Surg-3M: A Dataset and Foundation Model for Perception in Surgical Settings

Advancements in computer-assisted surgical procedures heavily rely on accurate visual data interpretation from camera systems used during surgeries. Traditional open-access datasets focusing on surgical procedures are often limited by their small size, typically consisting of fewer than 100 videos with less than 100K images. To address these constraints, a new dataset called Surg-3M has been compiled using a novel aggregation pipeline that collects high-resolution videos from online sources. Featuring an extensive collection of over 4K surgical videos and more than 3 million high-quality images from multiple procedure types, Surg-3M offers a comprehensive resource surpassing existing alternatives in size and scope, including two novel tasks. To demonstrate the effectiveness of this dataset, we present SurgFM, a self-supervised foundation model pretrained on Surg-3M that achieves impressive results in downstream tasks such as surgical phase recognition, action recognition, and tool presence detection. Combining key components from ConvNeXt, DINO, and an innovative augmented distillation method, SurgFM exhibits exceptional performance compared to specialist architectures across various benchmarks. Our experimental results show that SurgFM outperforms state-of-the-art models in multiple downstream tasks, including significant gains in surgical phase recognition (+8.9pp, +4.7pp, and +3.9pp of Jaccard in AutoLaparo, M2CAI16, and Cholec80), action recognition (+3.1pp of mAP in CholecT50) and tool presence detection (+4.6pp of mAP in Cholec80). Moreover, even when using only half of the data, SurgFM outperforms state-of-the-art models in AutoLaparo and achieves state-of-the-art performance in Cholec80. Both Surg-3M and SurgFM have significant potential to accelerate progress towards developing autonomous robotic surgery systems.

CoStoDet-DDPM: Collaborative Training of Stochastic and Deterministic Models Improves Surgical Workflow Anticipation and Recognition

Anticipating and recognizing surgical workflows are critical for intelligent surgical assistance systems. However, existing methods rely on deterministic decision-making, struggling to generalize across the large anatomical and procedural variations inherent in real-world surgeries.In this paper, we introduce an innovative framework that incorporates stochastic modeling through a denoising diffusion probabilistic model (DDPM) into conventional deterministic learning for surgical workflow analysis. At the heart of our approach is a collaborative co-training paradigm: the DDPM branch captures procedural uncertainties to enrich feature representations, while the task branch focuses on predicting surgical phases and instrument usage.Theoretically, we demonstrate that this mutual refinement mechanism benefits both branches: the DDPM reduces prediction errors in uncertain scenarios, and the task branch directs the DDPM toward clinically meaningful representations. Notably, the DDPM branch is discarded during inference, enabling real-time predictions without sacrificing accuracy.Experiments on the Cholec80 dataset show that for the anticipation task, our method achieves a 16% reduction in eMAE compared to state-of-the-art approaches, and for phase recognition, it improves the Jaccard score by 1.0%. Additionally, on the AutoLaparo dataset, our method achieves a 1.5% improvement in the Jaccard score for phase recognition, while also exhibiting robust generalization to patient-specific variations. Our code and weight are available at https://github.com/kk42yy/CoStoDet-DDPM.

ArthroPhase: A Novel Dataset and Method for Phase Recognition in Arthroscopic Video

This study aims to advance surgical phase recognition in arthroscopic procedures, specifically Anterior Cruciate Ligament (ACL) reconstruction, by introducing the first arthroscopy dataset and developing a novel transformer-based model. We aim to establish a benchmark for arthroscopic surgical phase recognition by leveraging spatio-temporal features to address the specific challenges of arthroscopic videos including limited field of view, occlusions, and visual distortions. We developed the ACL27 dataset, comprising 27 videos of ACL surgeries, each labeled with surgical phases. Our model employs a transformer-based architecture, utilizing temporal-aware frame-wise feature extraction through a ResNet-50 and transformer layers. This approach integrates spatio-temporal features and introduces a Surgical Progress Index (SPI) to quantify surgery progression. The model's performance was evaluated using accuracy, precision, recall, and Jaccard Index on the ACL27 and Cholec80 datasets. The proposed model achieved an overall accuracy of 72.91% on the ACL27 dataset. On the Cholec80 dataset, the model achieved a comparable performance with the state-of-the-art methods with an accuracy of 92.4%. The SPI demonstrated an output error of 10.6% and 9.86% on ACL27 and Cholec80 datasets respectively, indicating reliable surgery progression estimation. This study introduces a significant advancement in surgical phase recognition for arthroscopy, providing a comprehensive dataset and a robust transformer-based model. The results validate the model's effectiveness and generalizability, highlighting its potential to improve surgical training, real-time assistance, and operational efficiency in orthopedic surgery. The publicly available dataset and code will facilitate future research and development in this critical field.

Dual Invariance Self-training for Reliable Semi-supervised Surgical Phase Recognition

Accurate surgical phase recognition is crucial for advancing computer-assisted interventions, yet the scarcity of labeled data hinders training reliable deep learning models. Semi-supervised learning (SSL), particularly with pseudo-labeling, shows promise over fully supervised methods but often lacks reliable pseudo-label assessment mechanisms. To address this gap, we propose a novel SSL framework, Dual Invariance Self-Training (DIST), that incorporates both Temporal and Transformation Invariance to enhance surgical phase recognition. Our two-step self-training process dynamically selects reliable pseudo-labels, ensuring robust pseudo-supervision. Our approach mitigates the risk of noisy pseudo-labels, steering decision boundaries toward true data distribution and improving generalization to unseen data. Evaluations on Cataract and Cholec80 datasets show our method outperforms state-of-the-art SSL approaches, consistently surpassing both supervised and SSL baselines across various network architectures.

SWAG: Long-term Surgical Workflow Prediction with Generative-based Anticipation

While existing recognition approaches excel at identifying current surgical phases, they provide limited foresight into future procedural steps, restricting their intraoperative utility. Similarly, current anticipation methods are constrained to predicting short-term events or singular future occurrences, neglecting the dynamic and sequential nature of surgical workflows. To address these limitations, we propose SWAG (Surgical Workflow Anticipative Generation), a unified framework for phase recognition and long-term anticipation of surgical workflows. SWAG employs two generative decoding methods -- single-pass (SP) and auto-regressive (AR) -- to predict sequences of future surgical phases. A novel prior knowledge embedding mechanism enhances the accuracy of anticipatory predictions. The framework addresses future phase classification and remaining time regression tasks. Additionally, a regression-to-classification (R2C) method is introduced to map continuous predictions to discrete temporal segments. SWAG's performance was evaluated on the Cholec80 and AutoLaparo21 datasets. The single-pass classification model with prior knowledge embeddings (SWAG-SP\*) achieved 53.5\% accuracy in 15-minute anticipation on AutoLaparo21, while the R2C model reached 60.8\% accuracy on Cholec80. SWAG's single-pass regression approach outperformed existing methods for remaining time prediction, achieving weighted mean absolute errors of 0.32 and 0.48 minutes for 2- and 3-minute horizons, respectively. SWAG demonstrates versatility across classification and regression tasks, offering robust tools for real-time surgical workflow anticipation. By unifying recognition and anticipatory capabilities, SWAG provides actionable predictions to enhance intraoperative decision-making.

Neural Finite-State Machines for Surgical Phase Recognition

Surgical phase recognition is essential for analyzing procedure-specific surgical videos. While recent transformer-based architectures have advanced sequence processing capabilities, they struggle with maintaining consistency across lengthy surgical procedures. Drawing inspiration from classical hidden Markov models' finite-state interpretations, we introduce the neural finite-state machine (NFSM) module, which bridges procedural understanding with deep learning approaches. NFSM combines procedure-level understanding with neural networks through global state embeddings, attention-based dynamic transition tables, and transition-aware training and inference mechanisms for offline and online applications. When integrated into our future-aware architecture, NFSM improves video-level accuracy, phase-level precision, recall, and Jaccard indices on Cholec80 datasets by 2.3, 3.2, 3.0, and 4.8 percentage points respectively. As an add-on module to existing state-of-the-art models like Surgformer, NFSM further enhances performance, demonstrating its complementary value. Extended experiments on non-surgical datasets validate NFSM's generalizability beyond surgical domains. Comprehensive experiments demonstrate that incorporating NSFM into deep learning frameworks enables more robust and consistent phase recognition across long procedural videos.

Towards Robust Algorithms for Surgical Phase Recognition via Digital Twin-based Scene Representation

Purpose: Surgical phase recognition (SPR) is an integral component of surgical data science, enabling high-level surgical analysis. End-to-end trained neural networks that predict surgical phase directly from videos have shown excellent performance on benchmarks. However, these models struggle with robustness due to non-causal associations in the training set, resulting in poor generalizability. Our goal is to improve model robustness to variations in the surgical videos by leveraging the digital twin (DT) paradigm -- an intermediary layer to separate high-level analysis (SPR) from low-level processing (geometric understanding). This approach takes advantage of the recent vision foundation models that ensure reliable low-level scene understanding to craft DT-based scene representations that support various high-level tasks. Methods: We present a DT-based framework for SPR from videos. The framework employs vision foundation models to extract representations. We embed the representation in place of raw video inputs in the state-of-the-art Surgformer model. The framework is trained on the Cholec80 dataset and evaluated on out-of-distribution (OOD) and corrupted test samples. Results: Contrary to the vulnerability of the baseline model, our framework demonstrates strong robustness on both OOD and corrupted samples, with a video-level accuracy of 51.1 on the challenging CRCD dataset, 96.0 on an internal robotics training dataset, and 64.4 on a highly corrupted Cholec80 test set. Conclusion: Our findings lend support to the thesis that DT-based scene representations are effective in enhancing model robustness. Future work will seek to improve the feature informativeness, automate feature extraction, and incorporate interpretability for a more comprehensive framework.

SPRMamba: Surgical Phase Recognition for Endoscopic Submucosal Dissection with Mamba

Endoscopic Submucosal Dissection (ESD) is a minimally invasive procedure initially designed for the treatment of early gastric cancer but is now widely used for various gastrointestinal lesions. Computer-assisted Surgery systems have played a crucial role in improving the precision and safety of ESD procedures, however, their effectiveness is limited by the accurate recognition of surgical phases. The intricate nature of ESD, with different lesion characteristics and tissue structures, presents challenges for real-time surgical phase recognition algorithms. Existing surgical phase recognition algorithms struggle to efficiently capture temporal contexts in video-based scenarios, leading to insufficient performance. To address these issues, we propose SPRMamba, a novel Mamba-based framework for ESD surgical phase recognition. SPRMamba leverages the strengths of Mamba for long-term temporal modeling while introducing the Scaled Residual TranMamba block to enhance the capture of fine-grained details, overcoming the limitations of traditional temporal models like Temporal Convolutional Networks and Transformers. Moreover, a Temporal Sample Strategy is introduced to accelerate the processing, which is essential for real-time phase recognition in clinical settings. Extensive testing on the ESD385 dataset and the cholecystectomy Cholec80 dataset demonstrates that SPRMamba surpasses existing state-of-the-art methods and exhibits greater robustness across various surgical phase recognition tasks.

DACAT: Dual-stream Adaptive Clip-aware Time Modeling for Robust Online Surgical Phase Recognition

Surgical phase recognition has become a crucial requirement in laparoscopic surgery, enabling various clinical applications like surgical risk forecasting. Current methods typically identify the surgical phase using individual frame-wise embeddings as the fundamental unit for time modeling. However, this approach is overly sensitive to current observations, often resulting in discontinuous and erroneous predictions within a complete surgical phase. In this paper, we propose DACAT, a novel dual-stream model that adaptively learns clip-aware context information to enhance the temporal relationship. In one stream, DACAT pretrains a frame encoder, caching all historical frame-wise features. In the other stream, DACAT fine-tunes a new frame encoder to extract the frame-wise feature at the current moment. Additionally, a max clip-response read-out (Max-R) module is introduced to bridge the two streams by using the current frame-wise feature to adaptively fetch the most relevant past clip from the feature cache. The clip-aware context feature is then encoded via cross-attention between the current frame and its fetched adaptive clip, and further utilized to enhance the time modeling for accurate online surgical phase recognition. The benchmark results on three public datasets, i.e., Cholec80, M2CAI16, and AutoLaparo, demonstrate the superiority of our proposed DACAT over existing state-of-the-art methods, with improvements in Jaccard scores of at least 4.5%, 4.6%, and 2.7%, respectively. Our code and models have been released at https://github.com/kk42yy/DACAT.

VidLPRO: A $\underline{Vid}$eo-$\underline{L}$anguage $\underline{P}$re-training Framework for $\underline{Ro}$botic and Laparoscopic Surgery

We introduce VidLPRO, a novel video-language (VL) pre-training framework designed specifically for robotic and laparoscopic surgery. While existing surgical VL models primarily rely on contrastive learning, we propose a more comprehensive approach to capture the intricate temporal dynamics and align video with language. VidLPRO integrates video-text contrastive learning, video-text matching, and masked language modeling objectives to learn rich VL representations. To support this framework, we present GenSurg+, a carefully curated dataset derived from GenSurgery, comprising 17k surgical video clips paired with captions generated by GPT-4 using transcripts extracted by the Whisper model. This dataset addresses the need for large-scale, high-quality VL data in the surgical domain. Extensive experiments on benchmark datasets, including Cholec80 and AutoLaparo, demonstrate the efficacy of our approach. VidLPRO achieves state-of-the-art performance in zero-shot surgical phase recognition, significantly outperforming existing surgical VL models such as SurgVLP and HecVL. Our model demonstrates improvements of up to 21.5\% in accuracy and 15.7% in F1 score, setting a new benchmark in the field. Notably, VidLPRO exhibits robust performance even with single-frame inference, while effectively scaling with increased temporal context. Ablation studies reveal the impact of frame sampling strategies on model performance and computational efficiency. These results underscore VidLPRO's potential as a foundation model for surgical video understanding.