SurgAtt-Tracker: Online Surgical Attention Tracking via Temporal Proposal Reranking and Motion-Aware Refinement

Autonomous laparoscopic camera control requires continuous understanding of the surgeon's operative intent in dynamic surgical scenes, where the target operative region is not a stable physical object but a latent and temporally evolving attention state. In this work, we present Surgical Latent Attention Tracking (SurgLAT), a causal online framework for latent surgical attention modeling and autonomous laparoscopic view control. SurgLAT uses a frozen DINOv3 encoder and a state-conditioned spatial token mixer to extract operative evidence under a memory-guided spatial prior, while a selective causal latent memory module jointly models short-term motion continuity and long-horizon surgical intent evolution through dynamic retrieval of current, recent, and historical latent states. The learned latent surgical attention state is decoded into a probabilistic attention heatmap and operative region for downstream endoscope guidance. Beyond perception, we further introduce a robotic deployment framework with explicit laparoscopic Remote Center of Motion (RCM) constrained control based on virtual-axis formulation, together with redundancy-aware null-space initialization for stable and smooth manipulator motion. We validate the full system on real laparoscopic surgical videos and a physical robotic laparoscope platform. Experimental results demonstrate robust online operative-region tracking and stable autonomous endoscopy adjustment under occlusion, rapid motion, and target transitions, highlighting the effectiveness of latent surgical intent modeling for surgical autonomy.

Surgical navigation provides real-time guidance by estimating the pose of patient anatomy and surgical instruments to visualize relevant intraoperative information. In conventional systems, instruments are typically tracked using fiducial markers and stationary optical tracking systems (OTS). Augmented reality (AR) has further enabled intuitive visualization and motivated tracking using sensors embedded in head-mounted displays (HMDs). However, most existing approaches rely on a clear line of sight, which is difficult to maintain in dynamic operating room environments due to frequent occlusions caused by equipment, surgical tools, and personnel. This work introduces a framework for tracking surgical instruments under occlusion by fusing multiple sensing modalities within a dynamic scene graph representation. The proposed approach integrates tracking systems with different accuracy levels and motion characteristics while estimating tracking reliability in real time. Experimental results demonstrate improved robustness and enhanced consistency of AR visualization in the presence of occlusions.

Efficient and robust tracking of surgical robotic instruments is important for robot-assisted minimally invasive surgery, yet remains challenging due to the complexity of surgical scenes and the unconventional geometry of surgical instruments. Keypoint-based approaches are efficient, but their performance depends on reliable feature detection. Improving these detectors with real-world supervision is difficult because accurate real-world annotations are costly to obtain at scale. To address this limitation, we introduce a tracker-guided self-training framework that adapts a model pretrained on synthetic images to unlabeled real-world videos. Given measured robot joint states, an uncertainty-aware EKF recursively corrects the instrument pose and the observable joint angles by comparing projected model features with detected keypoints, shaft boundaries, and mask-derived cues. An RTS smoother subsequently refines the resulting trajectory, which is projected into pseudo-labels for fine-tuning the feature detector without laborious pose annotations. Experiments on real-world videos demonstrate consistent improvements from self-training across all evaluated keypoint metrics, and the resulting model outperforms prior approaches in both accuracy and runtime. The code and data will be released upon publication.