HyperVLP: Enhancing Hierarchical Surgical Video-Language Pre-training in Hyperbolic Space
Authors: Yaojun Hu, Kun Yuan, Nassir Navab, Haochao Ying, Jian Wu, Nicolas Padoy
Organizations: Zhejiang University, Hangzhou, China · University of Strasbourg, CNRS, INSERM, ICube, UMR7357, Strasbourg, France · IHU Strasbourg, Strasbourg, France · Technical University of Munich, Munich, Germany
Surgical vision-language foundation models typically adopt educational materials, such as surgical lecture videos, to transfer surgical knowledge encoded in language into visual representations. These knowledge are multi-dimensional and hierarchical: fine-grained action cues appear in narration, mid-level key steps are summarized in subsection headings, and global procedural context, such as patient history and surgical strategy, is described in abstract texts. Prior work largely collapses these heterogeneous signals into a single flat embedding space, implicitly assuming independence across hierarchy levels. However, this is suboptimal because it ignores cross-level semantic containment, e.g., actions belong to steps, steps compose phases, weakens long-range dependency modeling. To this end, we propose a hyperbolic surgical video-language pre-training framework that explicitly preserves the hierarchical structure by mitigating structural false negatives induced by procedural context and enforcing semantic consistency between parent phases and their constituent child steps. Extensive experiments on multiple surgical benchmarks show consistent gains in zero- and few-shot phase recognition across procedures and institutions.
Hyperbolic vision-language models (VLMs) represent image and text features in a geometry naturally suited to hierarchy, but their adaptation to downstream tasks has largely relied on fixed prompts. Existing prompt learning methods, meanwhile, treat class labels as a flat set and do not exploit available taxonomic structure. We address this gap with a hierarchical prompt learning plug-in for frozen hyperbolic VLMs. Given a fixed offline parent-class hierarchy, it augments a class prompt learner with a separate parent prompt learner, parent-level supervision, hyperbolic entailment regularization, and parent-feedback logit fusion. We instantiate the method with CoOp, CoCoOp and MaPLe, yielding HyPLO, CoHyPLO and MaHyPLO. Across the standard 11-dataset benchmark, all variants improve base-to-new generalization and cross-dataset transfer, and remain comparable to their prompt learning baselines under domain shift. Six hierarchical metrics and embedding analyses show that the method produces more taxonomically consistent predictions and induces a hierarchy-consistent organization of parent, class, and image embeddings in hyperbolic space. Its gains are largest when novel classes must be placed within a fixed taxonomy, and smallest for fine-grained confusions among sibling classes or shifts affecting only the image distribution.
We introduce SurgAtlas, the largest surgical video-language dataset to date, comprising 15,291 videos (2,391 hours) spanning 18 surgical specialties and over 5,000 procedure types, sourced entirely from publicly available YouTube content. SurgAtlas is also the first surgical video-language dataset to include open surgery at scale, with 6,182 open procedure videos alongside over 9,000 minimally invasive recordings, and the first to establish standardized benchmarks for open-surgery video understanding. We additionally provide an expert-validated subset with verified visual question-answer pairs across diverse open and minimally invasive procedures, serving as a clinically grounded benchmark for surgical reasoning. Compared with existing surgical video-language datasets, SurgAtlas provides one of the most diverse annotation schemas, combining segment-level captions, step- and phase-level descriptions, video-level surgical descriptions, and reasoning-oriented question-answer pairs organized within a hierarchical taxonomy. These annotations are constructed through an automated multi-tier pipeline with LLM-based enrichment and a staged VQA generation framework with explicit groundedness verification. The scale and diversity of SurgAtlas enable training surgical foundation models with broad procedural coverage: we finetune Qwen3-VL-8B through a two-stage captioning-then-instruction pipeline and achieve competitive or state-of-the-art results on multiple established surgical benchmarks, including phase recognition, triplet detection, and reasoning question answering. More broadly, SurgAtlas provides a large native public video corpus that can support future large-scale pretraining of multimodal surgical AI systems and contribute to the development of next-generation foundation models for surgery. Dataset publicly available at https://huggingface.co/datasets/filbel/SurgAtlas
Filippos Bellos, Andre S. Gala-Garza, Miaowei Wang +8
Recent advancements in self-supervised learning have led to powerful surgical vision encoders capable of spatiotemporal understanding. However, extending these visual foundations to multi-modal reasoning tasks is severely bottlenecked by the prohibitive cost of expert textual annotations. To overcome this scalability limitation, we introduce \textbf{LIME}, a large-scale multi-modal dataset derived from open-access surgical videos using human-free, Large Language Model (LLM)-generated narratives. While LIME offers immense scalability, unverified generated texts may contain errors, including hallucinations, that could potentially lead to catastrophically degraded pre-trained medical priors in standard contrastive pipelines. To mitigate this, we propose \textbf{SurgLIME}, a parameter-efficient Vision-Language Pre-training (VLP) framework designed to learn reliable cross-modal alignments using noisy narratives. SurgLIME preserves foundational medical priors using a LoRA-adapted dual-encoder architecture and introduces an automated confidence estimation mechanism that dynamically down-weights uncertain text during contrastive alignment. Evaluations on the AutoLaparo and Cholec80 benchmarks show that SurgLIME achieves competitive zero-shot cross-modal alignment while preserving the robust linear probing performance of the visual foundation model. Dataset, code, and models are publicly available at https://github.com/visurg-ai/SurgLIME.