On the Robustness of Temporal Vision-Language Models for Surgical Endoscopy Videos

Vision-language models (VLMs) achieve strong performance on standard, high-quality datasets, but we still do not fully understand how they perform under real-world image distortions. We present VLM-RobustBench, a benchmark spanning 49 augmentation types across noise, blur, weather, digital, and geometric perturbations, evaluated under graded severities (low/mid/high) and binary transforms, yielding 133 corrupted settings. We evaluate VLMs from four families (Qwen, InternVL, Molmo, Gemma) on two complementary benchmarks: MMBench (visually grounded) and MMMU-Pro (reasoning-oriented). Our results reveal that visual severity is a weak predictor of difficulty: low-severity spatial perturbations often degrade performance more than visually severe photometric corruptions. In particular, low-severity glass_blur reduces MMBench accuracy by about 8 pp on average across models, while the largest drops arise from resampling and geometric distortions (e.g., upsample, elastic_transform), reaching up to 34 pp. Overall, our findings suggest current VLMs are semantically strong but spatially fragile, motivating the definition of novel robustness evaluation protocols and training regimes that emphasize resampling and geometric invariances.

Surgical video understanding is a crucial prerequisite for advancing Computer-Assisted Surgery. While vision-language models (VLMs) have recently been applied to the surgical domain, existing surgical vision-language datasets lack in capturing and evaluating complex, interleaved spatial-temporal dynamics. Creating large scale datasets that accurately represent fine-grained spatial-temporal relationships in surgical videos is challenging due to costly manual annotations or error-prone generation using large language models. To address this gap, we introduce the SurgSTU-Pipeline, a deterministic generation pipeline featuring temporal and spatial continuity filtering to reliably create surgical datasets for fine-grained spatial-temporal multimodal understanding. Applying this pipeline to publicly available surgical datasets, we create the SurgSTU dataset, comprising 6711 video clips densely extended with 150k fine-grained spatial-temporal question-answer samples. Our comprehensive evaluation shows that while state-of-the-art generalist VLMs struggle in zero-shot settings, their spatial-temporal capabilities can be improved through in-context learning. A fine-tuned VLM on the SurgSTU training dataset achieves highest performance among all spatial-temporal tasks, validating the dataset's efficacy to improve spatial-temporal understanding of VLMs in surgical videos. The project is available here: https://lennart-maack.github.io/SurgSTU-project

Vision-language models (VLMs) such as CLIP achieve strong zero-shot recognition but remain highly fragile under adversarial perturbations. Recent test-time adaptation defenses improve robustness by leveraging many augmented views, but this leads to impractical slowdown and a clear robustness-throughput trade-off. To address this challenge, we present Stability and Suitability-guided Test-time Prompt Tuning (SS-TPT), evaluating the quality of each augmented view via two complementary scores: (1) stability, measuring prediction invariance to weak augmentations, and (2) suitability, measuring feature-space density among views. These stability and suitability (SS) scores guide both adaptation and inference through an SS-guided consistency loss and an SS-weighted prediction, amplifying trustworthy views while suppressing corrupted ones. Extensive experiments demonstrate that SS-TPT significantly outperforms prior state-of-the-art methods, achieving superior robustness-throughput trade-offs across diverse datasets and varying numbers of views, thereby demonstrating both strong practicality and generality. Our code is available at https://github.com/sunoh-kim/SS-TPT.