How can reasoning capability empower the AI copilot robot in endoscopic surgery

Reasoning capability has significantly advanced complex logical inference and robotic decision-making in general domains. However, its potential in the Artificial Intelligence (AI) copilot robot-particularly implemented based on the Vision-Language-Action (VLA) model-remains unexplored in endoscopic surgery. Effective reasoning should enable AI copilot robots to integrate multimodal cues, interpret surgical intent, and infer hidden tissue dynamics, thereby alleviating intraoperative uncertainty and cognitive burden on surgeons. Properly implemented, reasoning-driven autonomy can transform AI copilot robots from reactive executors into cognitive collaborators, enhancing precision, safety, and sustainability in clinical practice.

CoGE: Sim-to-Real Online Geometric Estimation for Monocular Colonoscopy

Geometric estimation including depth estimation and scene reconstruction is a crucial technique for colonoscopy which can provide surgeons with 3D spatial perception and navigation. However, geometric ground truth in colonoscopy is difficult to obtain due to narrow and enclosed space of the colon, while there is a large feature gap between simulated data and realistic data caused by artifacts and illumination. In this paper, we present CoGE, a novel framework for online monocular geometric estimation during colonoscopy. Firstly, we propose an illumination-aware supervision module based on the Retinex theory to address illumination diversity in different colonoscopy scenes. Moreover, a structure-aware perception module is proposed based on wavelet decomposition to extract common structural and local features of the colon. Both quantitative and qualitative results demonstrate that the proposed model solely trained on simulated data achieves state-of-the-art performance in geometric estimation for both simulated and realistic scenes.

Open-H-Embodiment: A Large-Scale Dataset for Enabling Foundation Models in Medical Robotics

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.

Leveling3D: Leveling Up 3D Reconstruction with Feed-Forward 3D Gaussian Splatting and Geometry-Aware Generation

Feed-forward 3D reconstruction has revolutionized 3D vision, providing a powerful baseline for downstream tasks such as novel-view synthesis with 3D Gaussian Splatting. Previous works explore fixing the corrupted rendering results with a diffusion model. However, they lack geometric concern and fail at filling the missing area on the extrapolated view. In this work, we introduce Leveling3D, a novel pipeline that integrates feed-forward 3D reconstruction with geometrical-consistent generation to enable holistic simultaneous reconstruction and generation. We propose a geometry-aware leveling adapter, a lightweight technique that aligns internal knowledge in the diffusion model with the geometry prior from the feed-forward model. The leveling adapter enables generation on the artifact area of the extrapolated novel views caused by underconstrained regions of the 3D representation. Specifically, to learn a more diverse distributed generation, we introduce the palette filtering strategy for training, and a test-time masking refinement to prevent messy boundaries along the fixing regions. More importantly, the enhanced extrapolated novel views from Leveling3D could be used as the inputs for feed-forward 3DGS, leveling up the 3D reconstruction. We achieve SOTA performance on public datasets, including tasks such as novel-view synthesis and depth estimation.

LiDAR-EVS: Enhance Extrapolated View Synthesis for 3D Gaussian Splatting with Pseudo-LiDAR Supervision

3D Gaussian Splatting (3DGS) has emerged as a powerful technique for real-time LiDAR and camera synthesis in autonomous driving simulation. However, simulating LiDAR with 3DGS remains challenging for extrapolated views beyond the training trajectory, as existing methods are typically trained on single-traversal sensor scans, suffer from severe overfitting and poor generalization to novel ego-vehicle paths. To enable reliable simulation of LiDAR along unseen driving trajectories without external multi-pass data, we present LiDAR-EVS, a lightweight framework for robust extrapolated-view LiDAR simulation in autonomous driving. Designed to be plug-and-play, LiDAR-EVS readily extends to diverse LiDAR sensors and neural rendering baselines with minimal modification. Our framework comprises two key components: (1) pseudo extrapolated-view point cloud supervision with multi-frame LiDAR fusion, view transformation, occlusion curling, and intensity adjustment; (2) spatially-constrained dropout regularization that promotes robustness to diverse trajectory variations encountered in real-world driving. Extensive experiments demonstrate that LiDAR-EVS achieves SOTA performance on extrapolated-view LiDAR synthesis across three datasets, making it a promising tool for data-driven simulation, closed-loop evaluation, and synthetic data generation in autonomous driving systems.

Generalized Recognition of Basic Surgical Actions Enables Skill Assessment and Vision-Language-Model-based Surgical Planning

Artificial intelligence, imaging, and large language models have the potential to transform surgical practice, training, and automation. Understanding and modeling of basic surgical actions (BSA), the fundamental unit of operation in any surgery, is important to drive the evolution of this field. In this paper, we present a BSA dataset comprising 10 basic actions across 6 surgical specialties with over 11,000 video clips, which is the largest to date. Based on the BSA dataset, we developed a new foundation model that conducts general-purpose recognition of basic actions. Our approach demonstrates robust cross-specialist performance in experiments validated on datasets from different procedural types and various body parts. Furthermore, we demonstrate downstream applications enabled by the BAS foundation model through surgical skill assessment in prostatectomy using domain-specific knowledge, and action planning in cholecystectomy and nephrectomy using large vision-language models. Multinational surgeons' evaluation of the language model's output of the action planning explainable texts demonstrated clinical relevance. These findings indicate that basic surgical actions can be robustly recognized across scenarios, and an accurate BSA understanding model can essentially facilitate complex applications and speed up the realization of surgical superintelligence.

Real-Time Glottis Detection Framework via Spatial-decoupled Feature Learning for Nasal Transnasal Intubation

Nasotracheal intubation (NTI) is a vital procedure in emergency airway management, where rapid and accurate glottis detection is essential to ensure patient safety. However, existing machine assisted visual detection systems often rely on high performance computational resources and suffer from significant inference delays, which limits their applicability in time critical and resource constrained scenarios. To overcome these limitations, we propose Mobile GlottisNet, a lightweight and efficient glottis detection framework designed for real time inference on embedded and edge devices. The model incorporates structural awareness and spatial alignment mechanisms, enabling robust glottis localization under complex anatomical and visual conditions. We implement a hierarchical dynamic thresholding strategy to enhance sample assignment, and introduce an adaptive feature decoupling module based on deformable convolution to support dynamic spatial reconstruction. A cross layer dynamic weighting scheme further facilitates the fusion of semantic and detail features across multiple scales. Experimental results demonstrate that the model, with a size of only 5MB on both our PID dataset and Clinical datasets, achieves inference speeds of over 62 FPS on devices and 33 FPS on edge platforms, showing great potential in the application of emergency NTI.

TMR-VLA:Vision-Language-Action Model for Magnetic Motion Control of Tri-leg Silicone-based Soft Robot

In-vivo environments, magnetically actuated soft robots offer advantages such as wireless operation and precise control, showing promising potential for painless detection and therapeutic procedures. We developed a trileg magnetically driven soft robot (TMR) whose multi-legged design enables more flexible gaits and diverse motion patterns. For the silicone made of reconfigurable soft robots, its navigation ability can be separated into sequential motions, namely squatting, rotation, lifting a leg, walking and so on. Its motion and behavior depend on its bending shapes. To bridge motion type description and specific low-level voltage control, we introduced TMR-VLA, an end-to-end multi-modal system for a trileg magnetic soft robot capable of performing hybrid motion types, which is promising for developing a navigation ability by adapting its shape to language-constrained motion types. The TMR-VLA deploys embodied endoluminal localization ability from EndoVLA, and fuses sequential frames and natural language commands as input. Low-level voltage output is generated based on the current observation state and specific motion type description. The result shows the TMR-VLA can predict how the voltage applied to TMR will change the dynamics of a silicon-made soft robot. The TMR-VLA reached a 74% average success rate.

EndoDDC: Learning Sparse to Dense Reconstruction for Endoscopic Robotic Navigation via Diffusion Depth Completion

Accurate depth estimation plays a critical role in the navigation of endoscopic surgical robots, forming the foundation for 3D reconstruction and safe instrument guidance. Fine-tuning pretrained models heavily relies on endoscopic surgical datasets with precise depth annotations. While existing self-supervised depth estimation techniques eliminate the need for accurate depth annotations, their performance degrades in environments with weak textures and variable lighting, leading to sparse reconstruction with invalid depth estimation. Depth completion using sparse depth maps can mitigate these issues and improve accuracy. Despite the advances in depth completion techniques in general fields, their application in endoscopy remains limited. To overcome these limitations, we propose EndoDDC, an endoscopy depth completion method that integrates images, sparse depth information with depth gradient features, and optimizes depth maps through a diffusion model, addressing the issues of weak texture and light reflection in endoscopic environments. Extensive experiments on two publicly available endoscopy datasets show that our approach outperforms state-of-the-art models in both depth accuracy and robustness. This demonstrates the potential of our method to reduce visual errors in complex endoscopic environments. Our code will be released at https://github.com/yinheng-lin/EndoDDC.

SurgAtt-Tracker: Online Surgical Attention Tracking via Temporal Proposal Reranking and Motion-Aware Refinement

Accurate and stable field-of-view (FoV) guidance is critical for safe and efficient minimally invasive surgery, yet existing approaches often conflate visual attention estimation with downstream camera control or rely on direct object-centric assumptions. In this work, we formulate surgical attention tracking as a spatio-temporal learning problem and model surgeon focus as a dense attention heatmap, enabling continuous and interpretable frame-wise FoV guidance. We propose SurgAtt-Tracker, a holistic framework that robustly tracks surgical attention by exploiting temporal coherence through proposal-level reranking and motion-aware refinement, rather than direct regression. To support systematic training and evaluation, we introduce SurgAtt-1.16M, a large-scale benchmark with a clinically grounded annotation protocol that enables comprehensive heatmap-based attention analysis across procedures and institutions. Extensive experiments on multiple surgical datasets demonstrate that SurgAtt-Tracker consistently achieves state-of-the-art performance and strong robustness under occlusion, multi-instrument interference, and cross-domain settings. Beyond attention tracking, our approach provides a frame-wise FoV guidance signal that can directly support downstream robotic FoV planning and automatic camera control.