Endoscopic images often suffer from diverse and co-occurring degradations such as low lighting, smoke, and bleeding, which obscure critical clinical details. Existing restoration methods are typically task-specific and often require prior knowledge of the degradation type, limiting their robustness in real-world clinical use. We propose EndoIR, an all-in-one, degradation-agnostic diffusion-based framework that restores multiple degradation types using a single model. EndoIR introduces a Dual-Domain Prompter that extracts joint spatial–frequency features, coupled with an adaptive embedding that encodes both shared and task-specific cues as conditioning for denoising. To mitigate feature confusion in conventional concatenation-based conditioning, we design a Dual-Stream Diffusion architecture that processes clean and degraded inputs separately, with a Rectified Fusion Block integrating them in a structured, degradation-aware manner. Furthermore, Noise-Aware Routing Block improves efficiency by dynamically selecting only noise-relevant features during denoising. Experiments on SegSTRONG-C and CEC datasets demonstrate that EndoIR achieves state-of-the-art performance across multiple degradation scenarios while using fewer parameters than strong baselines, and downstream segmentation experiments confirm its clinical utility.

Enabling intuitive, language-driven interaction with surgical scenes is a critical step toward intelligent operating rooms and autonomous surgical robotic assistance. However, the task of referring segmentation, localizing surgical instruments based on natural language descriptions, remains underexplored in surgical videos, with existing approaches struggling to generalize due to reliance on static visual cues and predefined instrument names. In this work, we introduce SurgRef, a novel motion-guided framework that grounds free-form language expressions in instrument motion, capturing how tools move and interact across time, rather than what they look like. This allows models to understand and segment instruments even under occlusion, ambiguity, or unfamiliar terminology. To train and evaluate SurgRef, we present Ref-IMotion, a diverse, multi-institutional video dataset with dense spatiotemporal masks and rich motion-centric expressions. SurgRef achieves state-of-the-art accuracy and generalization across surgical procedures, setting a new benchmark for robust, language-driven surgical video segmentation.

Reliable recognition and localization of surgical instruments in endoscopic video recordings are foundational for a wide range of applications in computer- and robot-assisted minimally invasive surgery (RAMIS), including surgical training, skill assessment, and autonomous assistance. However, robust performance under real-world conditions remains a significant challenge. Incorporating surgical context - such as the current procedural phase - has emerged as a promising strategy to improve robustness and interpretability. To address these challenges, we organized the Surgical Procedure Phase, Keypoint, and Instrument Recognition (PhaKIR) sub-challenge as part of the Endoscopic Vision (EndoVis) challenge at MICCAI 2024. We introduced a novel, multi-center dataset comprising thirteen full-length laparoscopic cholecystectomy videos collected from three distinct medical institutions, with unified annotations for three interrelated tasks: surgical phase recognition, instrument keypoint estimation, and instrument instance segmentation. Unlike existing datasets, ours enables joint investigation of instrument localization and procedural context within the same data while supporting the integration of temporal information across entire procedures. We report results and findings in accordance with the BIAS guidelines for biomedical image analysis challenges. The PhaKIR sub-challenge advances the field by providing a unique benchmark for developing temporally aware, context-driven methods in RAMIS and offers a high-quality resource to support future research in surgical scene understanding.

Recently, Multimodal Large Language Models (MLLMs) have demonstrated their immense potential in computer-aided diagnosis and decision-making. In the context of robotic-assisted surgery, MLLMs can serve as effective tools for surgical training and guidance. However, there is still a deficiency of MLLMs specialized for surgical scene understanding in endoscopic procedures. To this end, we present EndoChat, an MLLM tailored to address various dialogue paradigms and subtasks in understanding endoscopic procedures. To train our EndoChat, we construct the Surg-396K dataset through a novel pipeline that systematically extracts surgical information and generates structured annotations based on large-scale endoscopic surgery datasets. Furthermore, we introduce a multi-scale visual token interaction mechanism and a visual contrast-based reasoning mechanism to enhance the model's representation learning and reasoning capabilities. Our model achieves state-of-the-art performance across five dialogue paradigms and seven surgical scene understanding tasks. Additionally, we conduct evaluations with professional surgeons, who provide positive feedback on the majority of conversation cases generated by EndoChat. Overall, these results demonstrate that EndoChat has the potential to advance training and automation in robotic-assisted surgery. Our dataset and model are publicly available at https://github.com/gkw0010/EndoChat.

Point cloud video perception has become an essential task for the realm of 3D vision. Current 4D representation learning techniques typically engage in iterative processing coupled with dense query operations. Although effective in capturing temporal features, this approach leads to substantial computational redundancy. In this work, we propose a framework, named as PvNeXt, for effective yet efficient point cloud video recognition, via personalized one-shot query operation. Specially, PvNeXt consists of two key modules, the Motion Imitator and the Single-Step Motion Encoder. The former module, the Motion Imitator, is designed to capture the temporal dynamics inherent in sequences of point clouds, thus generating the virtual motion corresponding to each frame. The Single-Step Motion Encoder performs a one-step query operation, associating point cloud of each frame with its corresponding virtual motion frame, thereby extracting motion cues from point cloud sequences and capturing temporal dynamics across the entire sequence. Through the integration of these two modules, {PvNeXt} enables personalized one-shot queries for each frame, effectively eliminating the need for frame-specific looping and intensive query processes. Extensive experiments on multiple benchmarks demonstrate the effectiveness of our method.

Surgical phase recognition is critical for assisting surgeons in understanding surgical videos. Existing studies focused more on online surgical phase recognition, by leveraging preceding frames to predict the current frame. Despite great progress, they formulated the task as a series of frame-wise classification, which resulted in a lack of global context of the entire procedure and incoherent predictions. Moreover, besides online analysis, accurate offline surgical phase recognition is also in significant clinical need for retrospective analysis, and existing online algorithms do not fully analyze the entire video, thereby limiting accuracy in offline analysis. To over-come these challenges and enhance both online and offline inference capabilities, we propose a universal Surgical Phase LocalizAtion Network, named SurgPLAN++, with the principle of temporal detection. To ensure a global understanding of the surgical procedure, we devise a phase localization strategy for SurgPLAN ++ to predict phase segments across the entire video through phase proposals. For online analysis, to generate high-quality phase proposals, SurgPLAN++ incorporates a data augmentation strategy to extend the streaming video into a pseudo-complete video through mirroring, center-duplication, and down-sampling. For offline analysis, SurgPLAN++ capi-talizes on its global phase prediction framework to continu-ously refine preceding predictions during each online inference step, thereby significantly improving the accuracy of phase recognition. We perform extensive experiments to validate the effectiveness, and our SurgPLAN++ achieves remarkable performance in both online and offline modes, which outper-forms state-of-the-art methods. The source code is available at https://github.com/franciszchenlSurgPLAN-Plus.

Simultaneous Localization and Mapping (SLAM) is essential for precise surgical interventions and robotic tasks in minimally invasive procedures. While recent advancements in 3D Gaussian Splatting (3DGS) have improved SLAM with high-quality novel view synthesis and fast rendering, these systems struggle with accurate depth and surface reconstruction due to multi-view inconsistencies. Simply incorporating SLAM and 3DGS leads to mismatches between the reconstructed frames. In this work, we present Endo-2DTAM, a real-time endoscopic SLAM system with 2D Gaussian Splatting (2DGS) to address these challenges. Endo-2DTAM incorporates a surface normal-aware pipeline, which consists of tracking, mapping, and bundle adjustment modules for geometrically accurate reconstruction. Our robust tracking module combines point-topoint and point-to-plane distance metrics, while the mapping module utilizes normal consistency and depth distortion to enhance surface reconstruction quality. We also introduce a pose-consistent strategy for efficient and geometrically coherent keyframe sampling. Extensive experiments on public endoscopic datasets demonstrate that Endo-2DTAM achieves an RMSE of$1.87 \pm 0.63 \mathbf{m m}$for depth reconstruction of surgical scenes while maintaining computationally efficient tracking, high-quality visual appearance, and real-time rendering. Our code will be released at github.com/lastbasket/Endo-2DTAM.

Robot-assisted Endoscopic Submucosal Dissection (ESD) improves the surgical procedure by providing a more comprehensive view through advanced robotic instruments and bimanual operation, thereby enhancing dissection efficiency and accuracy. Accurate prediction of dissection trajectories is crucial for better decision-making, reducing intraoperative errors, and improving surgical training. Nevertheless, predicting these trajectories is challenging due to variable tumor margins and dynamic visual conditions. To address this issue, we create the ESD Trajectory and Confidence Map-based Safety Margin (ETSM) dataset with 1849 short clips, focusing on submucosal dissection with a dual-arm robotic system. We also introduce a framework that combines optimal dissection trajectory prediction with a confidence map-based safety margin, providing a more secure and intelligent decision-making tool to minimize surgical risks for ESD procedures. Additionally, we propose the Regression-based Confidence Map Prediction Network (RCMNet), which utilizes a regression approach to predict confidence maps for dissection areas, thereby delineating various levels of safety margins. We evaluate our RCMNet using three distinct experimental setups: in-domain evaluation, robustness assessment, and out-of-domain evaluation. Experimental results show that our approach excels in the confidence map-based safety margin prediction task, achieving a mean absolute error (MAE) of only 3.18. To the best of our knowledge, this is the first study to apply a regression approach for visual guidance concerning delineating varying safety levels of dissection areas. Our approach bridges gaps in current research by improving prediction accuracy and enhancing the safety of the dissection process, showing great clinical significance in practice. The dataset and code are available at https://github.com/FrankMOWJ/RCMNet.

Vision-Language-Action (VLA) models have emerged as a prominent research area, showcasing significant potential across a variety of applications. However, their performance in endoscopy robotics, particularly endoscopy capsule robots that perform actions within the digestive system, remains unexplored. The integration of VLA models into endoscopy robots allows more intuitive and efficient interactions between human operators and medical devices, improving both diagnostic accuracy and treatment outcomes. In this work, we design CapsDT, a Diffusion Transformer model for capsule robot manipulation in the stomach. By processing interleaved visual inputs, and textual instructions, CapsDT can infer corresponding robotic control signals to facilitate endoscopy tasks. In addition, we developed a capsule endoscopy robot system, a capsule robot controlled by a robotic arm-held magnet, addressing different levels of four endoscopy tasks and creating corresponding capsule robot datasets within the stomach simulator. Comprehensive evaluations on various robotic tasks indicate that CapsDT can serve as a robust vision-language generalist, achieving state-of-the-art performance in various levels of endoscopy tasks while achieving a 26.25% success rate in real-world simulation manipulation.

In surgical instrument segmentation, the increasing variety of instruments over time poses a significant challenge for existing neural networks, as they are unable to effectively learn such incremental tasks and suffer from catastrophic forgetting. When learning new data, the model experiences a sharp performance drop on previously learned data. Although several continual learning methods have been proposed for incremental understanding tasks in surgical scenarios, the issue of data imbalance often leads to a strong bias in the segmentation head, resulting in poor performance. Data imbalance can occur in two forms: (i) class imbalance between new and old data, and (ii) class imbalance within the same time point of data. Such imbalances often cause the dominant classes to take over the training process of continual semantic segmentation (CSS). To address this issue, we propose SurgCSS, a novel plug-and-play CSS framework for surgical instrument segmentation under data imbalance. Specifically, we generate realistic surgical backgrounds through inpainting and blend instrument foregrounds with the generated backgrounds in a class-aware manner to balance the data distribution in various scenarios. We further propose the Class Desensitization Loss by employing contrastive learning to correct edge biases caused by data imbalance. Moreover, we dynamically fuse the weight parameters of the old and new models to achieve a better trade-off between the biased and unbiased model weights. To investigate the data imbalance problem in surgical scenarios, we construct a new benchmark for surgical instrument CSS by integrating four public datasets: EndoVis 2017, EndoVis 2018, CholecSeg8k, and SAR-RAPR50. Extensive experiments demonstrate the effectiveness of the proposed framework, achieving significant performance improvement against existing baselines. Our method demonstrates excellent potential for clinical applications. The code is publicly available at github.com/Zzsf11/SurgCSS.

Deep learning can predict depth maps and capsule ego-motion from capsule endoscopy videos, aiding in 3D scene reconstruction and lesion localization. However, the collisions of the capsule endoscopies within the gastrointestinal tract cause vibration perturbations in the training data. Existing solutions focus solely on vision-based processing, neglecting other auxiliary signals like vibrations that could reduce noise and improve performance. Therefore, we propose V2-SfMLearner, a multimodal approach integrating vibration signals into vision-based depth and capsule motion estimation for monocular capsule endoscopy. We construct a multimodal capsule endoscopy dataset containing vibration and visual signals, and our artificial intelligence solution develops an unsupervised method using vision-vibration signals, effectively eliminating vibration perturbations through multimodal learning. Specifically, we carefully design a vibration network branch and a Fourier fusion module, to detect and mitigate vibration noises. The fusion framework is compatible with popular vision-only algorithms. Extensive validation on the multimodal dataset demonstrates superior performance and robustness against vision-only algorithms. Without the need for large external equipment, our V2-SfMLearner has the potential for integration into clinical capsule robots, providing real-time and dependable digestive examination tools. The findings show promise for practical implementation in clinical settings, enhancing the diagnostic capabilities of doctors. Note to Practitioners—This paper is motivated by the problem of estimating the depth and ego-motion information for the wireless capsule endoscopy in the human gastrointestinal tract to realize accurate, efficient, robust, and real-time inspection. Our estimation method does not engage any external localization equipment. Instead, inspired by the existing research on integrating capsule endoscopy and inertial measurement units, we introduce vibration signals into vision-based depth and ego-motion estimation approaches, improving the accuracy and robustness of the estimation results based on multimodal learning methods. Research on capsule robots or computer vision can readily be combined with our framework for various clinical and industrial applications.

In the realm of automated robotic surgery and computer-assisted interventions, understanding robotic surgical activities stands paramount. Existing algorithms dedicated to surgical activity recognition predominantly cater to pre-defined closed-set paradigms, ignoring the challenges of real-world open-set scenarios. Such algorithms often falter in the presence of test samples originating from classes unseen during training phases. To tackle this problem, we introduce an innovative Open-Set Surgical Activity Recognition (OSSAR) framework. Our solution leverages the hyperspherical reciprocal point strategy to enhance the distinction between known and unknown classes in the feature space. Additionally, we address the issue of over-confidence in the closed set by refining model calibration, avoiding misclassification of unknown classes as known ones. To support our assertions, we establish an open-set surgical activity benchmark utilizing the public JIGSAWS dataset. Besides, we also collect a novel dataset on endoscopic submucosal dissection for surgical activity tasks. Extensive comparisons and ablation experiments on these datasets demonstrate the significant outperformance of our method over existing state-of-the-art approaches. Our proposed solution can effectively address the challenges of real-world surgical scenarios. Our code is publicly accessible at github.com/longbai1006/OSSAR.

Surgical instrument segmentation is crucial in surgical scene understanding, thereby facilitating surgical safety. Existing algorithms directly detected all instruments of predefined categories in the input image, lacking the capability to segment specific instruments according to the surgeon’s intention. During different stages of surgery, surgeons exhibit varying preferences and focus toward different surgical instruments. Therefore, an instrument segmentation algorithm that adheres to the surgeon’s intention can minimize distractions from irrelevant instruments and assist surgeons to a great extent. The recent Segment Anything Model (SAM) reveals the capability to segment objects following prompts, but the manual annotations for prompts are impractical during the surgery. To address these limitations in operating rooms, we propose an audio-driven surgical instrument segmentation framework, named ASI-Seg, to accurately segment the required surgical instruments by parsing the audio commands of surgeons. Specifically, we propose an intention-oriented multimodal fusion to interpret the segmentation intention from audio commands and retrieve relevant instrument details to facilitate segmentation. Moreover, to guide our ASI-Seg segment of the required surgical instruments, we devise a contrastive learning prompt encoder to effectively distinguish the required instruments from the irrelevant ones. Therefore, our ASI-Seg promotes the workflow in the operating rooms, thereby providing targeted support and reducing the cognitive load on surgeons. Extensive experiments are performed to validate the ASI-Seg framework, which reveals remarkable advantages over classical state-of-the-art and medical SAMs in both semantic segmentation and intention-oriented segmentation. The source code is available at https://github.com/Zonmgin-Zhang/ASI-Seg.

Deep Neural Networks (DNNs) based semantic segmentation of the robotic instruments and tissues can enhance the precision of surgical activities in robot-assisted surgery. However, in biological learning, DNNs cannot learn incremental tasks over time and exhibit catastrophic forgetting, which refers to the sharp decline in performance on previously learned tasks after learning a new one. Specifically, when data scarcity is the issue, the model shows a rapid drop in performance on previously learned instruments after learning new data with new instruments. The problem becomes worse when it limits releasing the dataset of the old instruments for the old model due to privacy concerns and the unavailability of the data for the new or updated version of the instruments for the continual learning model. For this purpose, we develop a privacy-preserving synthetic continual semantic segmentation framework by blending and harmonizing (i) open-source old instruments foreground to the synthesized background without revealing real patient data in public and (ii) new instruments foreground to extensively augmented real background. To boost the balanced logit distillation from the old model to the continual learning model, we design overlapping class-aware temperature normalization (CAT) by controlling model learning utility. We also introduce multi-scale shifted-feature distillation (SD) to maintain long and short-range spatial relationships among the semantic objects where conventional short-range spatial features with limited information reduce the power of feature distillation. We demonstrate the effectiveness of our framework on the EndoVis 2017 and 2018 instrument segmentation dataset with a generalized continual learning setting. Code is available at https://github.com/XuMengyaAmy/Synthetic_CAT_SD.

Robust 3D perception under corruption has become an essential task for the realm of 3D vision. While current data augmentation techniques usually perform random transformations on all point cloud objects in an offline way and ignore the structure of the samples, resulting in over-or-under enhancement. In this work, we propose an alternative to make sample-adaptive transformations based on the structure of the sample to cope with potential corruption via an auto-augmentation framework, named as Adapt-Point. Specially, we leverage a imitator, consisting of a Deformation Controller and a Mask Controller, respectively in charge of predicting deformation parameters and producing a per-point mask, based on the intrinsic structural information of the input point cloud, and then conduct corruption simulations on top. Then a discriminator is utilized to prevent the generation of excessive corruption that deviates from the original data distribution. In addition, a perception-guidance feedback mechanism is incorporated to guide the generation of samples with appropriate difficulty level. Furthermore, to address the paucity of real-world corrupted point cloud, we also introduce a new dataset ScanObjectNN-C, that exhibits greater similarity to actual data in real-world environments, especially when contrasted with preceding CAD datasets. Experiments show that our method achieves state-of-the-art results on multiple corruption benchmarks, including ModelNet-C, our ScanObjectNN-C, and ShapeNet-C.

Despite the availability of computer-aided simulators and recorded videos of surgical procedures, junior residents still heavily rely on experts to answer their queries. However, expert surgeons are often overloaded with clinical and academic workloads and limit their time in answering. For this purpose, we develop a surgical question-answering system to facilitate robot-assisted surgical scene and activity understanding from recorded videos. Most of the existing visual question answering (VQA) methods require an object detector and regions based feature extractor to extract visual features and fuse them with the embedded text of the question for answer generation. However, (i) surgical object detection model is scarce due to smaller datasets and lack of bounding box annotation; (ii) current fusion strategy of heterogeneous modalities like text and image is naive; (iii) the localized answering is missing, which is crucial in complex surgical scenarios. In this paper, we propose Visual Question Localized-Answering in Robotic Surgery (Surgical-VQLA) to localize the specific surgical area during the answer prediction. To deal with the fusion of the heterogeneous modalities, we design gated vision-language embedding (GVLE) to build input patches for the Language Vision Transformer (LViT) to predict the answer. To get localization, we add the detection head in parallel with the prediction head of the LViT. We also integrate generalized intersection over union (GIoU) loss to boost localization performance by preserving the accuracy of the question-answering model. We annotate two datasets of VQLA by utilizing publicly available surgical videos from EndoVis-17 and 18 of the MICCAI challenges. Our validation results suggest that Surgical-VQLA can better understand the surgical scene and localized the specific area related to the question-answering. GVLE presents an efficient language-vision embedding technique by showing superior performance over the existing benchmarks.