Trajectory Divergence Horizon Decision for Reliable Dual-Arm Surgical Subtask Manipulation

Surgical robotic systems are increasingly being adopted as clinical workload rises, motivating autonomous solutions for repetitive manipulation subtasks. Learning-based controllers improve generalization compared with rule-based and analytic approaches, but most are trained for individual tasks and remain difficult to reuse across procedures. Vision-Language-Action (VLA) models provide a unified framework that integrates visual perception, language grounding, and action generation, offering a promising path toward more composable surgical autonomy. However, existing VLA policies rely on fixed-length open-loop action sequences, where changing scene conditions can lead to accumulated errors and potential risks in surgical manipulation. To mitigate this issue, we formulate surgical VLA deployment as an adaptive execution-horizon decision problem and propose Trajectory Divergence Horizon Decision (TDHD), a test-time mechanism that estimates step-wise action reliability by measuring the divergence between two flow-matching-generated trajectories under small noise perturbations and truncates execution using a dual-threshold rule to trigger timely replanning. We further establish a real-world da Vinci-like dual-arm benchmark with synchronized multi-view perception and language instructions, and collect 600 teleoperated demonstrations across needle (reach, pick, regrasp) and tissue (reach, lift, resection) manipulation suites. On real hardware with 20 trials per task setting, TDHD consistently improves performance over the latest VLA baselines: success increases from 55\% to 60\% for needle manipulation and from 55\% to 80\% for tissue manipulation, with the largest gains observed in the final manipulation stages. These results highlight the importance of adaptive execution control for reliable deployment of VLA models in surgical robotic manipulation.

SurgLAT: Surgical Latent Attention Tracking for Depth-Aware Robotic Laparoscope Control

Autonomous laparoscopic camera control requires continuous understanding of the surgeon's operative intent in dynamic surgical scenes, where the target operative region is not a stable physical object but a latent and temporally evolving attention state. In this work, we present Surgical Latent Attention Tracking (SurgLAT), a causal online framework for latent surgical attention modeling and autonomous laparoscopic view control. SurgLAT uses a frozen DINOv3 encoder and a state-conditioned spatial token mixer to extract operative evidence under a memory-guided spatial prior, while a selective causal latent memory module jointly models short-term motion continuity and long-horizon surgical intent evolution through dynamic retrieval of current, recent, and historical latent states. The learned latent surgical attention state is decoded into a probabilistic attention heatmap and operative region for downstream endoscope guidance. Beyond perception, we further introduce a robotic deployment framework with explicit laparoscopic Remote Center of Motion (RCM) constrained control based on virtual-axis formulation, together with redundancy-aware null-space initialization for stable and smooth manipulator motion. We validate the full system on real laparoscopic surgical videos and a physical robotic laparoscope platform. Experimental results demonstrate robust online operative-region tracking and stable autonomous endoscopy adjustment under occlusion, rapid motion, and target transitions, highlighting the effectiveness of latent surgical intent modeling for surgical autonomy.

Surg-UniWorld: A Unified Surgical World Model with Multimodal Control Experts

Controllable surgical world models can provide a generative foundation for surgical artificial intelligence and simulation by synthesizing realistic instrument--tissue interactions. However, existing methods lack a unified multimodal control paradigm, while direct fusion of heterogeneous visual conditions often causes anatomical distortion, instrument appearance drift, and temporally inconsistent interactions. In this work, we propose {Surg-UniWorld}, a unified surgical world model with multimodal control experts. Surg-UniWorld first constructs a {Hierarchical Surgical Anchor} from first-frame appearance and hierarchical semantic masks to preserve persistent scene identity, anatomical organization, and interaction boundaries. {Anchor-Relative Modality Experts} then interpret edge, depth, and optical-flow evidence relative to the shared anchor, capturing complementary boundary, geometric, and motion information. A {Multimodal Control Expert} further performs contribution-preserving stage-wise composition of the activated modality increments and generates control hints for the Wan2.2 video diffusion backbone. To support multimodal surgical world modeling, we further construct Cholec80-SurgWAM, a benchmark for controllable surgical video generation. Extensive experiments demonstrate that Surg-UniWorld consistently outperforms existing controllable video generation methods and surgical world-model baselines in generation quality, temporal consistency, and multimodal controllability.

CrossScope: A Role-Asymmetric World Model for Joint Dual-Scope Surgical Video Prediction

Visual world models typically learn future dynamics from a single observation stream, limiting their ability to model cooperative systems with multiple independently moving observers. We investigate this challenge in Mother--Child endoscopic retrograde cholangiopancreatography (ERCP), where two flexible scopes provide complementary yet role-dependent views without a calibrated stereo relationship. Unlike conventional multi-view fusion that assumes symmetric information exchange, we formulate \textbf{role-asymmetric dual-scope future prediction}, where cross-view evidence is selectively transferred according to the prediction target and its underlying spatial requirements. We propose \textbf{CrossScope}, a dual-stream surgical world model that preserves view-specific experts while enabling target-specific evidence routing through geometry-guided residual interactions. CrossScope learns two complementary communication directions: geometric motion cues from the Mother view guide Child-view future dynamics, while pose-aligned Child appearance supports Mother-view prediction only when valid spatial correspondence is established. This design allows each scope to contribute task-relevant evidence without compromising its view-specific representation. To evaluate this problem, we establish a paired dual-scope benchmark comprising synchronized phantom and real-world ERCP episodes, with evaluations assessing visual fidelity, structural preservation, target localization, and motion consistency. Experiments demonstrate that CrossScope consistently outperforms strong surgical video generation baselines, validating the importance of role-aware evidence routing for multi-observer visual world modeling.

EndoWAM: A Grounded World-Action Model for Generalizable Endoscopic Navigation

Autonomous endoscopic navigation can reduce clinicians' operational burden, yet robust control remains challenging due to tissue deformation, transient occlusions, and rapidly changing viewpoints. Existing learning-based policies typically predict actions from current observations without explicitly modeling future dynamics, limiting their robustness and reliability in safety-critical settings. World Action Models (WAMs) offer a promising alternative by coupling predictive visual dynamics with action generation, but extending them to robotic endoscopy remains challenging due to limited training data, restricted viewpoint diversity, deformable anatomy, and high inference latency. We present EndoWAM, which is, to our knowledge, the first WAM for generalizable robotic endoscopic navigation. EndoWAM introduces future grounding, which predicts task-relevant target regions in future observations from intermediate denoising features of a video world model. Specifically, EndoWAM couples a lightweight diffusion transformer for future target-region prediction with a discrete action expert through a shared predictive representation. This design injects target-aware supervision into predictive dynamics modeling, improving robustness to visual degradation and viewpoint changes while enabling real-time control in a single denoising pass. We further introduce EndoMotion, a robotic endoscopic motion dataset spanning three anatomically distinct procedures: ureteroscopy, esophagoscopy, and endoscopic retrograde cholangiopancreatography (ERCP). EndoWAM consistently outperforms all baselines and alternative grounding strategies, while demonstrating strong zero-shot generalization to unseen viewpoints, environments, and targets. These results establish EndoWAM as a predictive, target-grounded framework for accurate, generalizable, and long-horizon navigation in visually constrained endoscopic environments.

Boosting Generalizable Depth Estimation in Endoscopy by Mixture of Lightweight Experts and Intrinsic Image Alignment

Depth estimation is a significant task for 3D perception in endoscopic surgeries. However, illumination interference and feature diversity in various endoscopic scenes are still challenges for generalizable depth estimation and ego-motion estimation. Based on this, a novel self-supervised framework, EndoMINI, is proposed for depth estimation in endoscopic scenes. Specifically, mixture of low-rank experts (MiLoRE) is proposed to perform parameter-efficient fine-tuning, which can also boost the model adaptation to scenes with different characteristics. Meanwhile, an intrinsic image alignment (IIA) is introduced into the training loss to alleviate the influence of light reflectance in endoscopy with a novel intrinsic image decomposition network. The proposed method is evaluated on SCARED datasets for supervised depth estimation, and two endoscopic datasets, Hamlyn and SERV-CT, for zero-shot depth estimation, compared with state-of-the-art works as well. The experimental results demonstrate outstanding performance of the proposed model and the effects of the main contributions.

Parameter-Efficient Adaptation of SAM3 for Prompt-Driven Surgical Concept Segmentation

Efficient surgical segmentation empowers clinical diagnosis, intraoperative monitoring, and downstream robotic pipelines for reconstruction and simulation. Although prompt-driven foundation models like Segment Anything Model 3 (SAM3) achieve strong segmentation performance on natural images, surgical data exhibits domain gaps against its pre-training data, resulting in degraded segmentation accuracy. Furthermore, existing medical SAM methods require full-parameter fine-tuning, incurring heavy computational consumption and low efficiency. To address these limitations, this work proposes a parameter-efficient Low-Rank Adaptation (LoRA) adaptation of SAM3 for surgical concept segmentation. We inject low-rank adapters into the prompt encoder, detector and tracker while fully freezing the vision backbone, which only optimizes 0.98% of the total model parameters and supports training on a single consumer GPU. Comprehensive experiments demonstrate that our method consistently outperforms zero-shot SAM3 and other mainstream baselines, and the generated segmentation results can be directly deployed to support downstream robotic surgical scene reconstruction and physical simulation pipelines.

Learning-based Hierarchical Tracheal Anatomy Understanding from Sparse Surgical Demonstration Annotations for Ultrasound Robots

Tracheostomy requires precise localization of the tracheal incision site; however, conventional manual palpation is subjective and often unreliable, while ultrasound utility remains operator-dependent. This work presents a learning-based framework for hierarchical tracheal anatomy understanding, designed specifically for ultrasound-guided robotic systems. We propose a two-stage perception pipeline integrating a YOLOv8n localization backbone with a sparse, prompt-optimized SAM2 decoder to achieve high-fidelity segmentation from sparse surgical annotations. Our hybrid training strategy, bridging curated laboratory data with unconstrained sequences, ensures clinical robustness. Experimental benchmarks demonstrate that this decoupled architecture effectively balances generalization, precision, and efficiency. The YOLOv8n and SAM2 framework achieves a consistent Mean Dice Similarity Coefficient (DSC) of 0.777 across both controlled and generalized domains. This significantly outperforms U-Net baselines, which often suffer from anatomical fragmentation and performance degradation (Generalization DSC $\le$ 0.494). By constraining mask decoding to targeted, sparse regions of interest, our model achieves a throughput of 6.92 FPS, which is vital for closed-loop robotic teleoperation. This study confirms that a robust hierarchical understanding of tracheal anatomy can be derived by coupling lightweight localization with foundation-scale visual models. Our framework establishes a scalable foundation for standardized, autonomous surgical assistance, effectively navigating the variability of real-world ultrasound to enhance the safety and precision of robotic-assisted tracheostomy.

BiliVLA: Scene-Aware Vision-Language-Action Model with Reinforcement Learning for Autonomous Biliary Endoscopic Navigation

Endoscopic retrograde cholangiopancreatography (ERCP) demands precise endoscopic navigation and stable biliary cannulation within a narrow monocular field characterized by specular reflections, partial occlusions, and frequent tissue contact. Although recent robotic systems and vision-based assistance techniques improve operator ergonomics and provide perceptual cues, their performance degrades under pronounced anatomical variability and safety-critical visual artifacts, which hinders reliable autonomy in cannulation-grade procedures. Here, we present BiliVLA, a scene-aware Vision-Language-Action (VLA) framework that formulates biliary endoscopic navigation as an instruction-conditioned visuomotor learning problem. Given an endoscopic observation and a stage-specific language instruction, BiliVLA jointly predicts the target category, a grounded bounding box, and a discrete three degrees of freedom (DoF) motor command for a continuum endoscope. The proposed framework incorporates scene-aware supervision to enhance semantic target consistency and safety-aware recovery supervision to induce conservative retreat behaviors under luminal wall contact. A key component of BiliVLA is a two-stage training paradigm that combines grounding-enhanced supervised fine-tuning (SFT) with Group Relative Policy Optimization (GRPO), which significantly improves action reliability and decision consistency during closed-loop navigation. Across three ERCP subtasks, BiliVLA achieves an average action precision of 91.96\% and an overall success rate (SR) of 84.85\% in real-world phantom experiments. These results indicate that integrating semantic grounding, scene-aware learning, and reward-guided optimization improves perception-action alignment and enables robust autonomous endoscopic navigation.

GeoCFNet: Geometry-Aware Confidence Field Network for Robot-Assisted Endoscopic Submucosal Dissection

Advanced surgical robotics has made robot-assisted endoscopic submucosal dissection (ESD) a promising approach for the en-bloc resection of large lesions, with the potential to reduce recurrence and improve long-term outcomes. However, the technical complexity and risk of complications in ESD demand stable and precise visual guidance to maintain an accurate dissection corridor and a safe tissue margin. Dense confidence fields provide an effective representation for this purpose by describing both the preferred dissection region and its spatial transition to surrounding tissue. However, reliable confidence field estimation remains challenging in dynamic endoscopic scenes due to smoke, specular highlights, tissue deformation, weak texture, and the thin geometric structure of the target region. To address these challenges, we formulate dissection guidance as a geometry-aware confidence field estimation problem and propose GeoCFNet, a geometry-aware confidence field network built on a pretrained DINOv3 backbone. GeoCFNet integrates a Token-Differentiated Fusion module to aggregate class-token context with dense patch representations, a SegFormer decoder for confidence regression, and Geometry-Aware Spatial Regularization (GASR) to preserve spatial coherence and local geometric transitions. Experimental results show that GeoCFNet achieves RMSE 0.0480, PSNR 27.1995, SSIM 0.3397, and CC 0.2466, indicating accurate and geometrically stable confidence field estimation for robot-assisted ESD guidance.