Chang Han Low

Zhitao Zeng, Mengya Xu, Jian Jiang et al.

Surgical intelligence has the potential to improve the safety and consistency of surgical care, yet most existing surgical AI frameworks remain task-specific and struggle to generalize across procedures and institutions. Although multimodal foundation models, particularly multimodal large language models, have demonstrated strong cross-task capabilities across various medical domains, their advancement in surgery remains constrained by the lack of large-scale, systematically curated multimodal data. To address this challenge, we introduce Surg$Σ$, a spectrum of large-scale multimodal data and foundation models for surgical intelligence. At the core of this framework lies Surg$Σ$-DB, a large-scale multimodal data foundation designed to support diverse surgical tasks. Surg$Σ$-DB consolidates heterogeneous surgical data sources (including open-source datasets, curated in-house clinical collections and web-source data) into a unified schema, aiming to improve label consistency and data standardization across heterogeneous datasets. Surg$Σ$-DB spans 6 clinical specialties and diverse surgical types, providing rich image- and video-level annotations across 18 practical surgical tasks covering understanding, reasoning, planning, and generation, at an unprecedented scale (over 5.98M conversations). Beyond conventional multimodal conversations, Surg$Σ$-DB incorporates hierarchical reasoning annotations, providing richer semantic cues to support deeper contextual understanding in complex surgical scenarios. We further provide empirical evidence through recently developed surgical foundation models built upon Surg$Σ$-DB, illustrating the practical benefits of large-scale multimodal annotations, unified semantic design, and structured reasoning annotations for improving cross-task generalization and interpretability.

Daiyun Shen, Shuojue Yang, Chang Han Low et al.

Surgical instrument pose estimation provides crucial information for promising applications, including autonomous robotic surgery, skill assessment, and standardization of surgical workflow. However, this task remains highly challenging due to high precision requirements, frequent occlusions, textureless instruments, scarcity of depth information and very limited annotated data. These constraints often lead to unsatisfactory performance when employing general object pose estimation approaches to surgical scenarios. To address these issues, we first construct a new dataset SynSurg6D, to alleviate the data shortage in this task. We further propose SurfSurg6D, a dense-correspondence framework tailored for surgical instrument pose estimation. Experimental results on the SurgRIPE, EndoVis2018 and SurgPose datasets demonstrate that the introduction of our generated dataset SynSurg6D is able to diversify the pose distributions, thus enhancing the performance of existing approaches. Furthermore, SurfSurg6D outperforms existing methods, providing a robust solution for precise and efficient RGB-only pose estimation.

Guanyi Qin, Xiaozhen Wang, Zhu Zhuo et al.

Minimally invasive surgery has dramatically improved patient operative outcomes, yet identifying safe operative zones remains challenging in critical phases, requiring surgeons to integrate visual cues, procedural phase, and anatomical context under high cognitive load. Existing AI systems offer binary safety verification or static detection, ignoring the phase-dependent nature of intraoperative reasoning. We introduce ResGo, a benchmark of laparoscopic frames annotated with Go Zone bounding boxes and clinician-authored rationales covering phase, exposure quality reasoning, next action and risk reminder. We introduce evaluation metrics that treat correct grounding under incorrect phase as failures, revealing that most vision-language models cannot handle such tasks and perform poorly. We then present SurGo-R1, a model optimized via RLHF with a multi-turn phase-then-go architecture where the model first identifies the surgical phase, then generates reasoning and Go Zone coordinates conditioned on that context. On unseen procedures, SurGo-R1 achieves 76.6% phase accuracy, 32.7 mIoU, and 54.8% hardcore accuracy, a 6.6$\times$ improvement over the mainstream generalist VLMs. Code, model and benchmark will be available at https://github.com/jinlab-imvr/SurGo-R1

Ziyue Wang, Junde Wu, Linghan Cai et al.

In modern medicine, clinical diagnosis relies on the comprehensive analysis of primarily textual and visual data, drawing on medical expertise to ensure systematic and rigorous reasoning. Recent advances in large Vision-Language Models (VLMs) and agent-based methods hold great potential for medical diagnosis, thanks to the ability to effectively integrate multi-modal patient data. However, they often provide direct answers and draw empirical-driven conclusions without quantitative analysis, which reduces their reliability and clinical usability. We propose MedAgent-Pro, a new agentic reasoning paradigm that follows the diagnosis principle in modern medicine, to decouple the process into sequential components for step-by-step, evidence-based reasoning. Our MedAgent-Pro workflow presents a hierarchical diagnostic structure to mirror this principle, consisting of disease-level standardized plan generation and patient-level personalized step-by-step reasoning. To support disease-level planning, an RAG-based agent is designed to retrieve medical guidelines to ensure alignment with clinical standards. For patient-level reasoning, we propose to integrate professional tools such as visual models to enable quantitative assessments. Meanwhile, we propose to verify the reliability of each step to achieve evidence-based diagnosis, enforcing rigorous logical reasoning and a well-founded conclusion. Extensive experiments across a wide range of anatomical regions, imaging modalities, and diseases demonstrate the superiority of MedAgent-Pro to mainstream VLMs, agentic systems and state-of-the-art expert models. Ablation studies and human evaluation by clinical experts further validate its robustness and clinical relevance. Code is available at https://github.com/jinlab-imvr/MedAgent-Pro.

Haofeng Liu, Ziyue Wang, Alex Y. W. Kong et al.

Surgical video segmentation is fundamental to computer-assisted surgery. In practice, surgeons need to dynamically specify targets throughout extended procedures, using heterogeneous cues such as visual selections, textual expressions, or audio instructions. However, existing Promptable Video Object Segmentation (PVOS) methods are typically restricted to a single prompt modality and rely on coupled frameworks that cause optimization interference between target initialization and tracking. Moreover, these methods produce hallucinated predictions when the target is absent and suffer from accumulated mask drift without failure recovery. To address these challenges, we present UniSurgSAM, a unified PVOS model enabling reliable surgical video segmentation through visual, textual, or audio prompts. Specifically, UniSurgSAM employs a decoupled two-stage framework that independently optimizes initialization and tracking to resolve the optimization interference. Within this framework, we introduce three key designs for reliability: presence-aware decoding that models target absence to suppress hallucinations; boundary-aware long-term tracking that prevents mask drift over extended sequences; and adaptive state transition that closes the loop between stages for failure recovery. Furthermore, we establish a multi-modal and multi-granular benchmark from four public surgical datasets with precise instance-level masklets. Extensive experiments demonstrate that UniSurgSAM achieves state-of-the-art performance in real time across all prompt modalities and granularities, providing a practical foundation for computer-assisted surgery. Code and datasets will be available at https://jinlab-imvr.github.io/UniSurgSAM.

Shuojue Yang, Zijian Wu, Chengjiaao Liao et al.

High-quality and controllable digital twins of surgical instruments are critical for Real2Sim in robot-assisted surgery, as they enable realistic simulation, synthetic data generation, and perception learning under novel poses. We present Instrument-Splatting++, a monocular 3D Gaussian Splatting (3DGS) framework that reconstructs surgical instruments as a fully controllable Gaussian asset with high fidelity. Our pipeline starts with part-wise geometry pretraining that injects CAD priors into Gaussian primitives and equips the representation with part-aware semantic rendering. Built on the pretrained model, we propose a semantics-aware pose estimation and tracking (SAPET) method to recover per-frame 6-DoF pose and joint angles from unposed endoscopic videos, where a gripper-tip network trained purely from synthetic semantics provides robust supervision and a loose regularization suppresses singular articulations. Finally, we introduce Robust Texture Learning (RTL), which alternates pose refinement and robust appearance optimization, mitigating pose noise during texture learning. The proposed framework can perform pose estimation and learn realistic texture from unposed videos. We validate our method on sequences extracted from EndoVis17/18, SAR-RARP, and an in-house dataset, showing superior photometric quality and improved geometric accuracy over state-of-the-art baselines. We further demonstrate a downstream keypoint detection task where unseen-pose data augmentation from our controllable instrument Gaussian improves performance.

Ziyue Wang, Linghan Cai, Chang Han Low et al.

3D CT analysis spans a continuum from low-level perception to high-level clinical understanding. Existing 3D-oriented analysis methods adopt either isolated task-specific modeling or task-agnostic end-to-end paradigms to produce one-hop outputs, impeding the systematic accumulation of perceptual evidence for downstream reasoning. In parallel, recent multimodal large language models (MLLMs) exhibit improved visual perception and can integrate visual and textual information effectively, yet their predominantly 2D-oriented designs fundamentally limit their ability to perceive and analyze volumetric medical data. To bridge this gap, we propose 3DMedAgent, a unified agent that enables 2D MLLMs to perform general 3D CT analysis without 3D-specific fine-tuning. 3DMedAgent coordinates heterogeneous visual and textual tools through a flexible MLLM agent, progressively decomposing complex 3D analysis into tractable subtasks that transition from global to regional views, from 3D volumes to informative 2D slices, and from visual evidence to structured textual representations. Central to this design, 3DMedAgent maintains a long-term structured memory that aggregates intermediate tool outputs and supports query-adaptive, evidence-driven multi-step reasoning. We further introduce the DeepChestVQA benchmark for evaluating unified perception-to-understanding capabilities in 3D thoracic imaging. Experiments across over 40 tasks demonstrate that 3DMedAgent consistently outperforms general, medical, and 3D-specific MLLMs, highlighting a scalable path toward general-purpose 3D clinical assistants.Code and data are available at \href{https://github.com/jinlab-imvr/3DMedAgent}{https://github.com/jinlab-imvr/3DMedAgent}.

Chang Han Low, Ziyue Wang, Tianyi Zhang et al.

Integration of Vision-Language Models (VLMs) in surgical intelligence is hindered by hallucinations, domain knowledge gaps, and limited understanding of task interdependencies within surgical scenes, undermining clinical reliability. While recent VLMs demonstrate strong general reasoning and thinking capabilities, they still lack the domain expertise and task-awareness required for precise surgical scene interpretation. Although Chain-of-Thought (CoT) can structure reasoning more effectively, current approaches rely on self-generated CoT steps, which often exacerbate inherent domain gaps and hallucinations. To overcome this, we present SurgRAW, a CoT-driven multi-agent framework that delivers transparent, interpretable insights for most tasks in robotic-assisted surgery. By employing specialized CoT prompts across five tasks: instrument recognition, action recognition, action prediction, patient data extraction, and outcome assessment, SurgRAW mitigates hallucinations through structured, domain-aware reasoning. Retrieval-Augmented Generation (RAG) is also integrated to external medical knowledge to bridge domain gaps and improve response reliability. Most importantly, a hierarchical agentic system ensures that CoT-embedded VLM agents collaborate effectively while understanding task interdependencies, with a panel discussion mechanism promotes logical consistency. To evaluate our method, we introduce SurgCoTBench, the first reasoning-based dataset with structured frame-level annotations. With comprehensive experiments, we demonstrate the effectiveness of proposed SurgRAW with 29.32% accuracy improvement over baseline VLMs on 12 robotic procedures, achieving the state-of-the-art performance and advancing explainable, trustworthy, and autonomous surgical assistance.

Zhitao Zeng, Zhu Zhuo, Xiaojun Jia et al. · pku

Foundation models have achieved transformative success across biomedical domains by enabling holistic understanding of multimodal data. However, their application in surgery remains underexplored. Surgical intelligence presents unique challenges - requiring surgical visual perception, temporal analysis, and reasoning. Existing general-purpose vision-language models fail to address these needs due to insufficient domain-specific supervision and the lack of a large-scale high-quality surgical database. To bridge this gap, we propose SurgVLM, one of the first large vision-language foundation models for surgical intelligence, where this single universal model can tackle versatile surgical tasks. To enable this, we construct a large-scale multimodal surgical database, SurgVLM-DB, comprising over 1.81 million frames with 7.79 million conversations, spanning more than 16 surgical types and 18 anatomical structures. We unify and reorganize 23 public datasets across 10 surgical tasks, followed by standardizing labels and doing hierarchical vision-language alignment to facilitate comprehensive coverage of gradually finer-grained surgical tasks, from visual perception, temporal analysis, to high-level reasoning. Building upon this comprehensive dataset, we propose SurgVLM, which is built upon Qwen2.5-VL, and undergoes instruction tuning to 10+ surgical tasks. We further construct a surgical multimodal benchmark, SurgVLM-Bench, for method evaluation. SurgVLM-Bench consists of 6 popular and widely-used datasets in surgical domain, covering several crucial downstream tasks. Based on SurgVLM-Bench, we evaluate the performance of our SurgVLM (3 SurgVLM variants: SurgVLM-7B, SurgVLM-32B, and SurgVLM-72B), and conduct comprehensive comparisons with 14 mainstream commercial VLMs (e.g., GPT-4o, Gemini 2.0 Flash, Qwen2.5-Max).

Haofeng Liu, Ziyue Wang, Sudhanshu Mishra et al.

Surgical video segmentation is crucial for computer-assisted surgery, enabling precise localization and tracking of instruments and tissues. Interactive Video Object Segmentation (iVOS) models such as Segment Anything Model 2 (SAM2) provide prompt-based flexibility beyond methods with predefined categories, but face challenges in surgical scenarios due to the domain gap and limited long-term tracking. To address these limitations, we construct SA-SV, the largest surgical iVOS benchmark with instance-level spatio-temporal annotations (masklets) spanning eight procedure types (61k frames, 1.6k masklets), enabling comprehensive development and evaluation for long-term tracking and zero-shot generalization. Building on SA-SV, we propose SAM2S, a foundation model enhancing \textbf{SAM2} for \textbf{S}urgical iVOS through: (1) DiveMem, a trainable diverse memory mechanism for robust long-term tracking; (2) temporal semantic learning for instrument understanding; and (3) ambiguity-resilient learning to mitigate annotation inconsistencies across multi-source datasets. Extensive experiments demonstrate that fine-tuning on SA-SV enables substantial performance gains, with SAM2 improving by 12.99 average $\mathcal{J}$\&$\mathcal{F}$ over vanilla SAM2. SAM2S further advances performance to 80.42 average $\mathcal{J}$\&$\mathcal{F}$, surpassing vanilla and fine-tuned SAM2 by 17.10 and 4.11 points respectively, while maintaining 68 FPS real-time inference and strong zero-shot generalization. Code and dataset will be released at https://jinlab-imvr.github.io/SAM2S.