Track2Map: Online Deformable SLAM with Motion-Aware Pose Optimization in Robotic Surgery

Authors: Tianyi Song, Sierra Bonilla, Xinwei Ju, Evangelos Mazomenos, Danail Stoyanov, Adam Schmidt, Omid Mohareri, Sophia Bano, Francisco Vasconcelos

Abstract: Gaussian splatting is the current state-of-the-art for dense, deformable 3D anatomy reconstruction in robot-assisted minimally invasive surgery (RAMIS); however, most pipelines are offline and depend on accurate camera trajectory priors (often from robotic kinematics), limiting applicability when priors are missing or noisy. To address these limitations, we propose Track2Map, an online 3D Gaussian… ▽ More Gaussian splatting is the current state-of-the-art for dense, deformable 3D anatomy reconstruction in robot-assisted minimally invasive surgery (RAMIS); however, most pipelines are offline and depend on accurate camera trajectory priors (often from robotic kinematics), limiting applicability when priors are missing or noisy. To address these limitations, we propose Track2Map, an online 3D Gaussian Splatting pipeline that jointly optimizes camera trajectory and 3D deformable scene representation directly from surgical video. Track2Map is therefore capable of robust 3D reconstructions when camera trajectory priors are either absent or noisy, and due to its online nature it effectively works as a Simultaneous Localisation and Mapping (SLAM) method. To stabilize optimization in the presence of tissue motion and ambiguous visual cues, we introduce a track-anchored deformation initialization using dense 2D point tracks. Track statistics are further utilized to disentangle camera motion from scene deformation by detecting static camera periods and reducing drift during incremental mapping. Experiments on StereoMIS show improved reconstruction quality and camera trajectory against competing SLAM methods, as well as compared to non-SLAM methods that utilize camera trajectory priors. The code is available at https://track2map.github.io/. △ Less

Submitted 9 July, 2026; originally announced July 2026.

OSS: Open Suturing Skills Vision-Based Assessment Challenge 2024-2025

Authors: Hanna Hoffmann, Setareh Bady, Claas de Boer, Max Kirchner, Jan Egger, Rainer Röhrig, Frank Hölzle, Lennart Johannes Gruber, Kunpeng Xie, Marlon Neuhaus, Victor Alves, Guilherme Barbosa, Leonardo Barroso, João Carvalho, Hao Chen, Gabriella d'Albenzio, André Ferreira, Nuno Gomes, Yuichiro Hayashi, Kousuke Hirasawa, Rebecca Hisey, Seungjae Hong, Seoi Jeong, Tiago Jesus, Daehong Kang , et al. (32 additional authors not shown)

Abstract: Achieving high levels of surgical skill through effective training is essential for optimal patient outcomes. Automated, data-driven skill assessment holds significant potential to improve surgical training. While machine learning-based methods are increasingly popular for assessing skills in minimally invasive surgery, their application to open surgery remains limited. We present the results of a… ▽ More Achieving high levels of surgical skill through effective training is essential for optimal patient outcomes. Automated, data-driven skill assessment holds significant potential to improve surgical training. While machine learning-based methods are increasingly popular for assessing skills in minimally invasive surgery, their application to open surgery remains limited. We present the results of a dedicated MICCAI challenge designed to benchmark and advance vision-based skill assessment in open surgery. The challenge dataset comprises videos of an open suturing training task recorded with a static GoPro camera in a dry-lab setting, with instrument trajectories available in addition to the primary video modality. The OSS Challenge was hosted over two consecutive years, comprising two and three independent tasks, respectively: (1) classifying skill level into four classes, (2) predicting the full Objective Structured Assessment of Technical Skills across eight categories, and (3) tracking hands and surgical tools. Participants submitted diverse solutions including deep learning-based video models, tracking-driven methods, and hybrid approaches. General-purpose spatiotemporal video models consistently achieved the strongest performance, though conceptually diverse approaches reached competitive levels when well-executed. Predicting fine-grained OSATS scores remains challenging but benefits substantially from increased training data. Keypoint tracking proves difficult given frequent occlusions and out-of-frame instances, limiting current applicability for motion-based skill analysis. This work benchmarks innovative and diverse solutions for surgical skill assessment, highlighting both the promise and current limitations of video-based evaluation in open surgery and identifying critical directions for advancing automated skill assessment toward clinical impact. △ Less

Submitted 21 May, 2026; originally announced May 2026.

HyKey: Hyperspectral Keypoint Detection and Matching in Minimally Invasive Surgery

Authors: Alexander Saikia, Chiara Di Vece, Zhehua Mao, Sierra Bonilla, Chloe He, Joao Ramalhinho, Tobias Czempiel, Sophia Bano, Danail Stoyanov

Abstract: Purpose: 3D reconstruction in minimally invasive surgery (MIS) enables enhanced surgical guidance through improved visualisation, tool tracking, and augmented reality. However, traditional RGB-based keypoint detection and matching pipelines struggle with surgical challenges, such as poor texture and complex illumination. We investigate whether using snapshot hyperspectral imaging (HSI) can provide… ▽ More Purpose: 3D reconstruction in minimally invasive surgery (MIS) enables enhanced surgical guidance through improved visualisation, tool tracking, and augmented reality. However, traditional RGB-based keypoint detection and matching pipelines struggle with surgical challenges, such as poor texture and complex illumination. We investigate whether using snapshot hyperspectral imaging (HSI) can provide improved results on keypoint detection and matching surgical scenes. Methods: We developed HyKey, a HYperspectral KEYpoint detection and description model made up of a hybrid 3D-2D convolutional neural network that jointly extracts spatial-spectral features from HSI. The model was trained using synthetic homographic augmentation and epipolar geometry constraints on a robotically-acquired dual-camera RGB-HSI laparoscopic dataset of ex-vivo organs with calibrated camera poses. We benchmarked performance against established RGB-based methods, including SuperPoint and ALIKE. Results: Our HSI-based model outperformed RGB baselines on registered RGB frames, achieving 96.62% mean matching accuracy and 67.18% mean average accuracy at 10 degree on pose estimation, demonstrating consistent improvements across multiple evaluation metrics. Conclusion: Integrating spectral information from an HSI cube offers a promising approach for robust monocular 3D reconstruction in MIS, addressing limitations of texture-poor surgical environments through enhanced spectral-spatial feature discrimination. Our model and dataset are available at https://github.com/alexsaikia/HyKey-Hyperspectral-Keypoint-Detection △ Less

Submitted 19 April, 2026; originally announced April 2026.

Warm-Started Reinforcement Learning for Iterative 3D/2D Liver Registration

Authors: Hanyuan Zhang, Lucas He, Zijie Cheng, Abdolrahim Kadkhodamohammadi, Danail Stoyanov, Brian R. Davidson, Evangelos B. Mazomenos, Matthew. J Clarkson

Abstract: Registration between preoperative CT and intraoperative laparoscopic video plays a crucial role in augmented reality (AR) guidance for minimally invasive surgery. Learning-based methods have recently achieved registration errors comparable to optimization-based approaches while offering faster inference. However, many supervised methods produce coarse alignments that rely on additional optimizatio… ▽ More Registration between preoperative CT and intraoperative laparoscopic video plays a crucial role in augmented reality (AR) guidance for minimally invasive surgery. Learning-based methods have recently achieved registration errors comparable to optimization-based approaches while offering faster inference. However, many supervised methods produce coarse alignments that rely on additional optimization-based refinement, thereby increasing inference time. We present a discrete-action reinforcement learning (RL) framework that formulates CT-to-video registration as a sequential decision-making process. A shared feature encoder, warm-started from a supervised pose estimation network to provide stable geometric features and faster convergence, extracts representations from CT renderings and laparoscopic frames, while an RL policy head learns to choose rigid transformations along six degrees of freedom and to decide when to stop the iteration. Experiments on a public laparoscopic dataset demonstrated that our method achieved an average target registration error (TRE) of 15.70 mm, comparable to supervised approaches with optimization, while achieving faster convergence. The proposed RL-based formulation enables automated, efficient iterative registration without manually tuned step sizes or stopping criteria. This discrete framework provides a practical foundation for future continuous-action and deformable registration models in surgical AR applications. △ Less

Submitted 20 May, 2026; v1 submitted 11 April, 2026; originally announced April 2026.

CoRe-DA: Contrastive Regression for Unsupervised Domain Adaptation in Surgical Skill Assessment

Authors: Dimitrios Anastasiou, Razvan Caramalau, Jialang Xu, Runlong He, Freweini Tesfai, Matthew Boal, Nader Francis, Danail Stoyanov, Evangelos B. Mazomenos

Abstract: Vision-based surgical skill assessment (SSA) enables objective and scalable evaluation of operative performance. Progress in this field is constrained by the high cost and time demands for manual annotation of quantitative skill scores, as well as the poor generalization of existing regression models to new surgical tasks and environments. Meanwhile, appreciable volumes of unlabeled video data are… ▽ More Vision-based surgical skill assessment (SSA) enables objective and scalable evaluation of operative performance. Progress in this field is constrained by the high cost and time demands for manual annotation of quantitative skill scores, as well as the poor generalization of existing regression models to new surgical tasks and environments. Meanwhile, appreciable volumes of unlabeled video data are now available, motivating the development of unsupervised domain adaptation (UDA) methods for SSA. We introduce the first benchmark for UDA in SSA regression, spanning four datasets across dry-lab and clinical settings as well as open and robotic surgery. We evaluate eight representative models under challenging domain shifts and propose CoRe-DA, a novel contrastive regression-based adaptation framework. Our method learns domain-invariant representations through relative-score supervision and target-domain self-training. Comprehensive experiments across two UDA settings show that CoRe-DA is superior to state-of-the-art methods, achieving Spearman Correlation Coefficients of 0.46 and 0.41 on dry-lab and clinical target datasets, respectively, without using any labeled target data for training. Overall, CoRe-DA enables scalable SSA with reliable cross-domain generalization, where existing methods underperform. Our code and datasets will be released at https://github.com/anastadimi/CoRe-DA. △ Less

Submitted 31 March, 2026; originally announced March 2026.

Design, Modelling and Characterisation of a Miniature Fibre-Reinforced Soft Bending Actuator for Endoluminal Interventions

Authors: Xiangyi Tan, Aoife McDonald-Bowyer, Danail Stoyanov, Agostino Stilli

Abstract: Miniaturised soft pneumatic actuators are crucial for robotic intervention within highly constrained anatomical pathways. This work presents the design and validation of a fibre-reinforced soft actuator at the centimetre scale for inte- gration into an endoluminal robotic platform for natural-orifice interventional and diagnostic applications. A single-chamber geometry reinforced with embedded Kev… ▽ More Miniaturised soft pneumatic actuators are crucial for robotic intervention within highly constrained anatomical pathways. This work presents the design and validation of a fibre-reinforced soft actuator at the centimetre scale for inte- gration into an endoluminal robotic platform for natural-orifice interventional and diagnostic applications. A single-chamber geometry reinforced with embedded Kevlar fibre was de- signed to maximise curvature while preserving sealing integrity, fabricated using a multi-stage multi-stiffness silicone casting process, and validated against a high-fidelity Abaqus FEM using experimentally parametrised hyperelastic material models and embedded beam reinforcement. The semi-cylindrical actuator has an outer diameter of 18,mm and a length of 37.5,mm. Single and double helix winding configurations, fibre pitch, and fibre density were investigated. The optimal 100 SH configuration achieved a bending angle of 202.9° experimentally and 297.6° in simulation, with structural robustness maintained up to 100,kPa and radial expansion effectively constrained by the fibre reinforcement. Workspace evaluation confirmed suitability for integration into the target device envelope, demonstrating that fibre-reinforcement strategies can be effectively translated to the centimetre regime while retaining actuator performance. △ Less

Submitted 25 March, 2026; originally announced March 2026.

TemporalDoRA: Temporal PEFT for Robust Surgical Video Question Answering

Authors: Luca Carlini, Chiara Lena, Cesare Hassan, Danail Stoyanov, Elena De Momi, Sophia Bano, Mobarak I. Hoque

Abstract: Surgical Video Question Answering (VideoQA) requires accurate temporal grounding while remaining robust to natural variation in how clinicians phrase questions, where linguistic bias can arise. Standard Parameter Efficient Fine Tuning (PEFT) methods adapt pretrained projections without explicitly modeling frame-to-frame interactions within the adaptation pathway, limiting their ability to exploit… ▽ More Surgical Video Question Answering (VideoQA) requires accurate temporal grounding while remaining robust to natural variation in how clinicians phrase questions, where linguistic bias can arise. Standard Parameter Efficient Fine Tuning (PEFT) methods adapt pretrained projections without explicitly modeling frame-to-frame interactions within the adaptation pathway, limiting their ability to exploit sparse temporal evidence. We introduce TemporalDoRA, a video-specific PEFT formulation that extends Weight-Decomposed Low-Rank Adaptation by (i) inserting lightweight temporal Multi-Head Attention (MHA) inside the low-rank bottleneck of the vision encoder and (ii) selectively applying weight decomposition only to the trainable low-rank branch rather than the full adapted weight. This design enables temporally-aware updates while preserving a frozen backbone and stable scaling. By mixing information across frames within the adaptation subspace, TemporalDoRA steers updates toward temporally consistent visual cues and improves robustness with minimal parameter overhead. To benchmark this setting, we present REAL-Colon-VQA, a colonoscopy VideoQA dataset with 6,424 clip--question pairs, including paired rephrased Out-of-Template questions to evaluate sensitivity to linguistic variation. TemporalDoRA improves Out-of-Template performance, and ablation studies confirm that temporal mixing inside the low-rank branch is the primary driver of these gains. We also validate on EndoVis18-VQA adapted to short clips and observe consistent improvements on the Out-of-Template split. Code and dataset available at~\href{https://anonymous.4open.science/r/TemporalDoRA-BFC8/}{Anonymous GitHub}. △ Less

Submitted 10 March, 2026; originally announced March 2026.

Training-free Temporal Object Tracking in Surgical Videos

Authors: Subhadeep Koley, Abdolrahim Kadkhodamohammadi, Santiago Barbarisi, Danail Stoyanov, Imanol Luengo

Abstract: Purpose: In this paper, we present a novel approach for online object tracking in laparoscopic cholecystectomy (LC) surgical videos, targeting localisation and tracking of critical anatomical structures and instruments. Our method addresses the challenges of costly pixel-level annotations and label inconsistencies inherent in existing datasets. Methods: Leveraging the inherent object localisatio… ▽ More Purpose: In this paper, we present a novel approach for online object tracking in laparoscopic cholecystectomy (LC) surgical videos, targeting localisation and tracking of critical anatomical structures and instruments. Our method addresses the challenges of costly pixel-level annotations and label inconsistencies inherent in existing datasets. Methods: Leveraging the inherent object localisation capabilities of pre-trained text-to-image diffusion models, we extract representative features from surgical frames without any training or fine-tuning. Our tracking framework uses these features, along with cross-frame interactions via an affinity matrix inspired by query-key-value attention, to ensure temporal continuity in the tracking process. Results: Through a pilot study, we first demonstrate that diffusion features exhibit superior object localisation and consistent semantics across different decoder levels and temporal frames. Later, we perform extensive experiments to validate the effectiveness of our approach, showcasing its superiority over competitors for the task of temporal object tracking. Specifically, we achieve a per-pixel classification accuracy of 79.19%, mean Jaccard Score of 56.20%, and mean F-Score of 79.48% on the publicly available CholeSeg8K dataset. Conclusion: Our work not only introduces a novel application of text-to-image diffusion models but also contributes to advancing the field of surgical video analysis, offering a promising avenue for accurate and cost-effective temporal object tracking in minimally invasive surgery videos. △ Less

Submitted 8 March, 2026; originally announced March 2026.

Confidence-aware Monocular Depth Estimation for Minimally Invasive Surgery

Authors: Muhammad Asad, Emanuele Colleoni, Pritesh Mehta, Nicolas Toussaint, Ricardo Sanchez-Matilla, Maria Robu, Faisal Bashir, Rahim Mohammadi, Imanol Luengo, Danail Stoyanov

Abstract: Purpose: Monocular depth estimation (MDE) is vital for scene understanding in minimally invasive surgery (MIS). However, endoscopic video sequences are often contaminated by smoke, specular reflections, blur, and occlusions, limiting the accuracy of MDE models. In addition, current MDE models do not output depth confidence, which could be a valuable tool for improving their clinical reliability. M… ▽ More Purpose: Monocular depth estimation (MDE) is vital for scene understanding in minimally invasive surgery (MIS). However, endoscopic video sequences are often contaminated by smoke, specular reflections, blur, and occlusions, limiting the accuracy of MDE models. In addition, current MDE models do not output depth confidence, which could be a valuable tool for improving their clinical reliability. Methods: We propose a novel confidence-aware MDE framework featuring three significant contributions: (i) Calibrated confidence targets: an ensemble of fine-tuned stereo matching models is used to capture disparity variance into pixel-wise confidence probabilities; (ii) Confidence-aware loss: Baseline MDE models are optimized with confidence-aware loss functions, utilizing pixel-wise confidence probabilities such that reliable pixels dominate training; and (iii) Inference-time confidence: a confidence estimation head is proposed with two convolution layers to predict per-pixel confidence at inference, enabling assessment of depth reliability. Results: Comprehensive experimental validation across internal and public datasets demonstrates that our framework improves depth estimation accuracy and can robustly quantify the prediction's confidence. On the internal clinical endoscopic dataset (StereoKP), we improve dense depth estimation accuracy by ~8% as compared to the baseline model. Conclusion: Our confidence-aware framework enables improved accuracy of MDE models in MIS, addressing challenges posed by noise and artifacts in pre-clinical and clinical data, and allows MDE models to provide confidence maps that may be used to improve their reliability for clinical applications. △ Less

Submitted 3 March, 2026; originally announced March 2026.

SurgFusion-Net: Diversified Adaptive Multimodal Fusion Network for Surgical Skill Assessment

Authors: Runlong He, Freweini M. Tesfai, Matthew W. E. Boal, Nazir Sirajudeen, Dimitrios Anastasiou, Jialang Xu, Mobarak I. Hoque, Philip J. Edwards, John D. Kelly, Ashwin Sridhar, Abdolrahim Kadkhodamohammadi, Dhivya Chandrasekaran, Matthew J. Clarkson, Danail Stoyanov, Nader Francis, Evangelos B. Mazomenos

Abstract: Robotic-assisted surgery (RAS) is established in clinical practice, and automated surgical skill assessment utilizing multimodal data offers transformative potential for surgical analytics and education. However, developing effective multimodal methods remains challenging due to the task complexity, limited annotated datasets and insufficient techniques for cross-modal information fusion. Existing… ▽ More Robotic-assisted surgery (RAS) is established in clinical practice, and automated surgical skill assessment utilizing multimodal data offers transformative potential for surgical analytics and education. However, developing effective multimodal methods remains challenging due to the task complexity, limited annotated datasets and insufficient techniques for cross-modal information fusion. Existing state-of-the-art relies exclusively on RGB video and only applies on dry-lab settings, failing to address the significant domain gap between controlled simulation and real clinical cases, where the surgical environment together with camera and tissue motion introduce substantial complexities. This work introduces SurgFusion-Net and Divergence Regulated Attention (DRA), an innovative fusion strategy for multimodal surgical skill assessment. We contribute two first-of-their-kind clinical datasets: the RAH-skill dataset containing 279,691 RGB frames from 37 videos of Robot-assisted Hysterectomy (RAH), and the RARP-skill dataset containing 70,661 RGB frames from 33 videos of Robot-Assisted Radical Prostatectomy (RARP). Both datasets include M-GEARS skill annotations, corresponding optical flow and tool segmentation masks. DRA incorporates adaptive dual attention and diversity-promoting multi-head attention to fuse multimodal information, from three modalities, based on surgical context, enhancing assessment accuracy and reliability. Validated on the JIGSAWS benchmark, RAH-skill, and RARP-skill datasets, our approach outperforms recent baselines with SCC improvements of 0.02 in LOSO, 0.04 in LOUO across JIGSAWS tasks, and 0.0538 and 0.0493 gains on RAH-skill and RARP-skill, respectively. △ Less

Submitted 18 February, 2026; originally announced March 2026.

Diff2DGS: Reliable Reconstruction of Occluded Surgical Scenes via 2D Gaussian Splatting

Authors: Tianyi Song, Danail Stoyanov, Evangelos Mazomenos, Francisco Vasconcelos

Abstract: Real-time reconstruction of deformable surgical scenes is vital for advancing robotic surgery, improving surgeon guidance, and enabling automation. Recent methods achieve dense reconstructions from da Vinci robotic surgery videos, with Gaussian Splatting (GS) offering real-time performance via graphics acceleration. However, reconstruction quality in occluded regions remains limited, and depth acc… ▽ More Real-time reconstruction of deformable surgical scenes is vital for advancing robotic surgery, improving surgeon guidance, and enabling automation. Recent methods achieve dense reconstructions from da Vinci robotic surgery videos, with Gaussian Splatting (GS) offering real-time performance via graphics acceleration. However, reconstruction quality in occluded regions remains limited, and depth accuracy has not been fully assessed, as benchmarks like EndoNeRF and StereoMIS lack 3D ground truth. We propose Diff2DGS, a novel two-stage framework for reliable 3D reconstruction of occluded surgical scenes. In the first stage, a diffusion-based video module with temporal priors inpaints tissue occluded by instruments with high spatial-temporal consistency. In the second stage, we adapt 2D Gaussian Splatting (2DGS) with a Learnable Deformation Model (LDM) to capture dynamic tissue deformation and anatomical geometry. We also extend evaluation beyond prior image-quality metrics by performing quantitative depth accuracy analysis on the SCARED dataset. Diff2DGS outperforms state-of-the-art approaches in both appearance and geometry, reaching 38.02 dB PSNR on EndoNeRF and 34.40 dB on StereoMIS. Furthermore, our experiments demonstrate that optimizing for image quality alone does not necessarily translate into optimal 3D reconstruction accuracy. To address this, we further optimize the depth quality of the reconstructed 3D results, ensuring more faithful geometry in addition to high-fidelity appearance. △ Less

Submitted 20 February, 2026; originally announced February 2026.

Multi-Modal Monocular Endoscopic Depth and Pose Estimation with Edge-Guided Self-Supervision

Authors: Xinwei Ju, Rema Daher, Danail Stoyanov, Sophia Bano, Francisco Vasconcelos

Abstract: Monocular depth and pose estimation play an important role in the development of colonoscopy-assisted navigation, as they enable improved screening by reducing blind spots, minimizing the risk of missed or recurrent lesions, and lowering the likelihood of incomplete examinations. However, this task remains challenging due to the presence of texture-less surfaces, complex illumination patterns, def… ▽ More Monocular depth and pose estimation play an important role in the development of colonoscopy-assisted navigation, as they enable improved screening by reducing blind spots, minimizing the risk of missed or recurrent lesions, and lowering the likelihood of incomplete examinations. However, this task remains challenging due to the presence of texture-less surfaces, complex illumination patterns, deformation, and a lack of in-vivo datasets with reliable ground truth. In this paper, we propose **PRISM** (Pose-Refinement with Intrinsic Shading and edge Maps), a self-supervised learning framework that leverages anatomical and illumination priors to guide geometric learning. Our approach uniquely incorporates edge detection and luminance decoupling for structural guidance. Specifically, edge maps are derived using a learning-based edge detector (e.g., DexiNed or HED) trained to capture thin and high-frequency boundaries, while luminance decoupling is obtained through an intrinsic decomposition module that separates shading and reflectance, enabling the model to exploit shading cues for depth estimation. Experimental results on multiple real and synthetic datasets demonstrate state-of-the-art performance. We further conduct a thorough ablation study on training data selection to establish best practices for pose and depth estimation in colonoscopy. This analysis yields two practical insights: (1) self-supervised training on real-world data outperforms supervised training on realistic phantom data, underscoring the superiority of domain realism over ground truth availability; and (2) video frame rate is an extremely important factor for model performance, where dataset-specific video frame sampling is necessary for generating high quality training data. △ Less

Submitted 19 February, 2026; originally announced February 2026.

Depth Augmented and FE Free 3D/2D Liver Registration for Laparoscopic Liver AR

Authors: Hanyuan Zhang, Lucas He, Runlong He, Weixi Yi, Abdolrahim Kadkhodamohammadi, Danail Stoyanov, Brian R. Davidson, Evangelos B. Mazomenos, Matthew J. Clarkson

Abstract: Augmented reality (AR) guidance in laparoscopic liver surgery requires accurate registration of preoperative 3D models to intraoperative 2D video, but remains challenging due to partial visibility, specularities, and tissue deformation. Existing methods often rely on contour-based rigid initialization and finite-element (FE) models for deformable registration, increasing modeling and engineering c… ▽ More Augmented reality (AR) guidance in laparoscopic liver surgery requires accurate registration of preoperative 3D models to intraoperative 2D video, but remains challenging due to partial visibility, specularities, and tissue deformation. Existing methods often rely on contour-based rigid initialization and finite-element (FE) models for deformable registration, increasing modeling and engineering complexity. We present a depth-augmented, FE-free 3D--2D registration pipeline that combines robust rigid initialization with patient-specific non-rigid refinement. For rigid alignment, we adapt the RefineNet module of FoundationPose to laparoscopic liver scenes by using multi-class contour maps and monocular depth for relative pose refinement. For deformable alignment, we construct a patient-specific statistical deformation model from non-rigid ICP (NICP) correspondences and optimize pose and shape parameters using a coarse-to-fine L-BFGS-B strategy. On a public clinical laparoscopic liver dataset, the proposed method achieves a mean target registration error (TRE) of 14.73\,mm under a controlled manual-contour setting designed to isolate registration performance. Ablation studies show that monocular depth improves rigid initialization over contour-only inputs, while tumor-mapping analysis indicates that good surface alignment does not necessarily translate into lower target localization error. On an external dataset without ground truth, the method produces visually plausible overlays for qualitative assessment. These results suggest that depth-augmented pose refinement and FE-free statistical deformation modeling provide a promising alternative to FE-based pipelines for controlled 3D--2D liver registration in surgical AR. △ Less

Submitted 21 May, 2026; v1 submitted 19 February, 2026; originally announced February 2026.

A multi-centre, multi-device benchmark dataset for landmark-based comprehensive fetal biometry

Authors: Chiara Di Vece, Zhehua Mao, Netanell Avisdris, Brian Dromey, Raffaele Napolitano, Dafna Ben Bashat, Francisco Vasconcelos, Danail Stoyanov, Leo Joskowicz, Sophia Bano

Abstract: Accurate fetal growth assessment from ultrasound (US) relies on precise biometry measured by manually identifying anatomical landmarks in standard planes. Manual landmarking is time-consuming, operator-dependent, and sensitive to variability across scanners and sites, limiting the reproducibility of automated approaches. There is a need for multi-source annotated datasets to develop artificial int… ▽ More Accurate fetal growth assessment from ultrasound (US) relies on precise biometry measured by manually identifying anatomical landmarks in standard planes. Manual landmarking is time-consuming, operator-dependent, and sensitive to variability across scanners and sites, limiting the reproducibility of automated approaches. There is a need for multi-source annotated datasets to develop artificial intelligence-assisted fetal growth assessment methods. To address this bottleneck, we present an open, multi-centre, multi-device benchmark dataset of fetal US images with expert anatomical landmark annotations for clinically used fetal biometric measurements. These measurements include head bi-parietal and occipito-frontal diameters, abdominal transverse and antero-posterior diameters, and femoral length. The dataset comprises 4,513 de-identified US images from 1,904 subjects acquired at three clinical sites using seven different US devices. We provide standardised, subject-disjoint train/test splits, evaluation code, and baseline results to enable fair and reproducible comparison of methods. Using an automatic biometry model, we quantify domain shift and demonstrate that training and evaluation confined to a single centre substantially overestimate performance relative to multi-centre testing. To the best of our knowledge, this is the first publicly available multi-centre, multi-device, landmark-annotated dataset that covers all primary fetal biometry measures, providing a robust benchmark for domain adaptation and multi-centre generalisation in fetal biometry and enabling more reliable AI-assisted fetal growth assessment across centres. All data, annotations, training code, and evaluation pipelines are made publicly available. △ Less

Submitted 19 December, 2025; v1 submitted 18 December, 2025; originally announced December 2025.

Graph Neural Networks for Surgical Scene Segmentation

Authors: Yihan Li, Nikhil Churamani, Maria Robu, Imanol Luengo, Danail Stoyanov

Abstract: Purpose: Accurate identification of hepatocystic anatomy is critical to preventing surgical complications during laparoscopic cholecystectomy. Deep learning models often struggle with occlusions, long-range dependencies, and capturing the fine-scale geometry of rare structures. This work addresses these challenges by introducing graph-based segmentation approaches that enhance spatial and semantic… ▽ More Purpose: Accurate identification of hepatocystic anatomy is critical to preventing surgical complications during laparoscopic cholecystectomy. Deep learning models often struggle with occlusions, long-range dependencies, and capturing the fine-scale geometry of rare structures. This work addresses these challenges by introducing graph-based segmentation approaches that enhance spatial and semantic understanding in surgical scene analyses. Methods: We propose two segmentation models integrating Vision Transformer (ViT) feature encoders with Graph Neural Networks (GNNs) to explicitly model spatial relationships between anatomical regions. (1) A static k Nearest Neighbours (k-NN) graph with a Graph Convolutional Network with Initial Residual and Identity Mapping (GCNII) enables stable long-range information propagation. (2) A dynamic Differentiable Graph Generator (DGG) with a Graph Attention Network (GAT) supports adaptive topology learning. Both models are evaluated on the Endoscapes-Seg50 and CholecSeg8k benchmarks. Results: The proposed approaches achieve up to 7-8% improvement in Mean Intersection over Union (mIoU) and 6% improvement in Mean Dice (mDice) scores over state-of-the-art baselines. It produces anatomically coherent predictions, particularly on thin, rare and safety-critical structures. Conclusion: The proposed graph-based segmentation methods enhance both performance and anatomical consistency in surgical scene segmentation. By combining ViT-based global context with graph-based relational reasoning, the models improve interpretability and reliability, paving the way for safer laparoscopic and robot-assisted surgery through a precise identification of critical anatomical features. △ Less

Submitted 20 November, 2025; originally announced November 2025.

Learning from Single Timestamps: Complexity Estimation in Laparoscopic Cholecystectomy

Authors: Dimitrios Anastasiou, Santiago Barbarisi, Lucy Culshaw, Jayna Patel, Evangelos B. Mazomenos, Imanol Luengo, Danail Stoyanov

Abstract: Purpose: Accurate assessment of surgical complexity is essential in Laparoscopic Cholecystectomy (LC), where severe inflammation is associated with longer operative times and increased risk of postoperative complications. The Parkland Grading Scale (PGS) provides a clinically validated framework for stratifying inflammation severity; however, its automation in surgical videos remains largely unexp… ▽ More Purpose: Accurate assessment of surgical complexity is essential in Laparoscopic Cholecystectomy (LC), where severe inflammation is associated with longer operative times and increased risk of postoperative complications. The Parkland Grading Scale (PGS) provides a clinically validated framework for stratifying inflammation severity; however, its automation in surgical videos remains largely unexplored, particularly in realistic scenarios where complete videos must be analyzed without prior manual curation. Methods: In this work, we introduce STC-Net, a novel framework for SingleTimestamp-based Complexity estimation in LC via the PGS, designed to operate under weak temporal supervision. Unlike prior methods limited to static images or manually trimmed clips, STC-Net operates directly on full videos. It jointly performs temporal localization and grading through a localization, window proposal, and grading module. We introduce a novel loss formulation combining hard and soft localization objectives and background-aware grading supervision. Results: Evaluated on a private dataset of 1,859 LC videos, STC-Net achieves an accuracy of 62.11% and an F1-score of 61.42%, outperforming non-localized baselines by over 10% in both metrics and highlighting the effectiveness of weak supervision for surgical complexity assessment. Conclusion: STC-Net demonstrates a scalable and effective approach for automated PGS-based surgical complexity estimation from full LC videos, making it promising for post-operative analysis and surgical training. △ Less

Submitted 6 November, 2025; originally announced November 2025.

SurgViVQA: Temporally-Grounded Video Question Answering for Surgical Scene Understanding

Authors: Mauro Orazio Drago, Luca Carlini, Pelinsu Celebi Balyemez, Dennis Pierantozzi, Chiara Lena, Cesare Hassan, Danail Stoyanov, Elena De Momi, Sophia Bano, Mobarak I. Hoque

Abstract: Video Question Answering (VideoQA) in the surgical domain aims to enhance intraoperative understanding by enabling AI models to reason over temporally coherent events rather than isolated frames. Current approaches are limited to static image features, and available datasets often lack temporal annotations, ignoring the dynamics critical for accurate procedural interpretation. We propose SurgViVQA… ▽ More Video Question Answering (VideoQA) in the surgical domain aims to enhance intraoperative understanding by enabling AI models to reason over temporally coherent events rather than isolated frames. Current approaches are limited to static image features, and available datasets often lack temporal annotations, ignoring the dynamics critical for accurate procedural interpretation. We propose SurgViVQA, a surgical VideoQA model that extends visual reasoning from static images to dynamic surgical scenes. It uses a Masked Video--Text Encoder to fuse video and question features, capturing temporal cues such as motion and tool--tissue interactions, which a fine-tuned large language model (LLM) then decodes into coherent answers. To evaluate its performance, we curated REAL-Colon-VQA, a colonoscopic video dataset that includes motion-related questions and diagnostic attributes, as well as out-of-template questions with rephrased or semantically altered formulations to assess model robustness. Experimental validation on REAL-Colon-VQA and the public EndoVis18-VQA dataset shows that SurgViVQA outperforms existing image-based VQA benchmark models, particularly in keyword accuracy, improving over PitVQA by +11\% on REAL-Colon-VQA and +9\% on EndoVis18-VQA. A perturbation study on the questions further confirms improved generalizability and robustness to variations in question phrasing. SurgViVQA and the REAL-Colon-VQA dataset provide a framework for temporally-aware understanding in surgical VideoQA, enabling AI models to interpret dynamic procedural contexts more effectively. Code and dataset available at https://github.com/madratak/SurgViVQA. △ Less

Submitted 23 April, 2026; v1 submitted 5 November, 2025; originally announced November 2025.

SurgAnt-ViVQA: Learning to Anticipate Surgical Events through GRU-Driven Temporal Cross-Attention

Authors: Shreyas C. Dhake, Jiayuan Huang, Runlong He, Danyal Z. Khan, Evangelos B. Mazomenos, Sophia Bano, Hani J. Marcus, Danail Stoyanov, Matthew J. Clarkson, Mobarak I. Hoque

Abstract: Anticipating forthcoming surgical events is vital for real-time assistance in endonasal transsphenoidal pituitary surgery, where visibility is limited and workflow changes rapidly. Most visual question answering (VQA) systems reason on isolated frames with static vision language alignment, providing little support for forecasting next steps or instrument needs. Existing surgical VQA datasets likew… ▽ More Anticipating forthcoming surgical events is vital for real-time assistance in endonasal transsphenoidal pituitary surgery, where visibility is limited and workflow changes rapidly. Most visual question answering (VQA) systems reason on isolated frames with static vision language alignment, providing little support for forecasting next steps or instrument needs. Existing surgical VQA datasets likewise center on the current scene rather than the near future. We introduce PitVQA-Anticipation, the first VQA dataset designed for forward looking surgical reasoning. It comprises 33.5 hours of operative video and 734,769 question answer pairs built from temporally grouped clips and expert annotations across four tasks: predicting the future phase, next step, upcoming instrument, and remaining duration. We further propose SurgAnt-ViVQA, a video language model that adapts a large language model using a GRU Gated Temporal Cross-Attention module. A bidirectional GRU encodes frame to frame dynamics, while an adaptive gate injects visual context into the language stream at the token level. Parameter efficient fine tuning customizes the language backbone to the surgical domain. SurgAnt-ViVQA tested upon on PitVQA-Anticipation and EndoVis datasets, surpassing strong image and video based baselines. Ablations show that temporal recurrence and gated fusion drive most of the gains. A frame budget study indicates a trade-off: 8 frames maximize fluency, whereas 32 frames slightly reduce BLEU but improve numeric time estimation. By pairing a temporally aware encoder with fine grained gated cross-attention, SurgAnt-ViVQA advances surgical VQA from retrospective description to proactive anticipation. PitVQA-Anticipation offers a comprehensive benchmark for this setting and highlights the importance of targeted temporal modeling for reliable, future aware surgical assistance. △ Less

Submitted 4 November, 2025; originally announced November 2025.

When to Trust the Answer: Question-Aligned Semantic Nearest Neighbor Entropy for Safer Surgical VQA

Authors: Luca Carlini, Dennis Pierantozzi, Mauro Orazio Drago, Chiara Lena, Cesare Hassan, Elena De Momi, Danail Stoyanov, Sophia Bano, Mobarak I. Hoque

Abstract: Safety and reliability are critical for deploying visual question answering (VQA) systems in surgery, where incorrect or ambiguous responses can cause patient harm. A key limitation of existing uncertainty estimation methods, such as Semantic Nearest Neighbor Entropy (SNNE), is that they do not explicitly account for the conditioning question. As a result, they may assign high confidence to answer… ▽ More Safety and reliability are critical for deploying visual question answering (VQA) systems in surgery, where incorrect or ambiguous responses can cause patient harm. A key limitation of existing uncertainty estimation methods, such as Semantic Nearest Neighbor Entropy (SNNE), is that they do not explicitly account for the conditioning question. As a result, they may assign high confidence to answers that are semantically consistent yet misaligned with the clinical question, especially under variation in question phrasing. We propose Question-Aligned Semantic Nearest Neighbor Entropy (QA-SNNE), a black-box uncertainty estimator that incorporates question-answer alignment into semantic entropy through bilateral gating. QA-SNNE measures uncertainty by weighting pairwise semantic similarities among sampled answers according to their relevance to the question, using embedding-based, entailment-based, or cross-encoder alignment strategies. To assess robustness to language variation, we construct an out-of-template rephrased version of a benchmark surgical VQA dataset, where only the question wording is modified while images and ground-truth answers remain unchanged. We evaluate QA-SNNE on five VQA models across two benchmark surgical VQA datasets in both zero-shot and parameter-efficient fine-tuned (PEFT) settings, including out-of-template questions. QA-SNNE improves AUROC on EndoVis18-VQA for two of three zero-shot models in-template (e.g., +15% for Llama3.2 and +21% for Qwen2.5) and achieves up to +8% AUROC improvement under out-of-template rephrasing, with mixed results on external validation. Overall, QA-SNNE provides a practical, model-agnostic safeguard for surgical VQA by linking semantic uncertainty to question relevance. △ Less

Submitted 23 April, 2026; v1 submitted 3 November, 2025; originally announced November 2025.

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

Authors: Max Kirchner, Hanna Hoffmann, Alexander C. Jenke, Oliver L. Saldanha, Kevin Pfeiffer, Weam Kanjo, Julia Alekseenko, Claas de Boer, Santhi Raj Kolamuri, Lorenzo Mazza, Nicolas Padoy, Sophia Bano, Annika Reinke, Lena Maier-Hein, Danail Stoyanov, Jakob N. Kather, Fiona R. Kolbinger, Sebastian Bodenstedt, Stefanie Speidel

Abstract: Developing generalizable surgical AI requires multi-institutional data, yet patient privacy constraints preclude direct data sharing, making Federated Learning (FL) a natural candidate solution. The application of FL to complex, spatiotemporal surgical video data remains largely unbenchmarked. We present the FedSurg Challenge, the first international benchmarking initiative dedicated to FL in surg… ▽ More Developing generalizable surgical AI requires multi-institutional data, yet patient privacy constraints preclude direct data sharing, making Federated Learning (FL) a natural candidate solution. The application of FL to complex, spatiotemporal surgical video data remains largely unbenchmarked. We present the FedSurg Challenge, the first international benchmarking initiative dedicated to FL in surgical vision, evaluated as a proof-of-concept on a multi-center laparoscopic appendectomy dataset (preliminary subset of Appendix300). Three submissions were evaluated on generalization to an unseen center and center-specific adaptation. Centralized and Swarm Learning baselines isolate the contributions of task difficulty and decentralization to observed performance. Even with all data pooled centrally, the task achieved only 26.31\% F1-score on the unseen center, while decentralized training introduced an additional, separable performance penalty. Temporal modeling emerges as the dominant architectural factor: video-level spatiotemporal models consistently outperformed frame-level approaches regardless of aggregation strategy. Naive local fine-tuning leads to classifier collapse on imbalanced local data; structured personalized FL with parameter-efficient fine-tuning represents a more principled path toward center-specific adaptation. By characterizing current FL limitations through rigorous statistical analysis, this work establishes a methodological reference point for robust, privacy-preserving AI systems in surgical video analysis. △ Less

Submitted 23 April, 2026; v1 submitted 6 October, 2025; originally announced October 2025.

Zero-shot Monocular Metric Depth for Endoscopic Images

Authors: Nicolas Toussaint, Emanuele Colleoni, Ricardo Sanchez-Matilla, Joshua Sutcliffe, Vanessa Thompson, Muhammad Asad, Imanol Luengo, Danail Stoyanov

Abstract: Monocular relative and metric depth estimation has seen a tremendous boost in the last few years due to the sharp advancements in foundation models and in particular transformer based networks. As we start to see applications to the domain of endoscopic images, there is still a lack of robust benchmarks and high-quality datasets in that area. This paper addresses these limitations by presenting a… ▽ More Monocular relative and metric depth estimation has seen a tremendous boost in the last few years due to the sharp advancements in foundation models and in particular transformer based networks. As we start to see applications to the domain of endoscopic images, there is still a lack of robust benchmarks and high-quality datasets in that area. This paper addresses these limitations by presenting a comprehensive benchmark of state-of-the-art (metric and relative) depth estimation models evaluated on real, unseen endoscopic images, providing critical insights into their generalisation and performance in clinical scenarios. Additionally, we introduce and publish a novel synthetic dataset (EndoSynth) of endoscopic surgical instruments paired with ground truth metric depth and segmentation masks, designed to bridge the gap between synthetic and real-world data. We demonstrate that fine-tuning depth foundation models using our synthetic dataset boosts accuracy on most unseen real data by a significant margin. By providing both a benchmark and a synthetic dataset, this work advances the field of depth estimation for endoscopic images and serves as an important resource for future research. Project page, EndoSynth dataset and trained weights are available at https://github.com/TouchSurgery/EndoSynth. △ Less

Submitted 23 September, 2025; originally announced September 2025.

Automated Cervical Os Segmentation for Camera-Guided, Speculum-Free Screening

Authors: Aoife McDonald-Bowyer, Anjana Wijekoon, Ryan Laurance Love, Katie Allan, Scott Colvin, Aleksandra Gentry-Maharaj, Adeola Olaitan, Danail Stoyanov, Agostino Stilli, Sophia Bano

Abstract: Cervical cancer is highly preventable, yet persistent barriers to screening limit progress toward elimination goals. Speculum-free devices that integrate imaging and sampling could improve access, particularly in low-resource settings, but require reliable visual guidance. This study evaluates deep learning methods for real-time segmentation of the cervical os in transvaginal endoscopic images. Fi… ▽ More Cervical cancer is highly preventable, yet persistent barriers to screening limit progress toward elimination goals. Speculum-free devices that integrate imaging and sampling could improve access, particularly in low-resource settings, but require reliable visual guidance. This study evaluates deep learning methods for real-time segmentation of the cervical os in transvaginal endoscopic images. Five encoder-decoder architectures were compared using 913 frames from 200 cases in the IARC Cervical Image Dataset, annotated by gynaecologists. Performance was assessed using IoU, DICE, detection rate, and distance metrics with ten-fold cross-validation. EndoViT/DPT, a vision transformer pre-trained on surgical video, achieved the highest DICE (0.50 \pm 0.31) and detection rate (0.87 \pm 0.33), outperforming CNN-based approaches. External validation with phantom data demonstrated robust segmentation under variable conditions at 21.5 FPS, supporting real-time feasibility. These results establish a foundation for integrating automated os recognition into speculum-free cervical screening devices to support non-expert use in both high- and low-resource contexts. △ Less

Submitted 12 September, 2025; originally announced September 2025.

Exploring Pre-training Across Domains for Few-Shot Surgical Skill Assessment

Authors: Dimitrios Anastasiou, Razvan Caramalau, Nazir Sirajudeen, Matthew Boal, Philip Edwards, Justin Collins, John Kelly, Ashwin Sridhar, Maxine Tran, Faiz Mumtaz, Nevil Pavithran, Nader Francis, Danail Stoyanov, Evangelos B. Mazomenos

Abstract: Automated surgical skill assessment (SSA) is a central task in surgical computer vision. Developing robust SSA models is challenging due to the scarcity of skill annotations, which are time-consuming to produce and require expert consensus. Few-shot learning (FSL) offers a scalable alternative enabling model development with minimal supervision, though its success critically depends on effective p… ▽ More Automated surgical skill assessment (SSA) is a central task in surgical computer vision. Developing robust SSA models is challenging due to the scarcity of skill annotations, which are time-consuming to produce and require expert consensus. Few-shot learning (FSL) offers a scalable alternative enabling model development with minimal supervision, though its success critically depends on effective pre-training. While widely studied for several surgical downstream tasks, pre-training has remained largely unexplored in SSA. In this work, we formulate SSA as a few-shot task and investigate how self-supervised pre-training strategies affect downstream few-shot SSA performance. We annotate a publicly available robotic surgery dataset with Objective Structured Assessment of Technical Skill (OSATS) scores, and evaluate various pre-training sources across three few-shot settings. We quantify domain similarity and analyze how domain gap and the inclusion of procedure-specific data into pre-training influence transferability. Our results show that small but domain-relevant datasets can outperform large scale, less aligned ones, achieving accuracies of 60.16%, 66.03%, and 73.65% in the 1-, 2-, and 5-shot settings, respectively. Moreover, incorporating procedure-specific data into pre-training with a domain-relevant external dataset significantly boosts downstream performance, with an average gain of +1.22% in accuracy and +2.28% in F1-score; however, applying the same strategy with less similar but large-scale sources can instead lead to performance degradation. Code and models are available at https://github.com/anastadimi/ssa-fsl. △ Less

Submitted 11 September, 2025; originally announced September 2025.

CARES: Collaborative Agentic Reasoning for Error Detection in Surgery

Authors: Chang Han Low, Zhu Zhuo, Ziyue Wang, Jialang Xu, Haofeng Liu, Nazir Sirajudeen, Matthew Boal, Philip J. Edwards, Danail Stoyanov, Nader Francis, Jiehui Zhong, Di Gu, Evangelos B. Mazomenos, Yueming Jin

Abstract: Robotic-assisted surgery (RAS) introduces complex challenges that current surgical error detection methods struggle to address effectively due to limited training data and methodological constraints. Therefore, we construct MERP (Multi-class Error in Robotic Prostatectomy), a comprehensive dataset for error detection in robotic prostatectomy with frame-level annotations featuring six clinically al… ▽ More Robotic-assisted surgery (RAS) introduces complex challenges that current surgical error detection methods struggle to address effectively due to limited training data and methodological constraints. Therefore, we construct MERP (Multi-class Error in Robotic Prostatectomy), a comprehensive dataset for error detection in robotic prostatectomy with frame-level annotations featuring six clinically aligned error categories. In addition, we propose CARES (Collaborative Agentic Reasoning for Error Detection in Surgery), a novel zero-shot clinically-informed and risk-stratified agentic reasoning architecture for multi-class surgical error detection. CARES implements adaptive generation of medically informed, error-specific Chain-of-Thought (CoT) prompts across multiple expertise levels. The framework employs risk-aware routing to assign error task to expertise-matched reasoning pathways based on complexity and clinical impact. Subsequently, each pathway decomposes surgical error analysis into three specialized agents with temporal, spatial, and procedural analysis. Each agent analyzes using dynamically selected prompts tailored to the assigned expertise level and error type, generating detailed and transparent reasoning traces. By incorporating clinically informed reasoning from established surgical assessment guidelines, CARES enables zero-shot surgical error detection without prior training. Evaluation demonstrates superior performance with 54.3 mF1 on RARP and 52.0 mF1 on MERP datasets, outperforming existing zero-shot approaches by up to 14% while remaining competitive with trained models. Ablation studies demonstrate the effectiveness of our method. The dataset and code will be publicly available. △ Less

Submitted 12 August, 2025; originally announced August 2025.

Temporal Cluster Assignment for Efficient Real-Time Video Segmentation

Authors: Ka-Wai Yung, Felix J. S. Bragman, Jialang Xu, Imanol Luengo, Danail Stoyanov, Evangelos B. Mazomenos

Abstract: Vision Transformers have substantially advanced the capabilities of segmentation models across both image and video domains. Among them, the Swin Transformer stands out for its ability to capture hierarchical, multi-scale representations, making it a popular backbone for segmentation in videos. However, despite its window-attention scheme, it still incurs a high computational cost, especially in l… ▽ More Vision Transformers have substantially advanced the capabilities of segmentation models across both image and video domains. Among them, the Swin Transformer stands out for its ability to capture hierarchical, multi-scale representations, making it a popular backbone for segmentation in videos. However, despite its window-attention scheme, it still incurs a high computational cost, especially in larger variants commonly used for dense prediction in videos. This remains a major bottleneck for real-time, resource-constrained applications. Whilst token reduction methods have been proposed to alleviate this, the window-based attention mechanism of Swin requires a fixed number of tokens per window, limiting the applicability of conventional pruning techniques. Meanwhile, training-free token clustering approaches have shown promise in image segmentation while maintaining window consistency. Nevertheless, they fail to exploit temporal redundancy, missing a key opportunity to further optimize video segmentation performance. We introduce Temporal Cluster Assignment (TCA), a lightweight and effective, fine-tuning-free strategy that enhances token clustering by leveraging temporal coherence across frames. Instead of indiscriminately dropping redundant tokens, TCA refines token clusters using temporal correlations, thereby retaining fine-grained details while significantly reducing computation. Extensive evaluations on YouTube-VIS 2019, YouTube-VIS 2021, OVIS, and a private surgical video dataset show that TCA consistently boosts the accuracy-speed trade-off of existing clustering-based methods. Our results demonstrate that TCA generalizes competently across both natural and domain-specific videos. △ Less

Submitted 7 August, 2025; originally announced August 2025.

Comparative validation of surgical phase recognition, instrument keypoint estimation, and instrument instance segmentation in endoscopy: Results of the PhaKIR 2024 challenge

Authors: Tobias Rueckert, David Rauber, Raphaela Maerkl, Leonard Klausmann, Suemeyye R. Yildiran, Max Gutbrod, Danilo Weber Nunes, Alvaro Fernandez Moreno, Imanol Luengo, Danail Stoyanov, Nicolas Toussaint, Enki Cho, Hyeon Bae Kim, Oh Sung Choo, Ka Young Kim, Seong Tae Kim, Gonçalo Arantes, Kehan Song, Jianjun Zhu, Junchen Xiong, Tingyi Lin, Shunsuke Kikuchi, Hiroki Matsuzaki, Atsushi Kouno, João Renato Ribeiro Manesco , et al. (36 additional authors not shown)

Abstract: Reliable recognition and localization of surgical instruments in endoscopic video recordings are foundational for a wide range of applications in computer- and robot-assisted minimally invasive surgery (RAMIS), including surgical training, skill assessment, and autonomous assistance. However, robust performance under real-world conditions remains a significant challenge. Incorporating surgical con… ▽ More Reliable recognition and localization of surgical instruments in endoscopic video recordings are foundational for a wide range of applications in computer- and robot-assisted minimally invasive surgery (RAMIS), including surgical training, skill assessment, and autonomous assistance. However, robust performance under real-world conditions remains a significant challenge. Incorporating surgical context - such as the current procedural phase - has emerged as a promising strategy to improve robustness and interpretability. To address these challenges, we organized the Surgical Procedure Phase, Keypoint, and Instrument Recognition (PhaKIR) sub-challenge as part of the Endoscopic Vision (EndoVis) challenge at MICCAI 2024. We introduced a novel, multi-center dataset comprising thirteen full-length laparoscopic cholecystectomy videos collected from three distinct medical institutions, with unified annotations for three interrelated tasks: surgical phase recognition, instrument keypoint estimation, and instrument instance segmentation. Unlike existing datasets, ours enables joint investigation of instrument localization and procedural context within the same data while supporting the integration of temporal information across entire procedures. We report results and findings in accordance with the BIAS guidelines for biomedical image analysis challenges. The PhaKIR sub-challenge advances the field by providing a unique benchmark for developing temporally aware, context-driven methods in RAMIS and offers a high-quality resource to support future research in surgical scene understanding. △ Less

Submitted 19 January, 2026; v1 submitted 22 July, 2025; originally announced July 2025.

StereoMamba: Real-time and Robust Intraoperative Stereo Disparity Estimation via Long-range Spatial Dependencies

Authors: Xu Wang, Jialang Xu, Shuai Zhang, Baoru Huang, Danail Stoyanov, Evangelos B. Mazomenos

Abstract: Stereo disparity estimation is crucial for obtaining depth information in robot-assisted minimally invasive surgery (RAMIS). While current deep learning methods have made significant advancements, challenges remain in achieving an optimal balance between accuracy, robustness, and inference speed. To address these challenges, we propose the StereoMamba architecture, which is specifically designed f… ▽ More Stereo disparity estimation is crucial for obtaining depth information in robot-assisted minimally invasive surgery (RAMIS). While current deep learning methods have made significant advancements, challenges remain in achieving an optimal balance between accuracy, robustness, and inference speed. To address these challenges, we propose the StereoMamba architecture, which is specifically designed for stereo disparity estimation in RAMIS. Our approach is based on a novel Feature Extraction Mamba (FE-Mamba) module, which enhances long-range spatial dependencies both within and across stereo images. To effectively integrate multi-scale features from FE-Mamba, we then introduce a novel Multidimensional Feature Fusion (MFF) module. Experiments against the state-of-the-art on the ex-vivo SCARED benchmark demonstrate that StereoMamba achieves superior performance on EPE of 2.64 px and depth MAE of 2.55 mm, the second-best performance on Bad2 of 41.49% and Bad3 of 26.99%, while maintaining an inference speed of 21.28 FPS for a pair of high-resolution images (1280*1024), striking the optimum balance between accuracy, robustness, and efficiency. Furthermore, by comparing synthesized right images, generated from warping left images using the generated disparity maps, with the actual right image, StereoMamba achieves the best average SSIM (0.8970) and PSNR (16.0761), exhibiting strong zero-shot generalization on the in-vivo RIS2017 and StereoMIS datasets. △ Less

Submitted 4 May, 2026; v1 submitted 24 April, 2025; originally announced April 2025.

Point Tracking in Surgery--The 2024 Surgical Tattoos in Infrared (STIR) Challenge

Authors: Adam Schmidt, Mert Asim Karaoglu, Soham Sinha, Mingang Jang, Ho-Gun Ha, Kyungmin Jung, Kyeongmo Gu, Ihsan Ullah, Hyunki Lee, Jonáš Šerých, Michal Neoral, Jiří Matas, Rulin Zhou, Wenlong He, An Wang, Hongliang Ren, Bruno Silva, Sandro Queirós, Estêvão Lima, João L. Vilaça, Shunsuke Kikuchi, Atsushi Kouno, Hiroki Matsuzaki, Tongtong Li, Yulu Chen , et al. (15 additional authors not shown)

Abstract: Understanding tissue motion in surgery is crucial to enable applications in downstream tasks such as segmentation, 3D reconstruction, virtual tissue landmarking, autonomous probe-based scanning, and subtask autonomy. Labeled data are essential to enabling algorithms in these downstream tasks since they allow us to quantify and train algorithms. This paper introduces a point tracking challenge to a… ▽ More Understanding tissue motion in surgery is crucial to enable applications in downstream tasks such as segmentation, 3D reconstruction, virtual tissue landmarking, autonomous probe-based scanning, and subtask autonomy. Labeled data are essential to enabling algorithms in these downstream tasks since they allow us to quantify and train algorithms. This paper introduces a point tracking challenge to address this, wherein participants can submit their algorithms for quantification. The submitted algorithms are evaluated using a dataset named surgical tattoos in infrared (STIR), with the challenge aptly named the STIR Challenge 2024. The STIR Challenge 2024 comprises two quantitative components: accuracy and efficiency. The accuracy component tests the accuracy of algorithms on in vivo and ex vivo sequences. The efficiency component tests the latency of algorithm inference. The challenge was conducted as a part of MICCAI EndoVis 2024. In this challenge, we had 8 total teams, with 4 teams submitting before and 4 submitting after challenge day. This paper details the STIR Challenge 2024, which serves to move the field towards more accurate and efficient algorithms for spatial understanding in surgery. In this paper we summarize the design, submissions, and results from the challenge. The challenge dataset is available here: https://zenodo.org/records/14803158 , and the code for baseline models and metric calculation is available here: https://github.com/athaddius/STIRMetrics △ Less

Submitted 31 March, 2025; originally announced March 2025.

EndoLRMGS: Complete Endoscopic Scene Reconstruction combining Large Reconstruction Modelling and Gaussian Splatting

Authors: Xu Wang, Shuai Zhang, Baoru Huang, Danail Stoyanov, Evangelos B. Mazomenos

Abstract: Complete reconstruction of surgical scenes is crucial for robot-assisted surgery (RAS). Deep depth estimation is promising but existing works struggle with depth discontinuities, resulting in noisy predictions at object boundaries and do not achieve complete reconstruction omitting occluded surfaces. To address these issues we propose EndoLRMGS, that combines Large Reconstruction Modelling (LRM) a… ▽ More Complete reconstruction of surgical scenes is crucial for robot-assisted surgery (RAS). Deep depth estimation is promising but existing works struggle with depth discontinuities, resulting in noisy predictions at object boundaries and do not achieve complete reconstruction omitting occluded surfaces. To address these issues we propose EndoLRMGS, that combines Large Reconstruction Modelling (LRM) and Gaussian Splatting (GS), for complete surgical scene reconstruction. GS reconstructs deformable tissues and LRM generates 3D models for surgical tools while position and scale are subsequently optimized by introducing orthogonal perspective joint projection optimization (OPjPO) to enhance accuracy. In experiments on four surgical videos from three public datasets, our method improves the Intersection-over-union (IoU) of tool 3D models in 2D projections by>40%. Additionally, EndoLRMGS improves the PSNR of the tools projection from 3.82% to 11.07%. Tissue rendering quality also improves, with PSNR increasing from 0.46% to 49.87%, and SSIM from 1.53% to 29.21% across all test videos. △ Less

Submitted 28 March, 2025; originally announced March 2025.

3D Acetabular Surface Reconstruction from 2D Pre-operative X-ray Images using SRVF Elastic Registration and Deformation Graph

Authors: Shuai Zhang, Jinliang Wang, Sujith Konandetails, Xu Wang, Danail Stoyanov, Evangelos B. Mazomenos

Abstract: Accurate and reliable selection of the appropriate acetabular cup size is crucial for restoring joint biomechanics in total hip arthroplasty (THA). This paper proposes a novel framework that integrates square-root velocity function (SRVF)-based elastic shape registration technique with an embedded deformation (ED) graph approach to reconstruct the 3D articular surface of the acetabulum by fusing m… ▽ More Accurate and reliable selection of the appropriate acetabular cup size is crucial for restoring joint biomechanics in total hip arthroplasty (THA). This paper proposes a novel framework that integrates square-root velocity function (SRVF)-based elastic shape registration technique with an embedded deformation (ED) graph approach to reconstruct the 3D articular surface of the acetabulum by fusing multiple views of 2D pre-operative pelvic X-ray images and a hemispherical surface model. The SRVF-based elastic registration establishes 2D-3D correspondences between the parametric hemispherical model and X-ray images, and the ED framework incorporates the SRVF-derived correspondences as constraints to optimize the 3D acetabular surface reconstruction using nonlinear least-squares optimization. Validations using both simulation and real patient datasets are performed to demonstrate the robustness and the potential clinical value of the proposed algorithm. The reconstruction result can assist surgeons in selecting the correct acetabular cup on the first attempt in primary THA, minimising the need for revision surgery. △ Less

Submitted 28 March, 2025; originally announced March 2025.

Surgical AI Copilot: Energy-Based Fourier Gradient Low-Rank Adaptation for Surgical LLM Agent Reasoning and Planning

Authors: Jiayuan Huang, Runlong He, Danyal Zaman Khan, Evangelos B. Mazomenos, Danail Stoyanov, Hani Marcus, Linzhe Jiang, Matthew J Clarkson, Mobarak I. Hoque

Abstract: Image-guided surgery demands adaptive, real-time decision support, yet static AI models struggle with structured task planning and providing interactive guidance. Large language models (LLMs)-powered agents offer a promising solution by enabling dynamic task planning and predictive decision support. Despite recent advances, the absence of surgical agent datasets and robust parameter-efficient fine… ▽ More Image-guided surgery demands adaptive, real-time decision support, yet static AI models struggle with structured task planning and providing interactive guidance. Large language models (LLMs)-powered agents offer a promising solution by enabling dynamic task planning and predictive decision support. Despite recent advances, the absence of surgical agent datasets and robust parameter-efficient fine-tuning techniques limits the development of LLM agents capable of complex intraoperative reasoning. In this paper, we introduce Surgical AI Copilot, an LLM agent for image-guided pituitary surgery, capable of conversation, planning, and task execution in response to queries involving tasks such as MRI tumor segmentation, endoscope anatomy segmentation, overlaying preoperative imaging with intraoperative views, instrument tracking, and surgical visual question answering (VQA). To enable structured agent planning, we develop the PitAgent dataset, a surgical context-aware planning dataset covering surgical tasks like workflow analysis, instrument localization, anatomical segmentation, and query-based reasoning. Additionally, we propose DEFT-GaLore, a Deterministic Energy-based Fourier Transform (DEFT) gradient projection technique for efficient low-rank adaptation of recent LLMs (e.g., LLaMA 3.2, Qwen 2.5), enabling their use as surgical agent planners. We extensively validate our agent's performance and the proposed adaptation technique against other state-of-the-art low-rank adaptation methods on agent planning and prompt generation tasks, including a zero-shot surgical VQA benchmark, demonstrating the significant potential for truly efficient and scalable surgical LLM agents in real-time operative settings. △ Less

Submitted 12 November, 2025; v1 submitted 12 March, 2025; originally announced March 2025.

Endo-FASt3r: Endoscopic Foundation model Adaptation for Structure from motion

Authors: Mona Sheikh Zeinoddin, Mobarak I. Hoque, Zafer Tandogdu, Greg Shaw, Matthew J. Clarkson, Evangelos Mazomenos, Danail Stoyanov

Abstract: Accurate depth and camera pose estimation is essential for achieving high-quality 3D visualisations in robotic-assisted surgery. Despite recent advancements in foundation model adaptation to monocular depth estimation of endoscopic scenes via self-supervised learning (SSL), no prior work has explored their use for pose estimation. These methods rely on low rank-based adaptation approaches, which c… ▽ More Accurate depth and camera pose estimation is essential for achieving high-quality 3D visualisations in robotic-assisted surgery. Despite recent advancements in foundation model adaptation to monocular depth estimation of endoscopic scenes via self-supervised learning (SSL), no prior work has explored their use for pose estimation. These methods rely on low rank-based adaptation approaches, which constrain model updates to a low-rank space. We propose Endo-FASt3r, the first monocular SSL depth and pose estimation framework that uses foundation models for both tasks. We extend the Reloc3r relative pose estimation foundation model by designing Reloc3rX, introducing modifications necessary for convergence in SSL. We also present DoMoRA, a novel adaptation technique that enables higher-rank updates and faster convergence. Experiments on the SCARED dataset show that Endo-FASt3r achieves a substantial $10\%$ improvement in pose estimation and a $2\%$ improvement in depth estimation over prior work. Similar performance gains on the Hamlyn and StereoMIS datasets reinforce the generalisability of Endo-FASt3r across different datasets. △ Less

Submitted 20 August, 2025; v1 submitted 10 March, 2025; originally announced March 2025.

PitVQA++: Vector Matrix-Low-Rank Adaptation for Open-Ended Visual Question Answering in Pituitary Surgery

Authors: Runlong He, Danyal Z. Khan, Evangelos B. Mazomenos, Hani J. Marcus, Danail Stoyanov, Matthew J. Clarkson, Mobarakol Islam

Abstract: Vision-Language Models (VLMs) in visual question answering (VQA) offer a unique opportunity to enhance intra-operative decision-making, promote intuitive interactions, and significantly advancing surgical education. However, the development of VLMs for surgical VQA is challenging due to limited datasets and the risk of overfitting and catastrophic forgetting during full fine-tuning of pretrained w… ▽ More Vision-Language Models (VLMs) in visual question answering (VQA) offer a unique opportunity to enhance intra-operative decision-making, promote intuitive interactions, and significantly advancing surgical education. However, the development of VLMs for surgical VQA is challenging due to limited datasets and the risk of overfitting and catastrophic forgetting during full fine-tuning of pretrained weights. While parameter-efficient techniques like Low-Rank Adaptation (LoRA) and Matrix of Rank Adaptation (MoRA) address adaptation challenges, their uniform parameter distribution overlooks the feature hierarchy in deep networks, where earlier layers, that learn general features, require more parameters than later ones. This work introduces PitVQA++ with an open-ended PitVQA dataset and vector matrix-low-rank adaptation (Vector-MoLoRA), an innovative VLM fine-tuning approach for adapting GPT-2 to pituitary surgery. Open-Ended PitVQA comprises around 101,803 frames from 25 procedural videos with 745,972 question-answer sentence pairs, covering key surgical elements such as phase and step recognition, context understanding, tool detection, localization, and interactions recognition. Vector-MoLoRA incorporates the principles of LoRA and MoRA to develop a matrix-low-rank adaptation strategy that employs vector ranking to allocate more parameters to earlier layers, gradually reducing them in the later layers. Our approach, validated on the Open-Ended PitVQA and EndoVis18-VQA datasets, effectively mitigates catastrophic forgetting while significantly enhancing performance over recent baselines. Furthermore, our risk-coverage analysis highlights its enhanced reliability and trustworthiness in handling uncertain predictions. Our source code and dataset is available at~\url{https://github.com/HRL-Mike/PitVQA-Plus}. △ Less

Submitted 19 February, 2025; originally announced February 2025.

SHADeS: Self-supervised Monocular Depth Estimation Through Non-Lambertian Image Decomposition

Authors: Rema Daher, Francisco Vasconcelos, Danail Stoyanov

Abstract: Purpose: Visual 3D scene reconstruction can support colonoscopy navigation. It can help in recognising which portions of the colon have been visualised and characterising the size and shape of polyps. This is still a very challenging problem due to complex illumination variations, including abundant specular reflections. We investigate how to effectively decouple light and depth in this problem.… ▽ More Purpose: Visual 3D scene reconstruction can support colonoscopy navigation. It can help in recognising which portions of the colon have been visualised and characterising the size and shape of polyps. This is still a very challenging problem due to complex illumination variations, including abundant specular reflections. We investigate how to effectively decouple light and depth in this problem. Methods: We introduce a self-supervised model that simultaneously characterises the shape and lighting of the visualised colonoscopy scene. Our model estimates shading, albedo, depth, and specularities (SHADeS) from single images. Unlike previous approaches (IID), we use a non-Lambertian model that treats specular reflections as a separate light component. The implementation of our method is available at https://github.com/RemaDaher/SHADeS. Results: We demonstrate on real colonoscopy images (Hyper Kvasir) that previous models for light decomposition (IID) and depth estimation (MonoVIT, ModoDepth2) are negatively affected by specularities. In contrast, SHADeS can simultaneously produce light decomposition and depth maps that are robust to specular regions. We also perform a quantitative comparison on phantom data (C3VD) where we further demonstrate the robustness of our model. Conclusion: Modelling specular reflections improves depth estimation in colonoscopy. We propose an effective self-supervised approach that uses this insight to jointly estimate light decomposition and depth. Light decomposition has the potential to help with other problems, such as place recognition within the colon. △ Less

Submitted 18 February, 2025; originally announced February 2025.

SegCol Challenge: Semantic Segmentation for Tools and Fold Edges in Colonoscopy data

Authors: Xinwei Ju, Rema Daher, Razvan Caramalau, Baoru Huang, Danail Stoyanov, Francisco Vasconcelos

Abstract: Colorectal cancer (CRC) remains a leading cause of cancer-related deaths worldwide, with polyp removal being an effective early screening method. However, navigating the colon for thorough polyp detection poses significant challenges. To advance camera navigation in colonoscopy, we propose the Semantic Segmentation for Tools and Fold Edges in Colonoscopy (SegCol) Challenge. This challenge introduc… ▽ More Colorectal cancer (CRC) remains a leading cause of cancer-related deaths worldwide, with polyp removal being an effective early screening method. However, navigating the colon for thorough polyp detection poses significant challenges. To advance camera navigation in colonoscopy, we propose the Semantic Segmentation for Tools and Fold Edges in Colonoscopy (SegCol) Challenge. This challenge introduces a dataset from the EndoMapper repository, featuring manually annotated, pixel-level semantic labels for colon folds and endoscopic tools across selected frames from 96 colonoscopy videos. By providing fold edges as anatomical landmarks and depth discontinuity information from both fold and tool labels, the dataset is aimed to improve depth perception and localization methods. Hosted as part of the Endovis Challenge at MICCAI 2024, SegCol aims to drive innovation in colonoscopy navigation systems. Details are available at https://www.synapse.org/Synapse:syn54124209/wiki/626563, and code resources at https://github.com/surgical-vision/segcol_challenge . △ Less

Submitted 20 December, 2024; originally announced December 2024.

RRT-GPMP2: A Motion Planner for Mobile Robots in Complex Maze Environments

Authors: Jiawei Meng, Danail Stoyanov

Abstract: With the development of science and technology, mobile robots are playing a significant important role in the new round of world revolution. Further, mobile robots might assist or replace human beings in a great number of areas. To increase the degree of automation for mobile robots, advanced motion planners need to be integrated into them to cope with various environments. Complex maze environmen… ▽ More With the development of science and technology, mobile robots are playing a significant important role in the new round of world revolution. Further, mobile robots might assist or replace human beings in a great number of areas. To increase the degree of automation for mobile robots, advanced motion planners need to be integrated into them to cope with various environments. Complex maze environments are common in the potential application scenarios of different mobile robots. This article proposes a novel motion planner named the rapidly exploring random tree based Gaussian process motion planner 2, which aims to tackle the motion planning problem for mobile robots in complex maze environments. To be more specific, the proposed motion planner successfully combines the advantages of a trajectory optimisation motion planning algorithm named the Gaussian process motion planner 2 and a sampling-based motion planning algorithm named the rapidly exploring random tree. To validate the performance and practicability of the proposed motion planner, we have tested it in several simulations in the Matrix laboratory and applied it on a marine mobile robot in a virtual scenario in the Robotic operating system. △ Less

Submitted 10 December, 2024; originally announced December 2024.

Dynamic Obstacle Avoidance of Unmanned Surface Vehicles in Maritime Environments Using Gaussian Processes Based Motion Planning

Authors: Jiawei Meng, Yuanchang Liu, Danail Stoyanov

Abstract: During recent years, unmanned surface vehicles are extensively utilised in a variety of maritime applications such as the exploration of unknown areas, autonomous transportation, offshore patrol and others. In such maritime applications, unmanned surface vehicles executing relevant missions that might collide with potential static obstacles such as islands and reefs and dynamic obstacles such as o… ▽ More During recent years, unmanned surface vehicles are extensively utilised in a variety of maritime applications such as the exploration of unknown areas, autonomous transportation, offshore patrol and others. In such maritime applications, unmanned surface vehicles executing relevant missions that might collide with potential static obstacles such as islands and reefs and dynamic obstacles such as other moving unmanned surface vehicles. To successfully accomplish these missions, motion planning algorithms that can generate smooth and collision-free trajectories to avoid both these static and dynamic obstacles in an efficient manner are essential. In this article, we propose a novel motion planning algorithm named the Dynamic Gaussian process motion planner 2, which successfully extends the application scope of the Gaussian process motion planner 2 into complex and dynamic environments with both static and dynamic obstacles. First, we introduce an approach to generate safe areas for dynamic obstacles using modified multivariate Gaussian distributions. Second, we introduce an approach to integrate real-time status information of dynamic obstacles into the modified multivariate Gaussian distributions. The multivariate Gaussian distributions with real-time statuses of dynamic obstacles can be innovatively added into the optimisation process of factor graph to generate an optimised trajectory. We also develop a variant of the proposed algorithm that integrates the international regulations for preventing collisions at sea, enhancing its operational effectiveness in maritime environments. The proposed algorithms have been validated in a series of benchmark simulations and a dynamic obstacle avoidance mission in a high-fidelity maritime environment in the Robotic operating system to demonstrate the functionality and practicability. △ Less

Submitted 7 June, 2025; v1 submitted 10 December, 2024; originally announced December 2024.

NCDD: Nearest Centroid Distance Deficit for Out-Of-Distribution Detection in Gastrointestinal Vision

Authors: Sandesh Pokhrel, Sanjay Bhandari, Sharib Ali, Tryphon Lambrou, Anh Nguyen, Yash Raj Shrestha, Angus Watson, Danail Stoyanov, Prashnna Gyawali, Binod Bhattarai

Abstract: The integration of deep learning tools in gastrointestinal vision holds the potential for significant advancements in diagnosis, treatment, and overall patient care. A major challenge, however, is these tools' tendency to make overconfident predictions, even when encountering unseen or newly emerging disease patterns, undermining their reliability. We address this critical issue of reliability b… ▽ More The integration of deep learning tools in gastrointestinal vision holds the potential for significant advancements in diagnosis, treatment, and overall patient care. A major challenge, however, is these tools' tendency to make overconfident predictions, even when encountering unseen or newly emerging disease patterns, undermining their reliability. We address this critical issue of reliability by framing it as an out-of-distribution (OOD) detection problem, where previously unseen and emerging diseases are identified as OOD examples. However, gastrointestinal images pose a unique challenge due to the overlapping feature representations between in- Distribution (ID) and OOD examples. Existing approaches often overlook this characteristic, as they are primarily developed for natural image datasets, where feature distinctions are more apparent. Despite the overlap, we hypothesize that the features of an in-distribution example will cluster closer to the centroids of their ground truth class, resulting in a shorter distance to the nearest centroid. In contrast, OOD examples maintain an equal distance from all class centroids. Based on this observation, we propose a novel nearest-centroid distance deficit (NCCD) score in the feature space for gastrointestinal OOD detection. Evaluations across multiple deep learning architectures and two publicly available benchmarks, Kvasir2 and Gastrovision, demonstrate the effectiveness of our approach compared to several state-of-the-art methods. The code and implementation details are publicly available at: https://github.com/bhattarailab/NCDD △ Less

Submitted 2 December, 2024; originally announced December 2024.

RGB to Hyperspectral: Spectral Reconstruction for Enhanced Surgical Imaging

Authors: Tobias Czempiel, Alfie Roddan, Maria Leiloglou, Zepeng Hu, Kevin O'Neill, Giulio Anichini, Danail Stoyanov, Daniel Elson

Abstract: This study investigates the reconstruction of hyperspectral signatures from RGB data to enhance surgical imaging, utilizing the publicly available HeiPorSPECTRAL dataset from porcine surgery and an in-house neurosurgery dataset. Various architectures based on convolutional neural networks (CNNs) and transformer models are evaluated using comprehensive metrics. Transformer models exhibit superior p… ▽ More This study investigates the reconstruction of hyperspectral signatures from RGB data to enhance surgical imaging, utilizing the publicly available HeiPorSPECTRAL dataset from porcine surgery and an in-house neurosurgery dataset. Various architectures based on convolutional neural networks (CNNs) and transformer models are evaluated using comprehensive metrics. Transformer models exhibit superior performance in terms of RMSE, SAM, PSNR and SSIM by effectively integrating spatial information to predict accurate spectral profiles, encompassing both visible and extended spectral ranges. Qualitative assessments demonstrate the capability to predict spectral profiles critical for informed surgical decision-making during procedures. Challenges associated with capturing both the visible and extended hyperspectral ranges are highlighted using the MAE, emphasizing the complexities involved. The findings open up the new research direction of hyperspectral reconstruction for surgical applications and clinical use cases in real-time surgical environments. △ Less

Submitted 17 October, 2024; originally announced October 2024.

Robotic Arm Platform for Multi-View Image Acquisition and 3D Reconstruction in Minimally Invasive Surgery

Authors: Alexander Saikia, Chiara Di Vece, Sierra Bonilla, Chloe He, Morenike Magbagbeola, Laurent Mennillo, Tobias Czempiel, Sophia Bano, Danail Stoyanov

Abstract: Minimally invasive surgery (MIS) offers significant benefits such as reduced recovery time and minimised patient trauma, but poses challenges in visibility and access, making accurate 3D reconstruction a significant tool in surgical planning and navigation. This work introduces a robotic arm platform for efficient multi-view image acquisition and precise 3D reconstruction in MIS settings. We adapt… ▽ More Minimally invasive surgery (MIS) offers significant benefits such as reduced recovery time and minimised patient trauma, but poses challenges in visibility and access, making accurate 3D reconstruction a significant tool in surgical planning and navigation. This work introduces a robotic arm platform for efficient multi-view image acquisition and precise 3D reconstruction in MIS settings. We adapted a laparoscope to a robotic arm and captured ex-vivo images of several ovine organs across varying lighting conditions (operating room and laparoscopic) and trajectories (spherical and laparoscopic). We employed recently released learning-based feature matchers combined with COLMAP to produce our reconstructions. The reconstructions were evaluated against high-precision laser scans for quantitative evaluation. Our results show that whilst reconstructions suffer most under realistic MIS lighting and trajectory, many versions of our pipeline achieve close to sub-millimetre accuracy with an average of 1.05 mm Root Mean Squared Error and 0.82 mm Chamfer distance. Our best reconstruction results occur with operating room lighting and spherical trajectories. Our robotic platform provides a tool for controlled, repeatable multi-view data acquisition for 3D generation in MIS environments which we hope leads to new datasets for training learning-based models. △ Less

Submitted 15 October, 2024; originally announced October 2024.

SurgicalGS: Dynamic 3D Gaussian Splatting for Accurate Robotic-Assisted Surgical Scene Reconstruction

Authors: Jialei Chen, Xin Zhang, Mobarakol Islam, Francisco Vasconcelos, Danail Stoyanov, Daniel S. Elson, Baoru Huang

Abstract: Accurate 3D reconstruction of dynamic surgical scenes from endoscopic video is essential for robotic-assisted surgery. While recent 3D Gaussian Splatting methods have shown promise in achieving high-quality reconstructions with fast rendering speeds, their use of inverse depth loss functions compresses depth variations. This can lead to a loss of fine geometric details, limiting their ability to c… ▽ More Accurate 3D reconstruction of dynamic surgical scenes from endoscopic video is essential for robotic-assisted surgery. While recent 3D Gaussian Splatting methods have shown promise in achieving high-quality reconstructions with fast rendering speeds, their use of inverse depth loss functions compresses depth variations. This can lead to a loss of fine geometric details, limiting their ability to capture precise 3D geometry and effectiveness in intraoperative application. To address these challenges, we present SurgicalGS, a dynamic 3D Gaussian Splatting framework specifically designed for surgical scene reconstruction with improved geometric accuracy. Our approach first initialises a Gaussian point cloud using depth priors, employing binary motion masks to identify pixels with significant depth variations and fusing point clouds from depth maps across frames for initialisation. We use the Flexible Deformation Model to represent dynamic scene and introduce a normalised depth regularisation loss along with an unsupervised depth smoothness constraint to ensure more accurate geometric reconstruction. Extensive experiments on two real surgical datasets demonstrate that SurgicalGS achieves state-of-the-art reconstruction quality, especially in terms of accurate geometry, advancing the usability of 3D Gaussian Splatting in robotic-assisted surgery. △ Less

Submitted 11 October, 2024; originally announced October 2024.

Tracking Everything in Robotic-Assisted Surgery

Authors: Bohan Zhan, Wang Zhao, Yi Fang, Bo Du, Francisco Vasconcelos, Danail Stoyanov, Daniel S. Elson, Baoru Huang

Abstract: Accurate tracking of tissues and instruments in videos is crucial for Robotic-Assisted Minimally Invasive Surgery (RAMIS), as it enables the robot to comprehend the surgical scene with precise locations and interactions of tissues and tools. Traditional keypoint-based sparse tracking is limited by featured points, while flow-based dense two-view matching suffers from long-term drifts. Recently, th… ▽ More Accurate tracking of tissues and instruments in videos is crucial for Robotic-Assisted Minimally Invasive Surgery (RAMIS), as it enables the robot to comprehend the surgical scene with precise locations and interactions of tissues and tools. Traditional keypoint-based sparse tracking is limited by featured points, while flow-based dense two-view matching suffers from long-term drifts. Recently, the Tracking Any Point (TAP) algorithm was proposed to overcome these limitations and achieve dense accurate long-term tracking. However, its efficacy in surgical scenarios remains untested, largely due to the lack of a comprehensive surgical tracking dataset for evaluation. To address this gap, we introduce a new annotated surgical tracking dataset for benchmarking tracking methods for surgical scenarios, comprising real-world surgical videos with complex tissue and instrument motions. We extensively evaluate state-of-the-art (SOTA) TAP-based algorithms on this dataset and reveal their limitations in challenging surgical scenarios, including fast instrument motion, severe occlusions, and motion blur, etc. Furthermore, we propose a new tracking method, namely SurgMotion, to solve the challenges and further improve the tracking performance. Our proposed method outperforms most TAP-based algorithms in surgical instruments tracking, and especially demonstrates significant improvements over baselines in challenging medical videos. Our code and dataset are available at https://github.com/zhanbh1019/SurgicalMotion. △ Less

Submitted 20 March, 2025; v1 submitted 29 September, 2024; originally announced September 2024.

Automated Surgical Skill Assessment in Endoscopic Pituitary Surgery using Real-time Instrument Tracking on a High-fidelity Bench-top Phantom

Authors: Adrito Das, Bilal Sidiqi, Laurent Mennillo, Zhehua Mao, Mikael Brudfors, Miguel Xochicale, Danyal Z. Khan, Nicola Newall, John G. Hanrahan, Matthew J. Clarkson, Danail Stoyanov, Hani J. Marcus, Sophia Bano

Abstract: Improved surgical skill is generally associated with improved patient outcomes, although assessment is subjective; labour-intensive; and requires domain specific expertise. Automated data driven metrics can alleviate these difficulties, as demonstrated by existing machine learning instrument tracking models in minimally invasive surgery. However, these models have been tested on limited datasets o… ▽ More Improved surgical skill is generally associated with improved patient outcomes, although assessment is subjective; labour-intensive; and requires domain specific expertise. Automated data driven metrics can alleviate these difficulties, as demonstrated by existing machine learning instrument tracking models in minimally invasive surgery. However, these models have been tested on limited datasets of laparoscopic surgery, with a focus on isolated tasks and robotic surgery. In this paper, a new public dataset is introduced, focusing on simulated surgery, using the nasal phase of endoscopic pituitary surgery as an exemplar. Simulated surgery allows for a realistic yet repeatable environment, meaning the insights gained from automated assessment can be used by novice surgeons to hone their skills on the simulator before moving to real surgery. PRINTNet (Pituitary Real-time INstrument Tracking Network) has been created as a baseline model for this automated assessment. Consisting of DeepLabV3 for classification and segmentation; StrongSORT for tracking; and the NVIDIA Holoscan SDK for real-time performance, PRINTNet achieved 71.9% Multiple Object Tracking Precision running at 22 Frames Per Second. Using this tracking output, a Multilayer Perceptron achieved 87% accuracy in predicting surgical skill level (novice or expert), with the "ratio of total procedure time to instrument visible time" correlated with higher surgical skill. This therefore demonstrates the feasibility of automated surgical skill assessment in simulated endoscopic pituitary surgery. The new publicly available dataset can be found here: https://doi.org/10.5522/04/26511049. △ Less

Submitted 25 September, 2024; originally announced September 2024.

PitRSDNet: Predicting Intra-operative Remaining Surgery Duration in Endoscopic Pituitary Surgery

Authors: Anjana Wijekoon, Adrito Das, Roxana R. Herrera, Danyal Z. Khan, John Hanrahan, Eleanor Carter, Valpuri Luoma, Danail Stoyanov, Hani J. Marcus, Sophia Bano

Abstract: Accurate intra-operative Remaining Surgery Duration (RSD) predictions allow for anaesthetists to more accurately decide when to administer anaesthetic agents and drugs, as well as to notify hospital staff to send in the next patient. Therefore RSD plays an important role in improving patient care and minimising surgical theatre costs via efficient scheduling. In endoscopic pituitary surgery, it is… ▽ More Accurate intra-operative Remaining Surgery Duration (RSD) predictions allow for anaesthetists to more accurately decide when to administer anaesthetic agents and drugs, as well as to notify hospital staff to send in the next patient. Therefore RSD plays an important role in improving patient care and minimising surgical theatre costs via efficient scheduling. In endoscopic pituitary surgery, it is uniquely challenging due to variable workflow sequences with a selection of optional steps contributing to high variability in surgery duration. This paper presents PitRSDNet for predicting RSD during pituitary surgery, a spatio-temporal neural network model that learns from historical data focusing on workflow sequences. PitRSDNet integrates workflow knowledge into RSD prediction in two forms: 1) multi-task learning for concurrently predicting step and RSD; and 2) incorporating prior steps as context in temporal learning and inference. PitRSDNet is trained and evaluated on a new endoscopic pituitary surgery dataset with 88 videos to show competitive performance improvements over previous statistical and machine learning methods. The findings also highlight how PitRSDNet improve RSD precision on outlier cases utilising the knowledge of prior steps. △ Less

Submitted 4 November, 2024; v1 submitted 25 September, 2024; originally announced September 2024.

PitVis-2023 Challenge: Workflow Recognition in videos of Endoscopic Pituitary Surgery

Authors: Adrito Das, Danyal Z. Khan, Dimitrios Psychogyios, Yitong Zhang, John G. Hanrahan, Francisco Vasconcelos, You Pang, Zhen Chen, Jinlin Wu, Xiaoyang Zou, Guoyan Zheng, Abdul Qayyum, Moona Mazher, Imran Razzak, Tianbin Li, Jin Ye, Junjun He, Szymon Płotka, Joanna Kaleta, Amine Yamlahi, Antoine Jund, Patrick Godau, Satoshi Kondo, Satoshi Kasai, Kousuke Hirasawa , et al. (7 additional authors not shown)

Abstract: The field of computer vision applied to videos of minimally invasive surgery is ever-growing. Workflow recognition pertains to the automated recognition of various aspects of a surgery: including which surgical steps are performed; and which surgical instruments are used. This information can later be used to assist clinicians when learning the surgery; during live surgery; and when writing operat… ▽ More The field of computer vision applied to videos of minimally invasive surgery is ever-growing. Workflow recognition pertains to the automated recognition of various aspects of a surgery: including which surgical steps are performed; and which surgical instruments are used. This information can later be used to assist clinicians when learning the surgery; during live surgery; and when writing operation notes. The Pituitary Vision (PitVis) 2023 Challenge tasks the community to step and instrument recognition in videos of endoscopic pituitary surgery. This is a unique task when compared to other minimally invasive surgeries due to the smaller working space, which limits and distorts vision; and higher frequency of instrument and step switching, which requires more precise model predictions. Participants were provided with 25-videos, with results presented at the MICCAI-2023 conference as part of the Endoscopic Vision 2023 Challenge in Vancouver, Canada, on 08-Oct-2023. There were 18-submissions from 9-teams across 6-countries, using a variety of deep learning models. A commonality between the top performing models was incorporating spatio-temporal and multi-task methods, with greater than 50% and 10% macro-F1-score improvement over purely spacial single-task models in step and instrument recognition respectively. The PitVis-2023 Challenge therefore demonstrates state-of-the-art computer vision models in minimally invasive surgery are transferable to a new dataset, with surgery specific techniques used to enhance performance, progressing the field further. Benchmark results are provided in the paper, and the dataset is publicly available at: https://doi.org/10.5522/04/26531686. △ Less

Submitted 2 September, 2024; originally announced September 2024.

DARES: Depth Anything in Robotic Endoscopic Surgery with Self-supervised Vector-LoRA of the Foundation Model

Authors: Mona Sheikh Zeinoddin, Chiara Lena, Jiongqi Qu, Luca Carlini, Mattia Magro, Seunghoi Kim, Elena De Momi, Sophia Bano, Matthew Grech-Sollars, Evangelos Mazomenos, Daniel C. Alexander, Danail Stoyanov, Matthew J. Clarkson, Mobarakol Islam

Abstract: Robotic-assisted surgery (RAS) relies on accurate depth estimation for 3D reconstruction and visualization. While foundation models like Depth Anything Models (DAM) show promise, directly applying them to surgery often yields suboptimal results. Fully fine-tuning on limited surgical data can cause overfitting and catastrophic forgetting, compromising model robustness and generalization. Although L… ▽ More Robotic-assisted surgery (RAS) relies on accurate depth estimation for 3D reconstruction and visualization. While foundation models like Depth Anything Models (DAM) show promise, directly applying them to surgery often yields suboptimal results. Fully fine-tuning on limited surgical data can cause overfitting and catastrophic forgetting, compromising model robustness and generalization. Although Low-Rank Adaptation (LoRA) addresses some adaptation issues, its uniform parameter distribution neglects the inherent feature hierarchy, where earlier layers, learning more general features, require more parameters than later ones. To tackle this issue, we introduce Depth Anything in Robotic Endoscopic Surgery (DARES), a novel approach that employs a new adaptation technique, Vector Low-Rank Adaptation (Vector-LoRA) on the DAM V2 to perform self-supervised monocular depth estimation in RAS scenes. To enhance learning efficiency, we introduce Vector-LoRA by integrating more parameters in earlier layers and gradually decreasing parameters in later layers. We also design a reprojection loss based on the multi-scale SSIM error to enhance depth perception by better tailoring the foundation model to the specific requirements of the surgical environment. The proposed method is validated on the SCARED dataset and demonstrates superior performance over recent state-of-the-art self-supervised monocular depth estimation techniques, achieving an improvement of 13.3% in the absolute relative error metric. The code and pre-trained weights are available at https://github.com/mobarakol/DARES. △ Less

Submitted 21 October, 2024; v1 submitted 30 August, 2024; originally announced August 2024.

Mismatched: Evaluating the Limits of Image Matching Approaches and Benchmarks

Authors: Sierra Bonilla, Chiara Di Vece, Rema Daher, Xinwei Ju, Danail Stoyanov, Francisco Vasconcelos, Sophia Bano

Abstract: Three-dimensional (3D) reconstruction from two-dimensional images is an active research field in computer vision, with applications ranging from navigation and object tracking to segmentation and three-dimensional modeling. Traditionally, parametric techniques have been employed for this task. However, recent advancements have seen a shift towards learning-based methods. Given the rapid pace of re… ▽ More Three-dimensional (3D) reconstruction from two-dimensional images is an active research field in computer vision, with applications ranging from navigation and object tracking to segmentation and three-dimensional modeling. Traditionally, parametric techniques have been employed for this task. However, recent advancements have seen a shift towards learning-based methods. Given the rapid pace of research and the frequent introduction of new image matching methods, it is essential to evaluate them. In this paper, we present a comprehensive evaluation of various image matching methods using a structure-from-motion pipeline. We assess the performance of these methods on both in-domain and out-of-domain datasets, identifying key limitations in both the methods and benchmarks. We also investigate the impact of edge detection as a pre-processing step. Our analysis reveals that image matching for 3D reconstruction remains an open challenge, necessitating careful selection and tuning of models for specific scenarios, while also highlighting mismatches in how metrics currently represent method performance. △ Less

Submitted 15 September, 2024; v1 submitted 29 August, 2024; originally announced August 2024.

CathAction: A Benchmark for Endovascular Intervention Understanding

Authors: Baoru Huang, Tuan Vo, Chayun Kongtongvattana, Giulio Dagnino, Dennis Kundrat, Wenqiang Chi, Mohamed Abdelaziz, Trevor Kwok, Tudor Jianu, Tuong Do, Hieu Le, Minh Nguyen, Hoan Nguyen, Erman Tjiputra, Quang Tran, Jianyang Xie, Yanda Meng, Binod Bhattarai, Zhaorui Tan, Hongbin Liu, Hong Seng Gan, Wei Wang, Xi Yang, Qiufeng Wang, Jionglong Su , et al. (13 additional authors not shown)

Abstract: Real-time visual feedback from catheterization analysis is crucial for enhancing surgical safety and efficiency during endovascular interventions. However, existing datasets are often limited to specific tasks, small scale, and lack the comprehensive annotations necessary for broader endovascular intervention understanding. To tackle these limitations, we introduce CathAction, a large-scale datase… ▽ More Real-time visual feedback from catheterization analysis is crucial for enhancing surgical safety and efficiency during endovascular interventions. However, existing datasets are often limited to specific tasks, small scale, and lack the comprehensive annotations necessary for broader endovascular intervention understanding. To tackle these limitations, we introduce CathAction, a large-scale dataset for catheterization understanding. Our CathAction dataset encompasses approximately 500,000 annotated frames for catheterization action understanding and collision detection, and 25,000 ground truth masks for catheter and guidewire segmentation. For each task, we benchmark recent related works in the field. We further discuss the challenges of endovascular intentions compared to traditional computer vision tasks and point out open research questions. We hope that CathAction will facilitate the development of endovascular intervention understanding methods that can be applied to real-world applications. The dataset is available at https://airvlab.github.io/cathaction/. △ Less

Submitted 30 August, 2024; v1 submitted 23 August, 2024; originally announced August 2024.

Personalizing Federated Instrument Segmentation with Visual Trait Priors in Robotic Surgery

Authors: Jialang Xu, Jiacheng Wang, Lequan Yu, Danail Stoyanov, Yueming Jin, Evangelos B. Mazomenos

Abstract: Personalized federated learning (PFL) for surgical instrument segmentation (SIS) is a promising approach. It enables multiple clinical sites to collaboratively train a series of models in privacy, with each model tailored to the individual distribution of each site. Existing PFL methods rarely consider the personalization of multi-headed self-attention, and do not account for appearance diversity… ▽ More Personalized federated learning (PFL) for surgical instrument segmentation (SIS) is a promising approach. It enables multiple clinical sites to collaboratively train a series of models in privacy, with each model tailored to the individual distribution of each site. Existing PFL methods rarely consider the personalization of multi-headed self-attention, and do not account for appearance diversity and instrument shape similarity, both inherent in surgical scenes. We thus propose PFedSIS, a novel PFL method with visual trait priors for SIS, incorporating global-personalized disentanglement (GPD), appearance-regulation personalized enhancement (APE), and shape-similarity global enhancement (SGE), to boost SIS performance in each site. GPD represents the first attempt at head-wise assignment for multi-headed self-attention personalization. To preserve the unique appearance representation of each site and gradually leverage the inter-site difference, APE introduces appearance regulation and provides customized layer-wise aggregation solutions via hypernetworks for each site's personalized parameters. The mutual shape information of instruments is maintained and shared via SGE, which enhances the cross-style shape consistency on the image level and computes the shape-similarity contribution of each site on the prediction level for updating the global parameters. PFedSIS outperforms state-of-the-art methods with +1.51% Dice, +2.11% IoU, -2.79 ASSD, -15.55 HD95 performance gains. The corresponding code and models will be released at https://github.com/wzjialang/PFedSIS. △ Less

Submitted 15 August, 2024; v1 submitted 6 August, 2024; originally announced August 2024.

HUP-3D: A 3D multi-view synthetic dataset for assisted-egocentric hand-ultrasound pose estimation

Authors: Manuel Birlo, Razvan Caramalau, Philip J. "Eddie" Edwards, Brian Dromey, Matthew J. Clarkson, Danail Stoyanov

Abstract: We present HUP-3D, a 3D multi-view multi-modal synthetic dataset for hand-ultrasound (US) probe pose estimation in the context of obstetric ultrasound. Egocentric markerless 3D joint pose estimation has potential applications in mixed reality based medical education. The ability to understand hand and probe movements programmatically opens the door to tailored guidance and mentoring applications.… ▽ More We present HUP-3D, a 3D multi-view multi-modal synthetic dataset for hand-ultrasound (US) probe pose estimation in the context of obstetric ultrasound. Egocentric markerless 3D joint pose estimation has potential applications in mixed reality based medical education. The ability to understand hand and probe movements programmatically opens the door to tailored guidance and mentoring applications. Our dataset consists of over 31k sets of RGB, depth and segmentation mask frames, including pose related ground truth data, with a strong emphasis on image diversity and complexity. Adopting a camera viewpoint-based sphere concept allows us to capture a variety of views and generate multiple hand grasp poses using a pre-trained network. Additionally, our approach includes a software-based image rendering concept, enhancing diversity with various hand and arm textures, lighting conditions, and background images. Furthermore, we validated our proposed dataset with state-of-the-art learning models and we obtained the lowest hand-object keypoint errors. The dataset and other details are provided with the supplementary material. The source code of our grasp generation and rendering pipeline will be made publicly available. △ Less

Submitted 12 July, 2024; originally announced July 2024.