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
Organizations: Dipartimento di Elettronica, Informazione e Bioingegneria (DEIB), Politecnico di Milano, Italy · IRCCS Humanitas Research Hospital, Italy · UCL Hawkes Institute and Department of Computer Science, University College London, UK · Division of Informatics, Imaging and Data Science, University of Manchester, UK
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~Anonymous GitHub.
Figures & tables
Figure 1: TemporalDoRA overview. (A) VideoQA pipeline. (B) TemporalDoRA: down-project to rank- r , apply temporal MHA over T , then selectively DoRA up-project and add to frozen W0 .
Figure 2: REAL-Colon-VQA question distribution and an example instance.
Data
Model
PEFT
In-Template
Out-of-Template
B4
RL
MET
Acc
B4
RL
MET
Acc
REAL-Colon-VQA
SurgViVQA [ 5 ]
0.649
0.812
0.815
0.472
0.142
0.375
0.379
0.199
Qwen3-VL-2B
Zero-shot
0.196
0.514
0.538
0.457
0.112
0.433
0.459
0.470
LoRA [ 7 ]
0.742
0.815
0.809
0.636
0.435
0.623
0.622
0.607
DoRA [ 12 ]
0.730
0.836
0.826
0.680
0.246
0.611
0.617
0.669
VeRA [ 10 ]
0.249
0.524
0.539
0.501
0.138
0.436
0.463
0.504
Table 1: PEFT comparison on REAL-Colon-VQA and EndoVis18-VQA for In-Template and Out-of-Template splits using Qwen3-VL-2B [ 1 ] , InternVL3-1B [ 25 ] , and SurgViVQA [ 5 ] . Bold indicates best and underlined second best within each model block and split.
REAL-Colon-VQA (Out-of-Template, Qwen3-VL-2B)
Q1: When motion occurs, does the scope pull backward?
GT: No, the scope is advancing.
Pred (Zero-Shot): No, the scope is advancing forward.
Pred (TemporalDoRA): No, the scope is advancing.
EndoVis18-VQA (Out-of-Template, Qwen3-VL-2B)
Q2: What specific abdominal organ is currently undergoing surgical intervention during the robotic-assisted procedure?
Table 2: Out-of-Template examples with Qwen3-VL-2B.
Temporal operator
In-Template
Out-of-Template
B4
RL
MET
Acc
B4
RL
MET
Acc
3D Convolution
0.618
0.781
0.761
0.647
0.312
0.606
0.616
0.609
LSTM
0.717
0.828
0.818
0.669
0.375
0.653
0.648
0.612
Mamba
0.646
0.765
0.737
0.658
0.336
0.593
0.592
0.651
Self-Attention
0.554
0.706
0.680
0.620
0.367
0.628
0.623
0.610
MHA (Ours)
0.703
0.823
0.808
0.678
0.484
0.731
0.716
0.646
Table 3: REAL-Colon-VQA (Qwen3-VL-2B). Ablation of the temporal operator in the low-rank bottleneck.
PEFT
In-Template
Out-of-Template
B4
RL
MET
Acc
B4
RL
MET
Acc
LoRA
0.742
0.814
0.809
0.636
0.435
0.623
0.622
0.607
LoRA+MHA
0.638
0.801
0.791
0.689
0.305
0.627
0.642
0.661
DoRA
0.730
0.836
0.826
0.680
0.246
0.611
0.617
0.669
DoRA+MHA
0.662
0.750
0.741
0.601
0.510
0.649
0.647
0.597
TemporalDoRA (Ours)
0.703
0.823
0.808
0.678
0.484
0.731
0.716
0.646
Table 4: REAL-Colon-VQA (Qwen3-VL-2B). Effect of inserting MHA in the low-rank bottleneck of LoRA and DoRA compared to TemporalDoRA.