Danny T. M. Chan

Jinlin Wu, Felix Holm, Chuxi Chen et al.

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.

Zhen Chen, Xingjian Luo, Kun Yuan et al.

Surgical video understanding is crucial for facilitating Computer-Assisted Surgery (CAS) systems. Despite significant progress in existing studies, two major limitations persist, including inadequate visual content perception and insufficient temporal awareness in surgical videos, and hinder the development of versatile CAS solutions. In this work, we propose the SurgLLM framework, an effective large multimodal model tailored for versatile surgical video understanding tasks with enhanced spatial focus and temporal awareness. Specifically, to empower the spatial focus of surgical videos, we first devise Surgical Context-aware Multimodal Pretraining (Surg-Pretrain) for the video encoder of SurgLLM, by performing instrument-centric Masked Video Reconstruction (MV-Recon) and subsequent multimodal alignment. To incorporate surgical temporal knowledge into SurgLLM, we further propose Temporal-aware Multimodal Tuning (TM-Tuning) to enhance temporal reasoning with interleaved multimodal embeddings. Moreover, to accommodate various understanding tasks of surgical videos without conflicts, we devise a Surgical Task Dynamic Ensemble to efficiently triage a query with optimal learnable parameters in our SurgLLM. Extensive experiments performed on diverse surgical video understanding tasks, including captioning, general VQA, and temporal VQA, demonstrate significant improvements over the state-of-the-art approaches, validating the effectiveness of our SurgLLM in versatile surgical video understanding. The source code is available at https://github.com/franciszchen/SurgLLM.

Zhen Chen, Xingjian Luo, Jinlin Wu et al.

The surgical intervention is crucial to patient healthcare, and many studies have developed advanced algorithms to provide understanding and decision-making assistance for surgeons. Despite great progress, these algorithms are developed for a single specific task and scenario, and in practice require the manual combination of different functions, thus limiting the applicability. Thus, an intelligent and versatile surgical assistant is expected to accurately understand the surgeon's intentions and accordingly conduct the specific tasks to support the surgical process. In this work, by leveraging advanced multimodal large language models (MLLMs), we propose a Versatile Surgery Assistant (VS-Assistant) that can accurately understand the surgeon's intention and complete a series of surgical understanding tasks, e.g., surgical scene analysis, surgical instrument detection, and segmentation on demand. Specifically, to achieve superior surgical multimodal understanding, we devise a mixture of projectors (MOP) module to align the surgical MLLM in VS-Assistant to balance the natural and surgical knowledge. Moreover, we devise a surgical Function-Calling Tuning strategy to enable the VS-Assistant to understand surgical intentions, and thus make a series of surgical function calls on demand to meet the needs of the surgeons. Extensive experiments on neurosurgery data confirm that our VS-Assistant can understand the surgeon's intention more accurately than the existing MLLM, resulting in overwhelming performance in textual analysis and visual tasks. Source code and models will be made public.