Lalithkumar Seenivasan

Hao Ding, Lalithkumar Seenivasan, Hongchao Shu et al.

Large language model-based (LLM) agents are emerging as a powerful enabler of robust embodied intelligence due to their capability of planning complex action sequences. Sound planning ability is necessary for robust automation in many task domains, but especially in surgical automation. These agents rely on a highly detailed natural language representation of the scene. Thus, to leverage the emergent capabilities of LLM agents for surgical task planning, developing similarly powerful and robust perception algorithms is necessary to derive a detailed scene representation of the environment from visual input. Previous research has focused primarily on enabling LLM-based task planning while adopting simple yet severely limited perception solutions to meet the needs for bench-top experiments, but lacks the critical flexibility to scale to less constrained settings. In this work, we propose an alternate perception approach -- a digital twin (DT)-based machine perception approach that capitalizes on the convincing performance and out-of-the-box generalization of recent vision foundation models. Integrating our DT representation and LLM agent for planning with the dVRK platform, we develop an embodied intelligence system and evaluate its robustness in performing peg transfer and gauze retrieval tasks. Our approach shows strong task performance and generalizability to varied environmental settings. Despite a convincing performance, this work is merely a first step towards the integration of DT representations. Future studies are necessary for the realization of a comprehensive DT framework to improve the interpretability and generalizability of embodied intelligence in surgery.

Hao Ding, Yuqian Zhang, Tuxun Lu et al.

Surgical data science has seen rapid advancement due to the excellent performance of end-to-end deep neural networks (DNNs) for surgical video analysis. Despite their successes, end-to-end DNNs have been proven susceptible to even minor corruptions, substantially impairing the model's performance. This vulnerability has become a major concern for the translation of cutting-edge technology, especially for high-stakes decision-making in surgical data science. We introduce SegSTRONG-C, a benchmark and challenge in surgical data science dedicated, aiming to better understand model deterioration under unforeseen but plausible non-adversarial corruption and the capabilities of contemporary methods that seek to improve it. Through comprehensive baseline experiments and participating submissions from widespread community engagement, SegSTRONG-C reveals key themes for model failure and identifies promising directions for improving robustness. The performance of challenge winners, achieving an average 0.9394 DSC and 0.9301 NSD across the unreleased test sets with corruption types: bleeding, smoke, and low brightness, shows inspiring improvement of 0.1471 DSC and 0.2584 NSD in average comparing to strongest baseline methods with UNet architecture trained with AutoAugment. In conclusion, the SegSTRONG-C challenge has identified some practical approaches for enhancing model robustness, yet most approaches relied on conventional techniques that have known, and sometimes quite severe, limitations. Looking ahead, we advocate for expanding intellectual diversity and creativity in non-adversarial robustness beyond data augmentation or training scale, calling for new paradigms that enhance universal robustness to corruptions and may enable richer applications in surgical data science.

Florence Klitzner, Blanca Inigo, Benjamin D. Killeen et al.

Imitation learning-based robot control policies are enjoying renewed interest in video-based robotics. However, it remains unclear whether this approach applies to X-ray-guided procedures, such as spine instrumentation. This is because interpretation of multi-view X-rays is complex. We examine opportunities and challenges for imitation policy learning in bi-plane-guided cannula insertion. We develop an in silico sandbox for scalable, automated simulation of X-ray-guided spine procedures with a high degree of realism. We curate a dataset of correct trajectories and corresponding bi-planar X-ray sequences that emulate the stepwise alignment of providers. We then train imitation learning policies for planning and open-loop control that iteratively align a cannula solely based on visual information. This precisely controlled setup offers insights into limitations and capabilities of this method. Our policy succeeded on the first attempt in 68.5% of cases, maintaining safe intra-pedicular trajectories across diverse vertebral levels. The policy generalized to complex anatomy, including fractures, and remained robust to varied initializations. Rollouts on real bi-planar X-rays further suggest that the model can produce plausible trajectories, despite training exclusively in simulation. While these preliminary results are promising, we also identify limitations, especially in entry point precision. Full closed-look control will require additional considerations around how to provide sufficiently frequent feedback. With more robust priors and domain knowledge, such models may provide a foundation for future efforts toward lightweight and CT-free robotic intra-operative spinal navigation.

Hongchao Shu, Lalithkumar Seenivasan, Mingxu Liu et al.

Arthroscopic procedures can greatly benefit from navigation systems that enhance spatial awareness, depth perception, and field of view. However, existing optical tracking solutions impose strict workspace constraints and disrupt surgical workflow. Vision-based alternatives, though less invasive, often rely solely on the monocular arthroscope camera, making them prone to drift, scale ambiguity, and sensitivity to rapid motion or occlusion. We propose DualVision ArthroNav, a multi-camera arthroscopy navigation system that integrates an external camera rigidly mounted on the arthroscope. The external camera provides stable visual odometry and absolute localization, while the monocular arthroscope video enables dense scene reconstruction. By combining these complementary views, our system resolves the scale ambiguity and long-term drift inherent in monocular SLAM and ensures robust relocalization. Experiments demonstrate that our system effectively compensates for calibration errors, achieving an average absolute trajectory error of 1.09 mm. The reconstructed scenes reach an average target registration error of 2.16 mm, with high visual fidelity (SSIM = 0.69, PSNR = 22.19). These results indicate that our system provides a practical and cost-efficient solution for arthroscopic navigation, bridging the gap between optical tracking and purely vision-based systems, and paving the way toward clinically deployable, fully vision-based arthroscopic guidance.

Yiqing Shen, Bohan Liu, Chenjia Li et al.

Reasoning segmentation (RS) aims to identify and segment objects of interest based on implicit text queries. As such, RS is a catalyst for embodied AI agents, enabling them to interpret high-level commands without requiring explicit step-by-step guidance. However, current RS approaches rely heavily on the visual perception capabilities of multimodal large language models (LLMs), leading to several major limitations. First, they struggle with queries that require multiple steps of reasoning or those that involve complex spatial/temporal relationships. Second, they necessitate LLM fine-tuning, which may require frequent updates to maintain compatibility with contemporary LLMs and may increase risks of catastrophic forgetting during fine-tuning. Finally, being primarily designed for static images or offline video processing, they scale poorly to online video data. To address these limitations, we propose an agent framework that disentangles perception and reasoning for online video RS without LLM fine-tuning. Our innovation is the introduction of a just-in-time digital twin concept, where -- given an implicit query -- a LLM plans the construction of a low-level scene representation from high-level video using specialist vision models. We refer to this approach to creating a digital twin as "just-in-time" because the LLM planner will anticipate the need for specific information and only request this limited subset instead of always evaluating every specialist model. The LLM then performs reasoning on this digital twin representation to identify target objects. To evaluate our approach, we introduce a new comprehensive video reasoning segmentation benchmark comprising 200 videos with 895 implicit text queries. The benchmark spans three reasoning categories (semantic, spatial, and temporal) with three different reasoning chain complexity.

Yiqing Shen, Hao Ding, Lalithkumar Seenivasan et al.

Current foundation models (FMs) rely on token representations that directly fragment continuous real-world multimodal data into discrete tokens. They limit FMs to learning real-world knowledge and relationships purely through statistical correlation rather than leveraging explicit domain knowledge. Consequently, current FMs struggle with maintaining semantic coherence across modalities, capturing fine-grained spatial-temporal dynamics, and performing causal reasoning. These limitations cannot be overcome by simply scaling up model size or expanding datasets. This position paper argues that the machine learning community should consider digital twin (DT) representations, which are outcome-driven digital representations that serve as building blocks for creating virtual replicas of physical processes, as an alternative to the token representation for building FMs. Finally, we discuss how DT representations can address these challenges by providing physically grounded representations that explicitly encode domain knowledge and preserve the continuous nature of real-world processes.

Grayson Byrd, Corban Rivera, Bethany Kemp et al.

Replicating human-level intelligence in the execution of embodied tasks remains challenging due to the unconstrained nature of real-world environments. Novel use of large language models (LLMs) for task planning seeks to address the previously intractable state/action space of complex planning tasks, but hallucinations limit their reliability, and thus, viability beyond a research context. Additionally, the prompt engineering required to achieve adequate system performance lacks transparency, and thus, repeatability. In contrast to LLM planning, symbolic planning methods offer strong reliability and repeatability guarantees, but struggle to scale to the complexity and ambiguity of real-world tasks. We introduce a new robotic planning method that augments LLM planners with symbolic planning oversight to improve reliability and repeatability, and provide a transparent approach to defining hard constraints with considerably stronger clarity than traditional prompt engineering. Importantly, these augmentations preserve the reasoning capabilities of LLMs and retain impressive generalization in open-world environments. We demonstrate our approach in simulated and real-world environments. On the ALFWorld planning benchmark, our approach outperforms current state-of-the-art methods, achieving a near-perfect 99% success rate. Deployment of our method to a real-world quadruped robot resulted in 100% task success compared to 50% and 30% for pure LLM and symbolic planners across embodied pick and place tasks. Our approach presents an effective strategy to enhance the reliability, repeatability and transparency of LLM-based robot planners while retaining their key strengths: flexibility and generalizability to complex real-world environments. We hope that this work will contribute to the broad goal of building resilient embodied intelligent systems.

Catalina Gomez, Lalithkumar Seenivasan, Xinrui Zou et al.

Traditional surgical skill acquisition relies heavily on expert feedback, yet direct access is limited by faculty availability and variability in subjective assessments. While trainees can practice independently, the lack of personalized, objective, and quantitative feedback reduces the effectiveness of self-directed learning. Recent advances in computer vision and machine learning have enabled automated surgical skill assessment, demonstrating the feasibility of automatic competency evaluation. However, it is unclear whether such Artificial Intelligence (AI)-driven feedback can contribute to skill acquisition. Here, we examine the effectiveness of explainable AI (XAI)-generated feedback in surgical training through a human-AI study. We create a simulation-based training framework that utilizes XAI to analyze videos and extract surgical skill proxies related to primitive actions. Our intervention provides automated, user-specific feedback by comparing trainee performance to expert benchmarks and highlighting deviations from optimal execution through understandable proxies for actionable guidance. In a prospective user study with medical students, we compare the impact of XAI-guided feedback against traditional video-based coaching on task outcomes, cognitive load, and trainees' perceptions of AI-assisted learning. Results showed improved cognitive load and confidence post-intervention. While no differences emerged between the two feedback types in reducing performance gaps or practice adjustments, trends in the XAI group revealed desirable effects where participants more closely mimicked expert practice. This work encourages the study of explainable AI in surgical education and the development of data-driven, adaptive feedback mechanisms that could transform learning experiences and competency assessment.

Lalithkumar Seenivasan, Jiru Xu, Roger D. Soberanis Mukul et al.

Emerging surgical data science and robotics solutions, especially those designed to provide assistance in situ, require natural human-machine interfaces to fully unlock their potential in providing adaptive and intuitive aid. Contemporary AI-driven solutions remain inherently rigid, offering limited flexibility and restricting natural human-machine interaction in dynamic surgical environments. These solutions rely heavily on extensive task-specific pre-training, fixed object categories, and explicit manual-prompting. This work introduces a novel Perception Agent that leverages speech-integrated prompt-engineered large language models (LLMs), segment anything model (SAM), and any-point tracking foundation models to enable a more natural human-machine interaction in real-time intraoperative surgical assistance. Incorporating a memory repository and two novel mechanisms for segmenting unseen elements, Perception Agent offers the flexibility to segment both known and unseen elements in the surgical scene through intuitive interaction. Incorporating the ability to memorize novel elements for use in future surgeries, this work takes a marked step towards human-machine symbiosis in surgical procedures. Through quantitative analysis on a public dataset, we show that the performance of our agent is on par with considerably more labor-intensive manual-prompting strategies. Qualitatively, we show the flexibility of our agent in segmenting novel elements (instruments, phantom grafts, and gauze) in a custom-curated dataset. By offering natural human-machine interaction and overcoming rigidity, our Perception Agent potentially brings AI-based real-time assistance in dynamic surgical environments closer to reality.