UniSurg: A Video-Native Foundation Model for Universal Understanding of Surgical Videos

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

GeoLanG: Geometry-Aware Language-Guided Grasping with Unified RGB-D Multimodal Learning

Language-guided grasping has emerged as a promising paradigm for enabling robots to identify and manipulate target objects through natural language instructions, yet it remains highly challenging in cluttered or occluded scenes. Existing methods often rely on multi-stage pipelines that separate object perception and grasping, which leads to limited cross-modal fusion, redundant computation, and poor generalization in cluttered, occluded, or low-texture scenes. To address these limitations, we propose GeoLanG, an end-to-end multi-task framework built upon the CLIP architecture that unifies visual and linguistic inputs into a shared representation space for robust semantic alignment and improved generalization. To enhance target discrimination under occlusion and low-texture conditions, we explore a more effective use of depth information through the Depth-guided Geometric Module (DGGM), which converts depth into explicit geometric priors and injects them into the attention mechanism without additional computational overhead. In addition, we propose Adaptive Dense Channel Integration, which adaptively balances the contributions of multi-layer features to produce more discriminative and generalizable visual representations. Extensive experiments on the OCID-VLG dataset, as well as in both simulation and real-world hardware, demonstrate that GeoLanG enables precise and robust language-guided grasping in complex, cluttered environments, paving the way toward more reliable multimodal robotic manipulation in real-world human-centric settings.

Where It Moves, It Matters: Referring Surgical Instrument Segmentation via Motion

Enabling intuitive, language-driven interaction with surgical scenes is a critical step toward intelligent operating rooms and autonomous surgical robotic assistance. However, the task of referring segmentation, localizing surgical instruments based on natural language descriptions, remains underexplored in surgical videos, with existing approaches struggling to generalize due to reliance on static visual cues and predefined instrument names. In this work, we introduce SurgRef, a novel motion-guided framework that grounds free-form language expressions in instrument motion, capturing how tools move and interact across time, rather than what they look like. This allows models to understand and segment instruments even under occlusion, ambiguity, or unfamiliar terminology. To train and evaluate SurgRef, we present Ref-IMotion, a diverse, multi-institutional video dataset with dense spatiotemporal masks and rich motion-centric expressions. SurgRef achieves state-of-the-art accuracy and generalization across surgical procedures, setting a new benchmark for robust, language-driven surgical video segmentation.

More than Segmentation: Benchmarking SAM 3 for Segmentation, 3D Perception, and Reconstruction in Robotic Surgery

The recent SAM 3 and SAM 3D have introduced significant advancements over the predecessor, SAM 2, particularly with the integration of language-based segmentation and enhanced 3D perception capabilities. SAM 3 supports zero-shot segmentation across a wide range of prompts, including point, bounding box, and language-based prompts, allowing for more flexible and intuitive interactions with the model. In this empirical evaluation, we assess the performance of SAM 3 in robot-assisted surgery, benchmarking its zero-shot segmentation with point and bounding box prompts and exploring its effectiveness in dynamic video tracking, alongside its newly introduced language prompt segmentation. While language prompts show potential, their performance in the surgical domain is currently suboptimal, highlighting the need for further domain-specific training. Additionally, we investigate SAM 3D's depth reconstruction abilities, demonstrating its capacity to process surgical scene data and reconstruct 3D anatomical structures from 2D images. Through comprehensive testing on the MICCAI EndoVis 2017 and EndoVis 2018 benchmarks, SAM 3 shows clear improvements over SAM and SAM 2 in both image and video segmentation under spatial prompts, while the zero-shot evaluations of SAM 3D on SCARED, StereoMIS, and EndoNeRF indicate strong monocular depth estimation and realistic 3D instrument reconstruction, yet also reveal remaining limitations in complex, highly dynamic surgical scenes.

Bridging Vision and Language for Robust Context-Aware Surgical Point Tracking: The VL-SurgPT Dataset and Benchmark

Accurate point tracking in surgical environments remains challenging due to complex visual conditions, including smoke occlusion, specular reflections, and tissue deformation. While existing surgical tracking datasets provide coordinate information, they lack the semantic context necessary to understand tracking failure mechanisms. We introduce VL-SurgPT, the first large-scale multimodal dataset that bridges visual tracking with textual descriptions of point status in surgical scenes. The dataset comprises 908 in vivo video clips, including 754 for tissue tracking (17,171 annotated points across five challenging scenarios) and 154 for instrument tracking (covering seven instrument types with detailed keypoint annotations). We establish comprehensive benchmarks using eight state-of-the-art tracking methods and propose TG-SurgPT, a text-guided tracking approach that leverages semantic descriptions to improve robustness in visually challenging conditions. Experimental results demonstrate that incorporating point status information significantly improves tracking accuracy and reliability, particularly in adverse visual scenarios where conventional vision-only methods struggle. By bridging visual and linguistic modalities, VL-SurgPT enables the development of context-aware tracking systems crucial for advancing computer-assisted surgery applications that can maintain performance even under challenging intraoperative conditions.

Comparative validation of surgical phase recognition, instrument keypoint estimation, and instrument instance segmentation in endoscopy: Results of the PhaKIR 2024 challenge

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.

TR2M: Transferring Monocular Relative Depth to Metric Depth with Language Descriptions and Scale-Oriented Contrast

This work presents a generalizable framework to transfer relative depth to metric depth. Current monocular depth estimation methods are mainly divided into metric depth estimation (MMDE) and relative depth estimation (MRDE). MMDEs estimate depth in metric scale but are often limited to a specific domain. MRDEs generalize well across different domains, but with uncertain scales which hinders downstream applications. To this end, we aim to build up a framework to solve scale uncertainty and transfer relative depth to metric depth. Previous methods used language as input and estimated two factors for conducting rescaling. Our approach, TR2M, utilizes both text description and image as inputs and estimates two rescale maps to transfer relative depth to metric depth at pixel level. Features from two modalities are fused with a cross-modality attention module to better capture scale information. A strategy is designed to construct and filter confident pseudo metric depth for more comprehensive supervision. We also develop scale-oriented contrastive learning to utilize depth distribution as guidance to enforce the model learning about intrinsic knowledge aligning with the scale distribution. TR2M only exploits a small number of trainable parameters to train on datasets in various domains and experiments not only demonstrate TR2M's great performance in seen datasets but also reveal superior zero-shot capabilities on five unseen datasets. We show the huge potential in pixel-wise transferring relative depth to metric depth with language assistance. (Code is available at: https://github.com/BeileiCui/TR2M)

EndoARSS: Adapting Spatially-Aware Foundation Model for Efficient Activity Recognition and Semantic Segmentation in Endoscopic Surgery

Endoscopic surgery is the gold standard for robotic-assisted minimally invasive surgery, offering significant advantages in early disease detection and precise interventions. However, the complexity of surgical scenes, characterized by high variability in different surgical activity scenarios and confused image features between targets and the background, presents challenges for surgical environment understanding. Traditional deep learning models often struggle with cross-activity interference, leading to suboptimal performance in each downstream task. To address this limitation, we explore multi-task learning, which utilizes the interrelated features between tasks to enhance overall task performance. In this paper, we propose EndoARSS, a novel multi-task learning framework specifically designed for endoscopy surgery activity recognition and semantic segmentation. Built upon the DINOv2 foundation model, our approach integrates Low-Rank Adaptation to facilitate efficient fine-tuning while incorporating Task Efficient Shared Low-Rank Adapters to mitigate gradient conflicts across diverse tasks. Additionally, we introduce the Spatially-Aware Multi-Scale Attention that enhances feature representation discrimination by enabling cross-spatial learning of global information. In order to evaluate the effectiveness of our framework, we present three novel datasets, MTLESD, MTLEndovis and MTLEndovis-Gen, tailored for endoscopic surgery scenarios with detailed annotations for both activity recognition and semantic segmentation tasks. Extensive experiments demonstrate that EndoARSS achieves remarkable performance across multiple benchmarks, significantly improving both accuracy and robustness in comparison to existing models. These results underscore the potential of EndoARSS to advance AI-driven endoscopic surgical systems, offering valuable insights for enhancing surgical safety and efficiency.

EndoVLA: Dual-Phase Vision-Language-Action Model for Autonomous Tracking in Endoscopy

In endoscopic procedures, autonomous tracking of abnormal regions and following circumferential cutting markers can significantly reduce the cognitive burden on endoscopists. However, conventional model-based pipelines are fragile for each component (e.g., detection, motion planning) requires manual tuning and struggles to incorporate high-level endoscopic intent, leading to poor generalization across diverse scenes. Vision-Language-Action (VLA) models, which integrate visual perception, language grounding, and motion planning within an end-to-end framework, offer a promising alternative by semantically adapting to surgeon prompts without manual recalibration. Despite their potential, applying VLA models to robotic endoscopy presents unique challenges due to the complex and dynamic anatomical environments of the gastrointestinal (GI) tract. To address this, we introduce EndoVLA, designed specifically for continuum robots in GI interventions. Given endoscopic images and surgeon-issued tracking prompts, EndoVLA performs three core tasks: (1) polyp tracking, (2) delineation and following of abnormal mucosal regions, and (3) adherence to circular markers during circumferential cutting. To tackle data scarcity and domain shifts, we propose a dual-phase strategy comprising supervised fine-tuning on our EndoVLA-Motion dataset and reinforcement fine-tuning with task-aware rewards. Our approach significantly improves tracking performance in endoscopy and enables zero-shot generalization in diverse scenes and complex sequential tasks.

Can DeepSeek Reason Like a Surgeon? An Empirical Evaluation for Vision-Language Understanding in Robotic-Assisted Surgery

DeepSeek series have demonstrated outstanding performance in general scene understanding, question-answering (QA), and text generation tasks, owing to its efficient training paradigm and strong reasoning capabilities. In this study, we investigate the dialogue capabilities of the DeepSeek model in robotic surgery scenarios, focusing on tasks such as Single Phrase QA, Visual QA, and Detailed Description. The Single Phrase QA tasks further include sub-tasks such as surgical instrument recognition, action understanding, and spatial position analysis. We conduct extensive evaluations using publicly available datasets, including EndoVis18 and CholecT50, along with their corresponding dialogue data. Our comprehensive evaluation results indicate that, when provided with specific prompts, DeepSeek-V3 performs well in surgical instrument and tissue recognition tasks However, DeepSeek-V3 exhibits significant limitations in spatial position analysis and struggles to understand surgical actions accurately. Additionally, our findings reveal that, under general prompts, DeepSeek-V3 lacks the ability to effectively analyze global surgical concepts and fails to provide detailed insights into surgical scenarios. Based on our observations, we argue that the DeepSeek-V3 is not ready for vision-language tasks in surgical contexts without fine-tuning on surgery-specific datasets.