Benchmarking Laparoscopic Surgical Image Restoration and Beyond

In laparoscopic surgery, a clear and high-quality visual field is critical for surgeons to make accurate intraoperative decisions. However, persistent visual degradation, including smoke generated by energy devices, lens fogging from thermal gradients, and lens contamination due to blood or tissue fluid splashes during surgical procedures, severely impair visual clarity. These degenerations can seriously hinder surgical workflow and pose risks to patient safety. To systematically investigate and address various forms of surgical scene degradation, we introduce a real-world open-source surgical image restoration dataset covering laparoscopic environments, called SurgClean, which involves multi-type image restoration tasks, e.g., desmoking, defogging, and desplashing. SurgClean comprises 1,020 images with diverse degradation types and corresponding paired reference labels. Based on SurgClean, we establish a standardized evaluation benchmark and provide performance for 22 representative generic task-specific image restoration approaches, including 12 generic and 10 task-specific image restoration approaches. Experimental results reveal substantial performance gaps relative to clinical requirements, highlighting a critical opportunity for algorithm advancements in intelligent surgical restoration. Furthermore, we explore the degradation discrepancies between surgical and natural scenes from structural perception and semantic understanding perspectives, providing fundamental insights for domain-specific image restoration research. Our work aims to empower the capabilities of restoration algorithms to increase surgical environments and improve the efficiency of clinical procedures.

U2-BENCH: Benchmarking Large Vision-Language Models on Ultrasound Understanding

Ultrasound is a widely-used imaging modality critical to global healthcare, yet its interpretation remains challenging due to its varying image quality on operators, noises, and anatomical structures. Although large vision-language models (LVLMs) have demonstrated impressive multimodal capabilities across natural and medical domains, their performance on ultrasound remains largely unexplored. We introduce U2-BENCH, the first comprehensive benchmark to evaluate LVLMs on ultrasound understanding across classification, detection, regression, and text generation tasks. U2-BENCH aggregates 7,241 cases spanning 15 anatomical regions and defines 8 clinically inspired tasks, such as diagnosis, view recognition, lesion localization, clinical value estimation, and report generation, across 50 ultrasound application scenarios. We evaluate 20 state-of-the-art LVLMs, both open- and closed-source, general-purpose and medical-specific. Our results reveal strong performance on image-level classification, but persistent challenges in spatial reasoning and clinical language generation. U2-BENCH establishes a rigorous and unified testbed to assess and accelerate LVLM research in the uniquely multimodal domain of medical ultrasound imaging.

Landmark-Free Preoperative-to-Intraoperative Registration in Laparoscopic Liver Resection

Liver registration by overlaying preoperative 3D models onto intraoperative 2D frames can assist surgeons in perceiving the spatial anatomy of the liver clearly for a higher surgical success rate. Existing registration methods rely heavily on anatomical landmark-based workflows, which encounter two major limitations: 1) ambiguous landmark definitions fail to provide efficient markers for registration; 2) insufficient integration of intraoperative liver visual information in shape deformation modeling. To address these challenges, in this paper, we propose a landmark-free preoperative-to-intraoperative registration framework utilizing effective self-supervised learning, termed \ourmodel. This framework transforms the conventional 3D-2D workflow into a 3D-3D registration pipeline, which is then decoupled into rigid and non-rigid registration subtasks. \ourmodel~first introduces a feature-disentangled transformer to learn robust correspondences for recovering rigid transformations. Further, a structure-regularized deformation network is designed to adjust the preoperative model to align with the intraoperative liver surface. This network captures structural correlations through geometry similarity modeling in a low-rank transformer network. To facilitate the validation of the registration performance, we also construct an in-vivo registration dataset containing liver resection videos of 21 patients, called \emph{P2I-LReg}, which contains 346 keyframes that provide a global view of the liver together with liver mask annotations and calibrated camera intrinsic parameters. Extensive experiments and user studies on both synthetic and in-vivo datasets demonstrate the superiority and potential clinical applicability of our method.

Synergistic Bleeding Region and Point Detection in Surgical Videos

Intraoperative bleeding in laparoscopic surgery causes rapid obscuration of the operative field to hinder the surgical process. Intelligent detection of bleeding regions can quantify the blood loss to assist decision-making, while locating the bleeding point helps surgeons quickly identify the source of bleeding and achieve hemostasis in time. In this study, we first construct a real-world surgical bleeding detection dataset, named SurgBlood, comprising 5,330 frames from 95 surgical video clips with bleeding region and point annotations. Accordingly, we develop a dual-task synergistic online detector called BlooDet, designed to perform simultaneous detection of bleeding regions and points in surgical videos. Our framework embraces a dual-branch bidirectional guidance design based on Segment Anything Model 2 (SAM 2). The mask branch detects bleeding regions through adaptive edge and point prompt embeddings, while the point branch leverages mask memory to induce bleeding point memory modeling and captures the direction of bleed point movement through inter-frame optical flow. By interactive guidance and prompts, the two branches explore potential spatial-temporal relationships while leveraging memory modeling from previous frames to infer the current bleeding condition. Extensive experiments demonstrate that our approach outperforms other counterparts on SurgBlood in both bleeding region and point detection tasks, e.g., achieving 64.88% IoU for bleeding region detection and 83.69% PCK-10% for bleeding point detection.

Unconstrained Salient and Camouflaged Object Detection

Visual Salient Object Detection (SOD) and Camouflaged Object Detection (COD) are two interrelated yet distinct tasks. Both tasks model the human visual system's ability to perceive the presence of objects. The traditional SOD datasets and methods are designed for scenes where only salient objects are present, similarly, COD datasets and methods are designed for scenes where only camouflaged objects are present. However, scenes where both salient and camouflaged objects coexist, or where neither is present, are not considered. This simplifies the existing research on SOD and COD. In this paper, to explore a more generalized approach to SOD and COD, we introduce a benchmark called Unconstrained Salient and Camouflaged Object Detection (USCOD), which supports the simultaneous detection of salient and camouflaged objects in unconstrained scenes, regardless of their presence. Towards this, we construct a large-scale dataset, CS12K, that encompasses a variety of scenes, including four distinct types: only salient objects, only camouflaged objects, both, and neither. In our benchmark experiments, we identify a major challenge in USCOD: distinguishing between salient and camouflaged objects within the same scene. To address this challenge, we propose USCNet, a baseline model for USCOD that decouples the learning of attribute distinction from mask reconstruction. The model incorporates an APG module, which learns both sample-generic and sample-specific features to enhance the attribute differentiation between salient and camouflaged objects. Furthermore, to evaluate models' ability to distinguish between salient and camouflaged objects, we design a metric called Camouflage-Saliency Confusion Score (CSCS). The proposed method achieves state-of-the-art performance on the newly introduced USCOD task. The code and dataset will be publicly available.

Evaluation Study on SAM 2 for Class-agnostic Instance-level Segmentation

Segment Anything Model (SAM) has demonstrated powerful zero-shot segmentation performance in natural scenes. The recently released Segment Anything Model 2 (SAM2) has further heightened researchers' expectations towards image segmentation capabilities. To evaluate the performance of SAM2 on class-agnostic instance-level segmentation tasks, we adopt different prompt strategies for SAM2 to cope with instance-level tasks for three relevant scenarios: Salient Instance Segmentation (SIS), Camouflaged Instance Segmentation (CIS), and Shadow Instance Detection (SID). In addition, to further explore the effectiveness of SAM2 in segmenting granular object structures, we also conduct detailed tests on the high-resolution Dichotomous Image Segmentation (DIS) benchmark to assess the fine-grained segmentation capability. Qualitative and quantitative experimental results indicate that the performance of SAM2 varies significantly across different scenarios. Besides, SAM2 is not particularly sensitive to segmenting high-resolution fine details. We hope this technique report can drive the emergence of SAM2-based adapters, aiming to enhance the performance ceiling of large vision models on class-agnostic instance segmentation tasks.

Surgical Workflow Recognition and Blocking Effectiveness Detection in Laparoscopic Liver Resections with Pringle Maneuver

Pringle maneuver (PM) in laparoscopic liver resection aims to reduce blood loss and provide a clear surgical view by intermittently blocking blood inflow of the liver, whereas prolonged PM may cause ischemic injury. To comprehensively monitor this surgical procedure and provide timely warnings of ineffective and prolonged blocking, we suggest two complementary AI-assisted surgical monitoring tasks: workflow recognition and blocking effectiveness detection in liver resections. The former presents challenges in real-time capturing of short-term PM, while the latter involves the intraoperative discrimination of long-term liver ischemia states. To address these challenges, we meticulously collect a novel dataset, called PmLR50, consisting of 25,037 video frames covering various surgical phases from 50 laparoscopic liver resection procedures. Additionally, we develop an online baseline for PmLR50, termed PmNet. This model embraces Masked Temporal Encoding (MTE) and Compressed Sequence Modeling (CSM) for efficient short-term and long-term temporal information modeling, and embeds Contrastive Prototype Separation (CPS) to enhance action discrimination between similar intraoperative operations. Experimental results demonstrate that PmNet outperforms existing state-of-the-art surgical workflow recognition methods on the PmLR50 benchmark. Our research offers potential clinical applications for the laparoscopic liver surgery community. Source code and data will be publicly available.

Depth-Driven Geometric Prompt Learning for Laparoscopic Liver Landmark Detection

Laparoscopic liver surgery poses a complex intraoperative dynamic environment for surgeons, where remains a significant challenge to distinguish critical or even hidden structures inside the liver. Liver anatomical landmarks, e.g., ridge and ligament, serve as important markers for 2D-3D alignment, which can significantly enhance the spatial perception of surgeons for precise surgery. To facilitate the detection of laparoscopic liver landmarks, we collect a novel dataset called L3D, which comprises 1,152 frames with elaborated landmark annotations from surgical videos of 39 patients across two medical sites. For benchmarking purposes, 12 mainstream detection methods are selected and comprehensively evaluated on L3D. Further, we propose a depth-driven geometric prompt learning network, namely D2GPLand. Specifically, we design a Depth-aware Prompt Embedding (DPE) module that is guided by self-supervised prompts and generates semantically relevant geometric information with the benefit of global depth cues extracted from SAM-based features. Additionally, a Semantic-specific Geometric Augmentation (SGA) scheme is introduced to efficiently merge RGB-D spatial and geometric information through reverse anatomic perception. The experimental results indicate that D2GPLand obtains state-of-the-art performance on L3D, with 63.52% DICE and 48.68% IoU scores. Together with 2D-3D fusion technology, our method can directly provide the surgeon with intuitive guidance information in laparoscopic scenarios.

Epicardium Prompt-guided Real-time Cardiac Ultrasound Frame-to-volume Registration

A comprehensive guidance view for cardiac interventional surgery can be provided by the real-time fusion of the intraoperative 2D images and preoperative 3D volume based on the ultrasound frame-to-volume registration. However, cardiac ultrasound images are characterized by a low signal-to-noise ratio and small differences between adjacent frames, coupled with significant dimension variations between 2D frames and 3D volumes to be registered, resulting in real-time and accurate cardiac ultrasound frame-to-volume registration being a very challenging task. This paper introduces a lightweight end-to-end Cardiac Ultrasound frame-to-volume Registration network, termed CU-Reg. Specifically, the proposed model leverages epicardium prompt-guided anatomical clues to reinforce the interaction of 2D sparse and 3D dense features, followed by a voxel-wise local-global aggregation of enhanced features, thereby boosting the cross-dimensional matching effectiveness of low-quality ultrasound modalities. We further embed an inter-frame discriminative regularization term within the hybrid supervised learning to increase the distinction between adjacent slices in the same ultrasound volume to ensure registration stability. Experimental results on the reprocessed CAMUS dataset demonstrate that our CU-Reg surpasses existing methods in terms of registration accuracy and efficiency, meeting the guidance requirements of clinical cardiac interventional surgery.

Tri-modal Confluence with Temporal Dynamics for Scene Graph Generation in Operating Rooms

A comprehensive understanding of surgical scenes allows for monitoring of the surgical process, reducing the occurrence of accidents and enhancing efficiency for medical professionals. Semantic modeling within operating rooms, as a scene graph generation (SGG) task, is challenging since it involves consecutive recognition of subtle surgical actions over prolonged periods. To address this challenge, we propose a Tri-modal (i.e., images, point clouds, and language) confluence with Temporal dynamics framework, termed TriTemp-OR. Diverging from previous approaches that integrated temporal information via memory graphs, our method embraces two advantages: 1) we directly exploit bi-modal temporal information from the video streaming for hierarchical feature interaction, and 2) the prior knowledge from Large Language Models (LLMs) is embedded to alleviate the class-imbalance problem in the operating theatre. Specifically, our model performs temporal interactions across 2D frames and 3D point clouds, including a scale-adaptive multi-view temporal interaction (ViewTemp) and a geometric-temporal point aggregation (PointTemp). Furthermore, we transfer knowledge from the biomedical LLM, LLaVA-Med, to deepen the comprehension of intraoperative relations. The proposed TriTemp-OR enables the aggregation of tri-modal features through relation-aware unification to predict relations so as to generate scene graphs. Experimental results on the 4D-OR benchmark demonstrate the superior performance of our model for long-term OR streaming.