating widespread clinical AI applications for retinal imaging.

Purpose: A profound education of novice surgeons is crucial to ensure that surgical interventions are effective and safe. One important aspect is the teaching of technical skills for minimally invasive or robot-assisted procedures. This includes the objective and preferably automatic assessment of surgical skill. Recent studies presented good results for automatic, objective skill evaluation by collecting and analyzing motion data such as trajectories of surgical instruments. However, obtaining the motion data generally requires additional equipment for instrument tracking or the availability of a robotic surgery system to capture kinematic data. In contrast, we investigate a method for automatic, objective skill assessment that requires video data only. This has the advantage that video can be collected effortlessly during minimally invasive and robot-assisted training scenarios. Methods: Our method builds on recent advances in deep learning-based video classification. Specifically, we propose to use an inflated 3D ConvNet to classify snippets, i.e., stacks of a few consecutive frames, extracted from surgical video. The network is extended into a Temporal Segment Network during training. Results: We evaluate the method on the publicly available JIGSAWS dataset, which consists of recordings of basic robot-assisted surgery tasks performed on a dry lab bench-top model. Our approach achieves high skill classification accuracies ranging from 95.1% to 100.0%. Conclusions: Our results demonstrate the feasibility of deep learning-based assessment of technical skill from surgical video. Notably, the 3D ConvNet is able to learn meaningful patterns directly from the data, alleviating the need for manual feature engineering. Further evaluation will require more annotated data for training and testing.

Natural language could play an important role in developing generalist surgical models by providing a broad source of supervision from raw texts. This flexible form of supervision can enable the model's transferability across datasets and tasks as natural language can be used to reference learned visual concepts or describe new ones. In this work, we present HecVL, a novel hierarchical video-language pretraining approach for building a generalist surgical model. Specifically, we construct a hierarchical video-text paired dataset by pairing the surgical lecture video with three hierarchical levels of texts: at clip-level, atomic actions using transcribed audio texts; at phase-level, conceptual text summaries; and at video-level, overall abstract text of the surgical procedure. Then, we propose a novel fine-to-coarse contrastive learning framework that learns separate embedding spaces for the three video-text hierarchies using a single model. By disentangling embedding spaces of different hierarchical levels, the learned multi-modal representations encode short-term and long-term surgical concepts in the same model. Thanks to the injected textual semantics, we demonstrate that the HecVL approach can enable zero-shot surgical phase recognition without any human annotation. Furthermore, we show that the same HecVL model for surgical phase recognition can be transferred across different surgical procedures and medical centers. The code is available at https://github.com/CAMMA-public/SurgVLP

Large vision-language models struggle with medical video understanding, where spatial precision, temporal reasoning, and clinical semantics are critical. To address this, we first introduce MedVidBench, a large-scale benchmark of 531,850 video-instruction pairs across 8 medical sources spanning video, segment, and frame-level tasks, curated through a rigorous quality assurance pipeline with expert-guided prompting and dual-model validation. While supervised fine-tuning on MedVidBench yields noticeable gains, standard Reinforcement Learning (RL) fails due to imbalanced reward scales across datasets, which destabilizes optimization and leads to training collapse. To overcome this, we introduce MedGRPO, a novel RL framework for balanced multi-dataset training with two key innovations: (1) cross-dataset reward normalization that maps each dataset's median performance to a common reward value, ensuring fair optimization regardless of difficulty, and (2) a medical LLM judge that evaluates caption quality on five clinical dimensions through comparative similarity scoring. Supervised fine-tuning Qwen2.5-VL-7B on MedVidBench substantially outperforms GPT-4.1 and Gemini-2.5-Flash across all tasks, demonstrating MedVidBench's efficacy, while our MedGRPO framework further improves upon the SFT baseline across grounding and captioning tasks. Our work establishes a foundational benchmark and robust training methodology for advancing vision-language models in medical domains. Our project website is available at https://yuhaosu.github.io/MedGRPO/.

Medical video generation has transformative potential for enhancing surgical understanding and pathology insights through precise and controllable visual representations. However, current models face limitations in controllability and authenticity. To bridge this gap, we propose SurgSora, a motion-controllable surgical video generation framework that uses a single input frame and user-controllable motion cues. SurgSora consists of three key modules: the Dual Semantic Injector (DSI), which extracts object-relevant RGB and depth features from the input frame and integrates them with segmentation cues to capture detailed spatial features of complex anatomical structures; the Decoupled Flow Mapper (DFM), which fuses optical flow with semantic-RGB-D features at multiple scales to enhance temporal understanding and object spatial dynamics; and the Trajectory Controller (TC), which allows users to specify motion directions and estimates sparse optical flow, guiding the video generation process. The fused features are used as conditions for a frozen Stable Diffusion model to produce realistic, temporally coherent surgical videos. Extensive evaluations demonstrate that SurgSora outperforms state-of-the-art methods in controllability and authenticity, showing its potential to advance surgical video generation for medical education, training, and research.

Purpose: Surgical video is an important data stream for gesture recognition. Thus, robust visual encoders for those data-streams is similarly important. Methods: Leveraging the Bridge-Prompt framework, we fine-tune a pre-trained vision-text model (CLIP) for gesture recognition in surgical videos. This can utilize extensive outside video data such as text, but also make use of label meta-data and weakly supervised contrastive losses. Results: Our experiments show that prompt-based video encoder outperforms standard encoders in surgical gesture recognition tasks. Notably, it displays strong performance in zero-shot scenarios, where gestures/tasks that were not provided during the encoder training phase are included in the prediction phase. Additionally, we measure the benefit of inclusion text descriptions in the feature extractor training schema. Conclusion: Bridge-Prompt and similar pre-trained+fine-tuned video encoder models present significant visual representation for surgical robotics, especially in gesture recognition tasks. Given the diverse range of surgical tasks (gestures), the ability of these models to zero-shot transfer without the need for any task (gesture) specific retraining makes them invaluable.

Dynamic reconstruction of deformable tissues in endoscopic video is a key technology for robot-assisted surgery. Recent reconstruction methods based on neural radiance fields (NeRFs) have achieved remarkable results in the reconstruction of surgical scenes. However, based on implicit representation, NeRFs struggle to capture the intricate details of objects in the scene and cannot achieve real-time rendering. In addition, restricted single view perception and occluded instruments also propose special challenges in surgical scene reconstruction. To address these issues, we develop SurgicalGaussian, a deformable 3D Gaussian Splatting method to model dynamic surgical scenes. Our approach models the spatio-temporal features of soft tissues at each time stamp via a forward-mapping deformation MLP and regularization to constrain local 3D Gaussians to comply with consistent movement. With the depth initialization strategy and tool mask-guided training, our method can remove surgical instruments and reconstruct high-fidelity surgical scenes. Through experiments on various surgical videos, our network outperforms existing method on many aspects, including rendering quality, rendering speed and GPU usage. The project page can be found at https://surgicalgaussian.github.io.

Long-form clinical videos are central to visual evidence-based decision-making, with growing importance for applications such as surgical robotics and related settings. However, current multimodal large language models typically process videos with passive sampling or weakly grounded inspection, which limits their ability to iteratively locate, verify, and justify predictions with temporally targeted evidence. To close this gap, we propose MedScope, a tool-using clinical video reasoning model that performs coarse-to-fine evidence seeking over long-form procedures. By interleaving intermediate reasoning with targeted tool calls and verification on retrieved observations, MedScope produces more accurate and trustworthy predictions that are explicitly grounded in temporally localized visual evidence. To address the lack of high-fidelity supervision, we build ClinVideoSuite, an evidence-centric, fine-grained clinical video suite. We then optimize MedScope with Grounding-Aware Group Relative Policy Optimization (GA-GRPO), which directly reinforces tool use with grounding-aligned rewards and evidence-weighted advantages. On full and fine-grained video understanding benchmarks, MedScope achieves state-of-the-art performance in both in-domain and out-of-domain evaluations. Our approach illuminates a path toward medical AI agents that can genuinely "think with videos" through tool-integrated reasoning. We will release our code, models, and data.

The need for improved diagnostic methods in ophthalmology is acute, especially in the underdeveloped regions with limited access to specialists and advanced equipment. Therefore, we introduce VisionUnite, a novel vision-language foundation model for ophthalmology enhanced with clinical knowledge. VisionUnite has been pretrained on an extensive dataset comprising 1.24 million image-text pairs, and further refined using our proposed MMFundus dataset, which includes 296,379 high-quality fundus image-text pairs and 889,137 simulated doctor-patient dialogue instances. Our experiments indicate that VisionUnite outperforms existing generative foundation models such as GPT-4V and Gemini Pro. It also demonstrates diagnostic capabilities comparable to junior ophthalmologists. VisionUnite performs well in various clinical scenarios including open-ended multi-disease diagnosis, clinical explanation, and patient interaction, making it a highly versatile tool for initial ophthalmic disease screening. VisionUnite can also serve as an educational aid for junior ophthalmologists, accelerating their acquisition of knowledge regarding both common and underrepresented ophthalmic conditions. VisionUnite represents a significant advancement in ophthalmology, with broad implications for diagnostics, medical education, and understanding of disease mechanisms. The source code is at https://github.com/HUANGLIZI/VisionUnite.

Foundation models have revolutionized computer vision by achieving vastly superior performance across diverse tasks through large-scale pretraining on extensive datasets. However, their application in surgical computer vision has been limited. This study addresses this gap by introducing SurgeNetXL, a novel surgical foundation model that sets a new benchmark in surgical computer vision. Trained on the largest reported surgical dataset to date, comprising over 4.7 million video frames, SurgeNetXL achieves consistent top-tier performance across six datasets spanning four surgical procedures and three tasks, including semantic segmentation, phase recognition, and critical view of safety (CVS) classification. Compared with the best-performing surgical foundation models, SurgeNetXL shows mean improvements of 2.4, 9.0, and 12.6 percent for semantic segmentation, phase recognition, and CVS classification, respectively. Additionally, SurgeNetXL outperforms the best-performing ImageNet-based variants by 14.4, 4.0, and 1.6 percent in the respective tasks. In addition to advancing model performance, this study provides key insights into scaling pretraining datasets, extending training durations, and optimizing model architectures specifically for surgical computer vision. These findings pave the way for improved generalizability and robustness in data-scarce scenarios, offering a comprehensive framework for future research in this domain. All models and a subset of the SurgeNetXL dataset, including over 2 million video frames, are publicly available at: https://github.com/TimJaspers0801/SurgeNet.

Video Question Answering (VideoQA) in the surgical domain aims to enhance intraoperative understanding by enabling AI models to reason over temporally coherent events rather than isolated frames. Current approaches are limited to static image features, and available datasets often lack temporal annotations, ignoring the dynamics critical for accurate procedural interpretation. We propose SurgViVQA, a surgical VideoQA model that extends visual reasoning from static images to dynamic surgical scenes. It uses a Masked Video--Text Encoder to fuse video and question features, capturing temporal cues such as motion and tool--tissue interactions, which a fine-tuned large language model (LLM) then decodes into coherent answers. To evaluate its performance, we curated REAL-Colon-VQA, a colonoscopic video dataset that includes motion-related questions and diagnostic attributes, as well as out-of-template questions with rephrased or semantically altered formulations to assess model robustness. Experimental validation on REAL-Colon-VQA and the public EndoVis18-VQA dataset shows that SurgViVQA outperforms existing image-based VQA benchmark models, particularly in keyword accuracy, improving over PitVQA by +11\% on REAL-Colon-VQA and +9\% on EndoVis18-VQA. A perturbation study on the questions further confirms improved generalizability and robustness to variations in question phrasing. SurgViVQA and the REAL-Colon-VQA dataset provide a framework for temporally-aware understanding in surgical VideoQA, enabling AI models to interpret dynamic procedural contexts more effectively. Code and dataset available at https://github.com/madratak/SurgViVQA.

Intra-operative recognition of surgical phases holds significant potential for enhancing real-time contextual awareness in the operating room. However, we argue that online recognition, while beneficial, primarily lends itself to post-operative video analysis due to its limited direct impact on the actual surgical decisions and actions during ongoing procedures. In contrast, we contend that the prediction and anticipation of surgical phases are inherently more valuable for intra-operative assistance, as they can meaningfully influence a surgeon's immediate and long-term planning by providing foresight into future steps. To address this gap, we propose a dual approach that simultaneously recognises the current surgical phase and predicts upcoming ones, thus offering comprehensive intra-operative assistance and guidance on the expected remaining workflow. Our novel method, Surgical Phase Recognition and Anticipation (SuPRA), leverages past and current information for accurate intra-operative phase recognition while using future segments for phase prediction. This unified approach challenges conventional frameworks that treat these objectives separately. We have validated SuPRA on two reputed datasets, Cholec80 and AutoLaparo21, where it demonstrated state-of-the-art performance with recognition accuracies of 91.8% and 79.3%, respectively. Additionally, we introduce and evaluate our model using new segment-level evaluation metrics, namely Edit and F1 Overlap scores, for a more temporal assessment of segment classification. In conclusion, SuPRA presents a new multi-task approach that paves the way for improved intra-operative assistance through surgical phase recognition and prediction of future events.

Surgical future prediction, driven by real-time AI analysis of surgical video, is critical for operating room safety and efficiency. It provides actionable insights into upcoming events, their timing, and risks-enabling better resource allocation, timely instrument readiness, and early warnings for complications (e.g., bleeding, bile duct injury). Despite this need, current surgical AI research focuses on understanding what is happening rather than predicting future events. Existing methods target specific tasks in isolation, lacking unified approaches that span both short-term (action triplets, events) and long-term horizons (remaining surgery duration, phase transitions). These methods rely on coarse-grained supervision while fine-grained surgical action triplets and steps remain underexplored. Furthermore, methods based only on future feature prediction struggle to generalize across different surgical contexts and procedures. We address these limits by reframing surgical future prediction as state-change learning. Rather than forecasting raw observations, our approach classifies state transitions between current and future timesteps. We introduce SurgFUTR, implementing this through a teacher-student architecture. Video clips are compressed into state representations via Sinkhorn-Knopp clustering; the teacher network learns from both current and future clips, while the student network predicts future states from current videos alone, guided by our Action Dynamics (ActDyn) module. We establish SFPBench with five prediction tasks spanning short-term (triplets, events) and long-term (remaining surgery duration, phase and step transitions) horizons. Experiments across four datasets and three procedures show consistent improvements. Cross-procedure transfer validates generalizability.

Data scarcity remains a fundamental barrier to achieving fully autonomous surgical robots. While large scale vision language action (VLA) models have shown impressive generalization in household and industrial manipulation by leveraging paired video action data from diverse domains, surgical robotics suffers from the paucity of datasets that include both visual observations and accurate robot kinematics. In contrast, vast corpora of surgical videos exist, but they lack corresponding action labels, preventing direct application of imitation learning or VLA training. In this work, we aim to alleviate this problem by learning policy models from SurgWorld, a world model designed for surgical physical AI. We curated the Surgical Action Text Alignment (SATA) dataset with detailed action description specifically for surgical robots. Then we built SurgeWorld based on the most advanced physical AI world model and SATA. It's able to generate diverse, generalizable and realistic surgery videos. We are also the first to use an inverse dynamics model to infer pseudokinematics from synthetic surgical videos, producing synthetic paired video action data. We demonstrate that a surgical VLA policy trained with these augmented data significantly outperforms models trained only on real demonstrations on a real surgical robot platform. Our approach offers a scalable path toward autonomous surgical skill acquisition by leveraging the abundance of unlabeled surgical video and generative world modeling, thus opening the door to generalizable and data efficient surgical robot policies.

While foundation models have advanced surgical video analysis, current approaches rely predominantly on pixel-level reconstruction objectives that waste model capacity on low-level visual details - such as smoke, specular reflections, and fluid motion - rather than semantic structures essential for surgical understanding. We present UniSurg, a video-native foundation model that shifts the learning paradigm from pixel-level reconstruction to latent motion prediction. Built on the Video Joint Embedding Predictive Architecture (V-JEPA), UniSurg introduces three key technical innovations tailored to surgical videos: 1) motion-guided latent prediction to prioritize semantically meaningful regions, 2) spatiotemporal affinity self-distillation to enforce relational consistency, and 3) feature diversity regularization to prevent representation collapse in texture-sparse surgical scenes. To enable large-scale pretraining, we curate UniSurg-15M, the largest surgical video dataset to date, comprising 3,658 hours of video from 50 sources across 13 anatomical regions. Extensive experiments across 17 benchmarks demonstrate that UniSurg significantly outperforms state-of-the-art methods on surgical workflow recognition (+14.6% F1 on EgoSurgery, +10.3% on PitVis), action triplet recognition (39.54% mAP-IVT on CholecT50), skill assessment, polyp segmentation, and depth estimation. These results establish UniSurg as a new standard for universal, motion-oriented surgical video understanding.

High-resolution (HR) medical videos are vital for accurate diagnosis, yet are hard to acquire due to hardware limitations and physiological constraints. Clinically, the collected low-resolution (LR) medical videos present unique challenges for video super-resolution (VSR) models, including camera shake, noise, and abrupt frame transitions, which result in significant optical flow errors and alignment difficulties. Additionally, tissues and organs exhibit continuous and nuanced structures, but current VSR models are prone to introducing artifacts and distorted features that can mislead doctors. To this end, we propose MedVSR, a tailored framework for medical VSR. It first employs Cross State-Space Propagation (CSSP) to address the imprecise alignment by projecting distant frames as control matrices within state-space models, enabling the selective propagation of consistent and informative features to neighboring frames for effective alignment. Moreover, we design an Inner State-Space Reconstruction (ISSR) module that enhances tissue structures and reduces artifacts with joint long-range spatial feature learning and large-kernel short-range information aggregation. Experiments across four datasets in diverse medical scenarios, including endoscopy and cataract surgeries, show that MedVSR significantly outperforms existing VSR models in reconstruction performance and efficiency. Code released at https://github.com/CUHK-AIM-Group/MedVSR.

The lack of labeled datasets in 3D vision for surgical scenes inhibits the development of robust 3D reconstruction algorithms in the medical domain. Despite the popularity of Neural Radiance Fields and 3D Gaussian Splatting in the general computer vision community, these systems have yet to find consistent success in surgical scenes due to challenges such as non-stationary lighting and non-Lambertian surfaces. As a result, the need for labeled surgical datasets continues to grow. In this work, we introduce a differentiable rendering framework for material and lighting estimation from endoscopic images and known geometry. Compared to previous approaches that model lighting and material jointly as radiance, we explicitly disentangle these scene properties for robust and photorealistic novel view synthesis. To disambiguate the training process, we formulate domain-specific properties inherent in surgical scenes. Specifically, we model the scene lighting as a simple spotlight and material properties as a bidirectional reflectance distribution function, parameterized by a neural network. By grounding color predictions in the rendering equation, we can generate photorealistic images at arbitrary camera poses. We evaluate our method with various sequences from the Colonoscopy 3D Video Dataset and show that our method produces competitive novel view synthesis results compared with other approaches. Furthermore, we demonstrate that synthetic data can be used to develop 3D vision algorithms by finetuning a depth estimation model with our rendered outputs. Overall, we see that the depth estimation performance is on par with fine-tuning with the original real images.

Surgery video segmentation is an important topic in the surgical AI field. It allows the AI model to understand the spatial information of a surgical scene. Meanwhile, due to the lack of annotated surgical data, surgery segmentation models suffer from limited performance. With the emergence of SAM2 model, a large foundation model for video segmentation trained on natural videos, zero-shot surgical video segmentation became more realistic but meanwhile remains to be explored. In this paper, we systematically evaluate the performance of SAM2 model in zero-shot surgery video segmentation task. We conducted experiments under different configurations, including different prompting strategies, robustness, etc. Moreover, we conducted an empirical evaluation over the performance, including 9 datasets with 17 different types of surgeries.

In order to provide the right type of assistance at the right time, computer-assisted surgery systems need context awareness. To achieve this, methods for surgical workflow analysis are crucial. Currently, convolutional neural networks provide the best performance for video-based workflow analysis tasks. For training such networks, large amounts of annotated data are necessary. However, collecting a sufficient amount of data is often costly, time-consuming, and not always feasible. In this paper, we address this problem by presenting and comparing different approaches for self-supervised pretraining of neural networks on unlabeled laparoscopic videos using temporal coherence. We evaluate our pretrained networks on Cholec80, a publicly available dataset for surgical phase segmentation, on which a maximum F1 score of 84.6 was reached. Furthermore, we were able to achieve an increase of the F1 score of up to 10 points when compared to a non-pretrained neural network.

Conversation agents powered by large language models are revolutionizing the way we interact with visual data. Recently, large vision-language models (LVLMs) have been extensively studied for both images and videos. However, these studies typically focus on common scenarios. In this work, we introduce an LVLM specifically designed for surgical scenarios. We integrate visual representations of surgical images and videos into the language feature space. Consequently, we establish a LVLM model, Surgical-LLaVA, fine-tuned on instruction following data of surgical scenarios. Our experiments demonstrate that Surgical-LLaVA exhibits impressive multi-modal chat abilities in surgical contexts, occasionally displaying multi-modal behaviors on unseen instructions. We conduct a quantitative evaluation of visual question-answering datasets for surgical scenarios. The results show superior performance compared to previous works, indicating the potential of our model to tackle more complex surgery scenarios.

Understanding the workflow of surgical procedures in complex operating rooms requires a deep understanding of the interactions between clinicians and their environment. Surgical activity recognition (SAR) is a key computer vision task that detects activities or phases from multi-view camera recordings. Existing SAR models often fail to account for fine-grained clinician movements and multi-view knowledge, or they require calibrated multi-view camera setups and advanced point-cloud processing to obtain better results. In this work, we propose a novel calibration-free multi-view multi-modal pretraining framework called Multiview Pretraining for Video-Pose Surgical Activity Recognition PreViPS, which aligns 2D pose and vision embeddings across camera views. Our model follows CLIP-style dual-encoder architecture: one encoder processes visual features, while the other encodes human pose embeddings. To handle the continuous 2D human pose coordinates, we introduce a tokenized discrete representation to convert the continuous 2D pose coordinates into discrete pose embeddings, thereby enabling efficient integration within the dual-encoder framework. To bridge the gap between these two modalities, we propose several pretraining objectives using cross- and in-modality geometric constraints within the embedding space and incorporating masked pose token prediction strategy to enhance representation learning. Extensive experiments and ablation studies demonstrate improvements over the strong baselines, while data-efficiency experiments on two distinct operating room datasets further highlight the effectiveness of our approach. We highlight the benefits of our approach for surgical activity recognition in both multi-view and single-view settings, showcasing its practical applicability in complex surgical environments. Code will be made available at: https://github.com/CAMMA-public/PreViPS.

A large-scale labeled dataset is a key factor for the success of supervised deep learning in computer vision. However, a limited number of annotated data is very common, especially in ophthalmic image analysis, since manual annotation is time-consuming and labor-intensive. Self-supervised learning (SSL) methods bring huge opportunities for better utilizing unlabeled data, as they do not need massive annotations. With an attempt to use as many as possible unlabeled ophthalmic images, it is necessary to break the dimension barrier, simultaneously making use of both 2D and 3D images. In this paper, we propose a universal self-supervised Transformer framework, named Uni4Eye, to discover the inherent image property and capture domain-specific feature embedding in ophthalmic images. Uni4Eye can serve as a global feature extractor, which builds its basis on a Masked Image Modeling task with a Vision Transformer (ViT) architecture. We employ a Unified Patch Embedding module to replace the origin patch embedding module in ViT for jointly processing both 2D and 3D input images. Besides, we design a dual-branch multitask decoder module to simultaneously perform two reconstruction tasks on the input image and its gradient map, delivering discriminative representations for better convergence. We evaluate the performance of our pre-trained Uni4Eye encoder by fine-tuning it on six downstream ophthalmic image classification tasks. The superiority of Uni4Eye is successfully established through comparisons to other state-of-the-art SSL pre-training methods.

Clinicians spend a significant amount of time reviewing medical images and transcribing their findings regarding patient diagnosis, referral and treatment in text form. Vision-language models (VLMs), which automatically interpret images and summarize their findings as text, have enormous potential to alleviate clinical workloads and increase patient access to high-quality medical care. While foundational models have stirred considerable interest in the medical community, it is unclear whether their general capabilities translate to real-world clinical utility. In this work, we show that foundation VLMs markedly underperform compared to practicing ophthalmologists on specialist tasks crucial to the care of patients with age-related macular degeneration (AMD). To address this, we initially identified the essential capabilities required for image-based clinical decision-making, and then developed a curriculum to selectively train VLMs in these skills. The resulting model, RetinaVLM, can be instructed to write reports that significantly outperform those written by leading foundation medical VLMs in disease staging (F1 score of 0.63 vs. 0.11) and patient referral (0.67 vs. 0.39), and approaches the diagnostic performance of junior ophthalmologists (who achieve 0.77 and 0.78 on the respective tasks). Furthermore, in a reader study involving two senior ophthalmologists with up to 32 years of experience, RetinaVLM's reports were found to be similarly correct (78.6% vs. 82.1%) and complete (both 78.6%) as reports written by junior ophthalmologists with up to 10 years of experience. These results demonstrate that our curriculum-based approach provides a blueprint for specializing generalist foundation medical VLMs to handle real-world clinical tasks.

The Segment Anything Model 2 (SAM 2) is the latest generation foundation model for image and video segmentation. Trained on the expansive Segment Anything Video (SA-V) dataset, which comprises 35.5 million masks across 50.9K videos, SAM 2 advances its predecessor's capabilities by supporting zero-shot segmentation through various prompts (e.g., points, boxes, and masks). Its robust zero-shot performance and efficient memory usage make SAM 2 particularly appealing for surgical tool segmentation in videos, especially given the scarcity of labeled data and the diversity of surgical procedures. In this study, we evaluate the zero-shot video segmentation performance of the SAM 2 model across different types of surgeries, including endoscopy and microscopy. We also assess its performance on videos featuring single and multiple tools of varying lengths to demonstrate SAM 2's applicability and effectiveness in the surgical domain. We found that: 1) SAM 2 demonstrates a strong capability for segmenting various surgical videos; 2) When new tools enter the scene, additional prompts are necessary to maintain segmentation accuracy; and 3) Specific challenges inherent to surgical videos can impact the robustness of SAM 2.

Clinical diagnosis of the eye is performed over multifarious data modalities including scalar clinical labels, vectorized biomarkers, two-dimensional fundus images, and three-dimensional Optical Coherence Tomography (OCT) scans. Clinical practitioners use all available data modalities for diagnosing and treating eye diseases like Diabetic Retinopathy (DR) or Diabetic Macular Edema (DME). Enabling usage of machine learning algorithms within the ophthalmic medical domain requires research into the relationships and interactions between all relevant data over a treatment period. Existing datasets are limited in that they neither provide data nor consider the explicit relationship modeling between the data modalities. In this paper, we introduce the Ophthalmic Labels for Investigating Visual Eye Semantics (OLIVES) dataset that addresses the above limitation. This is the first OCT and near-IR fundus dataset that includes clinical labels, biomarker labels, disease labels, and time-series patient treatment information from associated clinical trials. The dataset consists of 1268 near-IR fundus images each with at least 49 OCT scans, and 16 biomarkers, along with 4 clinical labels and a disease diagnosis of DR or DME. In total, there are 96 eyes' data averaged over a period of at least two years with each eye treated for an average of 66 weeks and 7 injections. We benchmark the utility of OLIVES dataset for ophthalmic data as well as provide benchmarks and concrete research directions for core and emerging machine learning paradigms within medical image analysis.

Multimodal large language models (MLLMs) have recently demonstrated remarkable reasoning abilities with reinforcement learning paradigm. Although several multimodal reasoning models have been explored in the medical domain, most of them focus exclusively on basic reasoning, which refers to shallow inference based on visual feature matching. However, real-world clinical diagnosis extends beyond basic reasoning, demanding reasoning processes that integrate heterogeneous clinical information (such as chief complaints and medical history) with multimodal medical imaging data. To bridge this gap, we introduce MM-Retinal-Reason, the first ophthalmic multimodal dataset with the full spectrum of perception and reasoning. It encompasses both basic reasoning tasks and complex reasoning tasks, aiming to enhance visual-centric fundamental reasoning capabilities and emulate realistic clinical thinking patterns. Building upon MM-Retinal-Reason, we propose OphthaReason, the first ophthalmology-specific multimodal reasoning model with step-by-step reasoning traces. To enable flexible adaptation to both basic and complex reasoning tasks, we specifically design a novel method called Uncertainty-Aware Dynamic Thinking (UADT), which estimates sample-level uncertainty via entropy and dynamically modulates the model's exploration depth using a shaped advantage mechanism. Comprehensive experiments demonstrate that our model achieves state-of-the-art performance on both basic and complex reasoning tasks, outperforming general-purpose MLLMs, medical MLLMs, RL-based medical MLLMs, and ophthalmic MLLMs by at least 24.92\%, 15.00\%, 21.20\%, and 17.66\%. Project Page: https://github.com/lxirich/OphthaReason{link}.

Foundation models in video generation are demonstrating remarkable capabilities as potential world models for simulating the physical world. However, their application in high-stakes domains like surgery, which demand deep, specialized causal knowledge rather than general physical rules, remains a critical unexplored gap. To systematically address this challenge, we present SurgVeo, the first expert-curated benchmark for video generation model evaluation in surgery, and the Surgical Plausibility Pyramid (SPP), a novel, four-tiered framework tailored to assess model outputs from basic appearance to complex surgical strategy. On the basis of the SurgVeo benchmark, we task the advanced Veo-3 model with a zero-shot prediction task on surgical clips from laparoscopic and neurosurgical procedures. A panel of four board-certified surgeons evaluates the generated videos according to the SPP. Our results reveal a distinct "plausibility gap": while Veo-3 achieves exceptional Visual Perceptual Plausibility, it fails critically at higher levels of the SPP, including Instrument Operation Plausibility, Environment Feedback Plausibility, and Surgical Intent Plausibility. This work provides the first quantitative evidence of the chasm between visually convincing mimicry and causal understanding in surgical AI. Our findings from SurgVeo and the SPP establish a crucial foundation and roadmap for developing future models capable of navigating the complexities of specialized, real-world healthcare domains.

Retinal detachment (RD) is a vision-threatening condition that requires timely intervention to preserve vision. Macular involvement -- whether the macula is still intact (macula-intact) or detached (macula-detached) -- is the key determinant of visual outcomes and treatment urgency. Point-of-care ultrasound (POCUS) offers a fast, non-invasive, cost-effective, and accessible imaging modality widely used in diverse clinical settings to detect RD. However, ultrasound image interpretation is limited by a lack of expertise among healthcare providers, especially in resource-limited settings. Deep learning offers the potential to automate ultrasound-based assessment of RD. However, there are no ML ultrasound algorithms currently available for clinical use to detect RD and no prior research has been done on assessing macular status using ultrasound in RD cases -- an essential distinction for surgical prioritization. Moreover, no public dataset currently supports macular-based RD classification using ultrasound video clips. We introduce Eye Retinal DEtachment ultraSound, ERDES, the first open-access dataset of ocular ultrasound clips labeled for (i) presence of retinal detachment and (ii) macula-intact versus macula-detached status. The dataset is intended to facilitate the development and evaluation of machine learning models for detecting retinal detachment. We also provide baseline benchmarks using multiple spatiotemporal convolutional neural network (CNN) architectures. All clips, labels, and training code are publicly available at https://osupcvlab.github.io/ERDES/.

We investigate how both the adaptation of a generic foundation model via transfer learning and the integration of complementary modalities from the operating room (OR) can support surgical data science. To this end, we use V-JEPA as the single-modality foundation of a multimodal model for minimally invasive surgery support. We analyze how the model's downstream performance can benefit (a) from finetuning on unlabeled surgical video data and (b) from providing additional time-resolved data streams from the OR in a multimodal setup. In an in-house dataset of liver surgery videos, we analyze the tasks of predicting hospital length of stay and postoperative complications. In videos of the public HeiCo dataset, we analyze the task of surgical phase recognition. As a baseline, we apply pretrained V-JEPA to all tasks. We then finetune it on unlabeled, held-out videos to investigate its change in performance after domain adaptation. Following the idea of modular decision support networks, we integrate additional data streams from the OR by training a separate encoder to form a shared representation space with V-JEPA's embeddings. Our experiments show that finetuning on domain-specific data increases model performance. On the in-house data, integrating additional time-resolved data likewise benefits the model. On the HeiCo data, accuracy of the pretrained video-only, single-modality baseline setup is on par with the top-performing submissions of the EndoVis2017 challenge, while finetuning on domain-specific data increases accuracy further. Our results thus demonstrate how surgical data science can leverage public, generic foundation models. Likewise, they indicate the potential of domain adaptation and of integrating suitable complementary data streams from the OR. To support further research, we release our code and model weights at https://github.com/DigitalSurgeryLab-Basel/ML-CDS-2025.

OpenAI's CLIP, released in early 2021, have long been the go-to choice of vision encoder for building multimodal foundation models. Although recent alternatives such as SigLIP have begun to challenge this status quo, to our knowledge none are fully open: their training data remains proprietary and/or their training recipes are not released. This paper fills this gap with OpenVision, a fully-open, cost-effective family of vision encoders that match or surpass the performance of OpenAI's CLIP when integrated into multimodal frameworks like LLaVA. OpenVision builds on existing works -- e.g., CLIPS for training framework and Recap-DataComp-1B for training data -- while revealing multiple key insights in enhancing encoder quality and showcasing practical benefits in advancing multimodal models. By releasing vision encoders spanning from 5.9M to 632.1M parameters, OpenVision offers practitioners a flexible trade-off between capacity and efficiency in building multimodal models: larger models deliver enhanced multimodal performance, while smaller versions enable lightweight, edge-ready multimodal deployments.

Recent advances in video generation have shown remarkable progress in open-domain settings, yet medical video generation remains largely underexplored. Medical videos are critical for applications such as clinical training, education, and simulation, requiring not only high visual fidelity but also strict medical accuracy. However, current models often produce unrealistic or erroneous content when applied to medical prompts, largely due to the lack of large-scale, high-quality datasets tailored to the medical domain. To address this gap, we introduce MedVideoCap-55K, the first large-scale, diverse, and caption-rich dataset for medical video generation. It comprises over 55,000 curated clips spanning real-world medical scenarios, providing a strong foundation for training generalist medical video generation models. Built upon this dataset, we develop MedGen, which achieves leading performance among open-source models and rivals commercial systems across multiple benchmarks in both visual quality and medical accuracy. We hope our dataset and model can serve as a valuable resource and help catalyze further research in medical video generation. Our code and data is available at https://github.com/FreedomIntelligence/MedGen

Surgical video segmentation is a critical task in computer-assisted surgery and is vital for enhancing surgical quality and patient outcomes. Recently, the Segment Anything Model 2 (SAM2) framework has shown superior advancements in image and video segmentation. However, SAM2 struggles with efficiency due to the high computational demands of processing high-resolution images and complex and long-range temporal dynamics in surgical videos. To address these challenges, we introduce Surgical SAM 2 (SurgSAM-2), an advanced model to utilize SAM2 with an Efficient Frame Pruning (EFP) mechanism, to facilitate real-time surgical video segmentation. The EFP mechanism dynamically manages the memory bank by selectively retaining only the most informative frames, reducing memory usage and computational cost while maintaining high segmentation accuracy. Our extensive experiments demonstrate that SurgSAM-2 significantly improves both efficiency and segmentation accuracy compared to the vanilla SAM2. Remarkably, SurgSAM-2 achieves a 3times FPS compared with SAM2, while also delivering state-of-the-art performance after fine-tuning with lower-resolution data. These advancements establish SurgSAM-2 as a leading model for surgical video analysis, making real-time surgical video segmentation in resource-constrained environments a feasible reality.

During surgical training, real-time feedback from trainers to trainees is important for preventing errors and enhancing long-term skill acquisition. Accurately predicting the effectiveness of this feedback, specifically whether it leads to a change in trainee behavior, is crucial for developing methods for improving surgical training and education. However, relying on human annotations to assess feedback effectiveness is laborious and prone to biases, underscoring the need for an automated, scalable, and objective method. Creating such an automated system poses challenges, as it requires an understanding of both the verbal feedback delivered by the trainer and the visual context of the real-time surgical scene. To address this, we propose a method that integrates information from transcribed verbal feedback and corresponding surgical video to predict feedback effectiveness. Our findings show that both transcribed feedback and surgical video are individually predictive of trainee behavior changes, and their combination achieves an AUROC of 0.70+/-0.02, improving prediction accuracy by up to 6.6%. Additionally, we introduce self-supervised fine-tuning as a strategy for enhancing surgical video representation learning, which is scalable and further enhances prediction performance. Our results demonstrate the potential of multi-modal learning to advance the automated assessment of surgical feedback.

Echocardiography records ultrasound videos of the heart, enabling clinicians to assess cardiac function. Recent advances in large-scale vision-language models (VLMs) have spurred interest in automating echocardiographic interpretation. However, most existing medical VLMs rely on single-frame (image) inputs, which can reduce diagnostic accuracy for conditions identifiable only through cardiac motion. In addition, echocardiographic videos are captured from multiple views, each varying in suitability for detecting specific conditions. Leveraging multiple views may therefore improve diagnostic performance. We developed a video-language model that processes full video sequences from five standard views, trained on 60,747 echocardiographic video-report pairs. We evaluated the gains in retrieval performance from video input and multi-view support, including the contributions of various pretrained models.

Purpose: Surgical performance depends not only on surgeons' technical skills but also on team communication within and across the different professional groups present during the operation. Therefore, automatically identifying team communication in the OR is crucial for patient safety and advances in the development of computer-assisted surgical workflow analysis and intra-operative support systems. To take the first step, we propose a new task of detecting communication briefings involving all OR team members, i.e. the team Time-out and the StOP?-protocol, by localizing their start and end times in video recordings of surgical operations. Methods: We generate an OR dataset of real surgeries, called Team-OR, with more than one hundred hours of surgical videos captured by the multi-view camera system in the OR. The dataset contains temporal annotations of 33 Time-out and 22 StOP?-protocol activities in total. We then propose a novel group activity detection approach, where we encode both scene context and action features, and use an efficient neural network model to output the results. Results: The experimental results on the Team-OR dataset show that our approach outperforms existing state-of-the-art temporal action detection approaches. It also demonstrates the lack of research on group activities in the OR, proving the significance of our dataset. Conclusion: We investigate the Team Time-Out and the StOP?-protocol in the OR, by presenting the first OR dataset with temporal annotations of group activities protocols, and introducing a novel group activity detection approach that outperforms existing approaches. Code is available at https://github.com/CAMMA-public/Team-OR.

Understanding the intricate workflows of cataract surgery requires modeling complex interactions between surgical tools, anatomical structures, and procedural techniques. Existing datasets primarily address isolated aspects of surgical analysis, such as tool detection or phase segmentation, but lack comprehensive representations that capture the semantic relationships between entities over time. This paper introduces the Cataract Surgery Scene Graph (CAT-SG) dataset, the first to provide structured annotations of tool-tissue interactions, procedural variations, and temporal dependencies. By incorporating detailed semantic relations, CAT-SG offers a holistic view of surgical workflows, enabling more accurate recognition of surgical phases and techniques. Additionally, we present a novel scene graph generation model, CatSGG, which outperforms current methods in generating structured surgical representations. The CAT-SG dataset is designed to enhance AI-driven surgical training, real-time decision support, and workflow analysis, paving the way for more intelligent, context-aware systems in clinical practice.

Laparoscopic surgery is a complex surgical technique that requires extensive training. Recent advances in deep learning have shown promise in supporting this training by enabling automatic video-based assessment of surgical skills. However, the development and evaluation of deep learning models is currently hindered by the limited size of available annotated datasets. To address this gap, we introduce the Laparoscopic Skill Analysis and Assessment (LASANA) dataset, comprising 1270 stereo video recordings of four basic laparoscopic training tasks. Each recording is annotated with a structured skill rating, aggregated from three independent raters, as well as binary labels indicating the presence or absence of task-specific errors. The majority of recordings originate from a laparoscopic training course, thereby reflecting a natural variation in the skill of participants. To facilitate benchmarking of both existing and novel approaches for video-based skill assessment and error recognition, we provide predefined data splits for each task. Furthermore, we present baseline results from a deep learning model as a reference point for future comparisons.

Surgical robotics holds much promise for improving patient safety and clinician experience in the Operating Room (OR). However, it also comes with new challenges, requiring strong team coordination and effective OR management. Automatic detection of surgical activities is a key requirement for developing AI-based intelligent tools to tackle these challenges. The current state-of-the-art surgical activity recognition methods however operate on image-based representations and depend on large-scale labeled datasets whose collection is time-consuming and resource-expensive. This work proposes a new sample-efficient and object-based approach for surgical activity recognition in the OR. Our method focuses on the geometric arrangements between clinicians and surgical devices, thus utilizing the significant object interaction dynamics in the OR. We conduct experiments in a low-data regime study for long video activity recognition. We also benchmark our method againstother object-centric approaches on clip-level action classification and show superior performance.

Video descriptions are crucial for blind and low vision (BLV) users to access visual content. However, current artificial intelligence models for generating descriptions often fall short due to limitations in the quality of human annotations within training datasets, resulting in descriptions that do not fully meet BLV users' needs. To address this gap, we introduce VideoA11y, an approach that leverages multimodal large language models (MLLMs) and video accessibility guidelines to generate descriptions tailored for BLV individuals. Using this method, we have curated VideoA11y-40K, the largest and most comprehensive dataset of 40,000 videos described for BLV users. Rigorous experiments across 15 video categories, involving 347 sighted participants, 40 BLV participants, and seven professional describers, showed that VideoA11y descriptions outperform novice human annotations and are comparable to trained human annotations in clarity, accuracy, objectivity, descriptiveness, and user satisfaction. We evaluated models on VideoA11y-40K using both standard and custom metrics, demonstrating that MLLMs fine-tuned on this dataset produce high-quality accessible descriptions. Code and dataset are available at https://people-robots.github.io/VideoA11y.

Operating rooms (ORs) are complex, high-stakes environments requiring precise understanding of interactions among medical staff, tools, and equipment for enhancing surgical assistance, situational awareness, and patient safety. Current datasets fall short in scale, realism and do not capture the multimodal nature of OR scenes, limiting progress in OR modeling. To this end, we introduce MM-OR, a realistic and large-scale multimodal spatiotemporal OR dataset, and the first dataset to enable multimodal scene graph generation. MM-OR captures comprehensive OR scenes containing RGB-D data, detail views, audio, speech transcripts, robotic logs, and tracking data and is annotated with panoptic segmentations, semantic scene graphs, and downstream task labels. Further, we propose MM2SG, the first multimodal large vision-language model for scene graph generation, and through extensive experiments, demonstrate its ability to effectively leverage multimodal inputs. Together, MM-OR and MM2SG establish a new benchmark for holistic OR understanding, and open the path towards multimodal scene analysis in complex, high-stakes environments. Our code, and data is available at https://github.com/egeozsoy/MM-OR.

Every day, countless surgeries are performed worldwide, each within the distinct settings of operating rooms (ORs) that vary not only in their setups but also in the personnel, tools, and equipment used. This inherent diversity poses a substantial challenge for achieving a holistic understanding of the OR, as it requires models to generalize beyond their initial training datasets. To reduce this gap, we introduce ORacle, an advanced vision-language model designed for holistic OR domain modeling, which incorporates multi-view and temporal capabilities and can leverage external knowledge during inference, enabling it to adapt to previously unseen surgical scenarios. This capability is further enhanced by our novel data augmentation framework, which significantly diversifies the training dataset, ensuring ORacle's proficiency in applying the provided knowledge effectively. In rigorous testing, in scene graph generation, and downstream tasks on the 4D-OR dataset, ORacle not only demonstrates state-of-the-art performance but does so requiring less data than existing models. Furthermore, its adaptability is displayed through its ability to interpret unseen views, actions, and appearances of tools and equipment. This demonstrates ORacle's potential to significantly enhance the scalability and affordability of OR domain modeling and opens a pathway for future advancements in surgical data science. We will release our code and data upon acceptance.

Operating rooms (ORs) demand precise coordination among surgeons, nurses, and equipment in a fast-paced, occlusion-heavy environment, necessitating advanced perception models to enhance safety and efficiency. Existing datasets either provide partial egocentric views or sparse exocentric multi-view context, but do not explore the comprehensive combination of both. We introduce EgoExOR, the first OR dataset and accompanying benchmark to fuse first-person and third-person perspectives. Spanning 94 minutes (84,553 frames at 15 FPS) of two emulated spine procedures, Ultrasound-Guided Needle Insertion and Minimally Invasive Spine Surgery, EgoExOR integrates egocentric data (RGB, gaze, hand tracking, audio) from wearable glasses, exocentric RGB and depth from RGB-D cameras, and ultrasound imagery. Its detailed scene graph annotations, covering 36 entities and 22 relations (568,235 triplets), enable robust modeling of clinical interactions, supporting tasks like action recognition and human-centric perception. We evaluate the surgical scene graph generation performance of two adapted state-of-the-art models and offer a new baseline that explicitly leverages EgoExOR's multimodal and multi-perspective signals. This new dataset and benchmark set a new foundation for OR perception, offering a rich, multimodal resource for next-generation clinical perception.

Optical coherence tomography (OCT) and scanning laser ophthalmoscopy (SLO) of the eye has become essential to ophthalmology and the emerging field of oculomics, thus requiring a need for transparent, reproducible, and rapid analysis of this data for clinical research and the wider research community. Here, we introduce OCTolyzer, the first open-source toolkit for retinochoroidal analysis in OCT/SLO data. It features two analysis suites for OCT and SLO data, facilitating deep learning-based anatomical segmentation and feature extraction of the cross-sectional retinal and choroidal layers and en face retinal vessels. We describe OCTolyzer and evaluate the reproducibility of its OCT choroid analysis. At the population level, metrics for choroid region thickness were highly reproducible, with a mean absolute error (MAE)/Pearson correlation for macular volume choroid thickness (CT) of 6.7mum/0.99, macular B-scan CT of 11.6mum/0.99, and peripapillary CT of 5.0mum/0.99. Macular choroid vascular index (CVI) also showed strong reproducibility, with MAE/Pearson for volume CVI yielding 0.0271/0.97 and B-scan CVI 0.0130/0.91. At the eye level, measurement noise for regional and vessel metrics was below 5% and 20% of the population's variability, respectively. Outliers were caused by poor-quality B-scans with thick choroids and invisible choroid-sclera boundary. Processing times on a laptop CPU were under three seconds for macular/peripapillary B-scans and 85 seconds for volume scans. OCTolyzer can convert OCT/SLO data into reproducible and clinically meaningful retinochoroidal features and will improve the standardisation of ocular measurements in OCT/SLO image analysis, requiring no specialised training or proprietary software to be used. OCTolyzer is freely available here: https://github.com/jaburke166/OCTolyzer.

Purpose: General consensus amongst researchers and industry points to a lack of large, representative annotated datasets as the biggest obstacle to progress in the field of surgical data science. Self-supervised learning represents a solution to part of this problem, removing the reliance on annotations. However, the robustness of current self-supervised learning methods to domain shifts remains unclear, limiting our understanding of its utility for leveraging diverse sources of surgical data. Methods: In this work, we employ self-supervised learning to flexibly leverage diverse surgical datasets, thereby learning taskagnostic representations that can be used for various surgical downstream tasks. Based on this approach, to elucidate the impact of pre-training on downstream task performance, we explore 22 different pre-training dataset combinations by modulating three variables: source hospital, type of surgical procedure, and pre-training scale (number of videos). We then finetune the resulting model initializations on three diverse downstream tasks: namely, phase recognition and critical view of safety in laparoscopic cholecystectomy and phase recognition in laparoscopic hysterectomy. Results: Controlled experimentation highlights sizable boosts in performance across various tasks, datasets, and labeling budgets. However, this performance is intricately linked to the composition of the pre-training dataset, robustly proven through several study stages. Conclusion: The composition of pre-training datasets can severely affect the effectiveness of SSL methods for various downstream tasks and should critically inform future data collection efforts to scale the application of SSL methodologies. Keywords: Self-Supervised Learning, Transfer Learning, Surgical Computer Vision, Endoscopic Videos, Critical View of Safety, Phase Recognition

This technical report provides a detailed overview of Endoscapes, a dataset of laparoscopic cholecystectomy (LC) videos with highly intricate annotations targeted at automated assessment of the Critical View of Safety (CVS). Endoscapes comprises 201 LC videos with frames annotated sparsely but regularly with segmentation masks, bounding boxes, and CVS assessment by three different clinical experts. Altogether, there are 11090 frames annotated with CVS and 1933 frames annotated with tool and anatomy bounding boxes from the 201 videos, as well as an additional 422 frames from 50 of the 201 videos annotated with tool and anatomy segmentation masks. In this report, we provide detailed dataset statistics (size, class distribution, dataset splits, etc.) and a comprehensive performance benchmark for instance segmentation, object detection, and CVS prediction. The dataset and model checkpoints are publically available at https://github.com/CAMMA-public/Endoscapes.

In this work, we take aim towards increasing the effectiveness of surgical assistant robots. We intended to make assistant robots safer by making them aware about the actions of surgeon, so it can take appropriate assisting actions. In other words, we aim to solve the problem of surgeon action detection in endoscopic videos. To this, we introduce a challenging dataset for surgeon action detection in real-world endoscopic videos. Action classes are picked based on the feedback of surgeons and annotated by medical professional. Given a video frame, we draw bounding box around surgical tool which is performing action and label it with action label. Finally, we presenta frame-level action detection baseline model based on recent advances in ob-ject detection. Results on our new dataset show that our presented dataset provides enough interesting challenges for future method and it can serveas strong benchmark corresponding research in surgeon action detection in endoscopic videos.

Color fundus photography and Optical Coherence Tomography (OCT) are the two most cost-effective tools for glaucoma screening. Both two modalities of images have prominent biomarkers to indicate glaucoma suspected. Clinically, it is often recommended to take both of the screenings for a more accurate and reliable diagnosis. However, although numerous algorithms are proposed based on fundus images or OCT volumes in computer-aided diagnosis, there are still few methods leveraging both of the modalities for the glaucoma assessment. Inspired by the success of Retinal Fundus Glaucoma Challenge (REFUGE) we held previously, we set up the Glaucoma grAding from Multi-Modality imAges (GAMMA) Challenge to encourage the development of fundus \& OCT-based glaucoma grading. The primary task of the challenge is to grade glaucoma from both the 2D fundus images and 3D OCT scanning volumes. As part of GAMMA, we have publicly released a glaucoma annotated dataset with both 2D fundus color photography and 3D OCT volumes, which is the first multi-modality dataset for glaucoma grading. In addition, an evaluation framework is also established to evaluate the performance of the submitted methods. During the challenge, 1272 results were submitted, and finally, top-10 teams were selected to the final stage. We analysis their results and summarize their methods in the paper. Since all these teams submitted their source code in the challenge, a detailed ablation study is also conducted to verify the effectiveness of the particular modules proposed. We find many of the proposed techniques are practical for the clinical diagnosis of glaucoma. As the first in-depth study of fundus \& OCT multi-modality glaucoma grading, we believe the GAMMA Challenge will be an essential starting point for future research.

Precise spatial modeling in the operating room (OR) is foundational to many clinical tasks, supporting intraoperative awareness, hazard avoidance, and surgical decision-making. While existing approaches leverage large-scale multimodal datasets for latent-space alignment to implicitly learn spatial relationships, they overlook the 3D capabilities of MLLMs. However, this approach raises two issues: (1) Operating rooms typically lack multiple video and audio sensors, making multimodal 3D data difficult to obtain; (2) Training solely on readily available 2D data fails to capture fine-grained details in complex scenes. To address this gap, we introduce Spatial-ORMLLM, the first large vision-language model for 3D spatial reasoning in operating rooms using only RGB modality to infer volumetric and semantic cues, enabling downstream medical tasks with detailed and holistic spatial context. Spatial-ORMLLM incorporates a Spatial-Enhanced Feature Fusion Block, which integrates 2D modality inputs with rich 3D spatial knowledge extracted by the estimation algorithm and then feeds the combined features into the visual tower. By employing a unified end-to-end MLLM framework, it combines powerful spatial features with textual features to deliver robust 3D scene reasoning without any additional expert annotations or sensor inputs. Experiments on multiple benchmark clinical datasets demonstrate that Spatial-ORMLLM achieves state-of-the-art performance and generalizes robustly to previously unseen surgical scenarios and downstream tasks.

Vision foundation models (VFMs) have emerged as powerful tools for surgical scene understanding. However, current approaches predominantly rely on unimodal RGB pre-training, overlooking the complex 3D geometry inherent to surgical environments. Although several architectures support multimodal or geometry-aware inputs in general computer vision, the benefits of incorporating depth information in surgical settings remain underexplored. We conduct a large-scale empirical study comparing eight ViT-based VFMs that differ in pre-training domain, learning objective, and input modality (RGB vs. RGB-D). For pre-training, we use a curated dataset of 1.4 million robotic surgical images paired with depth maps generated from an off-the-shelf network. We evaluate these models under both frozen-backbone and end-to-end fine-tuning protocols across eight surgical datasets spanning object detection, segmentation, depth estimation, and pose estimation. Our experiments yield several consistent findings. Models incorporating explicit geometric tokenization, such as MultiMAE, substantially outperform unimodal baselines across all tasks. Notably, geometric-aware pre-training enables remarkable data efficiency: models fine-tuned on just 25% of labeled data consistently surpass RGB-only models trained on the full dataset. Importantly, these gains require no architectural or runtime changes at inference; depth is used only during pre-training, making adoption straightforward. These findings suggest that multimodal pre-training offers a viable path towards building more capable surgical vision systems.

The scarcity of high-quality, labelled retinal imaging data, which presents a significant challenge in the development of machine learning models for ophthalmology, hinders progress in the field. Existing methods for synthesising Colour Fundus Photographs (CFPs) largely rely on predefined disease labels, which restricts their ability to generate images that reflect fine-grained anatomical variations, subtle disease stages, and diverse pathological features beyond coarse class categories. To overcome these challenges, we first introduce an innovative pipeline that creates a large-scale, captioned retinal dataset comprising 1.4 million entries, called RetinaLogos-1400k. Specifically, RetinaLogos-1400k uses the visual language model(VLM) to describe retinal conditions and key structures, such as optic disc configuration, vascular distribution, nerve fibre layers, and pathological features. Building on this dataset, we employ a novel three-step training framework, RetinaLogos, which enables fine-grained semantic control over retinal images and accurately captures different stages of disease progression, subtle anatomical variations, and specific lesion types. Through extensive experiments, our method demonstrates superior performance across multiple datasets, with 62.07% of text-driven synthetic CFPs indistinguishable from real ones by ophthalmologists. Moreover, the synthetic data improves accuracy by 5%-10% in diabetic retinopathy grading and glaucoma detection. Codes are available at https://github.com/uni-medical/retina-text2cfp.

Age-related macular degeneration (AMD) and choroidal neovascularization (CNV)-related conditions are leading causes of vision loss worldwide, with optical coherence tomography (OCT) serving as a cornerstone for early detection and management. However, deploying state-of-the-art deep learning models like ConvNeXtV2-Large in clinical settings is hindered by their computational demands. Therefore, it is desirable to develop efficient models that maintain high diagnostic performance while enabling real-time deployment. In this study, a novel knowledge distillation framework, termed KD-OCT, is proposed to compress a high-performance ConvNeXtV2-Large teacher model, enhanced with advanced augmentations, stochastic weight averaging, and focal loss, into a lightweight EfficientNet-B2 student for classifying normal, drusen, and CNV cases. KD-OCT employs real-time distillation with a combined loss balancing soft teacher knowledge transfer and hard ground-truth supervision. The effectiveness of the proposed method is evaluated on the Noor Eye Hospital (NEH) dataset using patient-level cross-validation. Experimental results demonstrate that KD-OCT outperforms comparable multi-scale or feature-fusion OCT classifiers in efficiency- accuracy balance, achieving near-teacher performance with substantial reductions in model size and inference time. Despite the compression, the student model exceeds most existing frameworks, facilitating edge deployment for AMD screening. Code is available at https://github.com/erfan-nourbakhsh/KD- OCT.

Artificial intelligence (AI) has become a fundamental tool for assisting clinicians in analyzing ophthalmic images, such as optical coherence tomography (OCT). However, developing AI models often requires extensive annotation, and existing models tend to underperform on independent, unseen data. Foundation models (FMs), large AI models trained on vast unlabeled datasets, have shown promise in overcoming these challenges. Nonetheless, available FMs for ophthalmology lack extensive validation, especially for segmentation tasks, and focus on a single imaging modality. In this context, we propose MIRAGE, a novel multimodal FM for the analysis of OCT and scanning laser ophthalmoscopy (SLO) images. Additionally, we propose a new evaluation benchmark with OCT/SLO classification and segmentation tasks. The comparison with general and specialized FMs and segmentation methods shows the superiority of MIRAGE in both types of tasks, highlighting its suitability as a basis for the development of robust AI systems for retinal OCT image analysis. Both MIRAGE and the evaluation benchmark are publicly available: https://github.com/j-morano/MIRAGE.

Surgical video segmentation is crucial for computer-assisted surgery, enabling precise localization and tracking of instruments and tissues. Interactive Video Object Segmentation (iVOS) models such as Segment Anything Model 2 (SAM2) provide prompt-based flexibility beyond methods with predefined categories, but face challenges in surgical scenarios due to the domain gap and limited long-term tracking. To address these limitations, we construct SA-SV, the largest surgical iVOS benchmark with instance-level spatio-temporal annotations (masklets) spanning eight procedure types (61k frames, 1.6k masklets), enabling comprehensive development and evaluation for long-term tracking and zero-shot generalization. Building on SA-SV, we propose SAM2S, a foundation model enhancing SAM2 for Surgical iVOS through: (1) DiveMem, a trainable diverse memory mechanism for robust long-term tracking; (2) temporal semantic learning for instrument understanding; and (3) ambiguity-resilient learning to mitigate annotation inconsistencies across multi-source datasets. Extensive experiments demonstrate that fine-tuning on SA-SV enables substantial performance gains, with SAM2 improving by 12.99 average J\&F over vanilla SAM2. SAM2S further advances performance to 80.42 average J\&F, surpassing vanilla and fine-tuned SAM2 by 17.10 and 4.11 points respectively, while maintaining 68 FPS real-time inference and strong zero-shot generalization. Code and dataset will be released at https://jinlab-imvr.github.io/SAM2S.

Automated tracking of surgical tool keypoints in robotic surgery videos is an essential task for various downstream use cases such as skill assessment, expertise assessment, and the delineation of safety zones. In recent years, the explosion of deep learning for vision applications has led to many works in surgical instrument segmentation, while lesser focus has been on tracking specific tool keypoints, such as tool tips. In this work, we propose a novel, multi-frame context-driven deep learning framework to localize and track tool keypoints in surgical videos. We train and test our models on the annotated frames from the 2015 EndoVis Challenge dataset, resulting in state-of-the-art performance. By leveraging sophisticated deep learning models and multi-frame context, we achieve 90\% keypoint detection accuracy and a localization RMS error of 5.27 pixels. Results on a self-annotated JIGSAWS dataset with more challenging scenarios also show that the proposed multi-frame models can accurately track tool-tip and tool-base keypoints, with {<}4.2-pixel RMS error overall. Such a framework paves the way for accurately tracking surgical instrument keypoints, enabling further downstream use cases. Project and dataset webpage: https://tinyurl.com/mfc-tracker

The rise of imaging techniques such as optical coherence tomography (OCT) and advances in deep learning (DL) have enabled clinicians and researchers to streamline retinal disease staging. A popular DL approach is self-supervised learning (SSL), where models learn from vast amounts of unlabeled data, avoiding costly annotation. SSL has allowed the development of foundation models (FMs), large models that can be used for a variety of downstream tasks. However, existing FMs for OCT, trained solely on image data, lack a comprehensive and robust semantic understanding of images, as evidenced by their downstream performance (especially for complex tasks), and thus require supervised fine-tuning (which may be unfeasible) to better adapt to specific applications and populations. To address this, we propose RetFiner, an SSL vision-language refinement scheme that improves the representations of existing FMs and enables their efficient and direct adaptation to specific populations for improved downstream performance. Our method uses a diverse set of training objectives which take advantage of the rich supervisory signal found in textual data. We tested RetFiner on the retinal FMs RETFound, UrFound, and VisionFM, showing significant improvements in linear probing performance on seven highly diverse OCT classification tasks, with an average increase of 5.8, 3.9, and 2.1 percentage points over their baselines, respectively. Our code and model weights are publicly available at https://github.com/ronnief1/RetFiner.

This paper presents the Holistic and Multi-Granular Surgical Scene Understanding of Prostatectomies (GraSP) dataset, a curated benchmark that models surgical scene understanding as a hierarchy of complementary tasks with varying levels of granularity. Our approach encompasses long-term tasks, such as surgical phase and step recognition, and short-term tasks, including surgical instrument segmentation and atomic visual actions detection. To exploit our proposed benchmark, we introduce the Transformers for Actions, Phases, Steps, and Instrument Segmentation (TAPIS) model, a general architecture that combines a global video feature extractor with localized region proposals from an instrument segmentation model to tackle the multi-granularity of our benchmark. Through extensive experimentation in ours and alternative benchmarks, we demonstrate TAPIS's versatility and state-of-the-art performance across different tasks. This work represents a foundational step forward in Endoscopic Vision, offering a novel framework for future research towards holistic surgical scene understanding.

Optical coherence tomography (OCT) is a non-invasive imaging modality which is widely used in clinical ophthalmology. OCT images are capable of visualizing deep retinal layers which is crucial for early diagnosis of retinal diseases. In this paper, we describe a comprehensive open-access database containing more than 500 highresolution images categorized into different pathological conditions. The image classes include Normal (NO), Macular Hole (MH), Age-related Macular Degeneration (AMD), Central Serous Retinopathy (CSR), and Diabetic Retinopathy (DR). The images were obtained from a raster scan protocol with a 2mm scan length and 512x1024 pixel resolution. We have also included 25 normal OCT images with their corresponding ground truth delineations which can be used for an accurate evaluation of OCT image segmentation. In addition, we have provided a user-friendly GUI which can be used by clinicians for manual (and semi-automated) segmentation.

Most benchmarks for studying surgical interventions focus on a specific challenge instead of leveraging the intrinsic complementarity among different tasks. In this work, we present a new experimental framework towards holistic surgical scene understanding. First, we introduce the Phase, Step, Instrument, and Atomic Visual Action recognition (PSI-AVA) Dataset. PSI-AVA includes annotations for both long-term (Phase and Step recognition) and short-term reasoning (Instrument detection and novel Atomic Action recognition) in robot-assisted radical prostatectomy videos. Second, we present Transformers for Action, Phase, Instrument, and steps Recognition (TAPIR) as a strong baseline for surgical scene understanding. TAPIR leverages our dataset's multi-level annotations as it benefits from the learned representation on the instrument detection task to improve its classification capacity. Our experimental results in both PSI-AVA and other publicly available databases demonstrate the adequacy of our framework to spur future research on holistic surgical scene understanding.

Advances in artificial intelligence (AI) for surgical quality assessment promise to democratize access to expertise, with applications in training, guidance, and accreditation. This study presents the SAGES Critical View of Safety (CVS) Challenge, the first AI competition organized by a surgical society, using the CVS in laparoscopic cholecystectomy, a universally recommended yet inconsistently performed safety step, as an exemplar of surgical quality assessment. A global collaboration across 54 institutions in 24 countries engaged hundreds of clinicians and engineers to curate 1,000 videos annotated by 20 surgical experts according to a consensus-validated protocol. The challenge addressed key barriers to real-world deployment in surgery, including achieving high performance, capturing uncertainty in subjective assessment, and ensuring robustness to clinical variability. To enable this scale of effort, we developed EndoGlacier, a framework for managing large, heterogeneous surgical video and multi-annotator workflows. Thirteen international teams participated, achieving up to a 17\% relative gain in assessment performance, over 80\% reduction in calibration error, and a 17\% relative improvement in robustness over the state-of-the-art. Analysis of results highlighted methodological trends linked to model performance, providing guidance for future research toward robust, clinically deployable AI for surgical quality assessment.

The surgical usage of Mixed Reality (MR) has received growing attention in areas such as surgical navigation systems, skill assessment, and robot-assisted surgeries. For such applications, pose estimation for hand and surgical instruments from an egocentric perspective is a fundamental task and has been studied extensively in the computer vision field in recent years. However, the development of this field has been impeded by a lack of datasets, especially in the surgical field, where bloody gloves and reflective metallic tools make it hard to obtain 3D pose annotations for hands and objects using conventional methods. To address this issue, we propose POV-Surgery, a large-scale, synthetic, egocentric dataset focusing on pose estimation for hands with different surgical gloves and three orthopedic surgical instruments, namely scalpel, friem, and diskplacer. Our dataset consists of 53 sequences and 88,329 frames, featuring high-resolution RGB-D video streams with activity annotations, accurate 3D and 2D annotations for hand-object pose, and 2D hand-object segmentation masks. We fine-tune the current SOTA methods on POV-Surgery and further show the generalizability when applying to real-life cases with surgical gloves and tools by extensive evaluations. The code and the dataset are publicly available at batfacewayne.github.io/POV_Surgery_io/.

Monocular depth estimation (MDE) is a critical component of many medical tracking and mapping algorithms, particularly from endoscopic or laparoscopic video. However, because ground truth depth maps cannot be acquired from real patient data, supervised learning is not a viable approach to predict depth maps for medical scenes. Although self-supervised learning for MDE has recently gained attention, the outputs are difficult to evaluate reliably and each MDE's generalizability to other patients and anatomies is limited. This work evaluates the zero-shot performance of the newly released Depth Anything Model on medical endoscopic and laparoscopic scenes. We compare the accuracy and inference speeds of Depth Anything with other MDE models trained on general scenes as well as in-domain models trained on endoscopic data. Our findings show that although the zero-shot capability of Depth Anything is quite impressive, it is not necessarily better than other models in both speed and performance. We hope that this study can spark further research in employing foundation models for MDE in medical scenes.

Recent advances in multimodal large language models (LLMs) have highlighted their potential for medical and surgical applications. However, existing surgical datasets predominantly adopt a Visual Question Answering (VQA) format with heterogeneous taxonomies and lack support for pixel-level segmentation, limiting consistent evaluation and applicability. We present SurgMLLMBench, a unified multimodal benchmark explicitly designed for developing and evaluating interactive multimodal LLMs for surgical scene understanding, including the newly collected Micro-surgical Artificial Vascular anastomosIS (MAVIS) dataset. It integrates pixel-level instrument segmentation masks and structured VQA annotations across laparoscopic, robot-assisted, and micro-surgical domains under a unified taxonomy, enabling comprehensive evaluation beyond traditional VQA tasks and richer visual-conversational interactions. Extensive baseline experiments show that a single model trained on SurgMLLMBench achieves consistent performance across domains and generalizes effectively to unseen datasets. SurgMLLMBench will be publicly released as a robust resource to advance multimodal surgical AI research, supporting reproducible evaluation and development of interactive surgical reasoning models.

Modern operating room is becoming increasingly complex, requiring innovative intra-operative support systems. While the focus of surgical data science has largely been on video analysis, integrating surgical computer vision with language capabilities is emerging as a necessity. Our work aims to advance Visual Question Answering (VQA) in the surgical context with scene graph knowledge, addressing two main challenges in the current surgical VQA systems: removing question-condition bias in the surgical VQA dataset and incorporating scene-aware reasoning in the surgical VQA model design. First, we propose a Surgical Scene Graph-based dataset, SSG-QA, generated by employing segmentation and detection models on publicly available datasets. We build surgical scene graphs using spatial and action information of instruments and anatomies. These graphs are fed into a question engine, generating diverse QA pairs. Our SSG-QA dataset provides a more complex, diverse, geometrically grounded, unbiased, and surgical action-oriented dataset compared to existing surgical VQA datasets. We then propose SSG-QA-Net, a novel surgical VQA model incorporating a lightweight Scene-embedded Interaction Module (SIM), which integrates geometric scene knowledge in the VQA model design by employing cross-attention between the textual and the scene features. Our comprehensive analysis of the SSG-QA dataset shows that SSG-QA-Net outperforms existing methods across different question types and complexities. We highlight that the primary limitation in the current surgical VQA systems is the lack of scene knowledge to answer complex queries. We present a novel surgical VQA dataset and model and show that results can be significantly improved by incorporating geometric scene features in the VQA model design. The source code and the dataset will be made publicly available at: https://github.com/CAMMA-public/SSG-QA

Quantification of real-time informal feedback delivered by an experienced surgeon to a trainee during surgery is important for skill improvements in surgical training. Such feedback in the live operating room is inherently multimodal, consisting of verbal conversations (e.g., questions and answers) as well as non-verbal elements (e.g., through visual cues like pointing to anatomic elements). In this work, we leverage a clinically-validated five-category classification of surgical feedback: "Anatomic", "Technical", "Procedural", "Praise" and "Visual Aid". We then develop a multi-label machine learning model to classify these five categories of surgical feedback from inputs of text, audio, and video modalities. The ultimate goal of our work is to help automate the annotation of real-time contextual surgical feedback at scale. Our automated classification of surgical feedback achieves AUCs ranging from 71.5 to 77.6 with the fusion improving performance by 3.1%. We also show that high-quality manual transcriptions of feedback audio from experts improve AUCs to between 76.5 and 96.2, which demonstrates a clear path toward future improvements. Empirically, we find that the Staged training strategy, with first pre-training each modality separately and then training them jointly, is more effective than training different modalities altogether. We also present intuitive findings on the importance of modalities for different feedback categories. This work offers an important first look at the feasibility of automated classification of real-world live surgical feedback based on text, audio, and video modalities.

Procedural activities, ranging from routine cooking to complex surgical operations, are highly structured as a set of actions conducted in a specific temporal order. Despite their success on static images and short clips, current self-supervised learning methods often overlook the procedural nature that underpins such activities. We expose the lack of procedural awareness in current SSL methods with a motivating experiment: models pretrained on forward and time-reversed sequences produce highly similar features, confirming that their representations are blind to the underlying procedural order. To address this shortcoming, we propose PL-Stitch, a self-supervised framework that harnesses the inherent temporal order of video frames as a powerful supervisory signal. Our approach integrates two novel probabilistic objectives based on the Plackett-Luce (PL) model. The primary PL objective trains the model to sort sampled frames chronologically, compelling it to learn the global workflow progression. The secondary objective, a spatio-temporal jigsaw loss, complements the learning by capturing fine-grained, cross-frame object correlations. Our approach consistently achieves superior performance across five surgical and cooking benchmarks. Specifically, PL-Stitch yields significant gains in surgical phase recognition (e.g., +11.4 pp k-NN accuracy on Cholec80) and cooking action segmentation (e.g., +5.7 pp linear probing accuracy on Breakfast), demonstrating its effectiveness for procedural video representation learning.

Robotic surgical systems rely heavily on high-quality visual feedback for precise teleoperation; yet, surgical smoke from energy-based devices significantly degrades endoscopic video feeds, compromising the human-robot interface and surgical outcomes. This paper presents RGA-Net (Reciprocal Gating and Attention-fusion Network), a novel deep learning framework specifically designed for smoke removal in robotic surgery workflows. Our approach addresses the unique challenges of surgical smoke-including dense, non-homogeneous distribution and complex light scattering-through a hierarchical encoder-decoder architecture featuring two key innovations: (1) a Dual-Stream Hybrid Attention (DHA) module that combines shifted window attention with frequency-domain processing to capture both local surgical details and global illumination changes, and (2) an Axis-Decomposed Attention (ADA) module that efficiently processes multi-scale features through factorized attention mechanisms. These components are connected via reciprocal cross-gating blocks that enable bidirectional feature modulation between encoder and decoder pathways. Extensive experiments on the DesmokeData and LSD3K surgical datasets demonstrate that RGA-Net achieves superior performance in restoring visual clarity suitable for robotic surgery integration. Our method enhances the surgeon-robot interface by providing consistently clear visualization, laying a technical foundation for alleviating surgeons' cognitive burden, optimizing operation workflows, and reducing iatrogenic injury risks in minimally invasive procedures. These practical benefits could be further validated through future clinical trials involving surgeon usability assessments. The proposed framework represents a significant step toward more reliable and safer robotic surgical systems through computational vision enhancement.

Different medical imaging modalities capture diagnostic information at varying spatial resolutions, from coarse global patterns to fine-grained localized structures. However, most existing vision-language frameworks in the medical domain apply a uniform strategy for local feature extraction, overlooking the modality-specific demands. In this work, we present MedMoE, a modular and extensible vision-language processing framework that dynamically adapts visual representation based on the diagnostic context. MedMoE incorporates a Mixture-of-Experts (MoE) module conditioned on the report type, which routes multi-scale image features through specialized expert branches trained to capture modality-specific visual semantics. These experts operate over feature pyramids derived from a Swin Transformer backbone, enabling spatially adaptive attention to clinically relevant regions. This framework produces localized visual representations aligned with textual descriptions, without requiring modality-specific supervision at inference. Empirical results on diverse medical benchmarks demonstrate that MedMoE improves alignment and retrieval performance across imaging modalities, underscoring the value of modality-specialized visual representations in clinical vision-language systems.

Multimodal Large Language Models (MLLMs) have shown significant potential in medical image analysis. However, their capabilities in interpreting fundus images, a critical skill for ophthalmology, remain under-evaluated. Existing benchmarks lack fine-grained task divisions and fail to provide modular analysis of its two key modules, i.e., large language model (LLM) and vision encoder (VE). This paper introduces FunBench, a novel visual question answering (VQA) benchmark designed to comprehensively evaluate MLLMs' fundus reading skills. FunBench features a hierarchical task organization across four levels (modality perception, anatomy perception, lesion analysis, and disease diagnosis). It also offers three targeted evaluation modes: linear-probe based VE evaluation, knowledge-prompted LLM evaluation, and holistic evaluation. Experiments on nine open-source MLLMs plus GPT-4o reveal significant deficiencies in fundus reading skills, particularly in basic tasks such as laterality recognition. The results highlight the limitations of current MLLMs and emphasize the need for domain-specific training and improved LLMs and VEs.

The field of surgical computer vision has undergone considerable breakthroughs in recent years with the rising popularity of deep neural network-based methods. However, standard fully-supervised approaches for training such models require vast amounts of annotated data, imposing a prohibitively high cost; especially in the clinical domain. Self-Supervised Learning (SSL) methods, which have begun to gain traction in the general computer vision community, represent a potential solution to these annotation costs, allowing to learn useful representations from only unlabeled data. Still, the effectiveness of SSL methods in more complex and impactful domains, such as medicine and surgery, remains limited and unexplored. In this work, we address this critical need by investigating four state-of-the-art SSL methods (MoCo v2, SimCLR, DINO, SwAV) in the context of surgical computer vision. We present an extensive analysis of the performance of these methods on the Cholec80 dataset for two fundamental and popular tasks in surgical context understanding, phase recognition and tool presence detection. We examine their parameterization, then their behavior with respect to training data quantities in semi-supervised settings. Correct transfer of these methods to surgery, as described and conducted in this work, leads to substantial performance gains over generic uses of SSL - up to 7.4% on phase recognition and 20% on tool presence detection - as well as state-of-the-art semi-supervised phase recognition approaches by up to 14%. Further results obtained on a highly diverse selection of surgical datasets exhibit strong generalization properties. The code is available at https://github.com/CAMMA-public/SelfSupSurg.

Depth estimation plays a crucial role in various tasks within endoscopic surgery, including navigation, surface reconstruction, and augmented reality visualization. Despite the significant achievements of foundation models in vision tasks, including depth estimation, their direct application to the medical domain often results in suboptimal performance. This highlights the need for efficient adaptation methods to adapt these models to endoscopic depth estimation. We propose Endoscopic Depth Any Camera (EndoDAC) which is an efficient self-supervised depth estimation framework that adapts foundation models to endoscopic scenes. Specifically, we develop the Dynamic Vector-Based Low-Rank Adaptation (DV-LoRA) and employ Convolutional Neck blocks to tailor the foundational model to the surgical domain, utilizing remarkably few trainable parameters. Given that camera information is not always accessible, we also introduce a self-supervised adaptation strategy that estimates camera intrinsics using the pose encoder. Our framework is capable of being trained solely on monocular surgical videos from any camera, ensuring minimal training costs. Experiments demonstrate that our approach obtains superior performance even with fewer training epochs and unaware of the ground truth camera intrinsics. Code is available at https://github.com/BeileiCui/EndoDAC.

Tool tracking in surgical videos is essential for advancing computer-assisted interventions, such as skill assessment, safety zone estimation, and human-machine collaboration. However, the lack of context-rich datasets limits AI applications in this field. Existing datasets rely on overly generic tracking formalizations that fail to capture surgical-specific dynamics, such as tools moving out of the camera's view or exiting the body. This results in less clinically relevant trajectories and a lack of flexibility for real-world surgical applications. Methods trained on these datasets often struggle with visual challenges such as smoke, reflection, and bleeding, further exposing the limitations of current approaches. We introduce CholecTrack20, a specialized dataset for multi-class, multi-tool tracking in surgical procedures. It redefines tracking formalization with three perspectives: (i) intraoperative, (ii) intracorporeal, and (iii) visibility, enabling adaptable and clinically meaningful tool trajectories. The dataset comprises 20 full-length surgical videos, annotated at 1 fps, yielding over 35K frames and 65K labeled tool instances. Annotations include spatial location, category, identity, operator, phase, and scene visual challenge. Benchmarking state-of-the-art methods on CholecTrack20 reveals significant performance gaps, with current approaches (< 45\% HOTA) failing to meet the accuracy required for clinical translation. These findings motivate the need for advanced and intuitive tracking algorithms and establish CholecTrack20 as a foundation for developing robust AI-driven surgical assistance systems.

We present LLaVA-OneVision, a family of open large multimodal models (LMMs) developed by consolidating our insights into data, models, and visual representations in the LLaVA-NeXT blog series. Our experimental results demonstrate that LLaVA-OneVision is the first single model that can simultaneously push the performance boundaries of open LMMs in three important computer vision scenarios: single-image, multi-image, and video scenarios. Importantly, the design of LLaVA-OneVision allows strong transfer learning across different modalities/scenarios, yielding new emerging capabilities. In particular, strong video understanding and cross-scenario capabilities are demonstrated through task transfer from images to videos.

The ability to automatically detect and track surgical instruments in endoscopic videos can enable transformational interventions. Assessing surgical performance and efficiency, identifying skilled tool use and choreography, and planning operational and logistical aspects of OR resources are just a few of the applications that could benefit. Unfortunately, obtaining the annotations needed to train machine learning models to identify and localize surgical tools is a difficult task. Annotating bounding boxes frame-by-frame is tedious and time-consuming, yet large amounts of data with a wide variety of surgical tools and surgeries must be captured for robust training. Moreover, ongoing annotator training is needed to stay up to date with surgical instrument innovation. In robotic-assisted surgery, however, potentially informative data like timestamps of instrument installation and removal can be programmatically harvested. The ability to rely on tool installation data alone would significantly reduce the workload to train robust tool-tracking models. With this motivation in mind we invited the surgical data science community to participate in the challenge, SurgToolLoc 2022. The goal was to leverage tool presence data as weak labels for machine learning models trained to detect tools and localize them in video frames with bounding boxes. We present the results of this challenge along with many of the team's efforts. We conclude by discussing these results in the broader context of machine learning and surgical data science. The training data used for this challenge consisting of 24,695 video clips with tool presence labels is also being released publicly and can be accessed at https://console.cloud.google.com/storage/browser/isi-surgtoolloc-2022.

Most studies on surgical activity recognition utilizing Artificial intelligence (AI) have focused mainly on recognizing one type of activity from small and mono-centric surgical video datasets. It remains speculative whether those models would generalize to other centers. In this work, we introduce a large multi-centric multi-activity dataset consisting of 140 videos (MultiBypass140) of laparoscopic Roux-en-Y gastric bypass (LRYGB) surgeries performed at two medical centers: the University Hospital of Strasbourg (StrasBypass70) and Inselspital, Bern University Hospital (BernBypass70). The dataset has been fully annotated with phases and steps. Furthermore, we assess the generalizability and benchmark different deep learning models in 7 experimental studies: 1) Training and evaluation on BernBypass70; 2) Training and evaluation on StrasBypass70; 3) Training and evaluation on the MultiBypass140; 4) Training on BernBypass70, evaluation on StrasBypass70; 5) Training on StrasBypass70, evaluation on BernBypass70; Training on MultiBypass140, evaluation 6) on BernBypass70 and 7) on StrasBypass70. The model's performance is markedly influenced by the training data. The worst results were obtained in experiments 4) and 5) confirming the limited generalization capabilities of models trained on mono-centric data. The use of multi-centric training data, experiments 6) and 7), improves the generalization capabilities of the models, bringing them beyond the level of independent mono-centric training and validation (experiments 1) and 2)). MultiBypass140 shows considerable variation in surgical technique and workflow of LRYGB procedures between centers. Therefore, generalization experiments demonstrate a remarkable difference in model performance. These results highlight the importance of multi-centric datasets for AI model generalization to account for variance in surgical technique and workflows.

This paper provides a simplification on OpenVision's architecture and loss design for enhancing its training efficiency. Following the prior vision-language pretraining works CapPa and AIMv2, as well as modern multimodal designs like LLaVA, our changes are straightforward: we remove the text encoder (and therefore the contrastive loss), retaining only the captioning loss as a purely generative training signal. We name this new version OpenVision 2. The initial results are promising: despite this simplification, OpenVision 2 competitively matches the original model's performance on a broad set of multimodal benchmarks while substantially cutting both training time and memory consumption. For example, with ViT-L/14, it reduces training time by about 1.5x (from 83h to 57h), and memory usage by about 1.8x (from 24.5GB to 13.8GB, equivalently allowing the maximum batch size to grow from 2k to 8k). This superior training efficiency also allows us to scale far beyond the largest vision encoder used in OpenVision, reaching more than 1 billion parameters. We hold a strong belief that this lightweight, generative-only paradigm is compelling for future vision encoder development in multimodal foundation models.

Optical Coherence Tomography Angiography (OCTA) and its derived en-face projections provide high-resolution visualization of the retinal and choroidal vasculature, which is critical for the rapid and accurate diagnosis of retinal diseases. However, acquiring high-quality OCTA images is challenging due to motion sensitivity and the high costs associated with software modifications for conventional OCT devices. Moreover, current deep learning methods for OCT-to-OCTA translation often overlook the vascular differences across retinal layers and struggle to reconstruct the intricate, dense vascular details necessary for reliable diagnosis. To overcome these limitations, we propose XOCT, a novel deep learning framework that integrates Cross-Dimensional Supervision (CDS) with a Multi-Scale Feature Fusion (MSFF) network for layer-aware vascular reconstruction. Our CDS module leverages 2D layer-wise en-face projections, generated via segmentation-weighted z-axis averaging, as supervisory signals to compel the network to learn distinct representations for each retinal layer through fine-grained, targeted guidance. Meanwhile, the MSFF module enhances vessel delineation through multi-scale feature extraction combined with a channel reweighting strategy, effectively capturing vascular details at multiple spatial scales. Our experiments on the OCTA-500 dataset demonstrate XOCT's improvements, especially for the en-face projections which are significant for clinical evaluation of retinal pathologies, underscoring its potential to enhance OCTA accessibility, reliability, and diagnostic value for ophthalmic disease detection and monitoring. The code is available at https://github.com/uci-cbcl/XOCT.

Recent Artificial Intelligence (AI) models have matched or exceeded human experts in several benchmarks of biomedical task performance, but have lagged behind on surgical image-analysis benchmarks. Since surgery requires integrating disparate tasks -- including multimodal data integration, human interaction, and physical effects -- generally-capable AI models could be particularly attractive as a collaborative tool if performance could be improved. On the one hand, the canonical approach of scaling architecture size and training data is attractive, especially since there are millions of hours of surgical video data generated per year. On the other hand, preparing surgical data for AI training requires significantly higher levels of professional expertise, and training on that data requires expensive computational resources. These trade-offs paint an uncertain picture of whether and to-what-extent modern AI could aid surgical practice. In this paper, we explore this question through a case study of surgical tool detection using state-of-the-art AI methods available in 2026. We demonstrate that even with multi-billion parameter models and extensive training, current Vision Language Models fall short in the seemingly simple task of tool detection in neurosurgery. Additionally, we show scaling experiments indicating that increasing model size and training time only leads to diminishing improvements in relevant performance metrics. Thus, our experiments suggest that current models could still face significant obstacles in surgical use cases. Moreover, some obstacles cannot be simply ``scaled away'' with additional compute and persist across diverse model architectures, raising the question of whether data and label availability are the only limiting factors. We discuss the main contributors to these constraints and advance potential solutions.

Current vision-language models (VLMs) in medicine are primarily designed for categorical question answering (e.g., "Is this normal or abnormal?") or qualitative descriptive tasks. However, clinical decision-making often relies on quantitative assessments, such as measuring the size of a tumor or the angle of a joint, from which physicians draw their own diagnostic conclusions. This quantitative reasoning capability remains underexplored and poorly supported in existing VLMs. In this work, we introduce MedVision, a large-scale dataset and benchmark specifically designed to evaluate and improve VLMs on quantitative medical image analysis. MedVision spans 22 public datasets covering diverse anatomies and modalities, with 30.8 million image-annotation pairs. We focus on three representative quantitative tasks: (1) detection of anatomical structures and abnormalities, (2) tumor/lesion (T/L) size estimation, and (3) angle/distance (A/D) measurement. Our benchmarks show that current off-the-shelf VLMs perform poorly on these tasks. However, with supervised fine-tuning on MedVision, we significantly enhance their performance across detection, T/L estimation, and A/D measurement, demonstrating reduced error rates and improved precision. This work provides a foundation for developing VLMs with robust quantitative reasoning capabilities in medical imaging. Code and data are available at https://medvision-vlm.github.io.

Over the last decade, online lecture videos have become increasingly popular and have experienced a meteoric rise during the pandemic. However, video-language research has primarily focused on instructional videos or movies, and tools to help students navigate the growing online lectures are lacking. Our first contribution is to facilitate research in the educational domain, by introducing AVLectures, a large-scale dataset consisting of 86 courses with over 2,350 lectures covering various STEM subjects. Each course contains video lectures, transcripts, OCR outputs for lecture frames, and optionally lecture notes, slides, assignments, and related educational content that can inspire a variety of tasks. Our second contribution is introducing video lecture segmentation that splits lectures into bite-sized topics that show promise in improving learner engagement. We formulate lecture segmentation as an unsupervised task that leverages visual, textual, and OCR cues from the lecture, while clip representations are fine-tuned on a pretext self-supervised task of matching the narration with the temporally aligned visual content. We use these representations to generate segments using a temporally consistent 1-nearest neighbor algorithm, TW-FINCH. We evaluate our method on 15 courses and compare it against various visual and textual baselines, outperforming all of them. Our comprehensive ablation studies also identify the key factors driving the success of our approach.

Scale-aware monocular depth estimation poses a significant challenge in computer-aided endoscopic navigation. However, existing depth estimation methods that do not consider the geometric priors struggle to learn the absolute scale from training with monocular endoscopic sequences. Additionally, conventional methods face difficulties in accurately estimating details on tissue and instruments boundaries. In this paper, we tackle these problems by proposing a novel enhanced scale-aware framework that only uses monocular images with geometric modeling for depth estimation. Specifically, we first propose a multi-resolution depth fusion strategy to enhance the quality of monocular depth estimation. To recover the precise scale between relative depth and real-world values, we further calculate the 3D poses of instruments in the endoscopic scenes by algebraic geometry based on the image-only geometric primitives (i.e., boundaries and tip of instruments). Afterwards, the 3D poses of surgical instruments enable the scale recovery of relative depth maps. By coupling scale factors and relative depth estimation, the scale-aware depth of the monocular endoscopic scenes can be estimated. We evaluate the pipeline on in-house endoscopic surgery videos and simulated data. The results demonstrate that our method can learn the absolute scale with geometric modeling and accurately estimate scale-aware depth for monocular scenes.

Glaucoma is one of the leading causes of irreversible but preventable blindness in working age populations. Color fundus photography (CFP) is the most cost-effective imaging modality to screen for retinal disorders. However, its application to glaucoma has been limited to the computation of a few related biomarkers such as the vertical cup-to-disc ratio. Deep learning approaches, although widely applied for medical image analysis, have not been extensively used for glaucoma assessment due to the limited size of the available data sets. Furthermore, the lack of a standardize benchmark strategy makes difficult to compare existing methods in a uniform way. In order to overcome these issues we set up the Retinal Fundus Glaucoma Challenge, REFUGE (https://refuge.grand-challenge.org), held in conjunction with MICCAI 2018. The challenge consisted of two primary tasks, namely optic disc/cup segmentation and glaucoma classification. As part of REFUGE, we have publicly released a data set of 1200 fundus images with ground truth segmentations and clinical glaucoma labels, currently the largest existing one. We have also built an evaluation framework to ease and ensure fairness in the comparison of different models, encouraging the development of novel techniques in the field. 12 teams qualified and participated in the online challenge. This paper summarizes their methods and analyzes their corresponding results. In particular, we observed that two of the top-ranked teams outperformed two human experts in the glaucoma classification task. Furthermore, the segmentation results were in general consistent with the ground truth annotations, with complementary outcomes that can be further exploited by ensembling the results.

High-fidelity reconstruction of deformable tissues from endoscopic videos remains challenging due to the limitations of existing methods in capturing subtle color variations and modeling global deformations. While 3D Gaussian Splatting (3DGS) enables efficient dynamic reconstruction, its fixed per-Gaussian color assignment struggles with intricate textures, and linear deformation modeling fails to model consistent global deformation. To address these issues, we propose ColorGS, a novel framework that integrates spatially adaptive color encoding and enhanced deformation modeling for surgical scene reconstruction. First, we introduce Colored Gaussian Primitives, which employ dynamic anchors with learnable color parameters to adaptively encode spatially varying textures, significantly improving color expressiveness under complex lighting and tissue similarity. Second, we design an Enhanced Deformation Model (EDM) that combines time-aware Gaussian basis functions with learnable time-independent deformations, enabling precise capture of both localized tissue deformations and global motion consistency caused by surgical interactions. Extensive experiments on DaVinci robotic surgery videos and benchmark datasets (EndoNeRF, StereoMIS) demonstrate that ColorGS achieves state-of-the-art performance, attaining a PSNR of 39.85 (1.5 higher than prior 3DGS-based methods) and superior SSIM (97.25\%) while maintaining real-time rendering efficiency. Our work advances surgical scene reconstruction by balancing high fidelity with computational practicality, critical for intraoperative guidance and AR/VR applications.

We present OCTCube-M, a 3D OCT-based multi-modal foundation model for jointly analyzing OCT and en face images. OCTCube-M first developed OCTCube, a 3D foundation model pre-trained on 26,685 3D OCT volumes encompassing 1.62 million 2D OCT images. It then exploits a novel multi-modal contrastive learning framework COEP to integrate other retinal imaging modalities, such as fundus autofluorescence and infrared retinal imaging, into OCTCube, efficiently extending it into multi-modal foundation models. OCTCube achieves best performance on predicting 8 retinal diseases, demonstrating strong generalizability on cross-cohort, cross-device and cross-modality prediction. OCTCube can also predict cross-organ nodule malignancy (CT) and low cardiac ejection fraction as well as systemic diseases, such as diabetes and hypertension, revealing its wide applicability beyond retinal diseases. We further develop OCTCube-IR using COEP with 26,685 OCT and IR image pairs. OCTCube-IR can accurately retrieve between OCT and IR images, allowing joint analysis between 3D and 2D retinal imaging modalities. Finally, we trained a tri-modal foundation model OCTCube-EF from 4 million 2D OCT images and 400K en face retinal images. OCTCube-EF attains the best performance on predicting the growth rate of geographic atrophy (GA) across datasets collected from 6 multi-center global trials conducted in 23 countries. This improvement is statistically equivalent to running a clinical trial with more than double the size of the original study. Our analysis based on another retrospective case study reveals OCTCube-EF's ability to avoid false positive Phase-III results according to its accurate treatment effect estimation on the Phase-II results. In sum, OCTCube-M is a 3D multi-modal foundation model framework that integrates OCT and other retinal imaging modalities revealing substantial diagnostic and prognostic benefits.