Daily Papers

Intraoperative anesthesia requires systems to interpret evolving multimodal evidence, recommend timely management, and revise decisions as patient states change, yet existing benchmarks usually isolate perception or single-point reasoning. We introduce AnesTRACE, an evaluation suite comprising AnesTRACE-Bench and AnesTRACE-Eval. Built from public perioperative datasets with anesthesiologist annotation, AnesTRACE-Bench evaluates Intraoperative Perception, Single-point Anesthesia Decision-Making, and Multi-step Anesthesia Decision-Making. AnesTRACE-Eval assesses open-ended responses through anesthesiologist-defined criteria for Clinical Correctness, Evidence Grounding, Task Completeness, and Safety, with Temporal Consistency for multi-step decisions; its domain-specific evaluator is trained by supervised fine-tuning and preference alignment on expert-reviewed judgments. Across more than 30 models, fine-grained visual grounding and intervention selection remain difficult: the leading model reaches only 32.2 mIoU for TEE visual grounding and retains a 17.5\% Major/Critical Safety Error Rate in multi-step management. Evaluator alignment with anesthesiologists improves across both training stages, while the best decision quality is accompanied by a 74.3-second P95 Latency. These results show that aggregate performance alone does not establish safe, timely longitudinal decision-making. We release our code at https://zjudbxai.github.io/AnesTRACE/.

Surgical procedures are inherently complex and risky, requiring extensive expertise and constant focus to navigate evolving intraoperative scenes. Computer-assisted systems such as surgical visual question answering (VQA) offer promises for education and intraoperative support. Current surgical VQA research largely focuses on static frame analysis, overlooking rich temporal semantics. Surgical video question answering is further challenged by low visual contrast, its highly knowledge-driven nature, diverse analytical needs spanning scattered temporal windows, and the hierarchy from basic perception to high-level intraoperative assessment. To address these challenges, we propose SurgTEMP, a multimodal LLM framework featuring (i) a query-guided token selection module that builds hierarchical visual memory (spatial and temporal memory banks) and (ii) a Surgical Competency Progression (SCP) training scheme. Together, they enable effective modeling of variable-length surgical videos while preserving procedure-relevant cues and temporal coherence, and better support diverse downstream assessment tasks. To support model development, we introduce CholeVidQA-32K, a surgical video question answering dataset comprising 32K open-ended QA pairs and 3,855 video segments (approximately 128 h total) from laparoscopic cholecystectomy. The dataset is organized into a three-level hierarchy -- Perception, Assessment, and Reasoning -- spanning 11 tasks from instrument/action/anatomy perception to Critical View of Safety (CVS), intraoperative difficulty, skill proficiency, and adverse event assessment. In comprehensive evaluations against state-of-the-art open-source multimodal and video LLMs (fine-tuned and zero-shot), SurgTEMP achieves substantial performance improvements, advancing the state of video-based surgical VQA. The project page is available at: https://camma-public.github.io/SurgTEMP/

Visual Question Answering (VQA) in robotic surgery, referred to as surgical VQA, requires high-level understanding of complex surgical scenes and the integration of visual perception with language reasoning, with the potential to support surgical training and intraoperative decision-making. Recent Vision-Language Models (VLMs) have shown promising performance through parameter-efficient fine-tuning; however, most existing approaches rely on coarse visual grounding, typically limited to bounding boxes, which fails to capture the fine-grained spatial structure of surgical objects. In this work, we propose a unified framework that jointly performs pixel-level segmentation and visual question answering within a single framework. Our approach integrates a VLM with a Segment Anything Model (SAM)-based decoder and represents scene elements as object tokens generated by the VLM. These object tokens guide answer prediction and are further projected to the SAM-based decoder to produce segmentation masks. By optimizing the object token embeddings through both segmentation and question answering objectives, the model learns spatially grounded representations that enhance visual reasoning while providing explicit pixel-level grounding. We evaluate the proposed method on the private RAMIE (Robot-Assisted Minimally Invasive Esophagectomy) dataset and the public EndoVis18 dataset, where it consistently outperforms baseline methods for surgical VQA. These results demonstrate that incorporating context-aware object tokens into vision-language models improves fine-grained surgical scene understanding.

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.

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.

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.

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.

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.

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.

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.

To achieve human-level dexterity, robots must infer spatial awareness from multimodal sensing to reason over contact interactions. During in-hand manipulation of novel objects, such spatial awareness involves estimating the object's pose and shape. The status quo for in-hand perception primarily employs vision, and restricts to tracking a priori known objects. Moreover, visual occlusion of objects in-hand is imminent during manipulation, preventing current systems to push beyond tasks without occlusion. We combine vision and touch sensing on a multi-fingered hand to estimate an object's pose and shape during in-hand manipulation. Our method, NeuralFeels, encodes object geometry by learning a neural field online and jointly tracks it by optimizing a pose graph problem. We study multimodal in-hand perception in simulation and the real-world, interacting with different objects via a proprioception-driven policy. Our experiments show final reconstruction F-scores of 81% and average pose drifts of 4.7,mm, further reduced to 2.3,mm with known CAD models. Additionally, we observe that under heavy visual occlusion we can achieve up to 94% improvements in tracking compared to vision-only methods. Our results demonstrate that touch, at the very least, refines and, at the very best, disambiguates visual estimates during in-hand manipulation. We release our evaluation dataset of 70 experiments, FeelSight, as a step towards benchmarking in this domain. Our neural representation driven by multimodal sensing can serve as a perception backbone towards advancing robot dexterity. Videos can be found on our project website https://suddhu.github.io/neural-feels/

Objective: To enable context-aware computer assistance in the operating room of the future, cognitive systems need to understand automatically which surgical phase is being performed by the medical team. The primary source of information for surgical phase recognition is typically video, which presents two challenges: extracting meaningful features from the video stream and effectively modeling temporal information in the sequence of visual features. Methods: For temporal modeling, attention mechanisms have gained popularity due to their ability to capture long-range dependencies. In this paper, we explore design choices for attention in existing temporal models for surgical phase recognition and propose a novel approach that uses attention more effectively and does not require hand-crafted constraints: TUNeS, an efficient and simple temporal model that incorporates self-attention at the core of a convolutional U-Net structure. In addition, we propose to train the feature extractor, a standard CNN, together with an LSTM on preferably long video segments, i.e., with long temporal context. Results: In our experiments, almost all temporal models performed better on top of feature extractors that were trained with longer temporal context. On these contextualized features, TUNeS achieves state-of-the-art results on the Cholec80 dataset. Conclusion: This study offers new insights on how to use attention mechanisms to build accurate and efficient temporal models for surgical phase recognition. Significance: Implementing automatic surgical phase recognition is essential to automate the analysis and optimization of surgical workflows and to enable context-aware computer assistance during surgery, thus ultimately improving patient care.

Cortical visual prostheses aim to restore sight by electrically stimulating neurons in early visual cortex (V1). With the emergence of high-density and flexible neural interfaces, electrode placement within three-dimensional cortex has become a critical surgical planning problem. Existing strategies emphasize visual field coverage and anatomical heuristics but do not directly optimize predicted perceptual outcomes under safety constraints. We present a percept-aware framework for surgical planning of cortical visual prostheses that formulates electrode placement as a constrained optimization problem in anatomical space. Electrode coordinates are treated as learnable parameters and optimized end-to-end using a differentiable forward model of prosthetic vision. The objective minimizes task-level perceptual error while incorporating vascular avoidance and gray matter feasibility constraints. Evaluated on simulated reading and natural image tasks using realistic folded cortical geometry (FreeSurfer fsaverage), percept-aware optimization consistently improves reconstruction fidelity relative to coverage-based placement strategies. Importantly, vascular safety constraints eliminate margin violations while preserving perceptual performance. The framework further enables co-optimization of multi-electrode thread configurations under fixed insertion budgets. These results demonstrate how differentiable percept models can inform anatomically grounded, safety-aware computer-assisted planning for cortical neural interfaces and provide a foundation for optimizing next-generation visual prostheses.

Integration of Vision-Language Models (VLMs) in surgical intelligence is hindered by hallucinations, domain knowledge gaps, and limited understanding of task interdependencies within surgical scenes, undermining clinical reliability. While recent VLMs demonstrate strong general reasoning and thinking capabilities, they still lack the domain expertise and task-awareness required for precise surgical scene interpretation. Although Chain-of-Thought (CoT) can structure reasoning more effectively, current approaches rely on self-generated CoT steps, which often exacerbate inherent domain gaps and hallucinations. To overcome this, we present SurgRAW, a CoT-driven multi-agent framework that delivers transparent, interpretable insights for most tasks in robotic-assisted surgery. By employing specialized CoT prompts across five tasks: instrument recognition, action recognition, action prediction, patient data extraction, and outcome assessment, SurgRAW mitigates hallucinations through structured, domain-aware reasoning. Retrieval-Augmented Generation (RAG) is also integrated to external medical knowledge to bridge domain gaps and improve response reliability. Most importantly, a hierarchical agentic system ensures that CoT-embedded VLM agents collaborate effectively while understanding task interdependencies, with a panel discussion mechanism promotes logical consistency. To evaluate our method, we introduce SurgCoTBench, the first reasoning-based dataset with structured frame-level annotations. With comprehensive experiments, we demonstrate the effectiveness of proposed SurgRAW with 29.32% accuracy improvement over baseline VLMs on 12 robotic procedures, achieving the state-of-the-art performance and advancing explainable, trustworthy, and autonomous surgical assistance.

Surgical scene understanding is critical for surgical training and robotic decision-making in robot-assisted surgery. Recent advances in Multimodal Large Language Models (MLLMs) have demonstrated great potential for advancing scene perception in the medical domain, facilitating surgeons to understand surgical scenes and procedures. However, these methods are primarily oriented towards image-based analysis or global video understanding, overlooking the fine-grained video reasoning that is crucial for analyzing specific processes and capturing detailed task execution within a surgical procedure. To bridge this gap, we propose SurgVidLM, the first video language model designed to address both full and fine-grained surgical video comprehension. To train our SurgVidLM, we construct the SVU-31K that is a large-scale dataset with over 31K video-instruction pairs, enabling both holistic understanding and detailed analysis of surgical procedures. Building on this resource, SurgVidLM incorporates a two-stage StageFocus mechanism: the first stage extracts global procedural context, while the second stage performs high-frequency local analysis guided by temporal cues. We also develop the Multi-frequency Fusion Attention to effectively integrate low- and high-frequency visual tokens, ensuring the preservation of critical task-specific details. Experimental results demonstrate that SurgVidLM significantly outperforms state-of-the-art Vid-LLMs of comparable parameter scale in both full and fine-grained video understanding tasks, showcasing its superior capability in capturing the context of complex robot-assisted surgeries. Our code and dataset will be publicly accessible soon.

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

Accurate recognition of anatomical structures is essential for safe and effective minimally invasive surgery (MIS), yet it remains underexplored in surgical computer vision due to limited annotated data and methods tailored primarily to natural scenes. In this work, we present a combined dataset and model framework to advance anatomy-aware perception in MIS. First, we introduce ATLAS-120k, a large-scale clip-level semantic segmentation dataset comprising over 120,000 annotated frames from 100 surgical videos spanning 14 procedures and multiple modalities, including laparoscopic and robot-assisted surgery. The dataset captures substantial procedural variability and was created using a scalable annotation pipeline that integrates expert manual labeling, automated propagation, iterative refinement, and surgeon verification to ensure high-quality annotations. Second, we propose ATLAS (Anatomy Recognition with Context Learning using Foundation Representations), a video semantic segmentation model specifically designed for surgical anatomy recognition. Unlike conventional approaches that emphasize object tracking, ATLAS leverages foundation-model embeddings together with lightweight temporal reasoning to incorporate contextual cues such as procedure type, surgical phase, and short-term visual memory. This design enables temporally consistent and accurate predictions while maintaining real-time feasibility. Together, the dataset and model establish a practical foundation for robust surgical scene understanding and support the development of clinically applicable guidance systems for minimally invasive surgery. The models, dataset annotations and annotation platform are publicly available at: https://github.com/TimJaspers0801/ATLAS.

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.

Surgical phase recognition has gained significant attention due to its potential to offer solutions to numerous demands of the modern operating room. However, most existing methods concentrate on minimally invasive surgery (MIS), leaving surgical phase recognition for open surgery understudied. This discrepancy is primarily attributed to the scarcity of publicly available open surgery video datasets for surgical phase recognition. To address this issue, we introduce a new egocentric open surgery video dataset for phase recognition, named EgoSurgery-Phase. This dataset comprises 15 hours of real open surgery videos spanning 9 distinct surgical phases all captured using an egocentric camera attached to the surgeon's head. In addition to video, the EgoSurgery-Phase offers eye gaze. As far as we know, it is the first real open surgery video dataset for surgical phase recognition publicly available. Furthermore, inspired by the notable success of masked autoencoders (MAEs) in video understanding tasks (e.g., action recognition), we propose a gaze-guided masked autoencoder (GGMAE). Considering the regions where surgeons' gaze focuses are often critical for surgical phase recognition (e.g., surgical field), in our GGMAE, the gaze information acts as an empirical semantic richness prior to guiding the masking process, promoting better attention to semantically rich spatial regions. GGMAE significantly improves the previous state-of-the-art recognition method (6.4% in Jaccard) and the masked autoencoder-based method (3.1% in Jaccard) on EgoSurgery-Phase. The dataset is released at https://github.com/Fujiry0/EgoSurgery.

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.

We present Vision in Action (ViA), an active perception system for bimanual robot manipulation. ViA learns task-relevant active perceptual strategies (e.g., searching, tracking, and focusing) directly from human demonstrations. On the hardware side, ViA employs a simple yet effective 6-DoF robotic neck to enable flexible, human-like head movements. To capture human active perception strategies, we design a VR-based teleoperation interface that creates a shared observation space between the robot and the human operator. To mitigate VR motion sickness caused by latency in the robot's physical movements, the interface uses an intermediate 3D scene representation, enabling real-time view rendering on the operator side while asynchronously updating the scene with the robot's latest observations. Together, these design elements enable the learning of robust visuomotor policies for three complex, multi-stage bimanual manipulation tasks involving visual occlusions, significantly outperforming baseline systems.

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

Computer-assisted minimally invasive surgery has great potential in benefiting modern operating theatres. The video data streamed from the endoscope provides rich information to support context-awareness for next-generation intelligent surgical systems. To achieve accurate perception and automatic manipulation during the procedure, learning based technique is a promising way, which enables advanced image analysis and scene understanding in recent years. However, learning such models highly relies on large-scale, high-quality, and multi-task labelled data. This is currently a bottleneck for the topic, as available public dataset is still extremely limited in the field of CAI. In this paper, we present and release the first integrated dataset (named AutoLaparo) with multiple image-based perception tasks to facilitate learning-based automation in hysterectomy surgery. Our AutoLaparo dataset is developed based on full-length videos of entire hysterectomy procedures. Specifically, three different yet highly correlated tasks are formulated in the dataset, including surgical workflow recognition, laparoscope motion prediction, and instrument and key anatomy segmentation. In addition, we provide experimental results with state-of-the-art models as reference benchmarks for further model developments and evaluations on this dataset. The dataset is available at https://autolaparo.github.io.

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.

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.

High-frequency surgical maneuvers in ophthalmology necessitate high-fidelity temporal modeling, yet characterizing long-range procedural dependencies remains computationally prohibitive for attention-based architectures. Existing models often require aggressive temporal downsampling, which compromises the detection of fine-grained action boundaries and instrument-tissue interactions. To address these scalability constraints, we present OphBiWSSD, a framework that reformulates surgical temporal action localization leveraging Bidirectional State Space Duality. By employing a weight-tied selective scan mechanism that incorporates both preceding and succeeding surgical contexts, our approach facilitates the global synthesis of non-causal temporal cues with linear complexity. This streamlined architecture is well-suited to capture the bidirectional dependencies present in ophthalmic workflows, effectively bridging the gap between local boundary precision and long-range procedural context without incurring the quadratic memory overhead of traditional Transformers. Extensive experiments on the OphNet benchmark demonstrate that OphBiWSSD achieves state-of-the-art temporal localization performance, with mean Average Precisions of 44.42% on phases and 43.08% on operations, surpassing the baselines by 6.80% and 6.66%, respectively. Empirical validation indicates that our approach ensures precise temporal localization and offers a computationally viable pathway for deploying surgical intelligence systems in clinical environments. The code is publicly available at https://github.com/yo3nglau/OphBiWSSD.

Intraoperative registration of real-time ultrasound (iUS) to preoperative Magnetic Resonance Imaging (MRI) remains an unsolved problem due to severe modality-specific differences in appearance, resolution, and field-of-view. To address this, we propose a novel 3D cross-modal keypoint descriptor for MRI-iUS matching and registration. Our approach employs a patient-specific matching-by-synthesis approach, generating synthetic iUS volumes from preoperative MRI. This enables supervised contrastive training to learn a shared descriptor space. A probabilistic keypoint detection strategy is then employed to identify anatomically salient and modality-consistent locations. During training, a curriculum-based triplet loss with dynamic hard negative mining is used to learn descriptors that are i) robust to iUS artifacts such as speckle noise and limited coverage, and ii) rotation-invariant. At inference, the method detects keypoints in MR and real iUS images and identifies sparse matches, which are then used to perform rigid registration. Our approach is evaluated using 3D MRI-iUS pairs from the ReMIND dataset. Experiments show that our approach outperforms state-of-the-art keypoint matching methods across 11 patients, with an average precision of 69.8%. For image registration, our method achieves a competitive mean Target Registration Error of 2.39 mm on the ReMIND2Reg benchmark. Compared to existing iUS-MR registration approaches, our framework is interpretable, requires no manual initialization, and shows robustness to iUS field-of-view variation. Code, data and model weights are available at https://github.com/morozovdd/CrossKEY.

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.

Tactile perception has the potential to significantly enhance dexterous robotic manipulation by providing rich local information that can complement or substitute for other sensory modalities such as vision. However, because tactile sensing is inherently local, it is not well-suited for tasks that require broad spatial awareness or global scene understanding on its own. A human-inspired strategy to address this issue is to consider active perception techniques instead. That is, to actively guide sensors toward regions with more informative or significant features and integrate such information over time in order to understand a scene or complete a task. Both active perception and different methods for tactile sensing have received significant attention recently. Yet, despite advancements, both fields lack standardized benchmarks. To bridge this gap, we introduce the Tactile MNIST Benchmark Suite, an open-source, Gymnasium-compatible benchmark specifically designed for active tactile perception tasks, including localization, classification, and volume estimation. Our benchmark suite offers diverse simulation scenarios, from simple toy environments all the way to complex tactile perception tasks using vision-based tactile sensors. Furthermore, we also offer a comprehensive dataset comprising 13,500 synthetic 3D MNIST digit models and 153,600 real-world tactile samples collected from 600 3D printed digits. Using this dataset, we train a CycleGAN for realistic tactile simulation rendering. By providing standardized protocols and reproducible evaluation frameworks, our benchmark suite facilitates systematic progress in the fields of tactile sensing and active perception.

Reliable recognition and localization of surgical instruments in endoscopic video recordings are foundational for a wide range of applications in computer- and robot-assisted minimally invasive surgery (RAMIS), including surgical training, skill assessment, and autonomous assistance. However, robust performance under real-world conditions remains a significant challenge. Incorporating surgical context - such as the current procedural phase - has emerged as a promising strategy to improve robustness and interpretability. To address these challenges, we organized the Surgical Procedure Phase, Keypoint, and Instrument Recognition (PhaKIR) sub-challenge as part of the Endoscopic Vision (EndoVis) challenge at MICCAI 2024. We introduced a novel, multi-center dataset comprising thirteen full-length laparoscopic cholecystectomy videos collected from three distinct medical institutions, with unified annotations for three interrelated tasks: surgical phase recognition, instrument keypoint estimation, and instrument instance segmentation. Unlike existing datasets, ours enables joint investigation of instrument localization and procedural context within the same data while supporting the integration of temporal information across entire procedures. We report results and findings in accordance with the BIAS guidelines for biomedical image analysis challenges. The PhaKIR sub-challenge advances the field by providing a unique benchmark for developing temporally aware, context-driven methods in RAMIS and offers a high-quality resource to support future research in surgical scene understanding.

Recently, Multimodal Large Language Models (MLLMs) have demonstrated their immense potential in computer-aided diagnosis and decision-making. In the context of robotic-assisted surgery, MLLMs can serve as effective tools for surgical training and guidance. However, there is still a lack of MLLMs specialized for surgical scene understanding in clinical applications. In this work, we introduce EndoChat to address various dialogue paradigms and subtasks in surgical scene understanding that surgeons encounter. To train our EndoChat, we construct the Surg-396K dataset through a novel pipeline that systematically extracts surgical information and generates structured annotations based on collected large-scale endoscopic surgery datasets. Furthermore, we introduce a multi-scale visual token interaction mechanism and a visual contrast-based reasoning mechanism to enhance the model's representation learning and reasoning capabilities. Our model achieves state-of-the-art performance across five dialogue paradigms and eight surgical scene understanding tasks. Additionally, we conduct evaluations with professional surgeons, most of whom provide positive feedback on collaborating with EndoChat. Overall, these results demonstrate that our EndoChat has great potential to significantly advance training and automation in robotic-assisted surgery.

Realistic surgical simulation plays a crucial role in training novice surgeons and in the development of autonomous agents. World models can scale such simulation environments to realistic and diverse procedures by predicting future patient states conditioned on current observations and surgical actions. However, current state-of-the-art approaches often fail to satisfy key criteria required for clinical applicability, including visual realism, physically grounded interactions, and the ability to simulate scenarios beyond the training distribution. Hence, we introduce SWoMo, a neuro-symbolic world model for cataract surgery simulation that decouples motion generation from visual realism. The symbolic component, consisting of a rule-based simulator and scene graph representations, models motion dynamics and tool-tissue interactions, while a diffusion model produces realistic visual appearance, including textures and tissue deformations. We propose an inverse pairing strategy that reconstructs real surgical videos in the simulator to obtain paired simulated and real videos, which are then used to train our video diffusion model for the reverse objective of sim-to-real translation. Our experiments show both qualitative and quantitative improvements over prior work. We demonstrate that our simulator further satisfies the key criteria, including generalisation to unseen interaction geometries, improvements in downstream phase detection, and unsupervised video style transfer. The code, data, and model weights are available at: https://ssharvienkumar.github.io/SWoMo/

This work introduces the first framework for reconstructing surgical dialogue from unstructured real-world recordings, which is crucial for characterizing teaching tasks. In surgical training, the formative verbal feedback that trainers provide to trainees during live surgeries is crucial for ensuring safety, correcting behavior immediately, and facilitating long-term skill acquisition. However, analyzing and quantifying this feedback is challenging due to its unstructured and specialized nature. Automated systems are essential to manage these complexities at scale, allowing for the creation of structured datasets that enhance feedback analysis and improve surgical education. Our framework integrates voice activity detection, speaker diarization, and automated speech recaognition, with a novel enhancement that 1) removes hallucinations (non-existent utterances generated during speech recognition fueled by noise in the operating room) and 2) separates speech from trainers and trainees using few-shot voice samples. These aspects are vital for reconstructing accurate surgical dialogues and understanding the roles of operating room participants. Using data from 33 real-world surgeries, we demonstrated the system's capability to reconstruct surgical teaching dialogues and detect feedback instances effectively (F1 score of 0.79+/-0.07). Moreover, our hallucination removal step improves feedback detection performance by ~14%. Evaluation on downstream clinically relevant tasks of predicting Behavioral Adjustment of trainees and classifying Technical feedback, showed performances comparable to manual annotations with F1 scores of 0.82+/0.03 and 0.81+/0.03 respectively. These results highlight the effectiveness of our framework in supporting clinically relevant tasks and improving over manual methods.

The goal of this work is to characterize the representational impact that foveation operations have for machine vision systems, inspired by the foveated human visual system, which has higher acuity at the center of gaze and texture-like encoding in the periphery. To do so, we introduce models consisting of a first-stage fixed image transform followed by a second-stage learnable convolutional neural network, and we varied the first stage component. The primary model has a foveated-textural input stage, which we compare to a model with foveated-blurred input and a model with spatially-uniform blurred input (both matched for perceptual compression), and a final reference model with minimal input-based compression. We find that: 1) the foveated-texture model shows similar scene classification accuracy as the reference model despite its compressed input, with greater i.i.d. generalization than the other models; 2) the foveated-texture model has greater sensitivity to high-spatial frequency information and greater robustness to occlusion, w.r.t the comparison models; 3) both the foveated systems, show a stronger center image-bias relative to the spatially-uniform systems even with a weight sharing constraint. Critically, these results are preserved over different classical CNN architectures throughout their learning dynamics. Altogether, this suggests that foveation with peripheral texture-based computations yields an efficient, distinct, and robust representational format of scene information, and provides symbiotic computational insight into the representational consequences that texture-based peripheral encoding may have for processing in the human visual system, while also potentially inspiring the next generation of computer vision models via spatially-adaptive computation. Code + Data available here: https://github.com/ArturoDeza/EmergentProperties

Medical multimodal large language models (MLLMs) are increasingly expected to perform complex image understanding tasks, yet their reliability is often compromised by frequent errors in visual interpretation. To systematically trace these failures, we traverse the hierarchy from high-level clinical tasks down to fundamental visual perception. We therefore introduce Perception-Bench, a large-scale benchmark comprising 1.13 million samples that assesses medical MLLMs across six dimensions: attribute judgment, spatial grounding, spatial understanding, disease prediction, anomaly detection, and report generation, spanning both 2D and 3D radiology images. Our analysis on Perception-Bench reveals that existing MLLMs lack the ability to capture even the most basic lesion attributes, such as location, size, and density. This inability to ground clinical outputs in primary visual evidence reveals that the models' diagnostic unreliability is rooted in a critical but overlooked bottleneck in low-level visual perception. Motivated by this, we propose RadSight, a perception-driven MLLM built upon a dual 2D/3D encoder architecture that preserves native imaging spatial structures. RadSight formulates medical image understanding as a four-stage progressive process: visual-language alignment, fine-grained visual perception, clinical diagnosis, and diagnostic interpretation. The model is trained on an 8.37 million perception-oriented corpus using progressive curriculum learning. On Perception-Bench, RadSight consistently outperforms existing MLLMs across all six evaluation dimensions, with particularly strong gains in spatial grounding and clinical diagnosis. It also achieves consistent improvements on public 2D and 3D medical benchmarks, further demonstrating that robust low-level visual perception is a critical foundation for reliable clinical understanding. Code and model will be publicly available.

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.

Recently, "visual o1" began to enter people's vision, with expectations that this slow-thinking design can solve visual reasoning tasks, especially geometric math problems. However, the reality is that current LVLMs (Large Vision Language Models) can hardly even accurately copy a geometric figure, let alone truly understand the complex inherent logic and spatial relationships within geometric shapes. We believe accurate copying (strong perception) is the first step to visual o1. Accordingly, we introduce the concept of "slow perception" (SP), which guides the model to gradually perceive basic point-line combinations, as our humans, reconstruct complex geometric structures progressively. There are two-fold stages in SP: a) perception decomposition. Perception is not instantaneous. In this stage, complex geometric figures are broken down into basic simple units to unify geometry representation. b) perception flow, which acknowledges that accurately tracing a line is not an easy task. This stage aims to avoid "long visual jumps" in regressing line segments by using a proposed "perceptual ruler" to trace each line stroke-by-stroke. Surprisingly, such a human-like perception manner enjoys an inference time scaling law -- the slower, the better. Researchers strive to speed up the model's perception in the past, but we slow it down again, allowing the model to read the image step-by-step and carefully.

In Marius von Senden's Space and Sight, a newly sighted blind patient describes the experience of a corner as lemon-like, because corners "prick" sight like lemons prick the tongue. Prickliness, here, is a dimension in the feature space of sensory experience, an effect of the perceived on the perceiver that arises where the two interact. In the account of the newly sighted, an effect familiar from one interaction translates to a novel context. Perception serves as the vehicle for generalization, in that an effect shared across different experiences produces a concrete abstraction grounded in those experiences. Cezanne and the post-impressionists, fluent in the language of experience translation, realized that the way to paint a concrete form that best reflected reality was to paint not what they saw, but what it was like to see. We envision a future of creation using AI where what it is like to see is replicable, transferrable, manipulable - part of the artist's palette that is both grounded in a particular context, and generalizable beyond it. An active line of research maps human-interpretable features onto directions in GAN latent space. Supervised and self-supervised approaches that search for anticipated directions or use off-the-shelf classifiers to drive image manipulation in embedding space are limited in the variety of features they can uncover. Unsupervised approaches that discover useful new directions show that the space of perceptually meaningful directions is nowhere close to being fully mapped. As this space is broad and full of creative potential, we want tools for direction discovery that capture the richness and generalizability of human perception. Our approach puts creators in the discovery loop during real-time tool use, in order to identify directions that are perceptually meaningful to them, and generate interpretable image translations along those directions.

Intraoperative pathology is pivotal to precision surgery, yet its clinical impact is constrained by diagnostic complexity and the limited availability of high-quality frozen-section data. While computational pathology has made significant strides, the lack of large-scale, prospective validation has impeded its routine adoption in surgical workflows. Here, we introduce CRISP, a clinical-grade foundation model developed on over 100,000 frozen sections from eight medical centers, specifically designed to provide Clinical-grade Robust Intraoperative Support for Pathology (CRISP). CRISP was comprehensively evaluated on more than 15,000 intraoperative slides across nearly 100 retrospective diagnostic tasks, including benign-malignant discrimination, key intraoperative decision-making, and pan-cancer detection, etc. The model demonstrated robust generalization across diverse institutions, tumor types, and anatomical sites-including previously unseen sites and rare cancers. In a prospective cohort of over 2,000 patients, CRISP sustained high diagnostic accuracy under real-world conditions, directly informing surgical decisions in 92.6% of cases. Human-AI collaboration further reduced diagnostic workload by 35%, avoided 105 ancillary tests and enhanced detection of micrometastases with 87.5% accuracy. Together, these findings position CRISP as a clinical-grade paradigm for AI-driven intraoperative pathology, bridging computational advances with surgical precision and accelerating the translation of artificial intelligence into routine clinical practice.

Open procedures represent the dominant form of surgery worldwide. Artificial intelligence (AI) has the potential to optimize surgical practice and improve patient outcomes, but efforts have focused primarily on minimally invasive techniques. Our work overcomes existing data limitations for training AI models by curating, from YouTube, the largest dataset of open surgical videos to date: 1997 videos from 23 surgical procedures uploaded from 50 countries. Using this dataset, we developed a multi-task AI model capable of real-time understanding of surgical behaviors, hands, and tools - the building blocks of procedural flow and surgeon skill. We show that our model generalizes across diverse surgery types and environments. Illustrating this generalizability, we directly applied our YouTube-trained model to analyze open surgeries prospectively collected at an academic medical center and identified kinematic descriptors of surgical skill related to efficiency of hand motion. Our Annotated Videos of Open Surgery (AVOS) dataset and trained model will be made available for further development of surgical AI.

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.

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.

Surgical video understanding is a crucial prerequisite for advancing Computer-Assisted Surgery. While vision-language models (VLMs) have recently been applied to the surgical domain, existing surgical vision-language datasets lack in capturing and evaluating complex, interleaved spatial-temporal dynamics. Creating large scale datasets that accurately represent fine-grained spatial-temporal relationships in surgical videos is challenging due to costly manual annotations or error-prone generation using large language models. To address this gap, we introduce the SurgSTU-Pipeline, a deterministic generation pipeline featuring temporal and spatial continuity filtering to reliably create surgical datasets for fine-grained spatial-temporal multimodal understanding. Applying this pipeline to publicly available surgical datasets, we create the SurgSTU dataset, comprising 7515 video clips densely extended with 150k fine-grained spatial-temporal question-answer samples. Our comprehensive evaluation shows that while state-of-the-art generalist VLMs struggle in zero-shot settings, their spatial-temporal capabilities can be improved through in-context learning. A fine-tuned VLM on the SurgSTU training dataset achieves highest performance among all spatial-temporal tasks, validating the dataset's efficacy to improve spatial-temporal understanding of VLMs in surgical videos. Code will be made publicly available.

Biological systems perceive the world by simultaneously processing high-dimensional inputs from modalities as diverse as vision, audition, touch, proprioception, etc. The perception models used in deep learning on the other hand are designed for individual modalities, often relying on domain-specific assumptions such as the local grid structures exploited by virtually all existing vision models. These priors introduce helpful inductive biases, but also lock models to individual modalities. In this paper we introduce the Perceiver - a model that builds upon Transformers and hence makes few architectural assumptions about the relationship between its inputs, but that also scales to hundreds of thousands of inputs, like ConvNets. The model leverages an asymmetric attention mechanism to iteratively distill inputs into a tight latent bottleneck, allowing it to scale to handle very large inputs. We show that this architecture is competitive with or outperforms strong, specialized models on classification tasks across various modalities: images, point clouds, audio, video, and video+audio. The Perceiver obtains performance comparable to ResNet-50 and ViT on ImageNet without 2D convolutions by directly attending to 50,000 pixels. It is also competitive in all modalities in AudioSet.

Perception is often viewed as a process that transforms physical variables, external to an observer, into internal psychological variables. Such a process can be modeled by a function coined perceptual scale. The perceptual scale can be deduced from psychophysical measurements that consist in comparing the relative differences between stimuli (i.e. difference scaling experiments). However, this approach is often overlooked by the modeling and experimentation communities. Here, we demonstrate the value of measuring the perceptual scale of classical (spatial frequency, orientation) and less classical physical variables (interpolation between textures) by embedding it in recent probabilistic modeling of perception. First, we show that the assumption that an observer has an internal representation of univariate parameters such as spatial frequency or orientation while stimuli are high-dimensional does not lead to contradictory predictions when following the theoretical framework. Second, we show that the measured perceptual scale corresponds to the transduction function hypothesized in this framework. In particular, we demonstrate that it is related to the Fisher information of the generative model that underlies perception and we test the predictions given by the generative model of different stimuli in a set a of difference scaling experiments. Our main conclusion is that the perceptual scale is mostly driven by the stimulus power spectrum. Finally, we propose that this measure of perceptual scale is a way to push further the notion of perceptual distances by estimating the perceptual geometry of images i.e. the path between images instead of simply the distance between those.

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.

Surgical phase recognition is a basic component for different context-aware applications in computer- and robot-assisted surgery. In recent years, several methods for automatic surgical phase recognition have been proposed, showing promising results. However, a meaningful comparison of these methods is difficult due to differences in the evaluation process and incomplete reporting of evaluation details. In particular, the details of metric computation can vary widely between different studies. To raise awareness of potential inconsistencies, this paper summarizes common deviations in the evaluation of phase recognition algorithms on the Cholec80 benchmark. In addition, a structured overview of previously reported evaluation results on Cholec80 is provided, taking known differences in evaluation protocols into account. Greater attention to evaluation details could help achieve more consistent and comparable results on the surgical phase recognition task, leading to more reliable conclusions about advancements in the field and, finally, translation into clinical practice.

Human perception of the world is shaped by a multitude of viewpoints and modalities. While many existing datasets focus on scene understanding from a certain perspective (e.g. egocentric or third-person views), our dataset offers a panoptic perspective (i.e. multiple viewpoints with multiple data modalities). Specifically, we encapsulate third-person panoramic and front views, as well as egocentric monocular/binocular views with rich modalities including video, multi-channel audio, directional binaural delay, location data and textual scene descriptions within each scene captured, presenting comprehensive observation of the world. Figure 1 offers a glimpse of all 28 scene categories of our 360+x dataset. To the best of our knowledge, this is the first database that covers multiple viewpoints with multiple data modalities to mimic how daily information is accessed in the real world. Through our benchmark analysis, we presented 5 different scene understanding tasks on the proposed 360+x dataset to evaluate the impact and benefit of each data modality and perspective in panoptic scene understanding. We hope this unique dataset could broaden the scope of comprehensive scene understanding and encourage the community to approach these problems from more diverse perspectives.

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.

Seeing is believing, however, the underlying mechanism of how human visual perceptions are intertwined with our cognitions is still a mystery. Thanks to the recent advances in both neuroscience and artificial intelligence, we have been able to record the visually evoked brain activities and mimic the visual perception ability through computational approaches. In this paper, we pay attention to visual stimuli reconstruction by reconstructing the observed images based on portably accessible brain signals, i.e., electroencephalography (EEG) data. Since EEG signals are dynamic in the time-series format and are notorious to be noisy, processing and extracting useful information requires more dedicated efforts; In this paper, we propose a comprehensive pipeline, named NeuroImagen, for reconstructing visual stimuli images from EEG signals. Specifically, we incorporate a novel multi-level perceptual information decoding to draw multi-grained outputs from the given EEG data. A latent diffusion model will then leverage the extracted information to reconstruct the high-resolution visual stimuli images. The experimental results have illustrated the effectiveness of image reconstruction and superior quantitative performance of our proposed method.

Purpose: Accurate 3D hand pose estimation supports surgical applications such as skill assessment, robot-assisted interventions, and geometry-aware workflow analysis. However, surgical environments pose severe challenges, including intense and localized lighting, frequent occlusions by instruments or staff, and uniform hand appearance due to gloves, combined with a scarcity of annotated datasets for reliable model training. Method: We propose a robust multi-view pipeline for 3D hand pose estimation in surgical contexts that requires no domain-specific fine-tuning and relies solely on off-the-shelf pretrained models. The pipeline integrates reliable person detection, whole-body pose estimation, and state-of-the-art 2D hand keypoint prediction on tracked hand crops, followed by a constrained 3D optimization. In addition, we introduce a novel surgical benchmark dataset comprising over 68,000 frames and 3,000 manually annotated 2D hand poses with triangulated 3D ground truth, recorded in a replica operating room under varying levels of scene complexity. Results: Quantitative experiments demonstrate that our method consistently outperforms baselines, achieving a 31% reduction in 2D mean joint error and a 76% reduction in 3D mean per-joint position error. Conclusion: Our work establishes a strong baseline for 3D hand pose estimation in surgery, providing both a training-free pipeline and a comprehensive annotated dataset to facilitate future research in surgical computer vision.

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.

Surgical scene segmentation is critical in computer-assisted surgery and is vital for enhancing surgical quality and patient outcomes. Recently, referring surgical segmentation is emerging, given its advantage of providing surgeons with an interactive experience to segment the target object. However, existing methods are limited by low efficiency and short-term tracking, hindering their applicability in complex real-world surgical scenarios. In this paper, we introduce ReSurgSAM2, a two-stage surgical referring segmentation framework that leverages Segment Anything Model 2 to perform text-referred target detection, followed by tracking with reliable initial frame identification and diversity-driven long-term memory. For the detection stage, we propose a cross-modal spatial-temporal Mamba to generate precise detection and segmentation results. Based on these results, our credible initial frame selection strategy identifies the reliable frame for the subsequent tracking. Upon selecting the initial frame, our method transitions to the tracking stage, where it incorporates a diversity-driven memory mechanism that maintains a credible and diverse memory bank, ensuring consistent long-term tracking. Extensive experiments demonstrate that ReSurgSAM2 achieves substantial improvements in accuracy and efficiency compared to existing methods, operating in real-time at 61.2 FPS. Our code and datasets will be available at https://github.com/jinlab-imvr/ReSurgSAM2.

We respond to the recent paper by Makelov et al. (2023), which reviews subspace interchange intervention methods like distributed alignment search (DAS; Geiger et al. 2023) and claims that these methods potentially cause "interpretability illusions". We first review Makelov et al. (2023)'s technical notion of what an "interpretability illusion" is, and then we show that even intuitive and desirable explanations can qualify as illusions in this sense. As a result, their method of discovering "illusions" can reject explanations they consider "non-illusory". We then argue that the illusions Makelov et al. (2023) see in practice are artifacts of their training and evaluation paradigms. We close by emphasizing that, though we disagree with their core characterization, Makelov et al. (2023)'s examples and discussion have undoubtedly pushed the field of interpretability forward.

Vision-Language-Action (VLA) models have advanced robotic manipulation by combining vision, language, and proprioception to predict actions. However, previous methods fuse proprioceptive signals directly with VLM-encoded vision-language features, resulting in state-dominant bias and false completions despite visible execution failures. We attribute this to modality imbalance, where policies over-rely on internal state while underusing visual evidence. To address this, we present ReViP, a novel VLA framework with Vision-Proprioception Rebalance to enhance visual grounding and robustness under perturbations. The key insight is to introduce auxiliary task-aware environment priors to adaptively modulate the coupling between semantic perception and proprioceptive dynamics. Specifically, we use an external VLM as a task-stage observer to extract real-time task-centric visual cues from visual observations, which drive a Vision-Proprioception Feature-wise Linear Modulation to enhance environmental awareness and reduce state-driven errors. Moreover, to evaluate false completion, we propose the first False-Completion Benchmark Suite built on LIBERO with controlled settings such as Object-Drop. Extensive experiments show that ReViP effectively reduces false-completion rates and improves success rates over strong VLA baselines on our suite, with gains extending to LIBERO, RoboTwin 2.0, and real-world evaluations.

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.

Multimodal hallucination remains a persistent challenge for Vision-Language Models (VLMs). Standard textual Direct Preference Optimization (DPO) often fails to mitigate it due to a lack of explicit visual supervision. While existing works introduce visual preference DPO by contrasting original images against negative ones, they suffer from a theoretically inconsistent objective caused by partition function mismatches and rely on coarse-grained negatives that could enable shortcut learning. In this work, we propose In-Context Visual Contrastive Optimization (IC-VCO). By placing contrastive images within a shared multi-image context, IC-VCO ensures a mathematically rigorous objective. We further introduce Visual Contrast Distillation (VCDist), an auxiliary reliability-gated regularizer that encourages consistency between multi-image contrastive training and single-image inference. Finally, we propose a contrastive sample editing strategy that generates hard negatives via precise semantic perturbations. Experiments on five benchmarks demonstrate IC-VCO's best overall performance and the effectiveness of our sample editing strategy. Code and data are available at https://github.com/OPPO-Mente-Lab/IC-VCO.

In computer vision, reference datasets have been highly successful in promoting algorithmic development in stereo reconstruction. Surgical scenes gives rise to specific problems, including the lack of clear corner features, highly specular surfaces and the presence of blood and smoke. Publicly available datasets have been produced using CT and either phantom images or biological tissue samples covering a relatively small region of the endoscope field-of-view. We present a stereo-endoscopic reconstruction validation dataset based on CT (SERV-CT). Two {\it ex vivo} small porcine full torso cadavers were placed within the view of the endoscope with both the endoscope and target anatomy visible in the CT scan. Orientation of the endoscope was manually aligned to the stereoscopic view. Reference disparities and occlusions were calculated for 8 stereo pairs from each sample. For the second sample an RGB surface was acquired to aid alignment of smooth, featureless surfaces. Repeated manual alignments showed an RMS disparity accuracy of ~2 pixels and a depth accuracy of ~2mm. The reference dataset includes endoscope image pairs with corresponding calibration, disparities, depths and occlusions covering the majority of the endoscopic image and a range of tissue types. Smooth specular surfaces and images with significant variation of depth are included. We assessed the performance of various stereo algorithms from online available repositories. There is a significant variation between algorithms, highlighting some of the challenges of surgical endoscopic images. The SERV-CT dataset provides an easy to use stereoscopic validation for surgical applications with smooth reference disparities and depths with coverage over the majority of the endoscopic images. This complements existing resources well and we hope will aid the development of surgical endoscopic anatomical reconstruction algorithms.

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.

Recent advances in vision-language models (VLMs) emphasize long chain-of-thought reasoning; yet, we find that their performance on visual tasks is primarily limited by a lack of visual perception as opposed to reasoning itself. In this work, we systematically study the interplay between perception and reasoning in VLM post-training by decomposing their capabilities into three separate training stages: visual perception, visual reasoning, and textual reasoning, incorporating specialized training data. We demonstrate that visual perception (a) requires targeted optimization with specialized data; (b) serves as a fundamental scaffold that should be solidified through staged training before refining visual reasoning; and (c) is more effectively learned via RL than caption-based SFT. Our experiments across multiple VLMs demonstrate that staged training consistently improves both visual perception and reasoning performance over merged training. Notably, models trained with our approach achieve 1.5% higher reasoning accuracy with 20.8% shorter reasoning traces, suggesting that superior perception reduces the need for excessive reasoning. Furthermore, we show that this capability-based staging represents a new curriculum dimension orthogonal to traditional difficulty-based curricula, and combining both yields further additive gains. Our staged-training models achieve superior performance among open-weight VLMs, establishing advanced results on several visual math and perception (e.g., +5.2% on WeMath and +3.7% on RealWorldQA) tasks compared with the base counterpart.

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.

Vision language models (VLMs) excel at many tasks but still struggle with spatial reasoning when critical information is not directly observable. Many such problems require imaginative perception: inferring what would be seen from an unseen viewpoint, tracing paths through occluded spaces, or integrating partial observations into a coherent spatial representation. We introduce Imaginative Perception Tokens (IPT), intermediate perceptual representations that externalize what a VLM would perceive under alternative spatial configurations while remaining consistent with the observed input. To study this capability, we formulate three tasks, Perspective Taking (PET), Path Tracing (PT), and Multiview Counting (MVC), and construct datasets of approximately 20K examples with ground truth imaginations, answers, and evaluation benchmarks. Using the unified VLM BAGEL as the backbone, IPT supervision consistently improves spatial reasoning and often outperforms textual chain of thought training, even without generating images at inference time. On MVC, IPT improves accuracy by 3.4% and achieves competitive performance with strong closed-source models on PT. We further find that combining IPT and label-only supervision yields additional gains, whereas textual chain of thought can substantially degrade performance, suggesting a modality mismatch when spatial computation is forced through language. Overall, IPT provides a principled supervision signal for reasoning about unobserved spatial structure, improving generalization while producing interpretable intermediate representations.

Human's perception of the visual world is shaped by the stereo processing of 3D information. Understanding how the brain perceives and processes 3D visual stimuli in the real world has been a longstanding endeavor in neuroscience. Towards this goal, we introduce a new neuroscience task: decoding 3D visual perception from EEG signals, a neuroimaging technique that enables real-time monitoring of neural dynamics enriched with complex visual cues. To provide the essential benchmark, we first present EEG-3D, a pioneering dataset featuring multimodal analysis data and extensive EEG recordings from 12 subjects viewing 72 categories of 3D objects rendered in both videos and images. Furthermore, we propose Neuro-3D, a 3D visual decoding framework based on EEG signals. This framework adaptively integrates EEG features derived from static and dynamic stimuli to learn complementary and robust neural representations, which are subsequently utilized to recover both the shape and color of 3D objects through the proposed diffusion-based colored point cloud decoder. To the best of our knowledge, we are the first to explore EEG-based 3D visual decoding. Experiments indicate that Neuro-3D not only reconstructs colored 3D objects with high fidelity, but also learns effective neural representations that enable insightful brain region analysis. The dataset and associated code will be made publicly available.

A striking feature of the human visual system is that it ingests visual information through a series of local foveated glimpses, rather than a single global computation. This makes human vision distinctly different from most popular computer vision models in use today, which input images globally and in a single shot. A natural question therefore is whether local, sequential vision models may provide any fundamental computational benefits in addition to being biologically more plausible than global models. In this work, we investigate this question from the perspective of visual state tracking and length generalization. Inspired by recent studies of length generalization in language models, we study the behavior of vision models trained on simple vision tasks that require the aggregation of local information across an image. Our experiments reveal that, similar to language models, vision models can learn to exploit global shortcuts and thereby fail to generalize over task length or complexity. We also show that recurrent vision policies based on strictly local perception can mitigate these failures, thereby allowing models to generalize on these tasks. Our results show that local attention may be an essential overlooked requirement for robust compositional generalization.

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

Developing embodied AI for intelligent surgical systems requires safe, controllable environments for continual learning and evaluation. However, safety regulations and operational constraints in operating rooms (ORs) limit embodied agents from freely perceiving and interacting in realistic settings. Digital twins provide high-fidelity, risk-free environments for exploration and training. How we may create photorealistic and dynamic digital representations of ORs that capture relevant spatial, visual, and behavioral complexity remains unclear. We introduce TwinOR, a framework for constructing photorealistic, dynamic digital twins of ORs for embodied AI research. The system reconstructs static geometry from pre-scan videos and continuously models human and equipment motion through multi-view perception of OR activities. The static and dynamic components are fused into an immersive 3D environment that supports controllable simulation and embodied exploration. The proposed framework reconstructs complete OR geometry with centimeter level accuracy while preserving dynamic interaction across surgical workflows, enabling realistic renderings and a virtual playground for embodied AI systems. In our experiments, TwinOR simulates stereo and monocular sensor streams for geometry understanding and visual localization tasks. Models such as FoundationStereo and ORB-SLAM3 on TwinOR-synthesized data achieve performance within their reported accuracy on real indoor datasets, demonstrating that TwinOR provides sensor-level realism sufficient for perception and localization challenges. By establishing a real-to-sim pipeline for constructing dynamic, photorealistic digital twins of OR environments, TwinOR enables the safe, scalable, and data-efficient development and benchmarking of embodied AI, ultimately accelerating the deployment of embodied AI from sim-to-real.

Humans experience the world through constantly changing visual stimuli, where scenes can shift and move, change in appearance, and vary in distance. The dynamic nature of visual perception is a fundamental aspect of our daily lives, yet the large majority of research on object and scene processing, particularly using fMRI, has focused on static stimuli. While studies of static image perception are attractive due to their computational simplicity, they impose a strong non-naturalistic constraint on our investigation of human vision. In contrast, dynamic visual stimuli offer a more ecologically-valid approach but present new challenges due to the interplay between spatial and temporal information, making it difficult to disentangle the representations of stable image features and motion. To overcome this limitation -- given dynamic inputs, we explicitly decouple the modeling of static image representations and motion representations in the human brain. Three results demonstrate the feasibility of this approach. First, we show that visual motion information as optical flow can be predicted (or decoded) from brain activity as measured by fMRI. Second, we show that this predicted motion can be used to realistically animate static images using a motion-conditioned video diffusion model (where the motion is driven by fMRI brain activity). Third, we show prediction in the reverse direction: existing video encoders can be fine-tuned to predict fMRI brain activity from video imagery, and can do so more effectively than image encoders. This foundational work offers a novel, extensible framework for interpreting how the human brain processes dynamic visual information.

Multimodal large language models (MLLMs) often struggle to ground reasoning in perceptual evidence. We present a systematic study of perception strategies-explicit, implicit, visual, and textual-across four multimodal benchmarks and two MLLMs. Our findings show that explicit perception, especially when paired with textual cues, consistently yields the best improvements, particularly for smaller models. Based on this insight, we propose VTPerception-R1, a unified two-stage framework that decouples perception from reasoning. Stage 1 introduces perception-augmented fine-tuning, and Stage 2 applies perception-aware reinforcement learning with novel visual, textual, and consistency rewards. Experiments demonstrate that VTPerception-R1 significantly improves reasoning accuracy and robustness across diverse tasks, offering a scalable and auditable solution for perception-grounded multimodal reasoning. Our code is available at: https://github.com/yizhuoDi/VTPerceprion-R1.

Optical coherence tomography (OCT) imaging is essential for the diagnosis and treatment of retinal diseases. Although multimodal large language models (MLLMs) have demonstrated considerable potential in medical image analysis, existing benchmarks largely reduce OCT understanding to coarse-grained disease classification or isolated visual question answering, leaving the complete cognitive process from visual perception to clinical reasoning insufficiently evaluated. To address this limitation, we introduce OCT-Bench, a comprehensive benchmark dedicated to OCT image understanding. OCT-Bench comprises 10,076 high-quality multiple-choice questions constructed from 4,137 OCT images across seven public datasets. Following the real-world clinical interpretation workflow, we establish a hierarchical capability taxonomy consisting of 20 fine-grained tasks across three dimensions: Perception, Cognition, and Reasoning. These tasks cover a broad range of capabilities, including imaging attributes, retinal anatomy, lesion characteristics, spatial relationships, disease assessment, therapeutic decision-making, and prognostic management. We systematically evaluate 20 representative MLLMs, including proprietary models, open-source general-purpose models, and medical-domain models. Experimental results demonstrate that current models remain substantially short of reliable OCT understanding. Moreover, neither medical-domain adaptation nor increased model scale consistently improves performance across capability levels. OCT-Bench enables comprehensive and fine-grained evaluation of MLLMs, providing a foundation for identifying capability bottlenecks and advancing clinically grounded OCT understanding.

PURPOSE: Surgical workflow and skill analysis are key technologies for the next generation of cognitive surgical assistance systems. These systems could increase the safety of the operation through context-sensitive warnings and semi-autonomous robotic assistance or improve training of surgeons via data-driven feedback. In surgical workflow analysis up to 91% average precision has been reported for phase recognition on an open data single-center dataset. In this work we investigated the generalizability of phase recognition algorithms in a multi-center setting including more difficult recognition tasks such as surgical action and surgical skill. METHODS: To achieve this goal, a dataset with 33 laparoscopic cholecystectomy videos from three surgical centers with a total operation time of 22 hours was created. Labels included annotation of seven surgical phases with 250 phase transitions, 5514 occurences of four surgical actions, 6980 occurences of 21 surgical instruments from seven instrument categories and 495 skill classifications in five skill dimensions. The dataset was used in the 2019 Endoscopic Vision challenge, sub-challenge for surgical workflow and skill analysis. Here, 12 teams submitted their machine learning algorithms for recognition of phase, action, instrument and/or skill assessment. RESULTS: F1-scores were achieved for phase recognition between 23.9% and 67.7% (n=9 teams), for instrument presence detection between 38.5% and 63.8% (n=8 teams), but for action recognition only between 21.8% and 23.3% (n=5 teams). The average absolute error for skill assessment was 0.78 (n=1 team). CONCLUSION: Surgical workflow and skill analysis are promising technologies to support the surgical team, but are not solved yet, as shown by our comparison of algorithms. This novel benchmark can be used for comparable evaluation and validation of future work.

Bionic vision uses neuroprostheses to restore useful vision to people living with incurable blindness. However, a major outstanding challenge is predicting what people 'see' when they use their devices. The limited field of view of current devices necessitates head movements to scan the scene, which is difficult to simulate on a computer screen. In addition, many computational models of bionic vision lack biological realism. To address these challenges, we present VR-SPV, an open-source virtual reality toolbox for simulated prosthetic vision that uses a psychophysically validated computational model to allow sighted participants to 'see through the eyes' of a bionic eye user. To demonstrate its utility, we systematically evaluated how clinically reported visual distortions affect performance in a letter recognition and an immersive obstacle avoidance task. Our results highlight the importance of using an appropriate phosphene model when predicting visual outcomes for bionic vision.

Online surgical phase recognition (SPR) underpins context-aware operating-room systems and requires committing to a prediction at every frame from past context alone. Surgical video poses three demands that natural-video recognizers do not jointly address: procedures span tens of thousands of frames, time flows non-uniformly as long routine stretches are punctuated by brief phase-defining transitions, and the visual domain is narrow so backbone features are strongly correlated across channels. Existing recognizers either let per-frame cost grow with elapsed length, or hold cost bounded but advance state at a uniform rate with channel-independent dynamics, leaving the latter two demands unaddressed. We present SurgicalMamba, a causal SPR model built on Mamba2's structured state-space duality (SSD) that holds per-frame cost at O(d). It introduces three SSD-compatible components, each targeting one demand: a dual-path SSD block that separates long- and short-term regimes at the level of recurrent state; intensity-modulated stepping, a continuous-time time-warp that adapts the slow path's effective rate to phase-relevant information; and state regramming, a per-chunk Cayley rotation that opens cross-channel mixing in the otherwise axis-aligned SSM recurrence. The learned rotation planes inherit a phase-aligned structure without any direct supervision, offering an interpretable internal signature of surgical workflow. Across seven public SPR benchmarks, SurgicalMamba reaches state-of-the-art accuracy and phase-level Jaccard under strict online evaluation: 94.6%/82.7% on Cholec80 (+0.7 pp/+2.2 pp over the strongest prior) and 89.5%/68.9% on AutoLaparo (+1.7 pp/+2.0 pp), at 119 fps on a single GPU. Ablations isolate the contribution of each component. The code is publicly available at https://github.com/sukjuoh/Surgical-Mamba.

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.

This paper presents a novel paradigm of the local percept-perceiver phenomenon to formalize certain observations in neuroscientific theories of consciousness. Using this model, a set-theoretic formalism is developed for artificial systems, and the existence of machine consciousness is proved by invoking Zermelo-Fraenkel set theory. The article argues for the possibility of a reductionist form of epistemic consciousness within machines.

In this paper, we propose a novel text promptable surgical instrument segmentation approach to overcome challenges associated with diversity and differentiation of surgical instruments in minimally invasive surgeries. We redefine the task as text promptable, thereby enabling a more nuanced comprehension of surgical instruments and adaptability to new instrument types. Inspired by recent advancements in vision-language models, we leverage pretrained image and text encoders as our model backbone and design a text promptable mask decoder consisting of attention- and convolution-based prompting schemes for surgical instrument segmentation prediction. Our model leverages multiple text prompts for each surgical instrument through a new mixture of prompts mechanism, resulting in enhanced segmentation performance. Additionally, we introduce a hard instrument area reinforcement module to improve image feature comprehension and segmentation precision. Extensive experiments on several surgical instrument segmentation datasets demonstrate our model's superior performance and promising generalization capability. To our knowledge, this is the first implementation of a promptable approach to surgical instrument segmentation, offering significant potential for practical application in the field of robotic-assisted surgery. Code is available at https://github.com/franciszzj/TP-SIS.

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.

Visual perception connects high-level semantic understanding to pixel-level perception, but most existing settings assume that the decisive evidence for identifying a target is already in the image or frozen model knowledge. We study a more practical yet harder open-world case where a visible object must first be resolved from external facts, recent events, long-tail entities, or multi-hop relations before it can be localized. We formalize this challenge as Perception Deep Research and introduce WebEye, an object-anchored benchmark with verifiable evidence, knowledge-intensive queries, precise box/mask annotations, and three task views: Search-based Grounding, Search-based Segmentation, and Search-based VQA. WebEyes contains 120 images, 473 annotated object instances, 645 unique QA pairs, and 1,927 task samples. We further propose Pixel-Searcher, an agentic search-to-pixel workflow that resolves hidden target identities and binds them to boxes, masks, or grounded answers. Experiments show that Pixel-Searcher achieves the strongest open-source performance across all three task views, while failures mainly arise from evidence acquisition, identity resolution, and visual instance binding.

Clinical decision-making relies heavily on understanding relative positions of anatomical structures and anomalies. Therefore, for Vision-Language Models (VLMs) to be applicable in clinical practice, the ability to accurately determine relative positions on medical images is a fundamental prerequisite. Despite its importance, this capability remains highly underexplored. To address this gap, we evaluate the ability of state-of-the-art VLMs, GPT-4o, Llama3.2, Pixtral, and JanusPro, and find that all models fail at this fundamental task. Inspired by successful approaches in computer vision, we investigate whether visual prompts, such as alphanumeric or colored markers placed on anatomical structures, can enhance performance. While these markers provide moderate improvements, results remain significantly lower on medical images compared to observations made on natural images. Our evaluations suggest that, in medical imaging, VLMs rely more on prior anatomical knowledge than on actual image content for answering relative position questions, often leading to incorrect conclusions. To facilitate further research in this area, we introduce the MIRP , Medical Imaging Relative Positioning, benchmark dataset, designed to systematically evaluate the capability to identify relative positions in medical images.

We propose a novel multimodal video benchmark - the Perception Test - to evaluate the perception and reasoning skills of pre-trained multimodal models (e.g. Flamingo, BEiT-3, or GPT-4). Compared to existing benchmarks that focus on computational tasks (e.g. classification, detection or tracking), the Perception Test focuses on skills (Memory, Abstraction, Physics, Semantics) and types of reasoning (descriptive, explanatory, predictive, counterfactual) across video, audio, and text modalities, to provide a comprehensive and efficient evaluation tool. The benchmark probes pre-trained models for their transfer capabilities, in a zero-shot / few-shot or limited finetuning regime. For these purposes, the Perception Test introduces 11.6k real-world videos, 23s average length, designed to show perceptually interesting situations, filmed by around 100 participants worldwide. The videos are densely annotated with six types of labels (multiple-choice and grounded video question-answers, object and point tracks, temporal action and sound segments), enabling both language and non-language evaluations. The fine-tuning and validation splits of the benchmark are publicly available (CC-BY license), in addition to a challenge server with a held-out test split. Human baseline results compared to state-of-the-art video QA models show a significant gap in performance (91.4% vs 43.6%), suggesting that there is significant room for improvement in multimodal video understanding. Dataset, baselines code, and challenge server are available at https://github.com/deepmind/perception_test

A fundamental question in cognitive neuroscience is what shapes visual perception: the external world's structure or the brain's internal architecture. Although some perceptual variability can be traced to individual differences, brain responses to naturalistic stimuli evoke similar activity patterns across individuals, suggesting a convergent representational principle. Here, we test if this stimulus-driven convergence follows a common trajectory across people and deep neural networks (DNNs) during its transformation from sensory to high-level internal representations. We introduce a unified framework that traces representational flow by combining inter-subject similarity with alignment to model hierarchies. Applying this framework to three independent fMRI datasets of visual scene perception, we reveal a cortex-wide network, conserved across individuals, organized into two pathways: a medial-ventral stream for scene structure and a lateral-dorsal stream tuned for social and biological content. This functional organization is captured by the hierarchies of vision DNNs but not language models, reinforcing the specificity of the visual-to-semantic transformation. These findings show a convergent computational solution for visual encoding in both human and artificial vision, driven by the structure of the external world.

How do we know that a kitchen is a kitchen by looking? Relatively little is known about how we conceptualize and categorize different visual environments. Traditional models of visual perception posit that scene categorization is achieved through the recognition of a scene's objects, yet these models cannot account for the mounting evidence that human observers are relatively insensitive to the local details in an image. Psychologists have long theorized that the affordances, or actionable possibilities of a stimulus are pivotal to its perception. To what extent are scene categories created from similar affordances? Using a large-scale experiment using hundreds of scene categories, we show that the activities afforded by a visual scene provide a fundamental categorization principle. Affordance-based similarity explained the majority of the structure in the human scene categorization patterns, outperforming alternative similarities based on objects or visual features. We all models were combined, affordances provided the majority of the predictive power in the combined model, and nearly half of the total explained variance is captured only by affordances. These results challenge many existing models of high-level visual perception, and provide immediately testable hypotheses for the functional organization of the human perceptual system.

Purpose: Face detection is a needed component for the automatic analysis and assistance of human activities during surgical procedures. Efficient face detection algorithms can indeed help to detect and identify the persons present in the room, and also be used to automatically anonymize the data. However, current algorithms trained on natural images do not generalize well to the operating room (OR) images. In this work, we provide a comparison of state-of-the-art face detectors on OR data and also present an approach to train a face detector for the OR by exploiting non-annotated OR images. Methods: We propose a comparison of 6 state-of-the-art face detectors on clinical data using Multi-View Operating Room Faces (MVOR-Faces), a dataset of operating room images capturing real surgical activities. We then propose to use self-supervision, a domain adaptation method, for the task of face detection in the OR. The approach makes use of non-annotated images to fine-tune a state-of-the-art detector for the OR without using any human supervision. Results: The results show that the best model, namely the tiny face detector, yields an average precision of 0.536 at Intersection over Union (IoU) of 0.5. Our self-supervised model using non-annotated clinical data outperforms this result by 9.2%. Conclusion: We present the first comparison of state-of-the-art face detectors on operating room images and show that results can be significantly improved by using self-supervision on non-annotated data.

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.

In the past five years, the use of generative and foundational AI systems has greatly improved the decoding of brain activity. Visual perception, in particular, can now be decoded from functional Magnetic Resonance Imaging (fMRI) with remarkable fidelity. This neuroimaging technique, however, suffers from a limited temporal resolution (approx0.5 Hz) and thus fundamentally constrains its real-time usage. Here, we propose an alternative approach based on magnetoencephalography (MEG), a neuroimaging device capable of measuring brain activity with high temporal resolution (approx5,000 Hz). For this, we develop an MEG decoding model trained with both contrastive and regression objectives and consisting of three modules: i) pretrained embeddings obtained from the image, ii) an MEG module trained end-to-end and iii) a pretrained image generator. Our results are threefold: Firstly, our MEG decoder shows a 7X improvement of image-retrieval over classic linear decoders. Second, late brain responses to images are best decoded with DINOv2, a recent foundational image model. Third, image retrievals and generations both suggest that high-level visual features can be decoded from MEG signals, although the same approach applied to 7T fMRI also recovers better low-level features. Overall, these results, while preliminary, provide an important step towards the decoding -- in real-time -- of the visual processes continuously unfolding within the human brain.

In recent years, the application of machine learning to minimally invasive surgery (MIS) has attracted considerable interest. Datasets are critical to the use of such techniques. This paper presents a unique dataset recorded during ex vivo pseudo-cholecystectomy procedures on pig livers using the da Vinci Research Kit (dVRK). Unlike existing datasets, it addresses a critical gap by providing comprehensive kinematic data, recordings of all pedal inputs, and offers a time-stamped record of the endoscope's movements. This expanded version also includes segmentation and keypoint annotations of images, enhancing its utility for computer vision applications. Contributed by seven surgeons with varied backgrounds and experience levels that are provided as a part of this expanded version, the dataset is an important new resource for surgical robotics research. It enables the development of advanced methods for evaluating surgeon skills, tools for providing better context awareness, and automation of surgical tasks. Our work overcomes the limitations of incomplete recordings and imprecise kinematic data found in other datasets. To demonstrate the potential of the dataset for advancing automation in surgical robotics, we introduce two models that predict clutch usage and camera activation, a 3D scene reconstruction example, and the results from our keypoint and segmentation models.

Effective evaluation is critical for driving advancements in MLLM research. The surgical action planning (SAP) task, which aims to generate future action sequences from visual inputs, demands precise and sophisticated analytical capabilities. Unlike mathematical reasoning, surgical decision-making operates in life-critical domains and requires meticulous, verifiable processes to ensure reliability and patient safety. This task demands the ability to distinguish between atomic visual actions and coordinate complex, long-horizon procedures, capabilities that are inadequately evaluated by current benchmarks. To address this gap, we introduce SAP-Bench, a large-scale, high-quality dataset designed to enable multimodal large language models (MLLMs) to perform interpretable surgical action planning. Our SAP-Bench benchmark, derived from the cholecystectomy procedures context with the mean duration of 1137.5s, and introduces temporally-grounded surgical action annotations, comprising the 1,226 clinically validated action clips (mean duration: 68.7s) capturing five fundamental surgical actions across 74 procedures. The dataset provides 1,152 strategically sampled current frames, each paired with the corresponding next action as multimodal analysis anchors. We propose the MLLM-SAP framework that leverages MLLMs to generate next action recommendations from the current surgical scene and natural language instructions, enhanced with injected surgical domain knowledge. To assess our dataset's effectiveness and the broader capabilities of current models, we evaluate seven state-of-the-art MLLMs (e.g., OpenAI-o1, GPT-4o, QwenVL2.5-72B, Claude-3.5-Sonnet, GeminiPro2.5, Step-1o, and GLM-4v) and reveal critical gaps in next action prediction performance.

Automatic radiology report generation is booming due to its huge application potential for the healthcare industry. However, existing computer vision and natural language processing approaches to tackle this problem are limited in two aspects. First, when extracting image features, most of them neglect multi-view reasoning in vision and model single-view structure of medical images, such as space-view or channel-view. However, clinicians rely on multi-view imaging information for comprehensive judgment in daily clinical diagnosis. Second, when generating reports, they overlook context reasoning with multi-modal information and focus on pure textual optimization utilizing retrieval-based methods. We aim to address these two issues by proposing a model that better simulates clinicians' perspectives and generates more accurate reports. Given the above limitation in feature extraction, we propose a Globally-intensive Attention (GIA) module in the medical image encoder to simulate and integrate multi-view vision perception. GIA aims to learn three types of vision perception: depth view, space view, and pixel view. On the other hand, to address the above problem in report generation, we explore how to involve multi-modal signals to generate precisely matched reports, i.e., how to integrate previously predicted words with region-aware visual content in next word prediction. Specifically, we design a Visual Knowledge-guided Decoder (VKGD), which can adaptively consider how much the model needs to rely on visual information and previously predicted text to assist next word prediction. Hence, our final Intensive Vision-guided Network (IVGN) framework includes a GIA-guided Visual Encoder and the VKGD. Experiments on two commonly-used datasets IU X-Ray and MIMIC-CXR demonstrate the superior ability of our method compared with other state-of-the-art approaches.

Integrated Information Theory (IIT) provides a quantitative framework for explaining consciousness phenomenon, positing that conscious systems comprise elements integrated through causal properties. We apply IIT 3.0 and 4.0 -- the latest iterations of this framework -- to sequences of Large Language Model (LLM) representations, analyzing data derived from existing Theory of Mind (ToM) test results. Our study systematically investigates whether the differences of ToM test performances, when presented in the LLM representations, can be revealed by IIT estimates, i.e., Phi^{max} (IIT 3.0), Phi (IIT 4.0), Conceptual Information (IIT 3.0), and Phi-structure (IIT 4.0). Furthermore, we compare these metrics with the Span Representations independent of any estimate for consciousness. This additional effort aims to differentiate between potential "consciousness" phenomena and inherent separations within LLM representational space. We conduct comprehensive experiments examining variations across LLM transformer layers and linguistic spans from stimuli. Our results suggest that sequences of contemporary Transformer-based LLM representations lack statistically significant indicators of observed "consciousness" phenomena but exhibit intriguing patterns under spatio-permutational analyses. The Appendix and code are available as Supplementary Materials at: https://doi.org/10.1016/j.nlp.2025.100163.

This study reveals an unexpected parallel between instructible vision-language models (VLMs) and human cognitive disorders, specifically constructive apraxia. We tested 25 state-of-the-art VLMs, including GPT-4 Vision, DALL-E 3, and Midjourney v5, on their ability to generate images of the Ponzo illusion, a task that requires basic spatial reasoning and is often used in clinical assessments of constructive apraxia. Remarkably, 24 out of 25 models failed to correctly render two horizontal lines against a perspective background, mirroring the deficits seen in patients with parietal lobe damage. The models consistently misinterpreted spatial instructions, producing tilted or misaligned lines that followed the perspective of the background rather than remaining horizontal. This behavior is strikingly similar to how apraxia patients struggle to copy or construct simple figures despite intact visual perception and motor skills. Our findings suggest that current VLMs, despite their advanced capabilities in other domains, lack fundamental spatial reasoning abilities akin to those impaired in constructive apraxia. This limitation in AI systems provides a novel computational model for studying spatial cognition deficits and highlights a critical area for improvement in VLM architecture and training methodologies.

Vision-Language Models (VLMs) have recently witnessed significant progress in visual comprehension. As the permitting length of image context grows, VLMs can now comprehend a broader range of views and spaces. Current benchmarks provide insightful analysis of VLMs in tasks involving complex visual instructions following, multi-image understanding and spatial reasoning. However, they usually focus on spatially irrelevant images or discrete images captured from varied viewpoints. The compositional characteristic of images captured from a static viewpoint remains underestimated. We term this characteristic as Continuous Space Perception. When observing a scene from a static viewpoint while shifting orientations, it produces a series of spatially continuous images, enabling the reconstruction of the entire space. In this paper, we present CoSpace, a multi-image visual understanding benchmark designed to assess the Continuous Space perception ability for VLMs. CoSpace contains 2,918 images and 1,626 question-answer pairs, covering seven types of tasks. We conduct evaluation across 19 proprietary and open-source VLMs. Results reveal that there exist pitfalls on the continuous space perception ability for most of the evaluated models, including proprietary ones. Interestingly, we find that the main discrepancy between open-source and proprietary models lies not in accuracy but in the consistency of responses. We believe that enhancing the ability of continuous space perception is essential for VLMs to perform effectively in real-world tasks and encourage further research to advance this capability.

Reinforcement learning (RL) is increasingly used to post-train medical Vision-Language Models (VLMs), yet it remains unclear whether RL improves medical visual reasoning or mainly sharpens behaviors already induced by supervised fine-tuning (SFT). We present a controlled study that disentangles these effects along three axes: vision, SFT, and RL. Using MedMNIST as a multi-modality testbed, we probe visual perception by benchmarking VLM vision towers against vision-only baselines, quantify reasoning support and sampling efficiency via Accuracy@1 versus Pass@K, and evaluate when RL closes the support gap and how gains transfer across modalities. We find that RL is most effective when the model already has non-trivial support (high Pass@K): it primarily sharpens the output distribution, improving Acc@1 and sampling efficiency, while SFT expands support and makes RL effective. Based on these findings, we propose a boundary-aware recipe and instantiate it by RL post-training an OctoMed-initialized model on a small, balanced subset of PMC multiple-choice VQA, achieving strong average performance across six medical VQA benchmarks.

Recent advancements in Vision-Language Models (VLMs) have significantly pushed the boundaries of Visual Question Answering (VQA).However,high-resolution details can sometimes become noise that leads to hallucinations or reasoning errors. In this paper,we propose Degradation-Driven Prompting (DDP), a novel framework that improves VQA performance by strategically reducing image fidelity to force models to focus on essential structural information. We evaluate DDP across two distinct tasks. Physical attributes targets images prone to human misjudgment, where DDP employs a combination of 80p downsampling, structural visual aids (white background masks and orthometric lines), and In-Context Learning (ICL) to calibrate the model's focus. Perceptual phenomena addresses various machine-susceptible visual anomalies and illusions, including Visual Anomaly (VA), Color (CI), Motion(MI),Gestalt (GI), Geometric (GSI), and Visual Illusions (VI).For this task, DDP integrates a task-classification stage with specialized tools such as blur masks and contrast enhancement alongside downsampling. Our experimental results demonstrate that less is more: by intentionally degrading visual inputs and providing targeted structural prompts, DDP enables VLMs to bypass distracting textures and achieve superior reasoning accuracy on challenging visual benchmarks.

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.

In this paper, we study depth perception of vision-language models (VLMs) to isolate the effects of pictorial depth cues and disentangle vision and language influences on model performance. To this end, we combine depth-ordering and odd-one-out psychophysical tasks: the VLMs are presented with images where one object is at different depth relative to other, otherwise identical, objects, and must determine whether the odd-one-out target is closer or farther to the observer. To create stimuli, we generate 2D views from simulated and real 3D scenes while controlling the presence of individual pictorial depth cues, enabling a fine-grained analysis of cue-level contributions. Language effects are examined by varying referring expression clarity. We also introduce a novel metric to quantify vision-vs-language sensitivities. Applying this methodology, we create the Odd-One-Out Depth (O3-D) dataset with 37K real and synthetic images and 147K image-question pairs. Evaluation of 12 open-source and commercial models on O3-D shows under-utilization of depth cues and depth-ordering accuracies between 47% and 56%, with no model above chance level. At the same time, our metric reveals strong linguistic bias in the answers. Neither chain-of-thought (CoT) nor in-context learning (ICL) significantly improves performance, suggesting that static image data alone may be insufficient for depth understanding. All code, the image generation pipeline, and the O3-D dataset are publicly released at https://github.com/lyiqian/o3-d.

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.

Understanding the hidden mechanisms behind human's visual perception is a fundamental question in neuroscience. To that end, investigating into the neural responses of human mind activities, such as functional Magnetic Resonance Imaging (fMRI), has been a significant research vehicle. However, analyzing fMRI signals is challenging, costly, daunting, and demanding for professional training. Despite remarkable progress in fMRI analysis, existing approaches are limited to generating 2D images and far away from being biologically meaningful and practically useful. Under this insight, we propose to generate visually plausible and functionally more comprehensive 3D outputs decoded from brain signals, enabling more sophisticated modeling of fMRI data. Conceptually, we reformulate this task as a {\em fMRI conditioned 3D object generation} problem. We design a novel 3D object representation learning method, Brain3D, that takes as input the fMRI data of a subject who was presented with a 2D image, and yields as output the corresponding 3D object images. The key capabilities of this model include tackling the noises with high-level semantic signals and a two-stage architecture design for progressive high-level information integration. Extensive experiments validate the superior capability of our model over previous state-of-the-art 3D object generation methods. Importantly, we show that our model captures the distinct functionalities of each region of human vision system as well as their intricate interplay relationships, aligning remarkably with the established discoveries in neuroscience. Further, preliminary evaluations indicate that Brain3D can successfully identify the disordered brain regions in simulated scenarios, such as V1, V2, V3, V4, and the medial temporal lobe (MTL) within the human visual system. Our data and code will be available at https://brain-3d.github.io/.

This paper introduces a novel approach to evaluating deep learning models' capacity for in-diagram logic interpretation. Leveraging the intriguing realm of visual illusions, we establish a unique dataset, InDL, designed to rigorously test and benchmark these models. Deep learning has witnessed remarkable progress in domains such as computer vision and natural language processing. However, models often stumble in tasks requiring logical reasoning due to their inherent 'black box' characteristics, which obscure the decision-making process. Our work presents a new lens to understand these models better by focusing on their handling of visual illusions -- a complex interplay of perception and logic. We utilize six classic geometric optical illusions to create a comparative framework between human and machine visual perception. This methodology offers a quantifiable measure to rank models, elucidating potential weaknesses and providing actionable insights for model improvements. Our experimental results affirm the efficacy of our benchmarking strategy, demonstrating its ability to effectively rank models based on their logic interpretation ability. As part of our commitment to reproducible research, the source code and datasets will be made publicly available at https://github.com/rabbit-magic-wh/InDL

The "thinking-with-images" paradigm equips multimodal LLMs with active visual operations such as crop-and-zoom. However, models using these operations often achieve only marginal or negative gains over direct inference at substantially higher token cost. They may also repeatedly crop irrelevant regions and fail on questions that direct inference answers correctly. We ask whether the returned visual evidence causally affects the answer. To answer this question, we formulate visual tool-use as a causal graph that separates observation-mediated paths from action-induced shortcuts. We then audit it through interventions at the three levels: policy (comparing tool-use with direct inference), trajectory (corrupting all observations during rollout), and step (counterfactually replacing one individual observation under a fixed prefix). Our step-level estimand, Visual Evidence Gain, isolates the contribution of each returned observation. Across six representative models and five fine-grained perception benchmarks, we uncover policy miscalibration with two failure modes. In Calling Without Looking, returned observations have no causal effect on the answer. In Looking Without Planning, observations are informative but the call schedule is incoherent. A trajectory-level diagnostic decomposes the policy-level accuracy gain and shows that the gain is concentrated in a Calibrated minority. We term this discrepancy the illusion of visual tool-use: despite aggregate accuracy gains, visual tool-use is not causally effective across a broad range of rollouts. The code is available at https://github.com/OpenCausaLab/CauAudit.

Surgical robot automation has attracted increasing research interest over the past decade, expecting its potential to benefit surgeons, nurses and patients. Recently, the learning paradigm of embodied intelligence has demonstrated promising ability to learn good control policies for various complex tasks, where embodied AI simulators play an essential role to facilitate relevant research. However, existing open-sourced simulators for surgical robot are still not sufficiently supporting human interactions through physical input devices, which further limits effective investigations on how the human demonstrations would affect policy learning. In this work, we study human-in-the-loop embodied intelligence with a new interactive simulation platform for surgical robot learning. Specifically, we establish our platform based on our previously released SurRoL simulator with several new features co-developed to allow high-quality human interaction via an input device. We showcase the improvement of our simulation environment with the designed new features, and validate effectiveness of incorporating human factors in embodied intelligence through the use of human demonstrations and reinforcement learning as a representative example. Promising results are obtained in terms of learning efficiency. Lastly, five new surgical robot training tasks are developed and released, with which we hope to pave the way for future research on surgical embodied intelligence. Our learning platform is publicly released and will be continuously updated in the website: https://med-air.github.io/SurRoL.

Recent advancements in self-supervised learning have led to powerful surgical vision encoders capable of spatiotemporal understanding. However, extending these visual foundations to multi-modal reasoning tasks is severely bottlenecked by the prohibitive cost of expert textual annotations. To overcome this scalability limitation, we introduce LIME, a large-scale multi-modal dataset derived from open-access surgical videos using human-free, Large Language Model (LLM)-generated narratives. While LIME offers immense scalability, unverified generated texts may contain errors, including hallucinations, that could potentially lead to catastrophically degraded pre-trained medical priors in standard contrastive pipelines. To mitigate this, we propose SurgLIME, a parameter-efficient Vision-Language Pre-training (VLP) framework designed to learn reliable cross-modal alignments using noisy narratives. SurgLIME preserves foundational medical priors using a LoRA-adapted dual-encoder architecture and introduces an automated confidence estimation mechanism that dynamically down-weights uncertain text during contrastive alignment. Evaluations on the AutoLaparo and Cholec80 benchmarks show that SurgLIME achieves competitive zero-shot cross-modal alignment while preserving the robust linear probing performance of the visual foundation model. Dataset, code, and models are publicly available at https://github.com/visurg-ai/SurgLIME.

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/.

Exploring brain activity in relation to visual perception provides insights into the biological representation of the world. While functional magnetic resonance imaging (fMRI) and magnetoencephalography (MEG) have enabled effective image classification and reconstruction, their high cost and bulk limit practical use. Electroencephalography (EEG), by contrast, offers low cost and excellent temporal resolution, but its potential has been limited by the scarcity of large, high-quality datasets and by block-design experiments that introduce temporal confounds. To fill this gap, we present CrossPT-EEG, a benchmark for cross-participant and cross-time generalization of visual decoding from EEG. We collected EEG data from 16 participants while they viewed 4,000 images sampled from ImageNet, with image stimuli annotated at multiple levels of granularity. Our design includes two stages separated in time to allow cross-time generalization and avoid block-design artifacts. We also introduce benchmarks tailored to non-block design classification, as well as pre-training experiments to assess cross-time and cross-participant generalization. These findings highlight the dataset's potential to enhance EEG-based visual brain-computer interfaces, deepen our understanding of visual perception in biological systems, and suggest promising applications for improving machine vision models.

Many surface cues support three-dimensional shape perception, but people can sometimes still see shape when these features are missing -- in extreme cases, even when an object is completely occluded, as when covered with a draped cloth. We propose a framework for 3D shape perception that explains perception in both typical and atypical cases as analysis-by-synthesis, or inference in a generative model of image formation: the model integrates intuitive physics to explain how shape can be inferred from deformations it causes to other objects, as in cloth-draping. Behavioral and computational studies comparing this account with several alternatives show that it best matches human observers in both accuracy and response times, and is the only model that correlates significantly with human performance on difficult discriminations. Our results suggest that bottom-up deep neural network models are not fully adequate accounts of human shape perception, and point to how machine vision systems might achieve more human-like robustness.

Reconstruction of the soft tissues in robotic surgery from endoscopic stereo videos is important for many applications such as intra-operative navigation and image-guided robotic surgery automation. Previous works on this task mainly rely on SLAM-based approaches, which struggle to handle complex surgical scenes. Inspired by recent progress in neural rendering, we present a novel framework for deformable tissue reconstruction from binocular captures in robotic surgery under the single-viewpoint setting. Our framework adopts dynamic neural radiance fields to represent deformable surgical scenes in MLPs and optimize shapes and deformations in a learning-based manner. In addition to non-rigid deformations, tool occlusion and poor 3D clues from a single viewpoint are also particular challenges in soft tissue reconstruction. To overcome these difficulties, we present a series of strategies of tool mask-guided ray casting, stereo depth-cueing ray marching and stereo depth-supervised optimization. With experiments on DaVinci robotic surgery videos, our method significantly outperforms the current state-of-the-art reconstruction method for handling various complex non-rigid deformations. To our best knowledge, this is the first work leveraging neural rendering for surgical scene 3D reconstruction with remarkable potential demonstrated. Code is available at: https://github.com/med-air/EndoNeRF.

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.

Multimodal Large Language Models (MLLMs) strive to achieve a profound, human-like understanding of and interaction with the physical world, but often exhibit a shallow and incoherent integration when acquiring information (Perception) and conducting reasoning (Cognition). This disconnect leads to a spectrum of reasoning failures, with hallucination being the most prominent. Collectively, these issues expose a fundamental challenge: the ability to process pixels does not yet confer the ability to construct a coherent, credible internal world model. To systematically dissect and address this challenge, this survey introduces a novel and unified analytical framework: ``From Perception to Cognition." We deconstruct the complex process of vision-language interactive understanding into two interdependent layers: Perception, the foundational ability to accurately extract visual information and achieve fine-grained alignment with textual instructions; and Cognition, the higher-order capability for proactive, multi-step, goal-oriented reasoning built upon this perceptual foundation, the core of which is the formation of a dynamic observe-think-verify reasoning loop. Guided by this framework, this paper systematically analyzes the key bottlenecks of current MLLMs at both layers. It surveys the landscape of cutting-edge methods designed to address these challenges, spanning from techniques that enhance low-level visual representations to those that improve high-level reasoning paradigms. Furthermore, we review critical benchmarks and delineate future research directions. This survey aims to provide the research community with a clear, structured perspective for understanding the intrinsic limitations of current MLLMs and to illuminate the path toward building next-generation models capable of deep reasoning and a genuine understanding of the world.

When working around other agents such as humans, it is important to model their perception capabilities to predict and make sense of their behavior. In this work, we consider agents whose perception capabilities are determined by their limited field of view, viewing range, and the potential to miss objects within their viewing range. By considering the perception capabilities and observation model of agents independently from their motion policy, we show that we can better predict the agents' behavior; i.e., by reasoning about the perception capabilities of other agents, one can better make sense of their actions. We perform a user study where human operators navigate a cluttered scene while scanning the region for obstacles with a limited field of view and range. We show that by reasoning about the limited observation space of humans, a robot can better learn a human's strategy for navigating an environment and navigate with minimal collision with dynamic and static obstacles. We also show that this learned model helps it successfully navigate a physical hardware vehicle in real-time. Code available at https://github.com/labicon/HRMotion-RestrictedView.

We analyse perception and memory, using mathematical models for knowledge graphs and tensors, to gain insights into the corresponding functionalities of the human mind. Our discussion is based on the concept of propositional sentences consisting of subject-predicate-object (SPO) triples for expressing elementary facts. SPO sentences are the basis for most natural languages but might also be important for explicit perception and declarative memories, as well as intra-brain communication and the ability to argue and reason. A set of SPO sentences can be described as a knowledge graph, which can be transformed into an adjacency tensor. We introduce tensor models, where concepts have dual representations as indices and associated embeddings, two constructs we believe are essential for the understanding of implicit and explicit perception and memory in the brain. We argue that a biological realization of perception and memory imposes constraints on information processing. In particular, we propose that explicit perception and declarative memories require a semantic decoder, which, in a simple realization, is based on four layers: First, a sensory memory layer, as a buffer for sensory input, second, an index layer representing concepts, third, a memoryless representation layer for the broadcasting of information ---the "blackboard", or the "canvas" of the brain--- and fourth, a working memory layer as a processing center and data buffer. We discuss the operations of the four layers and relate them to the global workspace theory. In a Bayesian brain interpretation, semantic memory defines the prior for observable triple statements. We propose that ---in evolution and during development--- semantic memory, episodic memory, and natural language evolved as emergent properties in agents' process to gain a deeper understanding of sensory information.

Accurate segmentation of thin structures is critical for microsurgical scene understanding but remains challenging due to resolution loss, low contrast, and class imbalance. We propose Microsurgery Instrument Segmentation for Robotic Assistance(MISRA), a segmentation framework that augments RGB input with luminance channels, integrates skip attention to preserve elongated features, and employs an Iterative Feedback Module(IFM) for continuity restoration across multiple passes. In addition, we introduce a dedicated microsurgical dataset with fine-grained annotations of surgical instruments including thin objects, providing a benchmark for robust evaluation Dataset available at https://huggingface.co/datasets/KIST-HARILAB/MISAW-Seg. Experiments demonstrate that MISRA achieves competitive performance, improving the mean class IoU by 5.37% over competing methods, while delivering more stable predictions at instrument contacts and overlaps. These results position MISRA as a promising step toward reliable scene parsing for computer-assisted and robotic microsurgery.

Research on autonomous surgery has largely focused on simple task automation in controlled environments. However, real-world surgical applications demand dexterous manipulation over extended durations and generalization to the inherent variability of human tissue. These challenges remain difficult to address using existing logic-based or conventional end-to-end learning approaches. To address this gap, we propose a hierarchical framework for performing dexterous, long-horizon surgical steps. Our approach utilizes a high-level policy for task planning and a low-level policy for generating robot trajectories. The high-level planner plans in language space, generating task-level or corrective instructions that guide the robot through the long-horizon steps and correct for the low-level policy's errors. We validate our framework through ex vivo experiments on cholecystectomy, a commonly-practiced minimally invasive procedure, and conduct ablation studies to evaluate key components of the system. Our method achieves a 100\% success rate across eight unseen ex vivo gallbladders, operating fully autonomously without human intervention. This work demonstrates step-level autonomy in a surgical procedure, marking a milestone toward clinical deployment of autonomous surgical systems.

Assessing learner competency in clinical simulation requires expert observation that is time-intensive, difficult to scale, and subject to inter-rater variability. Vision-language models have emerged as a promising tool for understanding complex visual behavior. In this work, we investigate whether visual observations can provide educationally meaningful signals for competency assessment through a three-stage framework that (1) extracts action timelines from egocentric nursing simulation video using frozen visual encoders and few-shot learning, (2) derives sequence-level features and per-session recognition metrics, and (3) relates these to instructor-rated competency. Across 22 densely annotated sessions (3.8 hours, 493 actions), a frozen DINOv2 backbone with HMM Viterbi decoding achieves 57.4% MOF in leave-one-out 1-shot recognition. Surprisingly, we observe a negative trend between recognition accuracy and competency (rho = -0.524, p = 0.012 for mIoU), robust to six confound controls: more competent students produce diverse, harder-to-classify workflows, while simple sequence features show no such relationship. Per-item analysis identifies patient safety protocols and team communication as the expected behaviors most reflected in this pattern, and process model comparisons reveal that higher-competency students exhibit more protocol-consistent action transitions. These findings suggest that recognition accuracy may complement predicted action timelines as a pedagogically informative signal in automated competency assessment.

Multimodal learning enhances the perceptual capabilities of cognitive systems by integrating information from different sensory modalities. However, existing multimodal fusion research typically assumes static integration, not fully incorporating key dynamic mechanisms found in the brain. Specifically, the brain exhibits an inverse effectiveness phenomenon, wherein weaker unimodal cues yield stronger multisensory integration benefits; conversely, when individual modal cues are stronger, the effect of fusion is diminished. This mechanism enables biological systems to achieve robust cognition even with scarce or noisy perceptual cues. Inspired by this biological mechanism, we explore the relationship between multimodal output and information from individual modalities, proposing an inverse effectiveness driven multimodal fusion (IEMF) strategy. By incorporating this strategy into neural networks, we achieve more efficient integration with improved model performance and computational efficiency, demonstrating up to 50% reduction in computational cost across diverse fusion methods. We conduct experiments on audio-visual classification, continual learning, and question answering tasks to validate our method. Results consistently demonstrate that our method performs excellently in these tasks. To verify universality and generalization, we also conduct experiments on Artificial Neural Networks (ANN) and Spiking Neural Networks (SNN), with results showing good adaptability to both network types. Our research emphasizes the potential of incorporating biologically inspired mechanisms into multimodal networks and provides promising directions for the future development of multimodal artificial intelligence. The code is available at https://github.com/Brain-Cog-Lab/IEMF.

The advent of Vision Language Models (VLM) has allowed researchers to investigate the visual understanding of a neural network using natural language. Beyond object classification and detection, VLMs are capable of visual comprehension and common-sense reasoning. This naturally led to the question: How do VLMs respond when the image itself is inherently unreasonable? To this end, we present IllusionVQA: a diverse dataset of challenging optical illusions and hard-to-interpret scenes to test the capability of VLMs in two distinct multiple-choice VQA tasks - comprehension and soft localization. GPT4V, the best-performing VLM, achieves 62.99% accuracy (4-shot) on the comprehension task and 49.7% on the localization task (4-shot and Chain-of-Thought). Human evaluation reveals that humans achieve 91.03% and 100% accuracy in comprehension and localization. We discover that In-Context Learning (ICL) and Chain-of-Thought reasoning substantially degrade the performance of GeminiPro on the localization task. Tangentially, we discover a potential weakness in the ICL capabilities of VLMs: they fail to locate optical illusions even when the correct answer is in the context window as a few-shot example.

In the realm of robot-assisted minimally invasive surgery, dynamic scene reconstruction can significantly enhance downstream tasks and improve surgical outcomes. Neural Radiance Fields (NeRF)-based methods have recently risen to prominence for their exceptional ability to reconstruct scenes but are hampered by slow inference speed, prolonged training, and inconsistent depth estimation. Some previous work utilizes ground truth depth for optimization but is hard to acquire in the surgical domain. To overcome these obstacles, we present Endo-4DGS, a real-time endoscopic dynamic reconstruction approach that utilizes 3D Gaussian Splatting (GS) for 3D representation. Specifically, we propose lightweight MLPs to capture temporal dynamics with Gaussian deformation fields. To obtain a satisfactory Gaussian Initialization, we exploit a powerful depth estimation foundation model, Depth-Anything, to generate pseudo-depth maps as a geometry prior. We additionally propose confidence-guided learning to tackle the ill-pose problems in monocular depth estimation and enhance the depth-guided reconstruction with surface normal constraints and depth regularization. Our approach has been validated on two surgical datasets, where it can effectively render in real-time, compute efficiently, and reconstruct with remarkable accuracy.

We introduce PerceptionComp, a manually annotated benchmark for complex, long-horizon, perception-centric video reasoning. PerceptionComp is designed so that no single moment is sufficient: answering each question requires multiple temporally separated pieces of visual evidence and compositional constraints under conjunctive and sequential logic, spanning perceptual subtasks such as objects, attributes, relations, locations, actions, and events, and requiring skills including semantic recognition, visual correspondence, temporal reasoning, and spatial reasoning. The benchmark contains 1,114 highly complex questions on 279 videos from diverse domains including city walk tours, indoor villa tours, video games, and extreme outdoor sports, with 100% manual annotation. Human studies show that PerceptionComp requires substantial test-time thinking and repeated perception steps: participants take much longer than on prior benchmarks, and accuracy drops to near chance (18.97%) when rewatching is disallowed. State-of-the-art MLLMs also perform substantially worse on PerceptionComp than on existing benchmarks: the best model in our evaluation, Gemini-3-Flash, reaches only 45.96% accuracy in the five-choice setting, while open-source models remain below 40%. These results suggest that perception-centric long-horizon video reasoning remains a major bottleneck, and we hope PerceptionComp will help drive progress in perceptual reasoning.

Visual perception is conventionally formulated as a one-shot prediction from a single glance at the image, under the assumption that the image content and the model's parametric knowledge suffice to resolve the query. This assumption often fails in real-world scenarios that hinge on fine-grained visual details or require knowledge-intensive and up-to-date information. We term such cases perception under insufficient evidence and formulate perception as an agentic process that can obtain information beyond a single glance. To address the absence of data for this setting, we design two dedicated data generation pipelines, yielding EviRover-SFT-5K and EviRover-RL-12K for training. We further construct EviLens, a human-verified benchmark comprising 688 instances across five perception categories. Building on these data, we present EviRover, to our knowledge the first perception agent explicitly trained to resolve perceptual queries through interaction, using supervised fine-tuning followed by agentic reinforcement learning. Experiments show that the 4B EviRover outperforms its backbone by 30 points on average on EviLens, reaching performance comparable to advanced proprietary models. The gains transfer beyond EviLens to WebEyes, conventional perception benchmarks, and general multimodal benchmarks, including a 15-point improvement on BrowseComp-VL. All code, models, and data are released.

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.

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.

The development of computer-assisted surgery systems relies on large-scale, annotated datasets. Existing cataract surgery resources lack the diversity and annotation depth required to train generalizable deep-learning models. To address this gap, we present a dataset of 3,000 phacoemulsification cataract surgery videos acquired at two surgical centers from surgeons with varying expertise. The dataset provides four annotation layers: temporal surgical phases, instance segmentation of instruments and anatomical structures, instrument-tissue interaction tracking, and quantitative skill scores based on competency rubrics adapted from ICO-OSCAR and GRASIS. We demonstrate the technical utility of the dataset through benchmarking deep learning models across four tasks: workflow recognition, scene segmentation, instrument-tissue interaction tracking, and automated skill assessment. Furthermore, we establish a domain-adaptation baseline for phase recognition and instance segmentation by training on one surgical center and evaluating on a held-out center. Ultimately, these multi-source acquisitions, multi-layer annotations, and paired skill-kinematic labels facilitate the development of generalizable multi-task models for surgical workflow analysis, scene understanding, and competency-based training research. The dataset and annotations are available in Google Form (https://docs.google.com/forms/d/e/1FAIpQLSfmyMAPSTGrIy2sTnz0-TMw08ZagTimRulbAQcWdaPwDy187A/viewform?usp=dialog).

Vision-Language-Action (VLA) models achieve strong performance on standard manipulation benchmarks, but most evaluations assume that task-relevant objects are fully visible. This assumption often fails in realistic settings, where occlusion makes manipulation partially observable. In this paper, we study scene-induced occlusion as a fundamental challenge for VLA models and introduce LIBERO-Occ, an occlusion-oriented extension of LIBERO. Experiments show that state-of-the-art VLAs suffer substantial performance degradation under occlusion. To address this issue, we propose Viewpoint Imagination (VIM), which generates a complementary view from an occluded primary observation and conditions action prediction on both observed and imagined evidence. VIM improves robustness across task suites, occlusion types, and severity levels without requiring additional cameras at deployment time, suggesting that viewpoint imagination is an promising mechanism for perception completion in partially observable manipulation. Our benchmark and corresponding code are available at: https://github.com/litsh/Libero-Occ{https://github.com/litsh/Libero-Occ}.