Detecting anatomical structures in surgical video is essential for intraoperative safety frameworks such as the Critical View of Myopectineal Orifice (CVMPO) in inguinal hernia repair. While prominent structures like the Cooper's Ligament and Triangle of Doom are reliably detected by standard methods, smaller structures such as the epigastric vessels remain challenging due to their visual ambiguity and intermittent visibility. We observe that the spatial relationship between structures is anatomically constrained, and propose a Gaussian Spatial Prior (GSP) module that encodes this relationship as a compact, parametric bias injected into the self-attention of a DAB-DETR decoder. The prior is computed offline from training annotations as a small set of frozen Gaussian parameters and recomputed at each decoder layer using the iteratively refined reference points. On a dataset of inguinal hernia repair videos with 5-fold cross-validation, GSP improves dependent class detection by +33.5% (AP50) over DAB-DETR and +53.9% over YOLOv26, while also improving anchor detection by +6.0%. These gains are statistically significant across all folds (p=0.012, paired t−test).
Vision foundation models such as SAM 3 can provide transferable object-level structure across diverse surgical video conditions, but segmentation outputs do not explicitly encode the action-conditioned semantics that define functional surgical landmarks. Estimating instrument extent and geometry differs from localizing the tip or anchor relevant to clipping, grasping, or dissecting. We investigate vision foundation model-enabled sparse action-aware landmark localization, using zero-shot, point-prompted structural masks to provide dense instrument-level context without manual pixel-level mask annotations. We propose a lightweight refinement framework that uses SAM 3 as a structural prior. A coarse multi-frame network predicts tip and anchor prompts, generating non-oracle masks that are fused with visual and heatmap features to refine functional landmark predictions. We compare direct mask-augmented supervision, prediction-derived mask-prior refinement, and auxiliary mask supervision to examine how vision foundation model-derived structure should enter a precision-oriented localization system. Experiments on 7,867 clips from 60 surgical videos spanning YouTube, Cholec80, HeiChole, SurgVU, and CRCD evaluate the approach under heterogeneous conditions. Without manual pixel-level mask annotations for training, the proposed model achieves overall F1 scores of 72.4% for tip and 58.0% for anchor localization. Directly imposing masks on heatmap targets biases learning toward broad tool regions, whereas prediction-derived priors and auxiliary supervision provide effective intermediate structural guidance for action-dependent landmark prediction.
Accurate recognition of anatomical structures is essential for safe and effective minimally invasive surgery (MIS), yet it remains underexplored in surgical computer vision due to limited annotated data and methods tailored primarily to natural scenes. In this work, we present a combined dataset and model framework to advance anatomy-aware perception in MIS. First, we introduce ATLAS-120k, a large-scale clip-level semantic segmentation dataset comprising over 120,000 annotated frames from 100 surgical videos spanning 14 procedures and multiple modalities, including laparoscopic and robot-assisted surgery. The dataset captures substantial procedural variability and was created using a scalable annotation pipeline that integrates expert manual labeling, automated propagation, iterative refinement, and surgeon verification to ensure high-quality annotations. Second, we propose ATLAS (Anatomy Recognition with Context Learning using Foundation Representations), a video semantic segmentation model specifically designed for surgical anatomy recognition. Unlike conventional approaches that emphasize object tracking, ATLAS leverages foundation-model embeddings together with lightweight temporal reasoning to incorporate contextual cues such as procedure type, surgical phase, and short-term visual memory. This design enables temporally consistent and accurate predictions while maintaining real-time feasibility. Together, the dataset and model establish a practical foundation for robust surgical scene understanding and support the development of clinically applicable guidance systems for minimally invasive surgery. The models, dataset annotations and annotation platform are publicly available at: https://github.com/TimJaspers0801/ATLAS.
Ronald L. P. D. de Jong, Tim J. M. Jaspers, Raf A. H. Vervoort +9
Automated assessment of the Critical View of Safety (CVS) in laparoscopic cholecystectomy requires both recognition of the three CVS criteria and anatomical grounding in small, rare, and often occluded hepatocystic structures. Learning-based methods differ in the anatomical information they use, from image-level classification to detection, segmentation, or graph-based reasoning, yet grounding the safety-critical anatomy remains the main bottleneck. We propose CasCVS-Net, a staged multi-task cascade that jointly performs object detection, semantic segmentation, and CVS assessment, trained on the Endoscapes dataset. The model couples the tasks through predicted anatomy: predicted boxes guide segmentation, and predicted masks provide region-level features for CVS classification, so CVS assessment at inference uses only model predictions rather than ground-truth annotations. To reduce optimisation instability in this coupled setting, training progresses from detection to detection-segmentation and then to the full three-task cascade, followed by task-wise fine-tuning. Evaluation on the public unseen test set shows that CasCVS-Net improves over matched single-task baselines on all three tasks, achieving 32.0 detection mAP, 46.8 semantic mIoU, 15.3 rare-anatomy mIoU, and 67.2 CVS mAP. It outperforms the state-of-the-art LG-CVS and SV2LSTG by 6.3% and 4.5% relative CVS mAP, respectively, corresponding to 4.0 and 2.9 mAP points. These results show that staged task coupling through predicted boxes and masks improves anatomical grounding for CVS assessment, particularly for rare hepatocystic structures.