Robot-Assisted Surgery is integral to modern minimally invasive procedures, with automation emerging as the next frontier to enhance precision and reduce surgeon fatigue. This evolution is largely impeded by the inherent kinematic inaccuracies of surgical robots, where unreliable internal sensors lead to significant control errors. While previous methods attempted to mitigate these issues through complex model-based calibration, they often suffer from high cost and limited effectiveness. This work utilises a learning-policy to actively compensate for hardware inaccuracies using closed-loop visual feedback that was trained from a teacher-student learning framework. The policy can fuse unreliable internal readings with precise external visual data, allowing it to correct for kinematic errors in real time without needing a perfect physical model. The learned policy was successfully deployed on the da Vinci Research Kit, where experiments validated the fundamental feasibility of using external vision to overcome internal sensor deficits. This research provides a foundational and reliable control methodology, paving the way for more advanced and robust surgical automation.
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
Learning reliable surgical manipulation policies is bottlenecked by the scarcity of action-labeled demonstrations: teleoperated surgical robot (e.g., dVRK) trajectories with synchronized kinematics are costly to collect, while surgical tasks demand precise contact handling, long-horizon reasoning, and bimanual coordination. Endoscopic video is comparatively inexpensive and abundant relative to synchronized video--kinematics trajectories, and a natural way to exploit it is to learn world models of surgical scenes. However, existing surgical world models use video primarily for simulation or policy evaluation, and rarely translate the learned dynamics into closed-loop control. This gap raises our central question: under a fixed budget of action-labeled demonstrations, does action-free video pretraining improve closed-loop surgical manipulation? To answer it, we introduce the Surgical World-Action Model (Surgical WAM), a unified generative model built on Cosmos Policy that jointly predicts future endoscopic observations and executable surgical robot action chunks. Surgical WAM first learns surgical visual dynamics from action-free video and is then fine-tuned on the fixed action-labeled budget; at deployment, it acts as a closed-loop, receding-horizon controller that executes a short prefix of each predicted action chunk and replans from the resulting observation. On a suite of four simulated surgical manipulation tasks, video pretraining improves the average success rate from 63.5% to 77.8%, including an absolute gain of 20 percentage points on PegTransfer, with the largest improvements on contact-rich and bimanual tasks. These results demonstrate that action-free video provides transferable visual dynamics priors for learning surgical robot control with limited action supervision, positioning data-efficient video pretraining as a practical path toward scaling up surgical robot learning.
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.