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.

Multimodal Causal-Driven Representation Learning for Generalizable Medical Image Segmentation

Vision-Language Models (VLMs), such as CLIP, have demonstrated remarkable zero-shot capabilities in various computer vision tasks. However, their application to medical imaging remains challenging due to the high variability and complexity of medical data. Specifically, medical images often exhibit significant domain shifts caused by various confounders, including equipment differences, procedure artifacts, and imaging modes, which can lead to poor generalization when models are applied to unseen domains. To address this limitation, we propose Multimodal Causal-Driven Representation Learning (MCDRL), a novel framework that integrates causal inference with the VLM to tackle domain generalization in medical image segmentation. MCDRL is implemented in two steps: first, it leverages CLIP's cross-modal capabilities to identify candidate lesion regions and construct a confounder dictionary through text prompts, specifically designed to represent domain-specific variations; second, it trains a causal intervention network that utilizes this dictionary to identify and eliminate the influence of these domain-specific variations while preserving the anatomical structural information critical for segmentation tasks. Extensive experiments demonstrate that MCDRL consistently outperforms competing methods, yielding superior segmentation accuracy and exhibiting robust generalizability.

Bayesian Test-Time Adaptation for Vision-Language Models

Test-time adaptation with pre-trained vision-language models, such as CLIP, aims to adapt the model to new, potentially out-of-distribution test data. Existing methods calculate the similarity between visual embedding and learnable class embeddings, which are initialized by text embeddings, for zero-shot image classification. In this work, we first analyze this process based on Bayes theorem, and observe that the core factors influencing the final prediction are the likelihood and the prior. However, existing methods essentially focus on adapting class embeddings to adapt likelihood, but they often ignore the importance of prior. To address this gap, we propose a novel approach, \textbf{B}ayesian \textbf{C}lass \textbf{A}daptation (BCA), which in addition to continuously updating class embeddings to adapt likelihood, also uses the posterior of incoming samples to continuously update the prior for each class embedding. This dual updating mechanism allows the model to better adapt to distribution shifts and achieve higher prediction accuracy. Our method not only surpasses existing approaches in terms of performance metrics but also maintains superior inference rates and memory usage, making it highly efficient and practical for real-world applications.

Disentanglement Then Reconstruction: Learning Compact Features for Unsupervised Domain Adaptation

Recent works in domain adaptation always learn domain invariant features to mitigate the gap between the source and target domains by adversarial methods. The category information are not sufficiently used which causes the learned domain invariant features are not enough discriminative. We propose a new domain adaptation method based on prototype construction which likes capturing data cluster centers. Specifically, it consists of two parts: disentanglement and reconstruction. First, the domain specific features and domain invariant features are disentangled from the original features. At the same time, the domain prototypes and class prototypes of both domains are estimated. Then, a reconstructor is trained by reconstructing the original features from the disentangled domain invariant features and domain specific features. By this reconstructor, we can construct prototypes for the original features using class prototypes and domain prototypes correspondingly. In the end, the feature extraction network is forced to extract features close to these prototypes. Our contribution lies in the technical use of the reconstructor to obtain the original feature prototypes which helps to learn compact and discriminant features. As far as we know, this idea is proposed for the first time. Experiment results on several public datasets confirm the state-of-the-art performance of our method.