SURGENT: A Surgical Multi-Agent Assistance System Across the Perioperative Workflow

The intricate nature of modern surgical care necessitates intelligent systems that can synthesize extensive patient records, support collaborative decision-making, and provide transparent, auditable reasoning across the entire perioperative workflow. Although web-based Large Language Models (LLMs) possess advanced reasoning capabilities, they are ill-equipped for surgical applications due to critical limitations: input length constraints, incomplete memory management, and limited traceability. To address this issue, we present SURGENT, a surgical multi-agent assistance system that combines a Tree-of-Thought planner, multi-department collaboration agents, and retrieval-augmented reasoning with clinical guidelines and biomedical literature. SURGENT features a novel memory design that manages both long-term patient histories and short-term working summaries, enabling more complete, contextualized, and consistent reasoning. Experimental evaluations across five key perioperative tasks - case analysis, surgical plan simulation, safety monitoring, complication risk assessment, and rehabilitation guidance - show that SURGENT outperforms baseline LLMs and existing medical multi-agent frameworks, yielding recommendations more closely aligned with patient histories. Ablation studies further highlight the advantage of DeepSeek as a locally deployable backbone model, enabling privacy-preserving deployment without reliance on centralized services. These results position SURGENT as a practical and trustworthy advancement toward intelligent, equitable, and secure surgical assistance systems.

AGMark: Attention-Guided Dynamic Watermarking for Large Vision-Language Models

Watermarking has emerged as a pivotal solution for content traceability and intellectual property protection in Large Vision-Language Models (LVLMs). However, vision-agnostic watermarks may introduce visually irrelevant tokens and disrupt visual grounding by enforcing indiscriminate pseudo-random biases. Additionally, current vision-specific watermarks rely on a static, one-time estimation of vision critical weights and ignore the weight distribution density when determining the proportion of protected tokens. This design fails to account for dynamic changes in visual dependence during generation and may introduce low-quality tokens in the long tail. To address these challenges, we propose Attention-Guided Dynamic Watermarking (AGMark), a novel framework that embeds detectable signals while strictly preserving visual fidelity. At each decoding step, AGMark first dynamically identifies semantic-critical evidence based on attention weights for visual relevance, together with context-aware coherence cues, resulting in a more adaptive and well-calibrated evidence-weight distribution. It then determines the proportion of semantic-critical tokens by jointly considering uncertainty awareness (token entropy) and evidence calibration (weight density), thereby enabling adaptive vocabulary partitioning to avoid irrelevant tokens. Empirical results confirm that AGMark outperforms conventional methods, observably improving generation quality and yielding particularly strong gains in visual semantic fidelity in the later stages of generation. The framework maintains highly competitive detection accuracy (at least 99.36\% AUC) and robust attack resilience (at least 88.61\% AUC) without sacrificing inference efficiency, effectively establishing a new standard for reliability-preserving multi-modal watermarking.