SRT-H: A Hierarchical Framework for Autonomous Surgery via Language Conditioned Imitation Learning

Research on autonomous robotic surgery has largely focused on simple task automation in controlled environments. However, real-world surgical applications require dexterous manipulation over extended time scales while demanding generalization across diverse variations in human tissue. These challenges remain difficult to address using existing logic-based or conventional end-to-end learning strategies. To bridge this gap, we propose a hierarchical framework for dexterous, long-horizon surgical tasks. Our method employs a high-level policy for task planning and a low-level policy for generating task-space controls for the surgical robot. The high-level planner plans tasks using language, producing task-specific or corrective instructions that guide the robot at a coarse level. Leveraging language as a planning modality offers an intuitive and generalizable interface, mirroring how experienced surgeons instruct traineers during procedures. We validate our framework in ex-vivo experiments on a complex minimally invasive procedure, cholecystectomy, and conduct ablative studies to assess key design choices. Our approach achieves a 100% success rate across n=8 different ex-vivo gallbladders, operating fully autonomously without human intervention. The hierarchical approach greatly improves the policy's ability to recover from suboptimal states that are inevitable in the highly dynamic environment of realistic surgical applications. This work represents the first demonstration of step-level autonomy, marking a critical milestone toward autonomous surgical systems for clinical studies. By advancing generalizable autonomy in surgical robotics, our approach brings the field closer to real-world deployment.