Fine-Grained Action Segmentation for Renorrhaphy in Robot-Assisted Partial Nephrectomy

Fine-grained action segmentation during renorrhaphy in robot-assisted partial nephrectomy requires frame-level recognition of visually similar suturing gestures with variable duration and substantial class imbalance. The SIA-RAPN benchmark defines this problem on 50 clinical videos acquired with the da Vinci Xi system and annotated with 12 frame-level labels. The benchmark compares four temporal models built on I3D features: MS-TCN++, AsFormer, TUT, and DiffAct. Evaluation uses balanced accuracy, edit score, segmental F1 at overlap thresholds of 10, 25, and 50, frame-wise accuracy, and frame-wise mean average precision. In addition to the primary evaluation across five released split configurations on SIA-RAPN, the benchmark reports cross-domain results on a separate single-port RAPN dataset. Across the strongest reported values over those five runs on the primary dataset, DiffAct achieves the highest F1, frame-wise accuracy, edit score, and frame mAP, while MS-TCN++ attains the highest balanced accuracy.

SCISSR: Scribble-Conditioned Interactive Surgical Segmentation and Refinement

Accurate segmentation of tissues and instruments in surgical scenes is annotation-intensive due to irregular shapes, thin structures, specularities, and frequent occlusions. While SAM models support point, box, and mask prompts, points are often too sparse and boxes too coarse to localize such challenging targets. We present SCISSR, a scribble-promptable framework for interactive surgical scene segmentation. It introduces a lightweight Scribble Encoder that converts freehand scribbles into dense prompt embeddings compatible with the mask decoder, enabling iterative refinement for a target object by drawing corrective strokes on error regions. Because all added modules (the Scribble Encoder, Spatial Gated Fusion, and LoRA adapters) interact with the backbone only through its standard embedding interfaces, the framework is not tied to a single model: we build on SAM 2 in this work, yet the same components transfer to other prompt-driven segmentation architectures such as SAM 3 without structural modification. To preserve pre-trained capabilities, we train only these lightweight additions while keeping the remaining backbone frozen. Experiments on EndoVis 2018 demonstrate strong in-domain performance, while evaluation on the out-of-distribution CholecSeg8k further confirms robustness across surgical domains. SCISSR achieves 95.41% Dice on EndoVis 2018 with five interaction rounds and 96.30% Dice on CholecSeg8k with three interaction rounds, outperforming iterative point prompting on both benchmarks.

Surg$Σ$: A Spectrum of Large-Scale Multimodal Data and Foundation Models for Surgical Intelligence

Surgical intelligence has the potential to improve the safety and consistency of surgical care, yet most existing surgical AI frameworks remain task-specific and struggle to generalize across procedures and institutions. Although multimodal foundation models, particularly multimodal large language models, have demonstrated strong cross-task capabilities across various medical domains, their advancement in surgery remains constrained by the lack of large-scale, systematically curated multimodal data. To address this challenge, we introduce Surg$Σ$, a spectrum of large-scale multimodal data and foundation models for surgical intelligence. At the core of this framework lies Surg$Σ$-DB, a large-scale multimodal data foundation designed to support diverse surgical tasks. Surg$Σ$-DB consolidates heterogeneous surgical data sources (including open-source datasets, curated in-house clinical collections and web-source data) into a unified schema, aiming to improve label consistency and data standardization across heterogeneous datasets. Surg$Σ$-DB spans 6 clinical specialties and diverse surgical types, providing rich image- and video-level annotations across 18 practical surgical tasks covering understanding, reasoning, planning, and generation, at an unprecedented scale (over 5.98M conversations). Beyond conventional multimodal conversations, Surg$Σ$-DB incorporates hierarchical reasoning annotations, providing richer semantic cues to support deeper contextual understanding in complex surgical scenarios. We further provide empirical evidence through recently developed surgical foundation models built upon Surg$Σ$-DB, illustrating the practical benefits of large-scale multimodal annotations, unified semantic design, and structured reasoning annotations for improving cross-task generalization and interpretability.

Generalized Recognition of Basic Surgical Actions Enables Skill Assessment and Vision-Language-Model-based Surgical Planning

Artificial intelligence, imaging, and large language models have the potential to transform surgical practice, training, and automation. Understanding and modeling of basic surgical actions (BSA), the fundamental unit of operation in any surgery, is important to drive the evolution of this field. In this paper, we present a BSA dataset comprising 10 basic actions across 6 surgical specialties with over 11,000 video clips, which is the largest to date. Based on the BSA dataset, we developed a new foundation model that conducts general-purpose recognition of basic actions. Our approach demonstrates robust cross-specialist performance in experiments validated on datasets from different procedural types and various body parts. Furthermore, we demonstrate downstream applications enabled by the BAS foundation model through surgical skill assessment in prostatectomy using domain-specific knowledge, and action planning in cholecystectomy and nephrectomy using large vision-language models. Multinational surgeons' evaluation of the language model's output of the action planning explainable texts demonstrated clinical relevance. These findings indicate that basic surgical actions can be robustly recognized across scenarios, and an accurate BSA understanding model can essentially facilitate complex applications and speed up the realization of surgical superintelligence.

Surg-R1: A Hierarchical Reasoning Foundation Model for Scalable and Interpretable Surgical Decision Support with Multi-Center Clinical Validation

Surgical scene understanding demands not only accurate predictions but also interpretable reasoning that surgeons can verify against clinical expertise. However, existing surgical vision-language models generate predictions without reasoning chains, and general-purpose reasoning models fail on compositional surgical tasks without domain-specific knowledge. We present Surg-R1, a surgical Vision-Language Model that addresses this gap through hierarchical reasoning trained via a four-stage pipeline. Our approach introduces three key contributions: (1) a three-level reasoning hierarchy decomposing surgical interpretation into perceptual grounding, relational understanding, and contextual reasoning; (2) the largest surgical chain-of-thought dataset with 320,000 reasoning pairs; and (3) a four-stage training pipeline progressing from supervised fine-tuning to group relative policy optimization and iterative self-improvement. Evaluation on SurgBench, comprising six public benchmarks and six multi-center external validation datasets from five institutions, demonstrates that Surg-R1 achieves the highest Arena Score (64.9%) on public benchmarks versus Gemini 3.0 Pro (46.1%) and GPT-5.1 (37.9%), outperforming both proprietary reasoning models and specialized surgical VLMs on the majority of tasks spanning instrument localization, triplet recognition, phase recognition, action recognition, and critical view of safety assessment, with a 15.2 percentage point improvement over the strongest surgical baseline on external validation.

OMP: One-step Meanflow Policy with Directional Alignment

Robot manipulation, a key capability of embodied AI, has turned to data-driven generative policy frameworks, but mainstream approaches like Diffusion Models suffer from high inference latency and Flow-based Methods from increased architectural complexity. While simply applying meanFlow on robotic tasks achieves single-step inference and outperforms FlowPolicy, it lacks few-shot generalization due to fixed temperature hyperparameters in its Dispersive Loss and misaligned predicted-true mean velocities. To solve these issues, this study proposes an improved MeanFlow-based Policies: we introduce a lightweight Cosine Loss to align velocity directions and use the Differential Derivation Equation (DDE) to optimize the Jacobian-Vector Product (JVP) operator. Experiments on Adroit and Meta-World tasks show the proposed method outperforms MP1 and FlowPolicy in average success rate, especially in challenging Meta-World tasks, effectively enhancing few-shot generalization and trajectory accuracy of robot manipulation policies while maintaining real-time performance, offering a more robust solution for high-precision robotic manipulation.

Holistic Surgical Phase Recognition with Hierarchical Input Dependent State Space Models

Surgical workflow analysis is essential in robot-assisted surgeries, yet the long duration of such procedures poses significant challenges for comprehensive video analysis. Recent approaches have predominantly relied on transformer models; however, their quadratic attention mechanism restricts efficient processing of lengthy surgical videos. In this paper, we propose a novel hierarchical input-dependent state space model that leverages the linear scaling property of state space models to enable decision making on full-length videos while capturing both local and global dynamics. Our framework incorporates a temporally consistent visual feature extractor, which appends a state space model head to a visual feature extractor to propagate temporal information. The proposed model consists of two key modules: a local-aggregation state space model block that effectively captures intricate local dynamics, and a global-relation state space model block that models temporal dependencies across the entire video. The model is trained using a hybrid discrete-continuous supervision strategy, where both signals of discrete phase labels and continuous phase progresses are propagated through the network. Experiments have shown that our method outperforms the current state-of-the-art methods by a large margin (+2.8% on Cholec80, +4.3% on MICCAI2016, and +12.9% on Heichole datasets). Code will be publicly available after paper acceptance.

GenHOI: Generalizing Text-driven 4D Human-Object Interaction Synthesis for Unseen Objects

While diffusion models and large-scale motion datasets have advanced text-driven human motion synthesis, extending these advances to 4D human-object interaction (HOI) remains challenging, mainly due to the limited availability of large-scale 4D HOI datasets. In our study, we introduce GenHOI, a novel two-stage framework aimed at achieving two key objectives: 1) generalization to unseen objects and 2) the synthesis of high-fidelity 4D HOI sequences. In the initial stage of our framework, we employ an Object-AnchorNet to reconstruct sparse 3D HOI keyframes for unseen objects, learning solely from 3D HOI datasets, thereby mitigating the dependence on large-scale 4D HOI datasets. Subsequently, we introduce a Contact-Aware Diffusion Model (ContactDM) in the second stage to seamlessly interpolate sparse 3D HOI keyframes into densely temporally coherent 4D HOI sequences. To enhance the quality of generated 4D HOI sequences, we propose a novel Contact-Aware Encoder within ContactDM to extract human-object contact patterns and a novel Contact-Aware HOI Attention to effectively integrate the contact signals into diffusion models. Experimental results show that we achieve state-of-the-art results on the publicly available OMOMO and 3D-FUTURE datasets, demonstrating strong generalization abilities to unseen objects, while enabling high-fidelity 4D HOI generation.

Time Reversal Symmetry for Efficient Robotic Manipulations in Deep Reinforcement Learning

Symmetry is pervasive in robotics and has been widely exploited to improve sample efficiency in deep reinforcement learning (DRL). However, existing approaches primarily focus on spatial symmetries, such as reflection, rotation, and translation, while largely neglecting temporal symmetries. To address this gap, we explore time reversal symmetry, a form of temporal symmetry commonly found in robotics tasks such as door opening and closing. We propose Time Reversal symmetry enhanced Deep Reinforcement Learning (TR-DRL), a framework that combines trajectory reversal augmentation and time reversal guided reward shaping to efficiently solve temporally symmetric tasks. Our method generates reversed transitions from fully reversible transitions, identified by a proposed dynamics-consistent filter, to augment the training data. For partially reversible transitions, we apply reward shaping to guide learning, according to successful trajectories from the reversed task. Extensive experiments on the Robosuite and MetaWorld benchmarks demonstrate that TR-DRL is effective in both single-task and multi-task settings, achieving higher sample efficiency and stronger final performance compared to baseline methods.

Temporal Propagation of Asymmetric Feature Pyramid for Surgical Scene Segmentation

Surgical scene segmentation is crucial for robot-assisted laparoscopic surgery understanding. Current approaches face two challenges: (i) static image limitations including ambiguous local feature similarities and fine-grained structural details, and (ii) dynamic video complexities arising from rapid instrument motion and persistent visual occlusions. While existing methods mainly focus on spatial feature extraction, they fundamentally overlook temporal dependencies in surgical video streams. To address this, we present temporal asymmetric feature propagation network, a bidirectional attention architecture enabling cross-frame feature propagation. The proposed method contains a temporal query propagator that integrates multi-directional consistency constraints to enhance frame-specific feature representation, and an aggregated asymmetric feature pyramid module that preserves discriminative features for anatomical structures and surgical instruments. Our framework uniquely enables both temporal guidance and contextual reasoning for surgical scene understanding. Comprehensive evaluations on two public benchmarks show the proposed method outperforms the current SOTA methods by a large margin, with +16.4\% mIoU on EndoVis2018 and +3.3\% mAP on Endoscapes2023. The code will be publicly available after paper acceptance.