Saurav Sharma

Sanat Ramesh, Vinkle Srivastav, Deepak Alapatt et al.

The field of surgical computer vision has undergone considerable breakthroughs in recent years with the rising popularity of deep neural network-based methods. However, standard fully-supervised approaches for training such models require vast amounts of annotated data, imposing a prohibitively high cost; especially in the clinical domain. Self-Supervised Learning (SSL) methods, which have begun to gain traction in the general computer vision community, represent a potential solution to these annotation costs, allowing to learn useful representations from only unlabeled data. Still, the effectiveness of SSL methods in more complex and impactful domains, such as medicine and surgery, remains limited and unexplored. In this work, we address this critical need by investigating four state-of-the-art SSL methods (MoCo v2, SimCLR, DINO, SwAV) in the context of surgical computer vision. We present an extensive analysis of the performance of these methods on the Cholec80 dataset for two fundamental and popular tasks in surgical context understanding, phase recognition and tool presence detection. We examine their parameterization, then their behavior with respect to training data quantities in semi-supervised settings. Correct transfer of these methods to surgery, as described and conducted in this work, leads to substantial performance gains over generic uses of SSL - up to 7.4% on phase recognition and 20% on tool presence detection - as well as state-of-the-art semi-supervised phase recognition approaches by up to 14%. Further results obtained on a highly diverse selection of surgical datasets exhibit strong generalization properties. The code is available at https://github.com/CAMMA-public/SelfSupSurg.

Chinedu Innocent Nwoye, Tong Yu, Saurav Sharma et al.

Formalizing surgical activities as triplets of the used instruments, actions performed, and target anatomies is becoming a gold standard approach for surgical activity modeling. The benefit is that this formalization helps to obtain a more detailed understanding of tool-tissue interaction which can be used to develop better Artificial Intelligence assistance for image-guided surgery. Earlier efforts and the CholecTriplet challenge introduced in 2021 have put together techniques aimed at recognizing these triplets from surgical footage. Estimating also the spatial locations of the triplets would offer a more precise intraoperative context-aware decision support for computer-assisted intervention. This paper presents the CholecTriplet2022 challenge, which extends surgical action triplet modeling from recognition to detection. It includes weakly-supervised bounding box localization of every visible surgical instrument (or tool), as the key actors, and the modeling of each tool-activity in the form of <instrument, verb, target> triplet. The paper describes a baseline method and 10 new deep learning algorithms presented at the challenge to solve the task. It also provides thorough methodological comparisons of the methods, an in-depth analysis of the obtained results across multiple metrics, visual and procedural challenges; their significance, and useful insights for future research directions and applications in surgery.

Saurav Sharma, Chinedu Innocent Nwoye, Didier Mutter et al.

One of the recent advances in surgical AI is the recognition of surgical activities as triplets of (instrument, verb, target). Albeit providing detailed information for computer-assisted intervention, current triplet recognition approaches rely only on single frame features. Exploiting the temporal cues from earlier frames would improve the recognition of surgical action triplets from videos. In this paper, we propose Rendezvous in Time (RiT) - a deep learning model that extends the state-of-the-art model, Rendezvous, with temporal modeling. Focusing more on the verbs, our RiT explores the connectedness of current and past frames to learn temporal attention-based features for enhanced triplet recognition. We validate our proposal on the challenging surgical triplet dataset, CholecT45, demonstrating an improved recognition of the verb and triplet along with other interactions involving the verb such as (instrument, verb). Qualitative results show that the RiT produces smoother predictions for most triplet instances than the state-of-the-arts. We present a novel attention-based approach that leverages the temporal fusion of video frames to model the evolution of surgical actions and exploit their benefits for surgical triplet recognition.

Saurav Sharma, Chinedu Innocent Nwoye, Didier Mutter et al.

Surgical action triplets describe instrument-tissue interactions as (instrument, verb, target) combinations, thereby supporting a detailed analysis of surgical scene activities and workflow. This work focuses on surgical action triplet detection, which is challenging but more precise than the traditional triplet recognition task as it consists of joint (1) localization of surgical instruments and (2) recognition of the surgical action triplet associated with every localized instrument. Triplet detection is highly complex due to the lack of spatial triplet annotation. We analyze how the amount of instrument spatial annotations affects triplet detection and observe that accurate instrument localization does not guarantee better triplet detection due to the risk of erroneous associations with the verbs and targets. To solve the two tasks, we propose MCIT-IG, a two-stage network, that stands for Multi-Class Instrument-aware Transformer-Interaction Graph. The MCIT stage of our network models per class embedding of the targets as additional features to reduce the risk of misassociating triplets. Furthermore, the IG stage constructs a bipartite dynamic graph to model the interaction between the instruments and targets, cast as the verbs. We utilize a mixed-supervised learning strategy that combines weak target presence labels for MCIT and pseudo triplet labels for IG to train our network. We observed that complementing minimal instrument spatial annotations with target embeddings results in better triplet detection. We evaluate our model on the CholecT50 dataset and show improved performance on both instrument localization and triplet detection, topping the leaderboard of the CholecTriplet challenge in MICCAI 2022.

Shi Li, Vinkle Srivastav, Nicolas Chanel et al.

Surgical procedures are inherently complex and risky, requiring extensive expertise and constant focus to well navigate evolving intraoperative scenes. Computer-assisted systems such as surgical visual question answering (VQA) offer promises for education and intraoperative support. Current surgical VQA research largely focuses on static frame analysis, overlooking rich temporal semantics. Surgical video question answering is further challenged by low visual contrast, its highly knowledge-driven nature, diverse analytical needs spanning scattered temporal windows, and the hierarchy from basic perception to high-level intraoperative assessment. To address these challenges, we propose SurgTEMP, a multimodal LLM framework featuring (i) a query-guided token selection module that builds hierarchical visual memory (spatial and temporal memory banks) and (ii) a Surgical Competency Progression (SCP) training scheme. Together, these components enable effective modeling of variable-length surgical videos while preserving procedure-relevant cues and temporal coherence, and better support diverse downstream assessment tasks. To support model development, we introduce CholeVidQA-32K, a surgical video question answering dataset comprising 32K open-ended QA pairs and 3,855 video segments (approximately 128 h total) from laparoscopic cholecystectomy. The dataset is organized into a three-level hierarchy -- Perception, Assessment, and Reasoning -- spanning 11 tasks from instrument/action/anatomy perception to Critical View of Safety (CVS), intraoperative difficulty, skill proficiency, and adverse event assessment. In comprehensive evaluations against state-of-the-art open-source multimodal and video LLMs (fine-tuned and zero-shot), SurgTEMP achieves substantial performance improvements, advancing the state of video-based surgical VQA.

Saurav Sharma, Maria Vannucci, Leonardo Pestana Legori et al.

Purpose: Laparoscopic cholecystectomy (LC) operative difficulty (LCOD) is highly variable and influences outcomes. Despite extensive LC studies in surgical workflow analysis, limited efforts explore LCOD using intraoperative video data. Early recognition of LCOD could allow prompt review by expert surgeons, enhance operating room (OR) planning, and improve surgical outcomes. Methods: We propose the clinical task of early LCOD assessment using limited video observations. We design SurgPrOD, a deep learning model to assess LCOD by analyzing features from global and local temporal resolutions (snapshots) of the observed LC video. Also, we propose a novel snapshot-centric attention (SCA) module, acting across snapshots, to enhance LCOD prediction. We introduce the CholeScore dataset, featuring video-level LCOD labels to validate our method. Results: We evaluate SurgPrOD on 3 LCOD assessment scales in the CholeScore dataset. On our new metric assessing early and stable correct predictions, SurgPrOD surpasses baselines by at least 0.22 points. SurgPrOD improves over baselines by at least 9 and 5 percentage points in F1 score and top1-accuracy, respectively, demonstrating its effectiveness in correct predictions. Conclusion: We propose a new task for early LCOD assessment and a novel model, SurgPrOD analyzing surgical video from global and local perspectives. Our results on the CholeScore dataset establishes a new benchmark to study LCOD using intraoperative video data.

Saurav Sharma, Chinedu Innocent Nwoye, Didier Mutter et al.

Surgical future prediction, driven by real-time AI analysis of surgical video, is critical for operating room safety and efficiency. It provides actionable insights into upcoming events, their timing, and risks-enabling better resource allocation, timely instrument readiness, and early warnings for complications (e.g., bleeding, bile duct injury). Despite this need, current surgical AI research focuses on understanding what is happening rather than predicting future events. Existing methods target specific tasks in isolation, lacking unified approaches that span both short-term (action triplets, events) and long-term horizons (remaining surgery duration, phase transitions). These methods rely on coarse-grained supervision while fine-grained surgical action triplets and steps remain underexplored. Furthermore, methods based only on future feature prediction struggle to generalize across different surgical contexts and procedures. We address these limits by reframing surgical future prediction as state-change learning. Rather than forecasting raw observations, our approach classifies state transitions between current and future timesteps. We introduce SurgFUTR, implementing this through a teacher-student architecture. Video clips are compressed into state representations via Sinkhorn-Knopp clustering; the teacher network learns from both current and future clips, while the student network predicts future states from current videos alone, guided by our Action Dynamics (ActDyn) module. We establish SFPBench with five prediction tasks spanning short-term (triplets, events) and long-term (remaining surgery duration, phase and step transitions) horizons. Experiments across four datasets and three procedures show consistent improvements. Cross-procedure transfer validates generalizability.

Saurav Sharma, Didier Mutter, Nicolas Padoy

While vision-language models like CLIP have advanced zero-shot surgical phase recognition, they struggle with fine-grained surgical activities, especially action triplets. This limitation arises because current CLIP formulations rely on global image features, which overlook the fine-grained semantics and contextual details crucial for complex tasks like zero-shot triplet recognition. Furthermore, these models do not explore the hierarchical structure inherent in triplets, reducing their ability to generalize to novel triplets. To address these challenges, we propose fine-CLIP, which learns object-centric features and leverages the hierarchy in triplet formulation. Our approach integrates three components: hierarchical prompt modeling to capture shared semantics, LoRA-based vision backbone adaptation for enhanced feature extraction, and a graph-based condensation strategy that groups similar patch features into meaningful object clusters. Since triplet classification is a challenging task, we introduce an alternative yet meaningful base-to-novel generalization benchmark with two settings on the CholecT50 dataset: Unseen-Target, assessing adaptability to triplets with novel anatomical structures, and Unseen-Instrument-Verb, where models need to generalize to novel instrument-verb interactions. fine-CLIP shows significant improvements in F1 and mAP, enhancing zero-shot recognition of novel surgical triplets.

Rui Dai, Srijan Das, Saurav Sharma et al.

Designing activity detection systems that can be successfully deployed in daily-living environments requires datasets that pose the challenges typical of real-world scenarios. In this paper, we introduce a new untrimmed daily-living dataset that features several real-world challenges: Toyota Smarthome Untrimmed (TSU). TSU contains a wide variety of activities performed in a spontaneous manner. The dataset contains dense annotations including elementary, composite activities and activities involving interactions with objects. We provide an analysis of the real-world challenges featured by our dataset, highlighting the open issues for detection algorithms. We show that current state-of-the-art methods fail to achieve satisfactory performance on the TSU dataset. Therefore, we propose a new baseline method for activity detection to tackle the novel challenges provided by our dataset. This method leverages one modality (i.e. optic flow) to generate the attention weights to guide another modality (i.e RGB) to better detect the activity boundaries. This is particularly beneficial to detect activities characterized by high temporal variance. We show that the method we propose outperforms state-of-the-art methods on TSU and on another popular challenging dataset, Charades.

Srijan Das, Saurav Sharma, Rui Dai et al.

In this paper, we focus on the spatio-temporal aspect of recognizing Activities of Daily Living (ADL). ADL have two specific properties (i) subtle spatio-temporal patterns and (ii) similar visual patterns varying with time. Therefore, ADL may look very similar and often necessitate to look at their fine-grained details to distinguish them. Because the recent spatio-temporal 3D ConvNets are too rigid to capture the subtle visual patterns across an action, we propose a novel Video-Pose Network: VPN. The 2 key components of this VPN are a spatial embedding and an attention network. The spatial embedding projects the 3D poses and RGB cues in a common semantic space. This enables the action recognition framework to learn better spatio-temporal features exploiting both modalities. In order to discriminate similar actions, the attention network provides two functionalities - (i) an end-to-end learnable pose backbone exploiting the topology of human body, and (ii) a coupler to provide joint spatio-temporal attention weights across a video. Experiments show that VPN outperforms the state-of-the-art results for action classification on a large scale human activity dataset: NTU-RGB+D 120, its subset NTU-RGB+D 60, a real-world challenging human activity dataset: Toyota Smarthome and a small scale human-object interaction dataset Northwestern UCLA.