How can reasoning capability empower the AI copilot robot in endoscopic surgery

Robotic-assisted surgery (RAS) is central to modern surgery, driving the need for intelligent systems with accurate scene understanding. Most existing surgical AI methods rely on isolated, task-specific models, leading to fragmented pipelines with limited interpretability and no unified understanding of RAS scene. Vision-Language Models (VLMs) offer strong zero-shot reasoning, but struggle with hallucinations, domain gaps and weak task-interdependency modeling. To address the lack of unified data for RAS scene understanding, we introduce SurgCoTBench, the first reasoning-focused benchmark in RAS, covering 14256 QA pairs with frame-level annotations across five major surgical tasks. Building on SurgCoTBench, we propose SurgRAW, a clinically aligned Chain-of-Thought (CoT) driven agentic workflow for zero-shot multi-task reasoning in surgery. SurgRAW employs a hierarchical reasoning workflow where an orchestrator divides surgical scene understanding into two reasoning streams and directs specialized agents to generate task-level reasoning, while higher-level agents capture workflow interdependencies or ground output clinically. Specifically, we propose a panel discussion mechanism to ensure task-specific agents collaborate synergistically and leverage on task interdependencies. Similarly, we incorporate a retrieval-augmented generation module to enrich agents with surgical knowledge and alleviate domain gaps in general VLMs. We design task-specific CoT prompts grounded in surgical domain to ensure clinically aligned reasoning, reduce hallucinations and enhance interpretability. Extensive experiments show that SurgRAW surpasses mainstream VLMs and agentic systems and outperforms a supervised model by 14.61% accuracy. Dataset and code is available at https://github.com/jinlab-imvr/SurgRAW.git .

Innovations in digital intelligence are transforming robotic surgery with more informed decision-making. Real-time awareness of surgical instrument presence and actions (e.g., cutting tissue) is essential for such systems. Yet, despite decades of research, most machine learning models for this task are trained on small datasets and still struggle to generalize. Recently, vision-Language Models (VLMs) have brought transformative advances in reasoning across visual and textual modalities. Their unprecedented generalization capabilities suggest great potential for advancing intelligent robotic surgery. However, surgical VLMs remain under-explored, and existing models show limited performance, highlighting the need for benchmark studies to assess their capabilities and limitations and to inform future development. To this end, we benchmark the zero-shot performance of several advanced VLMs on two public robotic-assisted laparoscopic datasets for instrument and action classification. Beyond standard evaluation, we integrate explainable AI to visualize VLM attention and uncover causal explanations behind their predictions. This provides a previously underexplored perspective in this field for evaluating the reliability of model predictions. We also propose several explainability analysis-based metrics to complement standard evaluations. Our analysis reveals that surgical VLMs, despite domain-specific training, often rely on weak contextual cues rather than clinically relevant visual evidence, highlighting the need for stronger visual and reasoning supervision in surgical applications.

Vision-Language-Action (VLA) models have gained much attention from the research community thanks to their strength in translating multimodal observations with linguistic instructions into desired robotic actions. Despite their advancements, VLAs often overlook explicit reasoning and learn the functional input-action mappings, omitting crucial logical steps, which are especially pronounced in interpretability and generalization for complex, long-horizon manipulation tasks. In this work, we propose ReFineVLA, a multimodal reasoning-aware framework that fine-tunes VLAs with teacher-guided reasons. We first augment robotic datasets with reasoning rationales generated by an expert teacher model, guiding VLA models to learn to reason about their actions. Then, we fine-tune pre-trained VLAs with the reasoning-enriched datasets with ReFineVLA, while maintaining the underlying generalization abilities and boosting reasoning capabilities. We also conduct attention map visualization to analyze the alignment among visual observation, linguistic prompts, and to-be-executed actions of ReFineVLA, reflecting the model is ability to focus on relevant tasks and actions. Through this additional step, we explore that ReFineVLA-trained models exhibit a meaningful agreement between vision-language and action domains, highlighting the enhanced multimodal understanding and generalization. Evaluated across a suite of simulated manipulation benchmarks on SimplerEnv with both WidowX and Google Robot tasks, ReFineVLA achieves state-of-the-art performance, in success rate over the second-best method on the both the WidowX benchmark and Google Robot Tasks.