SurgiQ: A Large-Scale Multi-Domain Benchmark for Evaluating Surgical Understanding in Large Language Models

Reliable evaluation of large language models in surgery remains underdeveloped. Broad medical benchmarks test clinical knowledge, while surgery requires procedural reasoning, management trade-offs, negation handling, and selection among plausible operative decisions. We present SurgiQ, a text-only, source-grounded benchmark of 13,055 four-option multiple-choice questions spanning six surgical domains and four question formats: case-based, reasoning, best-option, and negative. SurgiQ is constructed from surgical textbooks, open-access papers, and examination material using a multi-stage generation, verification, and expert-audit pipeline. We evaluate 35 open-weight LLMs under a unified log-likelihood protocol. Our results show substantial remaining headroom: smaller models often remain near the 25\% random baseline, while the best model reaches 68.1\% accuracy. General-purpose models, especially Qwen2.5, outperform most biomedical models, suggesting that current medical specialization does not yet provide sufficiently broad surgical coverage. Calibration and error analysis further show that even strong models make confident mistakes on clinically plausible distractors, motivating more reliable and broader surgical LLM evaluation.

Multimodal Optimal Transport for Unsupervised Temporal Segmentation in Surgical Robotics

Recognizing surgical phases and steps from video is a fundamental problem in computer-assisted interventions. Recent approaches increasingly rely on large-scale pre-training on thousands of labeled surgical videos, followed by zero-shot transfer to specific procedures. While effective, this strategy incurs substantial computational and data collection costs. In this work, we question whether such heavy pre-training is truly necessary. We propose Text-Augmented Action Segmentation Optimal Transport (TASOT), an unsupervised method for surgical phase and step recognition that extends Action Segmentation Optimal Transport (ASOT) by incorporating textual information generated directly from the videos. TASOT formulates temporal action segmentation as a multimodal optimal transport problem, where the matching cost is defined as a weighted combination of visual and text-based costs. The visual term captures frame-level appearance similarity, while the text term provides complementary semantic cues, and both are jointly regularized through a temporally consistent unbalanced Gromov-Wasserstein formulation. This design enables effective alignment between video frames and surgical actions without surgical-specific pretraining or external web-scale supervision. We evaluate TASOT on multiple benchmark surgical datasets and observe consistent and substantial improvements over existing zero-shot methods, including StrasBypass70 (+23.7), BernBypass70 (+4.5), Cholec80 (+16.5), and AutoLaparo (+19.6). These results demonstrate that fine-grained surgical understanding can be achieved by exploiting information already present in standard visual and textual representations, without resorting to increasingly complex pre-training pipelines. The code will be available at https://github.com/omar8ahmed9/TASOT.

Hybrid Offline-Online Reinforcement Learning for Sensorless, High-Precision Force Regulation in Surgical Robotic Grasping

Precise grasp force regulation in tendon-driven surgical instruments is fundamentally limited by nonlinear coupling between motor dynamics, transmission compliance, friction, and distal mechanics. Existing solutions typically rely on distal force sensing or analytical compensation, increasing hardware complexity or degrading performance under dynamic motion. We present a sensorless control framework that combines physics-consistent modeling and hybrid reinforcement learning to achieve high-precision distal force regulation in a proximally actuated surgical end-effector. We develop a first-principles digital twin of the da Vinci Xi grasping mechanism that captures coupled electrical, transmission, and jaw dynamics within a unified differential-algebraic formulation. To safely learn control policies in this stiff and highly nonlinear system, we introduce a three-stage pipeline:(i)a receding-horizon CMA-ES oracle that generates dynamically feasible expert trajectories,(ii)fully offline policy learning via Implicit Q-Learning to ensure stable initialization without unsafe exploration, and (iii)online refinement using TD3 for adaptation to on-policy dynamics. The resulting policy directly maps proximal measurements to motor voltages and requires no distal sensing. In simulation, the controller maintains grasp force within 1% of the desired reference during multi-harmonic jaw motion. Hardware experiments demonstrate average force errors below 4% across diverse trajectories, validating sim-to-real transfer. The learned policy contains approximately 71k param and executes at kH rates, enabling real-time deployment. These results demonstrate that high-fidelity modeling combined with structured offline-online RL can recover precise distal force behavior without additional sensing, offering a scalable and mechanically compatible solution for surgical robotic manipulation.