Seeing Through Smoke: Surgical Desmoking for Improved Visual Perception

During laparoscopic surgery, smoke generated by tissue cauterization can significantly degrade the visual quality of endoscopic frames, increasing the risk of surgical errors and hindering both clinical decision-making and computer-assisted visual analysis. Consequently, removing surgical smoke is critical to ensuring patient safety and maintaining operative efficiency. In this study, we propose the Surgical Atmospheric Model (SurgiATM) for surgical smoke removal. SurgiATM statistically bridges a physics-based atmospheric model and data-driven deep learning models, combining the superior generalizability of the former with the high accuracy of the latter. Furthermore, SurgiATM is designed as a lightweight module that can be easily integrated into existing surgical desmoking architectures with minimal modification, aiming to enhance their accuracy and stability. The proposed method is derived via statistically optimizing a Mixture-of-Experts (MoE) model at the output end of arbitrary deep learning methods, with a Laplacian-like error distribution specifically leveraged to model surgical smoke. The output-stage MoE ensures minimal modification to the architecture of the original methods, while the Laplacian-like distribution characteristic of surgical smoke enables a lightweight reconstruction formulation with minimal parameters. Therefore, SurgiATM introduces only two hyperparameters and no additional trainable weights, preserving the original network architecture with minimal computational and modification overhead. We conduct extensive experiments on three public surgical datasets with ten desmoking methods, involving multiple network architectures and covering diverse procedures, including cholecystectomy, partial nephrectomy, and diaphragm dissection.

Surgical smoke severely degrades intraoperative video quality, obscuring anatomical structures and limiting surgical perception. Existing learning-based desmoking approaches rely on scarce paired supervision and deterministic restoration pipelines, making it difficult to perform exploration or reinforcement-driven refinement under real surgical conditions. We propose PhySe-RPO, a diffusion restoration framework optimized through Physics- and Semantics-Guided Relative Policy Optimization. The core idea is to transform deterministic restoration into a stochastic policy, enabling trajectory-level exploration and critic-free updates via group-relative optimization. A physics-guided reward imposes illumination and color consistency, while a visual-concept semantic reward learned from CLIP-based surgical concepts promotes smoke-free and anatomically coherent restoration. Together with a reference-free perceptual constraint, PhySe-RPO produces results that are physically consistent, semantically faithful, and clinically interpretable across synthetic and real robotic surgical datasets, providing a principled route to robust diffusion-based restoration under limited paired supervision.

This paper describes our method for Track 2 of the NTIRE 2026 3D Restoration and Reconstruction (3DRR) Challenge on smoke-degraded images. In this task, smoke reduces image visibility and weakens the cross-view consistency required by scene optimization and rendering. We address this problem with a multi-stage pipeline consisting of image restoration, dehazing, MLLM-based enhancement, 3DGS-MCMC optimization, and averaging over repeated runs. The main purpose of the pipeline is to improve visibility before rendering while limiting scene-content changes across input views. Experimental results on the challenge benchmark show improved quantitative performance and better visual quality than the provided baselines. The code is available at https://github.com/plbbl/GenSmoke-GS. Our method achieved a ranking of 1 out of 14 participants in Track 2 of the NTIRE 3DRR Challenge, as reported on the official competition website: https://www.codabench.org/competitions/13993/#/results-tab.