Reeling It In: Flexible Needle Pick Up via Thread Manipulation for Autonomous Suturing

Predicting surgical needle trajectories from endoscopic video is critical for robot-assisted suturing, enabling anticipatory planning, real-time guidance, and safer motion execution. Existing methods that directly learn motion distributions from visual observations tend to overlook the sequential dependency among adjacent motion steps. Moreover, sparse waypoint annotations often fail to provide sufficient supervision, further increasing the difficulty of supervised or imitation learning methods. To address these challenges, we formulate image-based needle trajectory prediction as a sequential decision-making problem, in which the needle tip is treated as an agent that moves step by step in pixel space. This formulation naturally captures the continuity of needle motion and enables the explicit modeling of physically plausible pixel-wise state transitions over time. From this perspective, we propose SutureFormer, a goal-conditioned offline reinforcement learning framework that leverages sparse annotations to dense reward signals via cubic spline interpolation, encouraging the policy to exploit limited expert guidance while exploring plausible future motion paths. SutureFormer encodes variable-length clips using an observation encoder to capture both local spatial cues and long-range temporal dynamics, and autoregressively predicts future waypoints through actions composed of discrete directions and continuous magnitudes. To enable stable offline policy optimization from expert demonstrations, we adopt Conservative Q-Learning with Behavioral Cloning regularization. Experiments on a new kidney wound suturing dataset containing 1,158 trajectories from 50 patients show that SutureFormer reduces Average Displacement Error by 58.6% compared with the strongest baseline, demonstrating the effectiveness of modeling needle trajectory prediction as pixel-level sequential action learning.

Recent advances in robotics research have created a strong demand for high-performance simulators. Surgical robotics simulation faces unique challenges due to the need to model diverse objects, such as rigid instruments, soft tissue, and fluids. While many studies simulate sutures or soft tissue independently, only a few have considered the complete soft-tissue suturing scenario, including the contact between sutures and deformable tissue during suture insertion. Building on previous work, this paper presents a novel suturing simulation environment using sutures modelled by position-based dynamics (PBD) and soft bodies modelled by the material point method (MPM) while considering two-way contact with frictional and drag forces. We introduce a contact coupling method between the PBD suture and the MPM soft tissue, enabling visually plausible suture-tissue interactions. The simulator is optimized for GPU execution with parallel scenes using multiple CUDA streams, and we present a Reinforcement Learning (RL) environment for autonomous suturing sub-tasks, including needle insertion, driving, and extraction. Using ML-Agents, RL agents trained in the simulator show stable learning and achieve 80% and 68% success rates in needle insertion and extraction, respectively, under the strictest distance threshold.

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, $π_0$) 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, $π_0$ 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, $π_0$ 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.