Structure-to-Image: Zero-Shot Depth Estimation in Colonoscopy via High-Fidelity Sim-to-Real Adaptation

Accurate monocular depth estimation is critical in colonoscopy for lesion localization and navigation. Foundation models trained on natural images fail to generalize directly to colonoscopy. We identify the core issue not as a semantic gap, but as a statistical shift in the frequency domain: colonoscopy images lack the strong high-frequency edge and texture gradients that these models rely on for geometric reasoning. To address this, we propose SpecDepth, a parameter-efficient adaptation framework that preserves the robust geometric representations of the pre-trained models while adapting to the colonoscopy domain. Its key innovation is an adaptive spectral rectification module, which uses a learnable wavelet decomposition to explicitly model and amplify the attenuated high-frequency components in feature maps. Different from conventional fine-tuning that risks distorting high-level semantic features, this targeted, low-level adjustment realigns the input signal with the original inductive bias of the foundational model. On the public C3VD and SimCol3D datasets, SpecDepth achieved state-of-the-art performance with an absolute relative error of 0.022 and 0.027, respectively. Our work demonstrates that directly addressing spectral mismatches is a highly effective strategy for adapting vision foundation models to specialized medical imaging tasks. The code will be released publicly after the manuscript is accepted for publication.

Accurate polyp segmentation in colonoscopy is essential for early colorectal cancer detection, yet real-world clinical environments pose persistent challenges such as motion blur, specular reflections, and illumination instability. Most existing methods are optimized on clean benchmark images and suffer noticeable performance degradation when deployed in authentic surgical scenarios. We propose DepthPolyp, a lightweight and robust segmentation framework based on pseudo-depth-guided multi-task learning and efficient feature modulation. The architecture combines hierarchical Ghost factorization for compact feature generation, Interleaved Shuffle Fusion for low-cost cross-scale interaction, and Dynamic Group Gating for adaptive group-wise feature weighting. Extensive experiments demonstrate that DepthPolyp achieves strong cross-dataset generalization when trained on degraded data and evaluated on both clean and noisy target domains, consistently outperforming lightweight baselines and remaining competitive with substantially larger models. In real surgical video evaluation on PolypGen, DepthPolyp achieves better segmentation performance than models up to $20\times$ larger while preserving real-time inference speed. With only 3.57M parameters and 0.86 GMACs, the proposed method runs at over 180 FPS on mobile devices, making it well suited for real-time deployment in resource-constrained clinical environments. Code and pretrained weights are available at: https://github.com/ReaganWu/DepthPolyp/

Monocular colonoscopic 3D reconstruction is important for surgical robotic colonoscopy, but remains challenging due to weak texture, specular reflections, limited view overlap, and non-rigid tissue motion. Conventional multi-view 3D reconstruction methods rely on stable correspondences and approximate rigidity, which are often violated in colonoscopy. Existing endoscopic methods often rely on domain-specific supervision, whereas there are not enough in-vivo labeled data available to adapt geometry foundation models to clinical colonoscopy. We present Colon3R, a cross-domain semi-supervised framework built on pretrained VGGT that transfers coupled camera, depth, and pointmap geometry from labeled phantom and simulated data to unlabeled in-vivo colonoscopy without requiring target-domain geometric annotations. Unlike source-only fine-tuning, which learns only from phantom and simulated data, Colon3R directly exploits unlabeled in-vivo video through teacher-derived cross-view supervision. Our proposed hierarchical quasi-rigid reliability selects reliable supervision at the sequence, directed-pair, and pixel levels, while source-preserving adaptation retains the learned coupled geometry during target-domain adaptation. Extensive experiments demonstrate that our method achieves superior overall performance over state-of-the-art approaches in depth, pointmap, and camera pose estimation. Qualitative comparisons on real in-vivo colonoscopy further show substantially more complete and geometrically consistent reconstructions than competing methods under clinical domain shift. The code is publicly available at https://github.com/vglx/Colon3R.