Extended KAFR: A kinematic-adaptive paradigm for the efficient analysis of surgical video

Computational attention models could help surgeons manage the visual demands of laparoscopy, but they require dense spatial labels that are difficult to obtain because surgical intent is highly specialized and tacit. Here, we introduce DiffeoAfford, an action-grounded tissue affordance framework that retrospectively derives visual attention supervision from completed surgical procedures. By combining diffeomorphism-constrained tissue tracking with instrument trajectory analysis, DiffeoAfford generates affordance hotspot labels without manual per-frame annotation. A real-time prediction model trained on these labels anticipates relevant surgical regions and enables AffordView, an assistive auto-framing system for laparoscopic visualization. The proposed framework aligns with expert annotations and intraoperative surgeon gaze, and reduces surgeon cognitive workload during real-world evaluations using subjective, physiological, and behavioral measures.

Precise spatial-temporal annotation of laparoscopic videos is time-consuming and requires expert knowledge. We propose a human-in-the-loop knowledge acquisition framework that combines active learning with dual-loss optimization to significantly reduce the annotation effort needed for automatic localization and segmentation of objects in the surgical field. Our method employs a foundation model to generate temporally consistent class activation maps (CAMs) from video using two complementary training objectives: a weak supervision loss on video-level tool presence labels for weakly annotated data, and an image-level mask loss on human-corrected annotations obtained through active learning. Rather than requiring dense pixel-level annotation upfront, our pipeline iteratively proposes pseudo-masks that guide the expert annotator to refine the knowledge previously captured by the model. We demonstrate that our framework reduces the effort of surgical video annotation by 50% by the end of training in comparison to fully manual annotation. Through eliminating the need for large, fully annotated datasets from the start, this framework enables scalability to the development of surgical tool segmentation models. This iterative human-in-the-loop refinement supports efficient knowledge acquisition with minimal expert input, providing a practical and deployable strategy for expanding tool segmentation to larger, more diverse datasets and real-world clinical settings.

While foundation models have advanced surgical video analysis, current approaches rely predominantly on pixel-level reconstruction objectives that waste model capacity on low-level visual details, such as smoke, specular reflections, and fluid motion, rather than semantic structures essential for surgical understanding. We present SurgMotion, a video-native foundation model that shifts the learning paradigm from pixel-level reconstruction to latent motion prediction. Built on the Video Joint Embedding Predictive Architecture (V-JEPA), SurgMotion introduces three key technical innovations tailored to surgical videos: (1) motion-guided latent masked prediction to prioritize semantically meaningful regions, (2) spatiotemporal affinity self-distillation to enforce relational consistency, and (3) spatiotemporal feature diversity regularization (SFDR) to prevent representation collapse in texture-sparse surgical scenes. To enable large-scale pretraining, we curate SurgMotion-15M, the largest surgical video dataset to date, comprising 3,658 hours of video from 50 sources across 13 anatomical regions. Extensive experiments across 17 benchmarks demonstrate that SurgMotion significantly outperforms state-of-the-art methods on surgical workflow recognition, achieving 14.6 percent improvement in F1 score on EgoSurgery and 10.3 percent on PitVis; on action triplet recognition with 39.54 percent mAP-IVT on CholecT50; as well as on skill assessment, polyp segmentation, and depth estimation. These results establish SurgMotion as a new standard for universal, motion-oriented surgical video understanding.