Daily Papers

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/

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 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.

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).

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.

Continuum robots are advancing bronchoscopy procedures by accessing complex lung airways and enabling targeted interventions. However, their development is limited by the lack of realistic training and test environments: Real data is difficult to collect due to ethical constraints and patient safety concerns, and developing autonomy algorithms requires realistic imaging and physical feedback. We present ROOM (Realistic Optical Observation in Medicine), a comprehensive simulation framework designed for generating photorealistic bronchoscopy training data. By leveraging patient CT scans, our pipeline renders multi-modal sensor data including RGB images with realistic noise and light specularities, metric depth maps, surface normals, optical flow and point clouds at medically relevant scales. We validate the data generated by ROOM in two canonical tasks for medical robotics -- multi-view pose estimation and monocular depth estimation, demonstrating diverse challenges that state-of-the-art methods must overcome to transfer to these medical settings. Furthermore, we show that the data produced by ROOM can be used to fine-tune existing depth estimation models to overcome these challenges, also enabling other downstream applications such as navigation. We expect that ROOM will enable large-scale data generation across diverse patient anatomies and procedural scenarios that are challenging to capture in clinical settings. Code and data: https://github.com/iamsalvatore/room.

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.

In the medical domain, the lack of large training data sets and benchmarks is often a limiting factor for training deep neural networks. In contrast to expensive manual labeling, computer simulations can generate large and fully labeled data sets with a minimum of manual effort. However, models that are trained on simulated data usually do not translate well to real scenarios. To bridge the domain gap between simulated and real laparoscopic images, we exploit recent advances in unpaired image-to-image translation. We extent an image-to-image translation method to generate a diverse multitude of realistically looking synthetic images based on images from a simple laparoscopy simulation. By incorporating means to ensure that the image content is preserved during the translation process, we ensure that the labels given for the simulated images remain valid for their realistically looking translations. This way, we are able to generate a large, fully labeled synthetic data set of laparoscopic images with realistic appearance. We show that this data set can be used to train models for the task of liver segmentation of laparoscopic images. We achieve average dice scores of up to 0.89 in some patients without manually labeling a single laparoscopic image and show that using our synthetic data to pre-train models can greatly improve their performance. The synthetic data set will be made publicly available, fully labeled with segmentation maps, depth maps, normal maps, and positions of tools and camera (http://opencas.dkfz.de/image2image).

Vision disorders significantly impact millions of lives, altering how visual information is processed and perceived. In this work, a computational framework was developed using the BrokenEyes system to simulate five common eye disorders: Age-related macular degeneration, cataract, glaucoma, refractive errors, and diabetic retinopathy and analyze their effects on neural-like feature representations in deep learning models. Leveraging a combination of human and non-human datasets, models trained under normal and disorder-specific conditions revealed critical disruptions in feature maps, particularly for cataract and glaucoma, which align with known neural processing challenges in these conditions. Evaluation metrics such as activation energy and cosine similarity quantified the severity of these distortions, providing insights into the interplay between degraded visual inputs and learned representations.

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.

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.

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.

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.

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.

Bokeh is widely used in photography to draw attention to the subject while effectively isolating distractions in the background. Computational methods simulate bokeh effects without relying on a physical camera lens. However, in the realm of digital bokeh synthesis, the two main challenges for bokeh synthesis are color bleeding and partial occlusion at object boundaries. Our primary goal is to overcome these two major challenges using physics principles that define bokeh formation. To achieve this, we propose a novel and accurate filtering-based bokeh rendering equation and a physically-based occlusion-aware bokeh renderer, dubbed Dr.Bokeh, which addresses the aforementioned challenges during the rendering stage without the need of post-processing or data-driven approaches. Our rendering algorithm first preprocesses the input RGBD to obtain a layered scene representation. Dr.Bokeh then takes the layered representation and user-defined lens parameters to render photo-realistic lens blur. By softening non-differentiable operations, we make Dr.Bokeh differentiable such that it can be plugged into a machine-learning framework. We perform quantitative and qualitative evaluations on synthetic and real-world images to validate the effectiveness of the rendering quality and the differentiability of our method. We show Dr.Bokeh not only outperforms state-of-the-art bokeh rendering algorithms in terms of photo-realism but also improves the depth quality from depth-from-defocus.

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.

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.

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.

Advances in 3D reconstruction have enabled high-quality 3D capture, but require a user to collect hundreds to thousands of images to create a 3D scene. We present CAT3D, a method for creating anything in 3D by simulating this real-world capture process with a multi-view diffusion model. Given any number of input images and a set of target novel viewpoints, our model generates highly consistent novel views of a scene. These generated views can be used as input to robust 3D reconstruction techniques to produce 3D representations that can be rendered from any viewpoint in real-time. CAT3D can create entire 3D scenes in as little as one minute, and outperforms existing methods for single image and few-view 3D scene creation. See our project page for results and interactive demos at https://cat3d.github.io .

Surgical simulation offers a promising addition to conventional surgical training. However, available simulation tools lack photorealism and rely on hardcoded behaviour. Denoising Diffusion Models are a promising alternative for high-fidelity image synthesis, but existing state-of-the-art conditioning methods fall short in providing precise control or interactivity over the generated scenes. We introduce SurGrID, a Scene Graph to Image Diffusion Model, allowing for controllable surgical scene synthesis by leveraging Scene Graphs. These graphs encode a surgical scene's components' spatial and semantic information, which are then translated into an intermediate representation using our novel pre-training step that explicitly captures local and global information. Our proposed method improves the fidelity of generated images and their coherence with the graph input over the state-of-the-art. Further, we demonstrate the simulation's realism and controllability in a user assessment study involving clinical experts. Scene Graphs can be effectively used for precise and interactive conditioning of Denoising Diffusion Models for simulating surgical scenes, enabling high fidelity and interactive control over the generated content.

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

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

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

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.

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

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.

In this work, we develop an open-source surgical simulation environment that includes a realistic model obtained by MRI-scanning a physical phantom, for the purpose of training and evaluating a Learning from Demonstration (LfD) algorithm for autonomous suturing. The LfD algorithm utilizes Dynamic Movement Primitives (DMP) and Locally Weighted Regression (LWR), but focuses on the needle trajectory, rather than the instruments, to obtain better generality with respect to needle grasps. We conduct a user study to collect multiple suturing demonstrations and perform a comprehensive analysis of the ability of the LfD algorithm to generalize from a demonstration at one location in one phantom to different locations in the same phantom and to a different phantom. Our results indicate good generalization, on the order of 91.5%, when learning from more experienced subjects, indicating the need to integrate skill assessment in the future.

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

Ultrasound (US) is a widely used medical imaging modality due to its real-time capabilities, non-invasive nature, and cost-effectiveness. Robotic ultrasound can further enhance its utility by reducing operator dependence and improving access to complex anatomical regions. For this, while deep reinforcement learning (DRL) and imitation learning (IL) have shown potential for autonomous navigation, their use in complex surgical tasks such as anatomy reconstruction and surgical guidance remains limited -- largely due to the lack of realistic and efficient simulation environments tailored to these tasks. We introduce SonoGym, a scalable simulation platform for complex robotic ultrasound tasks that enables parallel simulation across tens to hundreds of environments. Our framework supports realistic and real-time simulation of US data from CT-derived 3D models of the anatomy through both a physics-based and a generative modeling approach. Sonogym enables the training of DRL and recent IL agents (vision transformers and diffusion policies) for relevant tasks in robotic orthopedic surgery by integrating common robotic platforms and orthopedic end effectors. We further incorporate submodular DRL -- a recent method that handles history-dependent rewards -- for anatomy reconstruction and safe reinforcement learning for surgery. Our results demonstrate successful policy learning across a range of scenarios, while also highlighting the limitations of current methods in clinically relevant environments. We believe our simulation can facilitate research in robot learning approaches for such challenging robotic surgery applications. Dataset, codes, and videos are publicly available at https://sonogym.github.io/.

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.

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.

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.

We introduce neural lithography to address the 'design-to-manufacturing' gap in computational optics. Computational optics with large design degrees of freedom enable advanced functionalities and performance beyond traditional optics. However, the existing design approaches often overlook the numerical modeling of the manufacturing process, which can result in significant performance deviation between the design and the fabricated optics. To bridge this gap, we, for the first time, propose a fully differentiable design framework that integrates a pre-trained photolithography simulator into the model-based optical design loop. Leveraging a blend of physics-informed modeling and data-driven training using experimentally collected datasets, our photolithography simulator serves as a regularizer on fabrication feasibility during design, compensating for structure discrepancies introduced in the lithography process. We demonstrate the effectiveness of our approach through two typical tasks in computational optics, where we design and fabricate a holographic optical element (HOE) and a multi-level diffractive lens (MDL) using a two-photon lithography system, showcasing improved optical performance on the task-specific metrics.

Photorealistic simulators are essential for the training and evaluation of vision-centric autonomous vehicles (AVs). At their core is Novel View Synthesis (NVS), a crucial capability that generates diverse unseen viewpoints to accommodate the broad and continuous pose distribution of AVs. Recent advances in radiance fields, such as 3D Gaussian Splatting, achieve photorealistic rendering at real-time speeds and have been widely used in modeling large-scale driving scenes. However, their performance is commonly evaluated using an interpolated setup with highly correlated training and test views. In contrast, extrapolation, where test views largely deviate from training views, remains underexplored, limiting progress in generalizable simulation technology. To address this gap, we leverage publicly available AV datasets with multiple traversals, multiple vehicles, and multiple cameras to build the first Extrapolated Urban View Synthesis (EUVS) benchmark. Meanwhile, we conduct quantitative and qualitative evaluations of state-of-the-art Gaussian Splatting methods across different difficulty levels. Our results show that Gaussian Splatting is prone to overfitting to training views. Besides, incorporating diffusion priors and improving geometry cannot fundamentally improve NVS under large view changes, highlighting the need for more robust approaches and large-scale training. We have released our data to help advance self-driving and urban robotics simulation technology.

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

Realistic video simulation has shown significant potential across diverse applications, from virtual reality to film production. This is particularly true for scenarios where capturing videos in real-world settings is either impractical or expensive. Existing approaches in video simulation often fail to accurately model the lighting environment, represent the object geometry, or achieve high levels of photorealism. In this paper, we propose Anything in Any Scene, a novel and generic framework for realistic video simulation that seamlessly inserts any object into an existing dynamic video with a strong emphasis on physical realism. Our proposed general framework encompasses three key processes: 1) integrating a realistic object into a given scene video with proper placement to ensure geometric realism; 2) estimating the sky and environmental lighting distribution and simulating realistic shadows to enhance the light realism; 3) employing a style transfer network that refines the final video output to maximize photorealism. We experimentally demonstrate that Anything in Any Scene framework produces simulated videos of great geometric realism, lighting realism, and photorealism. By significantly mitigating the challenges associated with video data generation, our framework offers an efficient and cost-effective solution for acquiring high-quality videos. Furthermore, its applications extend well beyond video data augmentation, showing promising potential in virtual reality, video editing, and various other video-centric applications. Please check our project website https://anythinginanyscene.github.io for access to our project code and more high-resolution video results.

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.

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.

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.

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

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/

Recent advances in robot-assisted surgery have resulted in progressively more precise, efficient, and minimally invasive procedures, sparking a new era of robotic surgical intervention. This enables doctors, in collaborative interaction with robots, to perform traditional or minimally invasive surgeries with improved outcomes through smaller incisions. Recent efforts are working toward making robotic surgery more autonomous which has the potential to reduce variability of surgical outcomes and reduce complication rates. Deep reinforcement learning methodologies offer scalable solutions for surgical automation, but their effectiveness relies on extensive data acquisition due to the absence of prior knowledge in successfully accomplishing tasks. Due to the intensive nature of simulated data collection, previous works have focused on making existing algorithms more efficient. In this work, we focus on making the simulator more efficient, making training data much more accessible than previously possible. We introduce Surgical Gym, an open-source high performance platform for surgical robot learning where both the physics simulation and reinforcement learning occur directly on the GPU. We demonstrate between 100-5000x faster training times compared with previous surgical learning platforms. The code is available at: https://github.com/SamuelSchmidgall/SurgicalGym.

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

Surgical instrument segmentation under Federated Learning (FL) is a promising direction, which enables multiple surgical sites to collaboratively train the model without centralizing datasets. However, there exist very limited FL works in surgical data science, and FL methods for other modalities do not consider inherent characteristics in surgical domain: i) different scenarios show diverse anatomical backgrounds while highly similar instrument representation; ii) there exist surgical simulators which promote large-scale synthetic data generation with minimal efforts. In this paper, we propose a novel Personalized FL scheme, Spatio-Temporal Representation Decoupling and Enhancement (FedST), which wisely leverages surgical domain knowledge during both local-site and global-server training to boost segmentation. Concretely, our model embraces a Representation Separation and Cooperation (RSC) mechanism in local-site training, which decouples the query embedding layer to be trained privately, to encode respective backgrounds. Meanwhile, other parameters are optimized globally to capture the consistent representations of instruments, including the temporal layer to capture similar motion patterns. A textual-guided channel selection is further designed to highlight site-specific features, facilitating model adapta tion to each site. Moreover, in global-server training, we propose Synthesis-based Explicit Representation Quantification (SERQ), which defines an explicit representation target based on synthetic data to synchronize the model convergence during fusion for improving model generalization.

Reconstructing deformable tissues from endoscopic videos is essential in many downstream surgical applications. However, existing methods suffer from slow rendering speed, greatly limiting their practical use. In this paper, we introduce EndoGaussian, a real-time endoscopic scene reconstruction framework built on 3D Gaussian Splatting (3DGS). By integrating the efficient Gaussian representation and highly-optimized rendering engine, our framework significantly boosts the rendering speed to a real-time level. To adapt 3DGS for endoscopic scenes, we propose two strategies, Holistic Gaussian Initialization (HGI) and Spatio-temporal Gaussian Tracking (SGT), to handle the non-trivial Gaussian initialization and tissue deformation problems, respectively. In HGI, we leverage recent depth estimation models to predict depth maps of input binocular/monocular image sequences, based on which pixels are re-projected and combined for holistic initialization. In SPT, we propose to model surface dynamics using a deformation field, which is composed of an efficient encoding voxel and a lightweight deformation decoder, allowing for Gaussian tracking with minor training and rendering burden. Experiments on public datasets demonstrate our efficacy against prior SOTAs in many aspects, including better rendering speed (195 FPS real-time, 100times gain), better rendering quality (37.848 PSNR), and less training overhead (within 2 min/scene), showing significant promise for intraoperative surgery applications. Code is available at: https://yifliu3.github.io/EndoGaussian/.

Simulation offers a scalable and low-cost way to enrich vision-language-action (VLA) training, reducing reliance on expensive real-robot demonstrations. However, most sim-real co-training methods rely on supervised fine-tuning (SFT), which treats simulation as a static source of demonstrations and does not exploit large-scale closed-loop interaction. Consequently, real-world gains and generalization are often limited. In this paper, we propose an \textit{RL}-based sim-real \textit{Co}-training (RL-Co) framework that leverages interactive simulation while preserving real-world capabilities. Our method follows a generic two-stage design: we first warm-start the policy with SFT on a mixture of real and simulated demonstrations, then fine-tune it with reinforcement learning in simulation while adding an auxiliary supervised loss on real-world data to anchor the policy and mitigate catastrophic forgetting. We evaluate our framework on four real-world tabletop manipulation tasks using two representative VLA architectures, OpenVLA and π_{0.5}, and observe consistent improvements over real-only fine-tuning and SFT-based co-training, including +24% real-world success on OpenVLA and +20% on π_{0.5}. Beyond higher success rates, RL co-training yields stronger generalization to unseen task variations and substantially improved real-world data efficiency, providing a practical and scalable pathway for leveraging simulation to enhance real-robot deployment.

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

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.

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.

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.

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

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

Autonomous medical robots hold promise to improve patient outcomes, reduce provider workload, democratize access to care, and enable superhuman precision. However, autonomous medical robotics has been limited by a fundamental data problem: existing medical robotic datasets are small, single-embodiment, and rarely shared openly, restricting the development of foundation models that the field needs to advance. We introduce Open-H-Embodiment, the largest open dataset of medical robotic video with synchronized kinematics to date, spanning more than 49 institutions and multiple robotic platforms including the CMR Versius, Intuitive Surgical's da Vinci, da Vinci Research Kit (dVRK), Rob Surgical BiTrack, Virtual Incision's MIRA, Moon Surgical Maestro, and a variety of custom systems, spanning surgical manipulation, robotic ultrasound, and endoscopy procedures. We demonstrate the research enabled by this dataset through two foundation models. GR00T-H is the first open foundation vision-language-action model for medical robotics, which is the only evaluated model to achieve full end-to-end task completion on a structured suturing benchmark (25% of trials vs. 0% for all others) and achieves 64% average success across a 29-step ex vivo suturing sequence. We also train Cosmos-H-Surgical-Simulator, the first action-conditioned world model to enable multi-embodiment surgical simulation from a single checkpoint, spanning nine robotic platforms and supporting in silico policy evaluation and synthetic data generation for the medical domain. These results suggest that open, large-scale medical robot data collection can serve as critical infrastructure for the research community, enabling advances in robot learning, world modeling, and beyond.

Simulation is widely used in robotics for system verification and large-scale data collection. However, simulating sensors, including tactile sensors, has been a long-standing challenge. In this paper, we propose Taxim, a realistic and high-speed simulation model for a vision-based tactile sensor, GelSight. A GelSight sensor uses a piece of soft elastomer as the medium of contact and embeds optical structures to capture the deformation of the elastomer, which infers the geometry and forces applied at the contact surface. We propose an example-based method for simulating GelSight: we simulate the optical response to the deformation with a polynomial look-up table. This table maps the deformed geometries to pixel intensity sampled by the embedded camera. In order to simulate the surface markers' motion that is caused by the surface stretch of the elastomer, we apply the linear elastic deformation theory and the superposition principle. The simulation model is calibrated with less than 100 data points from a real sensor. The example-based approach enables the model to easily migrate to other GelSight sensors or its variations. To the best of our knowledge, our simulation framework is the first to incorporate marker motion field simulation that derives from elastomer deformation together with the optical simulation, creating a comprehensive and computationally efficient tactile simulation framework. Experiments reveal that our optical simulation has the lowest pixel-wise intensity errors compared to prior work and can run online with CPU computing. Our code and supplementary materials are open-sourced at https://github.com/CMURoboTouch/Taxim.

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

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

Acupuncture is a widely adopted medical practice that involves inserting thin needles into specific points on the body to alleviate pain and treat various health conditions. Current learning practices heavily rely on 2D atlases and practice on peers, which are notably less intuitive and pose risks, particularly in sensitive areas such as the eyes. To address these challenges, we introduce AcuVR, a Virtual Reality (VR) based system designed to add a layer of interactivity and realism. This innovation aims to reduce the risks associated with practicing acupuncture techniques while offering more effective learning strategies. Furthermore, AcuVR incorporates medical imaging and standardized anatomy models, enabling the simulation of customized acupuncture scenarios. This feature represents a significant advancement beyond the limitations of conventional resources such as atlases and textbooks, facilitating a more immersive and personalized learning experience. The evaluation study with eight acupuncture students and practitioners revealed high participant satisfaction and pointed to the effectiveness and potential of AcuVR as a valuable addition to acupuncture training.

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.

While self-supervised pretraining has reduced vision systems' reliance on synthetic data, simulation remains an indispensable tool for closed-loop optimization and rigorous out-of-distribution (OOD) evaluation. However, modern simulation platforms often present steep technical barriers, requiring extensive expertise in computer graphics and game development. In this work, we present LychSim, a highly controllable and interactive simulation framework built upon Unreal Engine 5 to bridge this gap. LychSim is built around three key designs: (1) a streamlined Python API that abstracts away underlying engine complexities; (2) a procedural data pipeline capable of generating diverse, high-fidelity environments with varying out-of-distribution (OOD) visual challenges, paired with rich 2D and 3D ground truths; and (3) a native integration of the Model Context Protocol (MCP) that transforms the simulator into a dynamic, closed-loop playground for reasoning agentic LLMs. We further annotate scene-level procedural rules and object-level pose alignments to enable semantically aligned 3D ground truths and automated scene modification. We demonstrate LychSim's capability across multiple downstream applications, including serving as a synthetic data engine, powering reinforcement learning-based adversarial examiners, and facilitating interactive, language-driven scene layout generation. To benefit the broader vision community, LychSim will be made publicly available, including full source code and various data annotations.

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.

Throughout the different phases of a drug development program, randomized trials are used to establish the tolerability, safety, and efficacy of a candidate drug. At each stage one aims to optimize the design of future studies by extrapolation from the available evidence at the time. This includes collected trial data and relevant external data. However, relevant external data are typically available as averages only, for example from trials on alternative treatments reported in the literature. Here we report on such an example from a drug development for wet age-related macular degeneration. This disease is the leading cause of severe vision loss in the elderly. While current treatment options are efficacious, they are also a substantial burden for the patient. Hence, new treatments are under development which need to be compared against existing treatments. The general statistical problem this leads to is meta-analysis, which addresses the question of how we can combine datasets collected under different conditions. Bayesian methods have long been used to achieve partial pooling. Here we consider the challenge when the model of interest is complex (hierarchical and nonlinear) and one dataset is given as raw data while the second dataset is given as averages only. In such a situation, common meta-analytic methods can only be applied when the model is sufficiently simple for analytic approaches. When the model is too complex, for example nonlinear, an analytic approach is not possible. We provide a Bayesian solution by using simulation to approximately reconstruct the likelihood of the external summary and allowing the parameters in the model to vary under the different conditions. We first evaluate our approach using fake-data simulations and then report results for the drug development program that motivated this research.

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.

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.

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

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

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

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/.

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.

Optical design is the process of configuring optical elements to precisely manipulate light for high-fidelity imaging. It is inherently a highly non-convex optimization problem that relies heavily on human heuristic expertise and domain-specific knowledge. While Large Language Models (LLMs) possess extensive optical knowledge, their capabilities in leveraging the knowledge in designing lens system remain significantly constrained. This work represents the first attempt to employ LLMs in the field of optical design. We bridge the expertise gap by enabling users without formal optical training to successfully develop functional lens systems. Concretely, we curate a comprehensive dataset, named OptiDesignQA, which encompasses both classical lens systems sourced from standard optical textbooks and novel configurations generated by automated design algorithms for training and evaluation. Furthermore, we inject domain-specific optical expertise into the LLM through a hybrid objective of full-system synthesis and lens completion. To align the model with optical principles, we employ Group Relative Policy Optimization Done Right (DrGRPO) guided by Optical Lexicographic Reward for physics-driven policy alignment. This reward system incorporates structural format rewards, physical feasibility rewards, light-manipulation accuracy, and LLM-based heuristics. Finally, our model integrates with specialized optical optimization routines for end-to-end fine-tuning and precision refinement. We benchmark our proposed method against both traditional optimization-based automated design algorithms and LLM counterparts, and experimental results show the superiority of our method.

Problem: Effective patient-centered communication is a core competency for physicians. However, both seasoned providers and medical trainees report decreased confidence in leading conversations on sensitive topics such as goals of care or end-of-life discussions. The significant administrative burden and the resources required to provide dedicated training in leading difficult conversations has been a long-standing problem in medical education. Approach: In this work, we present a novel educational tool designed to facilitate interactive, real-time simulations of difficult conversations in a video-based format through the use of multimodal generative artificial intelligence (AI). Leveraging recent advances in language modeling, computer vision, and generative audio, this tool creates realistic, interactive scenarios with avatars, or "synthetic patients." These synthetic patients interact with users throughout various stages of medical care using a custom-built video chat application, offering learners the chance to practice conversations with patients from diverse belief systems, personalities, and ethnic backgrounds. Outcomes: While the development of this platform demanded substantial upfront investment in labor, it offers a highly-realistic simulation experience with minimal financial investment. For medical trainees, this educational tool can be implemented within programs to simulate patient-provider conversations and can be incorporated into existing palliative care curriculum to provide a scalable, high-fidelity simulation environment for mastering difficult conversations. Next Steps: Future developments will explore enhancing the authenticity of these encounters by working with patients to incorporate their histories and personalities, as well as employing the use of AI-generated evaluations to offer immediate, constructive feedback to learners post-simulation.

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

Providing effective treatment and making informed clinical decisions are essential goals of modern medicine and clinical care. We are interested in simulating disease dynamics for clinical decision-making, leveraging recent advances in large generative models. To this end, we introduce the Medical World Model (MeWM), the first world model in medicine that visually predicts future disease states based on clinical decisions. MeWM comprises (i) vision-language models to serve as policy models, and (ii) tumor generative models as dynamics models. The policy model generates action plans, such as clinical treatments, while the dynamics model simulates tumor progression or regression under given treatment conditions. Building on this, we propose the inverse dynamics model that applies survival analysis to the simulated post-treatment tumor, enabling the evaluation of treatment efficacy and the selection of the optimal clinical action plan. As a result, the proposed MeWM simulates disease dynamics by synthesizing post-treatment tumors, with state-of-the-art specificity in Turing tests evaluated by radiologists. Simultaneously, its inverse dynamics model outperforms medical-specialized GPTs in optimizing individualized treatment protocols across all metrics. Notably, MeWM improves clinical decision-making for interventional physicians, boosting F1-score in selecting the optimal TACE protocol by 13%, paving the way for future integration of medical world models as the second readers.

The integration of artificial intelligence in image-guided interventions holds transformative potential, promising to extract 3D geometric and quantitative information from conventional 2D imaging modalities during complex procedures. Achieving this requires the rapid and precise alignment of 2D intraoperative images (e.g., X-ray) with 3D preoperative volumes (e.g., CT, MRI). However, current 2D/3D registration methods fail across the broad spectrum of procedures dependent on X-ray guidance: traditional optimization techniques require custom parameter tuning for each subject, whereas neural networks trained on small datasets do not generalize to new patients or require labor-intensive manual annotations, increasing clinical burden and precluding application to new anatomical targets. To address these challenges, we present xvr, a fully automated framework for training patient-specific neural networks for 2D/3D registration. xvr uses physics-based simulation to generate abundant high-quality training data from a patient's own preoperative volumetric imaging, thereby overcoming the inherently limited ability of supervised models to generalize to new patients and procedures. Furthermore, xvr requires only 5 minutes of training per patient, making it suitable for emergency interventions as well as planned procedures. We perform the largest evaluation of a 2D/3D registration algorithm on real X-ray data to date and find that xvr robustly generalizes across a diverse dataset comprising multiple anatomical structures, imaging modalities, and hospitals. Across surgical tasks, xvr achieves submillimeter-accurate registration at intraoperative speeds, improving upon existing methods by an order of magnitude. xvr is released as open-source software freely available at https://github.com/eigenvivek/xvr.

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

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

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.

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.

Realistic physics engines play a crucial role for learning to manipulate deformable objects such as garments in simulation. By doing so, researchers can circumvent challenges such as sensing the deformation of the object in the realworld. In spite of the extensive use of simulations for this task, few works have evaluated the reality gap between deformable object simulators and real-world data. We present a benchmark dataset to evaluate the sim-to-real gap in cloth manipulation. The dataset is collected by performing a dynamic as well as a quasi-static cloth manipulation task involving contact with a rigid table. We use the dataset to evaluate the reality gap, computational time, and simulation stability of four popular deformable object simulators: MuJoCo, Bullet, Flex, and SOFA. Additionally, we discuss the benefits and drawbacks of each simulator. The benchmark dataset is open-source. Supplementary material, videos, and code, can be found at https://sites.google.com/view/cloth-sim2real-benchmark.

Minimally invasive and robot-assisted surgery relies heavily on endoscopic imaging, yet surgical smoke produced by electrocautery and vessel-sealing instruments can severely degrade visual perception and hinder vision-based functionalities. We present a transformer-based surgical desmoking model with a physics-inspired desmoking head that jointly predicts smoke-free image and corresponding smoke map. To address the scarcity of paired smoky-to-smoke-free training data, we develop a synthetic data generation pipeline that blends artificial smoke patterns with real endoscopic images, yielding over 80,000 paired samples for supervised training. We further curate, to our knowledge, the largest paired surgical smoke dataset to date, comprising 5,817 image pairs captured with the da Vinci robotic surgical system, enabling benchmarking on high-resolution endoscopic images. Extensive experiments on both a public benchmark and our dataset demonstrate state-of-the-art performance in image reconstruction compared to existing dehazing and desmoking approaches. We also assess the impact of desmoking on downstream stereo depth estimation and instrument segmentation, highlighting both the potential benefits and current limitations of digital smoke removal methods.

Though the success of CLIP-based training recipes in vision-language models, their scalability to more modalities (e.g., 3D, audio, etc.) is limited to large-scale data, which is expensive or even inapplicable for rare modalities. In this paper, we present ViT-Lens that facilitates efficient omni-modal representation learning by perceiving novel modalities with a pretrained ViT and aligning to a pre-defined space. Specifically, the modality-specific lens is tuned to project multimodal signals to the shared embedding space, which are then processed by a strong ViT that carries pre-trained image knowledge. The encoded multimodal representations are optimized toward aligning with the modal-independent space, pre-defined by off-the-shelf foundation models. A well-trained lens with a ViT backbone has the potential to serve as one of these foundation models, supervising the learning of subsequent modalities. ViT-Lens provides a unified solution for representation learning of increasing modalities with two appealing benefits: (i) Exploiting the pretrained ViT across tasks and domains effectively with efficient data regime; (ii) Emergent downstream capabilities of novel modalities are demonstrated due to the modality alignment space. We evaluate ViT-Lens in the context of 3D as an initial verification. In zero-shot 3D classification, ViT-Lens achieves substantial improvements over previous state-of-the-art, showing 52.0% accuracy on Objaverse-LVIS, 87.4% on ModelNet40, and 60.6% on ScanObjectNN. Furthermore, we enable zero-shot 3D question-answering by simply integrating the trained 3D lens into the InstructBLIP model without any adaptation. We will release the results of ViT-Lens on more modalities in the near future.

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

The reflective nature of the human eye is an underappreciated source of information about what the world around us looks like. By imaging the eyes of a moving person, we can collect multiple views of a scene outside the camera's direct line of sight through the reflections in the eyes. In this paper, we reconstruct a 3D scene beyond the camera's line of sight using portrait images containing eye reflections. This task is challenging due to 1) the difficulty of accurately estimating eye poses and 2) the entangled appearance of the eye iris and the scene reflections. Our method jointly refines the cornea poses, the radiance field depicting the scene, and the observer's eye iris texture. We further propose a simple regularization prior on the iris texture pattern to improve reconstruction quality. Through various experiments on synthetic and real-world captures featuring people with varied eye colors, we demonstrate the feasibility of our approach to recover 3D scenes using eye reflections.

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

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.

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.

Benchmarking vision-based driving policies is challenging. On one hand, open-loop evaluation with real data is easy, but these results do not reflect closed-loop performance. On the other, closed-loop evaluation is possible in simulation, but is hard to scale due to its significant computational demands. Further, the simulators available today exhibit a large domain gap to real data. This has resulted in an inability to draw clear conclusions from the rapidly growing body of research on end-to-end autonomous driving. In this paper, we present NAVSIM, a middle ground between these evaluation paradigms, where we use large datasets in combination with a non-reactive simulator to enable large-scale real-world benchmarking. Specifically, we gather simulation-based metrics, such as progress and time to collision, by unrolling bird's eye view abstractions of the test scenes for a short simulation horizon. Our simulation is non-reactive, i.e., the evaluated policy and environment do not influence each other. As we demonstrate empirically, this decoupling allows open-loop metric computation while being better aligned with closed-loop evaluations than traditional displacement errors. NAVSIM enabled a new competition held at CVPR 2024, where 143 teams submitted 463 entries, resulting in several new insights. On a large set of challenging scenarios, we observe that simple methods with moderate compute requirements such as TransFuser can match recent large-scale end-to-end driving architectures such as UniAD. Our modular framework can potentially be extended with new datasets, data curation strategies, and metrics, and will be continually maintained to host future challenges. Our code is available at https://github.com/autonomousvision/navsim.

Over the past decade, computer vision applications in minimally invasive surgery have rapidly increased. Despite this growth, the impact of surgical computer vision remains limited compared to other medical fields like pathology and radiology, primarily due to the scarcity of representative annotated data. Whereas transfer learning from large annotated datasets such as ImageNet has been conventionally the norm to achieve high-performing models, recent advancements in self-supervised learning (SSL) have demonstrated superior performance. In medical image analysis, in-domain SSL pretraining has already been shown to outperform ImageNet-based initialization. Although unlabeled data in the field of surgical computer vision is abundant, the diversity within this data is limited. This study investigates the role of dataset diversity in SSL for surgical computer vision, comparing procedure-specific datasets against a more heterogeneous general surgical dataset across three different downstream surgical applications. The obtained results show that using solely procedure-specific data can lead to substantial improvements of 13.8%, 9.5%, and 36.8% compared to ImageNet pretraining. However, extending this data with more heterogeneous surgical data further increases performance by an additional 5.0%, 5.2%, and 2.5%, suggesting that increasing diversity within SSL data is beneficial for model performance. The code and pretrained model weights are made publicly available at https://github.com/TimJaspers0801/SurgeNet.

We present an imaging and neural rendering technique that seeks to synthesize videos of light propagating through a scene from novel, moving camera viewpoints. Our approach relies on a new ultrafast imaging setup to capture a first-of-its kind, multi-viewpoint video dataset with picosecond-level temporal resolution. Combined with this dataset, we introduce an efficient neural volume rendering framework based on the transient field. This field is defined as a mapping from a 3D point and 2D direction to a high-dimensional, discrete-time signal that represents time-varying radiance at ultrafast timescales. Rendering with transient fields naturally accounts for effects due to the finite speed of light, including viewpoint-dependent appearance changes caused by light propagation delays to the camera. We render a range of complex effects, including scattering, specular reflection, refraction, and diffraction. Additionally, we demonstrate removing viewpoint-dependent propagation delays using a time warping procedure, rendering of relativistic effects, and video synthesis of direct and global components of light transport.

Reliable depth estimation under real optical conditions remains a core challenge for camera vision in systems such as autonomous robotics and augmented reality. Despite recent progress in depth estimation and depth-of-field rendering, research remains constrained by the lack of large-scale, high-fidelity, real stereo DSLR datasets, limiting real-world generalization and evaluation of models trained on synthetic data as shown extensively in literature. We present the first high-resolution (5472times3648px) stereo DSLR dataset with 18000 images, systematically varying focal length and aperture across complex real scenes and capturing the optical realism and complexity of professional camera systems. For 9 scenes with varying scene complexity, lighting and background, images are captured with two identical camera assemblies at 10 focal lengths (28-70mm) and 5 apertures (f/2.8-f/22), spanning 50 optical configurations in 2000 images per scene. This full-range optics coverage enables controlled analysis of geometric and optical effects for monocular and stereo depth estimation, shallow depth-of-field rendering, deblurring, 3D scene reconstruction and novel view synthesis. Each focal configuration has a dedicated calibration image set, supporting evaluation of classical and learning based methods for intrinsic and extrinsic calibration. The dataset features challenging visual elements such as multi-scale optical illusions, reflective surfaces, mirrors, transparent glass walls, fine-grained details, and natural / artificial ambient light variations. This work attempts to bridge the realism gap between synthetic training data and real camera optics, and demonstrates challenges with the current state-of-the-art monocular, stereo depth and depth-of-field methods. We release the dataset, calibration files, and evaluation code to support reproducible research on real-world optical generalization.

We introduce VascX models, a comprehensive set of model ensembles for analyzing retinal vasculature from color fundus images (CFIs). Annotated CFIs were aggregated from public datasets for vessel, artery-vein, and disc segmentation; and fovea localization. Additional CFIs from the population-based Rotterdam Study were, with arteries and veins annotated by graders at pixel level. Our models achieved robust performance across devices from different vendors, varying levels of image quality levels, and diverse pathologies. Our models demonstrated superior segmentation performance compared to existing systems under a variety of conditions. Significant enhancements were observed in artery-vein and disc segmentation performance, particularly in segmentations of these structures on CFIs of intermediate quality, a common characteristic of large cohorts and clinical datasets. Our model outperformed human graders in segmenting vessels with greater precision. With VascX models we provide a robust, ready-to-use set of model ensembles and inference code aimed at simplifying the implementation and enhancing the quality of automated retinal vasculature analyses. The precise vessel parameters generated by the model can serve as starting points for the identification of disease patterns in and outside of the eye.

The accuracy of learning-based optical flow estimation models heavily relies on the realism of the training datasets. Current approaches for generating such datasets either employ synthetic data or generate images with limited realism. However, the domain gap of these data with real-world scenes constrains the generalization of the trained model to real-world applications. To address this issue, we investigate generating realistic optical flow datasets from real-world images. Firstly, to generate highly realistic new images, we construct a layered depth representation, known as multiplane images (MPI), from single-view images. This allows us to generate novel view images that are highly realistic. To generate optical flow maps that correspond accurately to the new image, we calculate the optical flows of each plane using the camera matrix and plane depths. We then project these layered optical flows into the output optical flow map with volume rendering. Secondly, to ensure the realism of motion, we present an independent object motion module that can separate the camera and dynamic object motion in MPI. This module addresses the deficiency in MPI-based single-view methods, where optical flow is generated only by camera motion and does not account for any object movement. We additionally devise a depth-aware inpainting module to merge new images with dynamic objects and address unnatural motion occlusions. We show the superior performance of our method through extensive experiments on real-world datasets. Moreover, our approach achieves state-of-the-art performance in both unsupervised and supervised training of learning-based models. The code will be made publicly available at: https://github.com/Sharpiless/MPI-Flow.

In recent years, the potential applications of machine learning to Minimally Invasive Surgery (MIS) have spurred interest in data sets that can be used to develop data-driven tools. This paper introduces a novel dataset recorded during ex vivo pseudo-cholecystectomy procedures on pig livers, utilizing the da Vinci Research Kit (dVRK). Unlike current datasets, ours bridges a critical gap by offering not only full kinematic data but also capturing all pedal inputs used during the procedure and providing a time-stamped record of the endoscope's movements. Contributed by seven surgeons, this data set introduces a new dimension to surgical robotics research, allowing the creation of advanced models for automating console functionalities. Our work addresses the existing limitation of incomplete recordings and imprecise kinematic data, common in other datasets. By introducing two models, dedicated to predicting clutch usage and camera activation, we highlight the dataset's potential for advancing automation in surgical robotics. The comparison of methodologies and time windows provides insights into the models' boundaries and limitations.

Currently, evaluating vision-language models (VLMs) in medical imaging tasks oversimplifies clinical reality by relying on pre-selected 2D images that demand significant manual labor to curate. This setup misses the core challenge of realworld diagnostics: a true clinical agent must actively navigate full 3D volumes across multiple sequences or modalities to gather evidence and ultimately support a final decision. To address this, we propose MEDOPENCLAW, an auditable runtime designed to let VLMs operate dynamically within standard medical tools or viewers (e.g., 3D Slicer). On top of this runtime, we introduce MEDFLOWBENCH, a full-study medical imaging benchmark covering multi-sequence brain MRI and lung CT/PET. It systematically evaluates medical agentic capabilities across viewer-only, tool-use, and open-method tracks. Initial results reveal a critical insight: while state-of-the-art LLMs/VLMs (e.g., Gemini 3.1 Pro and GPT-5.4) can successfully navigate the viewer to solve basic study-level tasks, their performance paradoxically degrades when given access to professional support tools due to a lack of precise spatial grounding. By bridging the gap between static-image perception and interactive clinical workflows, MEDOPENCLAW and MEDFLOWBENCH establish a reproducible foundation for developing auditable, full-study medical imaging agents.

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

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.

We present CAT4D, a method for creating 4D (dynamic 3D) scenes from monocular video. CAT4D leverages a multi-view video diffusion model trained on a diverse combination of datasets to enable novel view synthesis at any specified camera poses and timestamps. Combined with a novel sampling approach, this model can transform a single monocular video into a multi-view video, enabling robust 4D reconstruction via optimization of a deformable 3D Gaussian representation. We demonstrate competitive performance on novel view synthesis and dynamic scene reconstruction benchmarks, and highlight the creative capabilities for 4D scene generation from real or generated videos. See our project page for results and interactive demos: cat-4d.github.io.

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

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.

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.

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

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

While there has been significant progress in the field of 3D avatar creation from visual observations, modeling physically plausible dynamics of humans with loose garments remains a challenging problem. Although a few existing works address this problem by leveraging physical simulation, they suffer from limited accuracy or robustness to novel animation inputs. In this work, we present MPMAvatar, a framework for creating 3D human avatars from multi-view videos that supports highly realistic, robust animation, as well as photorealistic rendering from free viewpoints. For accurate and robust dynamics modeling, our key idea is to use a Material Point Method-based simulator, which we carefully tailor to model garments with complex deformations and contact with the underlying body by incorporating an anisotropic constitutive model and a novel collision handling algorithm. We combine this dynamics modeling scheme with our canonical avatar that can be rendered using 3D Gaussian Splatting with quasi-shadowing, enabling high-fidelity rendering for physically realistic animations. In our experiments, we demonstrate that MPMAvatar significantly outperforms the existing state-of-the-art physics-based avatar in terms of (1) dynamics modeling accuracy, (2) rendering accuracy, and (3) robustness and efficiency. Additionally, we present a novel application in which our avatar generalizes to unseen interactions in a zero-shot manner-which was not achievable with previous learning-based methods due to their limited simulation generalizability. Our project page is at: https://KAISTChangmin.github.io/MPMAvatar/

Smoke generated by surgical instruments during laparoscopic surgery can obscure the visual field, impairing surgeons' ability to perform operations accurately and safely. Thus, smoke removal task for laparoscopic images is highly desirable. Despite laparoscopic image desmoking has attracted the attention of researchers in recent years and several algorithms have emerged, the lack of publicly available high-quality benchmark datasets is the main bottleneck to hamper the development progress of this task. To advance this field, we construct a new high-quality dataset for Laparoscopic Surgery image Desmoking, named LSD3K, consisting of 3,000 paired synthetic non-homogeneous smoke images. In this paper, we provide a dataset generation pipeline, which includes modeling smoke shape using Blender, collecting ground-truth images from the Cholec80 dataset, random sampling of smoke masks and etc. Based on the proposed benchmark, we further conducted a comprehensive evaluation of the existing representative desmoking algorithms. The proposed dataset is publicly available at https://drive.google.com/file/d/1v0U5_3S4nJpaUiP898Q0pc-MfEAtnbOq/view?usp=sharing

Accurate 3D scene reconstruction is essential for numerous medical tasks. Given the challenges in obtaining ground truth data, there has been an increasing focus on self-supervised learning (SSL) for endoscopic depth estimation as a basis for scene reconstruction. While foundation models have shown remarkable progress in visual tasks, their direct application to the medical domain often leads to suboptimal results. However, the visual features from these models can still enhance endoscopic tasks, emphasizing the need for efficient adaptation strategies, which still lack exploration currently. In this paper, we introduce Endo3DAC, a unified framework for endoscopic scene reconstruction that efficiently adapts foundation models. We design an integrated network capable of simultaneously estimating depth maps, relative poses, and camera intrinsic parameters. By freezing the backbone foundation model and training only the specially designed Gated Dynamic Vector-Based Low-Rank Adaptation (GDV-LoRA) with separate decoder heads, Endo3DAC achieves superior depth and pose estimation while maintaining training efficiency. Additionally, we propose a 3D scene reconstruction pipeline that optimizes depth maps' scales, shifts, and a few parameters based on our integrated network. Extensive experiments across four endoscopic datasets demonstrate that Endo3DAC significantly outperforms other state-of-the-art methods while requiring fewer trainable parameters. To our knowledge, we are the first to utilize a single network that only requires surgical videos to perform both SSL depth estimation and scene reconstruction tasks. The code will be released upon acceptance.

Simulators are indispensable for research in autonomous systems such as self-driving cars, autonomous robots and drones. Despite significant progress in various simulation aspects, such as graphical realism, an evident gap persists between the virtual and real-world environments. Since the ultimate goal is to deploy the autonomous systems in the real world, closing the sim2real gap is of utmost importance. In this paper, we employ a state-of-the-art approach to enhance the photorealism of simulated data, aligning them with the visual characteristics of real-world datasets. Based on this, we developed CARLA2Real, an easy-to-use, publicly available tool (plug-in) for the widely used and open-source CARLA simulator. This tool enhances the output of CARLA in near real-time, achieving a frame rate of 13 FPS, translating it to the visual style and realism of real-world datasets such as Cityscapes, KITTI, and Mapillary Vistas. By employing the proposed tool, we generated synthetic datasets from both the simulator and the enhancement model outputs, including their corresponding ground truth annotations for tasks related to autonomous driving. Then, we performed a number of experiments to evaluate the impact of the proposed approach on feature extraction and semantic segmentation methods when trained on the enhanced synthetic data. The results demonstrate that the sim2real gap is significant and can indeed be reduced by the introduced approach.

Neural Radiance Fields (NeRF) is a revolutionary approach for rendering scenes by sampling a single ray per pixel and it has demonstrated impressive capabilities in novel-view synthesis from static scene images. However, in practice, we usually need to recover NeRF from unconstrained image collections, which poses two challenges: 1) the images often have dynamic changes in appearance because of different capturing time and camera settings; 2) the images may contain transient objects such as humans and cars, leading to occlusion and ghosting artifacts. Conventional approaches seek to address these challenges by locally utilizing a single ray to synthesize a color of a pixel. In contrast, humans typically perceive appearance and objects by globally utilizing information across multiple pixels. To mimic the perception process of humans, in this paper, we propose Cross-Ray NeRF (CR-NeRF) that leverages interactive information across multiple rays to synthesize occlusion-free novel views with the same appearances as the images. Specifically, to model varying appearances, we first propose to represent multiple rays with a novel cross-ray feature and then recover the appearance by fusing global statistics, i.e., feature covariance of the rays and the image appearance. Moreover, to avoid occlusion introduced by transient objects, we propose a transient objects handler and introduce a grid sampling strategy for masking out the transient objects. We theoretically find that leveraging correlation across multiple rays promotes capturing more global information. Moreover, extensive experimental results on large real-world datasets verify the effectiveness of CR-NeRF.

Gaze redirection is the task of changing the gaze to a desired direction for a given monocular eye patch image. Many applications such as videoconferencing, films, games, and generation of training data for gaze estimation require redirecting the gaze, without distorting the appearance of the area surrounding the eye and while producing photo-realistic images. Existing methods lack the ability to generate perceptually plausible images. In this work, we present a novel method to alleviate this problem by leveraging generative adversarial training to synthesize an eye image conditioned on a target gaze direction. Our method ensures perceptual similarity and consistency of synthesized images to the real images. Furthermore, a gaze estimation loss is used to control the gaze direction accurately. To attain high-quality images, we incorporate perceptual and cycle consistency losses into our architecture. In extensive evaluations we show that the proposed method outperforms state-of-the-art approaches in terms of both image quality and redirection precision. Finally, we show that generated images can bring significant improvement for the gaze estimation task if used to augment real training data.

Digitally reconstructed radiographs (DRRs) are simulated 2D X-ray images generated from 3D CT volumes, widely used in preoperative settings but limited in intraoperative applications due to computational bottlenecks, especially for accurate but heavy physics-based Monte Carlo methods. While analytical DRR renderers offer greater efficiency, they overlook anisotropic X-ray image formation phenomena, such as Compton scattering. We present a novel approach that marries realistic physics-inspired X-ray simulation with efficient, differentiable DRR generation using 3D Gaussian splatting (3DGS). Our direction-disentangled 3DGS (DDGS) method separates the radiosity contribution into isotropic and direction-dependent components, approximating complex anisotropic interactions without intricate runtime simulations. Additionally, we adapt the 3DGS initialization to account for tomography data properties, enhancing accuracy and efficiency. Our method outperforms state-of-the-art techniques in image accuracy. Furthermore, our DDGS shows promise for intraoperative applications and inverse problems such as pose registration, delivering superior registration accuracy and runtime performance compared to analytical DRR methods.

Portrait mode is widely available on smartphone cameras to provide an enhanced photographic experience. One of the primary effects applied to images captured in portrait mode is a synthetic shallow depth of field (DoF). The synthetic DoF (or bokeh effect) selectively blurs regions in the image to emulate the effect of using a large lens with a wide aperture. In addition, many applications now incorporate a new image motion attribute (NIMAT) to emulate background motion, where the motion is correlated with estimated depth at each pixel. In this work, we follow the trend of rendering the NIMAT effect by introducing a modification on the blur synthesis procedure in portrait mode. In particular, our modification enables a high-quality synthesis of multi-view bokeh from a single image by applying rotated blurring kernels. Given the synthesized multiple views, we can generate aesthetically realistic image motion similar to the NIMAT effect. We validate our approach qualitatively compared to the original NIMAT effect and other similar image motions, like Facebook 3D image. Our image motion demonstrates a smooth image view transition with fewer artifacts around the object boundary.

Domain shift remains a persistent challenge in deep-learning-based computer vision, often requiring extensive model modifications or large labeled datasets to address. Inspired by human visual perception, which adjusts input quality through corrective lenses rather than over-training the brain, we propose Lens, a novel camera sensor control method that enhances model performance by capturing high-quality images from the model's perspective rather than relying on traditional human-centric sensor control. Lens is lightweight and adapts sensor parameters to specific models and scenes in real-time. At its core, Lens utilizes VisiT, a training-free, model-specific quality indicator that evaluates individual unlabeled samples at test time using confidence scores without additional adaptation costs. To validate Lens, we introduce ImageNet-ES Diverse, a new benchmark dataset capturing natural perturbations from varying sensor and lighting conditions. Extensive experiments on both ImageNet-ES and our new ImageNet-ES Diverse show that Lens significantly improves model accuracy across various baseline schemes for sensor control and model modification while maintaining low latency in image captures. Lens effectively compensates for large model size differences and integrates synergistically with model improvement techniques. Our code and dataset are available at github.com/Edw2n/Lens.git.

While there has been significant progress to use simulated data to learn robotic manipulation of rigid objects, applying its success to deformable objects has been hindered by the lack of both deformable object models and realistic non-rigid body simulators. In this paper, we present Real Garment Benchmark (RGBench), a comprehensive benchmark for robotic manipulation of garments. It features a diverse set of over 6000 garment mesh models, a new high-performance simulator, and a comprehensive protocol to evaluate garment simulation quality with carefully measured real garment dynamics. Our experiments demonstrate that our simulator outperforms currently available cloth simulators by a large margin, reducing simulation error by 20% while maintaining a speed of 3 times faster. We will publicly release RGBench to accelerate future research in robotic garment manipulation. Website: https://rgbench.github.io/

Existing evaluation paradigms for Autonomous Vehicles (AVs) face critical limitations. Real-world evaluation is often challenging due to safety concerns and a lack of reproducibility, whereas closed-loop simulation can face insufficient realism or high computational costs. Open-loop evaluation, while being efficient and data-driven, relies on metrics that generally overlook compounding errors. In this paper, we propose pseudo-simulation, a novel paradigm that addresses these limitations. Pseudo-simulation operates on real datasets, similar to open-loop evaluation, but augments them with synthetic observations generated prior to evaluation using 3D Gaussian Splatting. Our key idea is to approximate potential future states the AV might encounter by generating a diverse set of observations that vary in position, heading, and speed. Our method then assigns a higher importance to synthetic observations that best match the AV's likely behavior using a novel proximity-based weighting scheme. This enables evaluating error recovery and the mitigation of causal confusion, as in closed-loop benchmarks, without requiring sequential interactive simulation. We show that pseudo-simulation is better correlated with closed-loop simulations (R^2=0.8) than the best existing open-loop approach (R^2=0.7). We also establish a public leaderboard for the community to benchmark new methodologies with pseudo-simulation. Our code is available at https://github.com/autonomousvision/navsim.

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

Recent communities have seen significant progress in building photo-realistic animatable avatars from sparse multi-view videos. However, current workflows struggle to render realistic garment dynamics for loose-fitting characters as they predominantly rely on naked body models for human modeling while leaving the garment part un-modeled. This is mainly due to that the deformations yielded by loose garments are highly non-rigid, and capturing such deformations often requires dense views as supervision. In this paper, we introduce AniDress, a novel method for generating animatable human avatars in loose clothes using very sparse multi-view videos (4-8 in our setting). To allow the capturing and appearance learning of loose garments in such a situation, we employ a virtual bone-based garment rigging model obtained from physics-based simulation data. Such a model allows us to capture and render complex garment dynamics through a set of low-dimensional bone transformations. Technically, we develop a novel method for estimating temporal coherent garment dynamics from a sparse multi-view video. To build a realistic rendering for unseen garment status using coarse estimations, a pose-driven deformable neural radiance field conditioned on both body and garment motions is introduced, providing explicit control of both parts. At test time, the new garment poses can be captured from unseen situations, derived from a physics-based or neural network-based simulator to drive unseen garment dynamics. To evaluate our approach, we create a multi-view dataset that captures loose-dressed performers with diverse motions. Experiments show that our method is able to render natural garment dynamics that deviate highly from the body and generalize well to both unseen views and poses, surpassing the performance of existing methods. The code and data will be publicly available.

Creating accurate, physical simulations directly from real-world robot motion holds great value for safe, scalable, and affordable robot learning, yet remains exceptionally challenging. Real robot data suffers from occlusions, noisy camera poses, dynamic scene elements, which hinder the creation of geometrically accurate and photorealistic digital twins of unseen objects. We introduce a novel real-to-sim framework tackling all these challenges at once. Our key insight is a hybrid scene representation merging the photorealistic rendering of 3D Gaussian Splatting with explicit object meshes suitable for physics simulation within a single representation. We propose an end-to-end optimization pipeline that leverages differentiable rendering and differentiable physics within MuJoCo to jointly refine all scene components - from object geometry and appearance to robot poses and physical parameters - directly from raw and imprecise robot trajectories. This unified optimization allows us to simultaneously achieve high-fidelity object mesh reconstruction, generate photorealistic novel views, and perform annotation-free robot pose calibration. We demonstrate the effectiveness of our approach both in simulation and on challenging real-world sequences using an ALOHA 2 bi-manual manipulator, enabling more practical and robust real-to-simulation pipelines.

Computer-assisted surgery has been developed to enhance surgery correctness and safety. However, researchers and engineers suffer from limited annotated data to develop and train better algorithms. Consequently, the development of fundamental algorithms such as Simultaneous Localization and Mapping (SLAM) is limited. This article elaborates on the efforts of preparing the dataset for semantic segmentation, which is the foundation of many computer-assisted surgery mechanisms. Based on the Cholec80 dataset [3], we extracted 8,080 laparoscopic cholecystectomy image frames from 17 video clips in Cholec80 and annotated the images. The dataset is named CholecSeg8K and its total size is 3GB. Each of these images is annotated at pixel-level for thirteen classes, which are commonly founded in laparoscopic cholecystectomy surgery. CholecSeg8k is released under the license CC BY- NC-SA 4.0.

Video generation models have emerged as high-fidelity models of the physical world, capable of synthesizing high-quality videos capturing fine-grained interactions between agents and their environments conditioned on multi-modal user inputs. Their impressive capabilities address many of the long-standing challenges faced by physics-based simulators, driving broad adoption in many problem domains, e.g., robotics. For example, video models enable photorealistic, physically consistent deformable-body simulation without making prohibitive simplifying assumptions, which is a major bottleneck in physics-based simulation. Moreover, video models can serve as foundation world models that capture the dynamics of the world in a fine-grained and expressive way. They thus overcome the limited expressiveness of language-only abstractions in describing intricate physical interactions. In this survey, we provide a review of video models and their applications as embodied world models in robotics, encompassing cost-effective data generation and action prediction in imitation learning, dynamics and rewards modeling in reinforcement learning, visual planning, and policy evaluation. Further, we highlight important challenges hindering the trustworthy integration of video models in robotics, which include poor instruction following, hallucinations such as violations of physics, and unsafe content generation, in addition to fundamental limitations such as significant data curation, training, and inference costs. We present potential future directions to address these open research challenges to motivate research and ultimately facilitate broader applications, especially in safety-critical settings.

3D data simulation aims to bridge the gap between simulated and real-captured 3D data, which is a fundamental problem for real-world 3D visual tasks. Most 3D data simulation methods inject predefined physical priors but struggle to capture the full complexity of real data. An optimal approach involves learning an implicit mapping from synthetic to realistic data in a data-driven manner, but progress in this solution has met stagnation in recent studies. This work explores a new solution path of data-driven 3D simulation, called Stable-Sim2Real, based on a novel two-stage depth diffusion model. The initial stage finetunes Stable-Diffusion to generate the residual between the real and synthetic paired depth, producing a stable but coarse depth, where some local regions may deviate from realistic patterns. To enhance this, both the synthetic and initial output depth are fed into a second-stage diffusion, where diffusion loss is adjusted to prioritize these distinct areas identified by a 3D discriminator. We provide a new benchmark scheme to evaluate 3D data simulation methods. Extensive experiments show that training the network with the 3D simulated data derived from our method significantly enhances performance in real-world 3D visual tasks. Moreover, the evaluation demonstrates the high similarity between our 3D simulated data and real-captured patterns. Project page: https://mutianxu.github.io/stable-sim2real/.

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

Synthetic Data Generation (SDG) based on Artificial Intelligence (AI) can transform the way clinical medicine is delivered by overcoming privacy barriers that currently render clinical data sharing difficult. This is the key to accelerating the development of digital tools contributing to enhanced patient safety. Such tools include robust data-driven clinical decision support systems, and example-based digital training tools that will enable healthcare professionals to improve their diagnostic performance for enhanced patient safety. This study focuses on the clinical evaluation of medical SDG, with a proof-of-concept investigation on diagnosing Inflammatory Bowel Disease (IBD) using Wireless Capsule Endoscopy (WCE) images. Its scientific contributions include a) a novel protocol for the systematic Clinical Evaluation of Medical Image Synthesis (CEMIS); b) a novel variational autoencoder-based model for the generation of high-resolution synthetic WCE images; and c) a comprehensive evaluation of the synthetic images using the CEMIS protocol by 10 international WCE specialists, in terms of image quality, diversity, and realism, as well as their utility for clinical decision-making. The results show that TIDE-II generates clinically plausible, very realistic WCE images, of improved quality compared to relevant state-of-the-art generative models. Concludingly, CEMIS can serve as a reference for future research on medical image-generation techniques, while the adaptation/extension of the architecture of TIDE-II to other imaging domains can be promising.