Angelo Henriques, Korab Hoxha, Daniel Zapp et al.
Scene graphs (SGs) provide structured relational representations crucial for decoding complex, dynamic surgical environments. This PRISMA-ScR-guided scoping review systematically maps the evolving landscape of SG research in surgery, charting its applications, methodological advancements, and future directions. Our analysis reveals rapid growth, yet uncovers a critical 'data divide': internal-view research (e.g., triplet recognition) almost exclusively uses real-world 2D video, while external-view 4D modeling relies heavily on simulated data, exposing a key translational research gap. Methodologically, the field has advanced from foundational graph neural networks to specialized foundation models that now significantly outperform generalist large vision-language models in surgical contexts. This progress has established SGs as a cornerstone technology for both analysis, such as workflow recognition and automated safety monitoring, and generative tasks like controllable surgical simulation. Although challenges in data annotation and real-time implementation persist, they are actively being addressed through emerging techniques. Surgical SGs are maturing into an essential semantic bridge, enabling a new generation of intelligent systems to improve surgical safety, efficiency, and training.