Autonomous navigation for mechanical thrombectomy (MT) remains a critical challenge due to the complexity of vascular anatomy and the need for precise, real-time decision-making. Reinforcement learning (RL)-based approaches have demonstrated potential in automating endovascular navigation, but current methods often struggle with generalization across multiple patient vasculatures and long-horizon tasks. We propose a world model for autonomous endovascular navigation using TD-MPC2, a model-based RL algorithm. We trained a single RL agent across multiple endovascular navigation tasks in ten real patient vasculatures, comparing performance against the state-of-the-art Soft Actor-Critic (SAC) method. Results indicate that TD-MPC2 significantly outperforms SAC in multi-task learning, achieving a 65% mean success rate compared to SAC’s 37% ( $$p < 0.001$$ ), with notable improvements in path ratio. TD-MPC2 exhibited increased procedure times, suggesting a trade-off between success rate and execution speed. These findings highlight the potential of world models for improving autonomous endovascular navigation and lay the foundation for future research in generalizable AI-driven robotic interventions.

Online surgical phase recognition plays a significant role towards building contextual tools that could quantify performance and oversee the execution of surgical workflows. Current approaches are limited since they train spatial feature extractors using frame-level supervision that could lead to incorrect predictions due to similar frames appearing at different phases, and poorly fuse local and global features due to computational constraints which can affect the analysis of long videos commonly encountered in surgical interventions. In this paper, we present a two-stage method, called Long Video Transformer (LoViT), emphasizing the development of a temporally-rich spatial feature extractor and a phase transition map. The temporally-rich spatial feature extractor is designed to capture critical temporal information within the surgical video frames. The phase transition map provides essential insights into the dynamic transitions between different surgical phases. LoViT combines these innovations with a multiscale temporal aggregator consisting of two cascaded L-Trans modules based on self-attention, followed by a G-Informer module based on ProbSparse self-attention for processing global temporal information. The multi-scale temporal head then leverages the temporally-rich spatial features and phase transition map to classify surgical phases using phase transition-aware supervision. Our approach outperforms state-of-the-art methods on the Cholec80 and AutoLaparo datasets consistently. Compared to Trans-SVNet, LoViT achieves a 2.4 pp (percentage point) improvement in video-level accuracy on Cholec80 and a 3.1 pp improvement on AutoLaparo. Our results demonstrate the effectiveness of our approach in achieving state-of-the-art performance of surgical phase recognition on two datasets of different surgical procedures and temporal sequencing characteristics. The project page is available at https://github.com/MRUIL/LoViT.

This paper introduces SKiT, a fast Key information Transformer for phase recognition of videos. Unlike previous methods that rely on complex models to capture long-term temporal information, SKiT accurately recognizes high-level stages of videos using an efficient key pooling operation. This operation records important key information by retaining the maximum value recorded from the beginning up to the current video frame, with a time complexity of ${\mathcal{O}}\left( 1 \right)$. Experimental results on Cholec80 and AutoLaparo surgical datasets demonstrate the ability of our model to recognize phases in an online manner. SKiT achieves higher performance than state-of-the-art methods with an accuracy of 92.5% and 82.9% on Cholec80 and AutoLaparo, respectively, while running the temporal model eight times faster (7ms v.s. 55ms) than LoViT, which uses ProbSparse to capture global information. We highlight that the inference time of SKiT is constant, and independent from the input length, making it a stable choice for keeping a record of important global information, that appears on long surgical videos, essential for phase recognition. To sum up, we propose an effective and efficient model for surgical phase recognition that leverages key global information. This has an intrinsic value when performing this task in an online manner on long surgical videos for stable real-time surgical recognition systems.