LAR-MoE: Latent-Aligned Routing for Mixture of Experts in Robotic Imitation Learning

Imitation learning enables robots to acquire manipulation skills from demonstrations, yet deploying a policy across tasks with heterogeneous dynamics remains challenging, as models tend to average over distinct behavioral modes present in the demonstrations. Mixture-of-Experts (MoE) architectures address this by activating specialized subnetworks, but requires meaningful skill decompositions for expert routing. We introduce Latent-Aligned Routing for Mixture of Experts (LAR-MoE), a two-stage framework that decouples unsupervised skill discovery from policy learning. In pre-training, we learn a joint latent representation between observations and future actions through student-teacher co-training. In a post-training stage, the expert routing is regularized to follow the structure of the learned latent space, preventing expert collapse while maintaining parameter efficiency. We evaluate LAR-MoE in simulation and on hardware. On the LIBERO benchmark, our method achieves a 95.2% average success rate with 150M parameters. On a surgical bowel grasping and retraction task, LAR-MoE matches a supervised MoE baseline without requiring any phase annotations, and transfers zero-shot to ex vivo porcine tissue. Our findings suggest that latent-aligned routing provides a principled alternative to supervised skill decomposition, enabling structured expert specialization from unlabeled demonstrations.

An Open-Source Robotics Research Platform for Autonomous Laparoscopic Surgery

Autonomous robot-assisted surgery demands reliable, high-precision platforms that strictly adhere to the safety and kinematic constraints of minimally invasive procedures. Existing research platforms, primarily based on the da Vinci Research Kit, suffer from cable-driven mechanical limitations that degrade state-space consistency and hinder the downstream training of reliable autonomous policies. We present an open-source, robot-agnostic Remote Center of Motion (RCM) controller based on a closed-form analytical velocity solver that enforces the trocar constraint deterministically without iterative optimization. The controller operates in Cartesian space, enabling any industrial manipulator to function as a surgical robot. We provide implementations for the UR5e and Franka Emika Panda manipulators, and integrate stereoscopic 3D perception. We integrate the robot control into a full-stack ROS-based surgical robotics platform supporting teleoperation, demonstration recording, and deployment of learned policies via a decoupled server-client architecture. We validate the system on a bowel grasping and retraction task across phantom, ex vivo, and in vivo porcine laparoscopic procedures. RCM deviations remain sub-millimeter across all conditions, and trajectory smoothness metrics (SPARC, LDLJ) are comparable to expert demonstrations from the JIGSAWS benchmark recorded on the da Vinci system. These results demonstrate that the platform provides the precision and robustness required for teleoperation, data collection and autonomous policy deployment in realistic surgical scenarios.

A benchmark for video-based laparoscopic skill analysis and assessment

Laparoscopic surgery is a complex surgical technique that requires extensive training. Recent advances in deep learning have shown promise in supporting this training by enabling automatic video-based assessment of surgical skills. However, the development and evaluation of deep learning models is currently hindered by the limited size of available annotated datasets. To address this gap, we introduce the Laparoscopic Skill Analysis and Assessment (LASANA) dataset, comprising 1270 stereo video recordings of four basic laparoscopic training tasks. Each recording is annotated with a structured skill rating, aggregated from three independent raters, as well as binary labels indicating the presence or absence of task-specific errors. The majority of recordings originate from a laparoscopic training course, thereby reflecting a natural variation in the skill of participants. To facilitate benchmarking of both existing and novel approaches for video-based skill assessment and error recognition, we provide predefined data splits for each task. Furthermore, we present baseline results from a deep learning model as a reference point for future comparisons.

MoE-ACT: Improving Surgical Imitation Learning Policies through Supervised Mixture-of-Experts

Imitation learning has achieved remarkable success in robotic manipulation, yet its application to surgical robotics remains challenging due to data scarcity, constrained workspaces, and the need for an exceptional level of safety and predictability. We present a supervised Mixture-of-Experts (MoE) architecture designed for phase-structured surgical manipulation tasks, which can be added on top of any autonomous policy. Unlike prior surgical robot learning approaches that rely on multi-camera setups or thousands of demonstrations, we show that a lightweight action decoder policy like Action Chunking Transformer (ACT) can learn complex, long-horizon manipulation from less than 150 demonstrations using solely stereo endoscopic images, when equipped with our architecture. We evaluate our approach on the collaborative surgical task of bowel grasping and retraction, where a robot assistant interprets visual cues from a human surgeon, executes targeted grasping on deformable tissue, and performs sustained retraction. We benchmark our method against state-of-the-art Vision-Language-Action (VLA) models and the standard ACT baseline. Our results show that generalist VLAs fail to acquire the task entirely, even under standard in-distribution conditions. Furthermore, while standard ACT achieves moderate success in-distribution, adopting a supervised MoE architecture significantly boosts its performance, yielding higher success rates in-distribution and demonstrating superior robustness in out-of-distribution scenarios, including novel grasp locations, reduced illumination, and partial occlusions. Notably, it generalizes to unseen testing viewpoints and also transfers zero-shot to ex vivo porcine tissue without additional training, offering a promising pathway toward in vivo deployment. To support this, we present qualitative preliminary results of policy roll-outs during in vivo porcine surgery.

Federated Learning for Surgical Vision in Appendicitis Classification: Results of the FedSurg EndoVis 2024 Challenge

Purpose: The FedSurg challenge was designed to benchmark the state of the art in federated learning for surgical video classification. Its goal was to assess how well current methods generalize to unseen clinical centers and adapt through local fine-tuning while enabling collaborative model development without sharing patient data. Methods: Participants developed strategies to classify inflammation stages in appendicitis using a preliminary version of the multi-center Appendix300 video dataset. The challenge evaluated two tasks: generalization to an unseen center and center-specific adaptation after fine-tuning. Submitted approaches included foundation models with linear probing, metric learning with triplet loss, and various FL aggregation schemes (FedAvg, FedMedian, FedSAM). Performance was assessed using F1-score and Expected Cost, with ranking robustness evaluated via bootstrapping and statistical testing. Results: In the generalization task, performance across centers was limited. In the adaptation task, all teams improved after fine-tuning, though ranking stability was low. The ViViT-based submission achieved the strongest overall performance. The challenge highlighted limitations in generalization, sensitivity to class imbalance, and difficulties in hyperparameter tuning in decentralized training, while spatiotemporal modeling and context-aware preprocessing emerged as promising strategies. Conclusion: The FedSurg Challenge establishes the first benchmark for evaluating FL strategies in surgical video classification. Findings highlight the trade-off between local personalization and global robustness, and underscore the importance of architecture choice, preprocessing, and loss design. This benchmarking offers a reference point for future development of imbalance-aware, adaptive, and robust FL methods in clinical surgical AI.

Federated EndoViT: Pretraining Vision Transformers via Federated Learning on Endoscopic Image Collections

Purpose: In this study, we investigate the training of foundation models using federated learning to address data-sharing limitations and enable collaborative model training without data transfer for minimally invasive surgery. Methods: Inspired by the EndoViT study, we adapt the Masked Autoencoder for federated learning, enhancing it with adaptive Sharpness-Aware Minimization (FedSAM) and Stochastic Weight Averaging (SWA). Our model is pretrained on the Endo700k dataset collection and later fine-tuned and evaluated for tasks such as Semantic Segmentation, Action Triplet Recognition, and Surgical Phase Recognition. Results: Our findings demonstrate that integrating adaptive FedSAM into the federated MAE approach improves pretraining, leading to a reduction in reconstruction loss per patch. The application of FL-EndoViT in surgical downstream tasks results in performance comparable to CEN-EndoViT. Furthermore, FL-EndoViT exhibits advantages over CEN-EndoViT in surgical scene segmentation when data is limited and in action triplet recognition when large datasets are used. Conclusion: These findings highlight the potential of federated learning for privacy-preserving training of surgical foundation models, offering a robust and generalizable solution for surgical data science. Effective collaboration requires adapting federated learning methods, such as the integration of FedSAM, which can accommodate the inherent data heterogeneity across institutions. In future, exploring FL in video-based models may enhance these capabilities by incorporating spatiotemporal dynamics crucial for real-world surgical environments.

One model to use them all: Training a segmentation model with complementary datasets

Understanding a surgical scene is crucial for computer-assisted surgery systems to provide any intelligent assistance functionality. One way of achieving this scene understanding is via scene segmentation, where every pixel of a frame is classified and therefore identifies the visible structures and tissues. Progress on fully segmenting surgical scenes has been made using machine learning. However, such models require large amounts of annotated training data, containing examples of all relevant object classes. Such fully annotated datasets are hard to create, as every pixel in a frame needs to be annotated by medical experts and, therefore, are rarely available. In this work, we propose a method to combine multiple partially annotated datasets, which provide complementary annotations, into one model, enabling better scene segmentation and the use of multiple readily available datasets. Our method aims to combine available data with complementary labels by leveraging mutual exclusive properties to maximize information. Specifically, we propose to use positive annotations of other classes as negative samples and to exclude background pixels of binary annotations, as we cannot tell if they contain a class not annotated but predicted by the model. We evaluate our method by training a DeepLabV3 on the publicly available Dresden Surgical Anatomy Dataset, which provides multiple subsets of binary segmented anatomical structures. Our approach successfully combines 6 classes into one model, increasing the overall Dice Score by 4.4% compared to an ensemble of models trained on the classes individually. By including information on multiple classes, we were able to reduce confusion between stomach and colon by 24%. Our results demonstrate the feasibility of training a model on multiple datasets. This paves the way for future work further alleviating the need for one large, fully segmented datasets.

SAR-RARP50: Segmentation of surgical instrumentation and Action Recognition on Robot-Assisted Radical Prostatectomy Challenge

Surgical tool segmentation and action recognition are fundamental building blocks in many computer-assisted intervention applications, ranging from surgical skills assessment to decision support systems. Nowadays, learning-based action recognition and segmentation approaches outperform classical methods, relying, however, on large, annotated datasets. Furthermore, action recognition and tool segmentation algorithms are often trained and make predictions in isolation from each other, without exploiting potential cross-task relationships. With the EndoVis 2022 SAR-RARP50 challenge, we release the first multimodal, publicly available, in-vivo, dataset for surgical action recognition and semantic instrumentation segmentation, containing 50 suturing video segments of Robotic Assisted Radical Prostatectomy (RARP). The aim of the challenge is twofold. First, to enable researchers to leverage the scale of the provided dataset and develop robust and highly accurate single-task action recognition and tool segmentation approaches in the surgical domain. Second, to further explore the potential of multitask-based learning approaches and determine their comparative advantage against their single-task counterparts. A total of 12 teams participated in the challenge, contributing 7 action recognition methods, 9 instrument segmentation techniques, and 4 multitask approaches that integrated both action recognition and instrument segmentation.

Graph data modelling for outcome prediction in oropharyngeal cancer patients

Graph neural networks (GNNs) are becoming increasingly popular in the medical domain for the tasks of disease classification and outcome prediction. Since patient data is not readily available as a graph, most existing methods either manually define a patient graph, or learn a latent graph based on pairwise similarities between the patients. There are also hypergraph neural network (HGNN)-based methods that were introduced recently to exploit potential higher order associations between the patients by representing them as a hypergraph. In this work, we propose a patient hypergraph network (PHGN), which has been investigated in an inductive learning setup for binary outcome prediction in oropharyngeal cancer (OPC) patients using computed tomography (CT)-based radiomic features for the first time. Additionally, the proposed model was extended to perform time-to-event analyses, and compared with GNN and baseline linear models.

Non-rigid Point Cloud Registration for Middle Ear Diagnostics with Endoscopic Optical Coherence Tomography

Purpose: Middle ear infection is the most prevalent inflammatory disease, especially among the pediatric population. Current diagnostic methods are subjective and depend on visual cues from an otoscope, which is limited for otologists to identify pathology. To address this shortcoming, endoscopic optical coherence tomography (OCT) provides both morphological and functional in-vivo measurements of the middle ear. However, due to the shadow of prior structures, interpretation of OCT images is challenging and time-consuming. To facilitate fast diagnosis and measurement, improvement in the readability of OCT data is achieved by merging morphological knowledge from ex-vivo middle ear models with OCT volumetric data, so that OCT applications can be further promoted in daily clinical settings. Methods: We propose C2P-Net: a two-staged non-rigid registration pipeline for complete to partial point clouds, which are sampled from ex-vivo and in-vivo OCT models, respectively. To overcome the lack of labeled training data, a fast and effective generation pipeline in Blender3D is designed to simulate middle ear shapes and extract in-vivo noisy and partial point clouds. Results: We evaluate the performance of C2P-Net through experiments on both synthetic and real OCT datasets. The results demonstrate that C2P-Net is generalized to unseen middle ear point clouds and capable of handling realistic noise and incompleteness in synthetic and real OCT data. Conclusion: In this work, we aim to enable diagnosis of middle ear structures with the assistance of OCT images. We propose C2P-Net: a two-staged non-rigid registration pipeline for point clouds to support the interpretation of in-vivo noisy and partial OCT images for the first time. Code is available at: https://gitlab.com/nct\_tso\_public/c2p-net.