Organizations: Department of Biomedical Informatics, Harvard Medical School, Boston, MA · Department of Surgery, Massachusetts General Hospital, Boston, MA
This study presents the first evaluation of general-purpose imitation learning for surgeon-robot collaborative assistance in open surgery, targeting suture following: the grab-pull-release motion an assistant performs at every stitch. We collect 160 teleoperated demonstrations (32,374 frames) on an open-source robot arm, benchmark four architecturally diverse imitation learning policies (ACT, Diffusion Policy, SmolVLA, π0) across 28 trained models evaluated in 32 configurations along three clinically motivated dimensions: dataset size, camera viewpoint, and background variation. Our results demonstrate that under ideal conditions, the four policies achieve 50-75% task success, with depth error as the dominant failure mode across all architectures. Among all policies, π0 achieves the strongest results with a pretrained vision-language backbone, demonstrating superior data efficiency, greater robustness to background variation, and smoother trajectories compatible with surgical workflow. When deployed in a surgeon-robot suturing trial, π0 yields a 92% stitch completion rate. These findings establish collaborative robotic assistance in open surgery as a feasible target for imitation learning and highlight depth perception and end-effector design as key priorities for clinical translation.
Large behaviour models have transformed the field of robotic manipulation, but prohibitive data requirements have thus far prevented a revolution similar to vision language models. We believe that instrumentation, i.e. sensor integration in objects, can provide invaluable state information and enable efficient learning for robotic manipulation. In this paper, we present instrumented imitation learning of clothes hanger insertion. Using 180 teleoperated demonstrations, we train diffusion policies with and without access to instrumentation data. Results show that policies leveraging instrumentation outperform vision-only counterparts by 14-25 %pt and exhibit greater task awareness. Crucially, a black-box imitation learning policy learns to prioritise instrumentation signals without explicit guidance. In addition, enhancing the teleoperation dataset with rollouts from an instrumented expert policy, enables a vision-only student policy to achieve performance comparable to the instrumented expert, thereby surpassing the original vision-only policy. These findings establish instrumentation as a promising strategy to enhance imitation learning for robotic manipulation. Datasets are available on Zenodo.
Learning-based policies are being considered to augment the dexterity of human surgeons in robot-assisted surgery. Can the end-to-end mapping from visual observations to robot actions be vulnerable to adversarial attacks, potentially leading to patient injury? In this paper, we present the first study of adversarial threats to learning-based policies in surgical robotics. We investigate two threat modes: (a) disruptive attacks, where imperceptible visual perturbations interrupt policy execution, and (b) steering attacks, where such perturbations steer policy actions toward attacker-specified directions. We formulate three adversarial attack methods, each with increasing access to policy information, and evaluate their impact on two surgical subtasks: debridement and suturing. Our evaluation covers three end-to-end policy architectures: ACT, Diffusion Policy, and Pi0. In addition, we introduce a new class of photometric adversarial attacks that mimic natural visual changes, such as lighting variations, to generate effective yet visually plausible perturbations. Results from 560 physical experiments using phantoms for debridement and suturing suggest that state-of-the-art policies can be significantly disrupted, resulting in an average 61% reduction in surgical subtask success rates. Project page: https://sites.google.com/view/adversary-surgery
Most minimally invasive surgery is still performed with hand-held laparoscopic instruments, and the surgeon's instrument kinematics are lost when the operation ends; only the endoscope video is kept. This paper presents an end-to-end pipeline that captures this motion in the operating room and uses it to train a surgical robot policy, validated on live animals. We introduce a surgical instrument-state logger that mounts on the shaft of a standard laparoscopic instrument and recovers its pose and jaw state from an inertial sensor, a time-of-flight sensor and a Hall sensor, with no external camera or tracker. A data pipeline measures the latency of every sensor channel against a robot ground truth and aligns the channels before forming observation-action pairs. On these demonstrations we train a diffusion policy with a fine-tuned DINOv3 backbone, selecting its design by closed-loop rollouts in a physics simulator reconstructed from depth maps of an ex-vivo rabbit appendix. The policy is then retrained on 849 in-vivo demonstrations from four live rabbits and deployed on four additional live rabbits with electrosurgery armed. With the surgeon selecting the surgical phase, the policy completed the appendectomy in three of the four animals. The results show that demonstrations recorded from a surgeon's own instruments are sufficient to train, select and deploy a bimanual surgical policy in vivo. The robot serves only as the timing reference for sensor calibration and as the executor, and collects no demonstrations. Both demonstration corpora are released to support future surgical robot learning research.