Instrument-Splatting++: Towards Controllable Surgical Instrument Digital Twin Using Gaussian Splatting

High-quality and controllable digital twins of surgical instruments are critical for Real2Sim in robot-assisted surgery, as they enable realistic simulation, synthetic data generation, and perception learning under novel poses. We present Instrument-Splatting++, a monocular 3D Gaussian Splatting (3DGS) framework that reconstructs surgical instruments as a fully controllable Gaussian asset with high fidelity. Our pipeline starts with part-wise geometry pretraining that injects CAD priors into Gaussian primitives and equips the representation with part-aware semantic rendering. Built on the pretrained model, we propose a semantics-aware pose estimation and tracking (SAPET) method to recover per-frame 6-DoF pose and joint angles from unposed endoscopic videos, where a gripper-tip network trained purely from synthetic semantics provides robust supervision and a loose regularization suppresses singular articulations. Finally, we introduce Robust Texture Learning (RTL), which alternates pose refinement and robust appearance optimization, mitigating pose noise during texture learning. The proposed framework can perform pose estimation and learn realistic texture from unposed videos. We validate our method on sequences extracted from EndoVis17/18, SAR-RARP, and an in-house dataset, showing superior photometric quality and improved geometric accuracy over state-of-the-art baselines. We further demonstrate a downstream keypoint detection task where unseen-pose data augmentation from our controllable instrument Gaussian improves performance.

Surg$Σ$: A Spectrum of Large-Scale Multimodal Data and Foundation Models for Surgical Intelligence

Surgical intelligence has the potential to improve the safety and consistency of surgical care, yet most existing surgical AI frameworks remain task-specific and struggle to generalize across procedures and institutions. Although multimodal foundation models, particularly multimodal large language models, have demonstrated strong cross-task capabilities across various medical domains, their advancement in surgery remains constrained by the lack of large-scale, systematically curated multimodal data. To address this challenge, we introduce Surg$Σ$, a spectrum of large-scale multimodal data and foundation models for surgical intelligence. At the core of this framework lies Surg$Σ$-DB, a large-scale multimodal data foundation designed to support diverse surgical tasks. Surg$Σ$-DB consolidates heterogeneous surgical data sources (including open-source datasets, curated in-house clinical collections and web-source data) into a unified schema, aiming to improve label consistency and data standardization across heterogeneous datasets. Surg$Σ$-DB spans 6 clinical specialties and diverse surgical types, providing rich image- and video-level annotations across 18 practical surgical tasks covering understanding, reasoning, planning, and generation, at an unprecedented scale (over 5.98M conversations). Beyond conventional multimodal conversations, Surg$Σ$-DB incorporates hierarchical reasoning annotations, providing richer semantic cues to support deeper contextual understanding in complex surgical scenarios. We further provide empirical evidence through recently developed surgical foundation models built upon Surg$Σ$-DB, illustrating the practical benefits of large-scale multimodal annotations, unified semantic design, and structured reasoning annotations for improving cross-task generalization and interpretability.

SurGo-R1: Benchmarking and Modeling Contextual Reasoning for Operative Zone in Surgical Video

Minimally invasive surgery has dramatically improved patient operative outcomes, yet identifying safe operative zones remains challenging in critical phases, requiring surgeons to integrate visual cues, procedural phase, and anatomical context under high cognitive load. Existing AI systems offer binary safety verification or static detection, ignoring the phase-dependent nature of intraoperative reasoning. We introduce ResGo, a benchmark of laparoscopic frames annotated with Go Zone bounding boxes and clinician-authored rationales covering phase, exposure quality reasoning, next action and risk reminder. We introduce evaluation metrics that treat correct grounding under incorrect phase as failures, revealing that most vision-language models cannot handle such tasks and perform poorly. We then present SurGo-R1, a model optimized via RLHF with a multi-turn phase-then-go architecture where the model first identifies the surgical phase, then generates reasoning and Go Zone coordinates conditioned on that context. On unseen procedures, SurGo-R1 achieves 76.6% phase accuracy, 32.7 mIoU, and 54.8% hardcore accuracy, a 6.6$\times$ improvement over the mainstream generalist VLMs. Code, model and benchmark will be available at https://github.com/jinlab-imvr/SurGo-R1

SurgRAW: Multi-Agent Workflow with Chain-of-Thought Reasoning for Surgical Intelligence

Integration of Vision-Language Models (VLMs) in surgical intelligence is hindered by hallucinations, domain knowledge gaps, and limited understanding of task interdependencies within surgical scenes, undermining clinical reliability. While recent VLMs demonstrate strong general reasoning and thinking capabilities, they still lack the domain expertise and task-awareness required for precise surgical scene interpretation. Although Chain-of-Thought (CoT) can structure reasoning more effectively, current approaches rely on self-generated CoT steps, which often exacerbate inherent domain gaps and hallucinations. To overcome this, we present SurgRAW, a CoT-driven multi-agent framework that delivers transparent, interpretable insights for most tasks in robotic-assisted surgery. By employing specialized CoT prompts across five tasks: instrument recognition, action recognition, action prediction, patient data extraction, and outcome assessment, SurgRAW mitigates hallucinations through structured, domain-aware reasoning. Retrieval-Augmented Generation (RAG) is also integrated to external medical knowledge to bridge domain gaps and improve response reliability. Most importantly, a hierarchical agentic system ensures that CoT-embedded VLM agents collaborate effectively while understanding task interdependencies, with a panel discussion mechanism promotes logical consistency. To evaluate our method, we introduce SurgCoTBench, the first reasoning-based dataset with structured frame-level annotations. With comprehensive experiments, we demonstrate the effectiveness of proposed SurgRAW with 29.32% accuracy improvement over baseline VLMs on 12 robotic procedures, achieving the state-of-the-art performance and advancing explainable, trustworthy, and autonomous surgical assistance.

UnPuzzle: A Unified Framework for Pathology Image Analysis

Pathology image analysis plays a pivotal role in medical diagnosis, with deep learning techniques significantly advancing diagnostic accuracy and research. While numerous studies have been conducted to address specific pathological tasks, the lack of standardization in pre-processing methods and model/database architectures complicates fair comparisons across different approaches. This highlights the need for a unified pipeline and comprehensive benchmarks to enable consistent evaluation and accelerate research progress. In this paper, we present UnPuzzle, a novel and unified framework for pathological AI research that covers a broad range of pathology tasks with benchmark results. From high-level to low-level, upstream to downstream tasks, UnPuzzle offers a modular pipeline that encompasses data pre-processing, model composition,taskconfiguration,andexperimentconduction.Specifically, it facilitates efficient benchmarking for both Whole Slide Images (WSIs) and Region of Interest (ROI) tasks. Moreover, the framework supports variouslearningparadigms,includingself-supervisedlearning,multi-task learning,andmulti-modallearning,enablingcomprehensivedevelopment of pathology AI models. Through extensive benchmarking across multiple datasets, we demonstrate the effectiveness of UnPuzzle in streamlining pathology AI research and promoting reproducibility. We envision UnPuzzle as a cornerstone for future advancements in pathology AI, providing a more accessible, transparent, and standardized approach to model evaluation. The UnPuzzle repository is publicly available at https://github.com/Puzzle-AI/UnPuzzle.