Autonomous precision milling of biological structures is challenged by incomplete knowledge of target geometry, local material thickness, and critical internal boundaries. Subject-specific preoperative models can address geometric and thickness variations, but static models cannot determine boundary status encountered during execution, while repeated target-specific imaging limits scalability. This article presents an uncertainty-aware autonomous milling framework that assigns complementary roles to generic anatomical priors and active boundary perception. A generic anatomical prior provides conservative global guidance and is transformed through semantic-guided registration and hybrid vision-force calibration into robot-executable guidance for individual targets. As milling approaches uncertain boundaries, the robot actively probes the remaining structure and uses relative stiffness changes to estimate boundary status and structural detachability. A state-adaptive controller governs transitions between active perception and spatially selective incremental refinement, repeating this cycle until the termination criterion is satisfied. Hierarchical experiments on biological surrogates and in vivo mouse cranial window creation demonstrate accurate anatomical prior transfer, reliable boundary adaptation, and autonomous precision milling of biological structures.
Accurate recognition of anatomical structures is essential for safe and effective minimally invasive surgery (MIS), yet it remains underexplored in surgical computer vision due to limited annotated data and methods tailored primarily to natural scenes. In this work, we present a combined dataset and model framework to advance anatomy-aware perception in MIS. First, we introduce ATLAS-120k, a large-scale clip-level semantic segmentation dataset comprising over 120,000 annotated frames from 100 surgical videos spanning 14 procedures and multiple modalities, including laparoscopic and robot-assisted surgery. The dataset captures substantial procedural variability and was created using a scalable annotation pipeline that integrates expert manual labeling, automated propagation, iterative refinement, and surgeon verification to ensure high-quality annotations. Second, we propose ATLAS (Anatomy Recognition with Context Learning using Foundation Representations), a video semantic segmentation model specifically designed for surgical anatomy recognition. Unlike conventional approaches that emphasize object tracking, ATLAS leverages foundation-model embeddings together with lightweight temporal reasoning to incorporate contextual cues such as procedure type, surgical phase, and short-term visual memory. This design enables temporally consistent and accurate predictions while maintaining real-time feasibility. Together, the dataset and model establish a practical foundation for robust surgical scene understanding and support the development of clinically applicable guidance systems for minimally invasive surgery. The models, dataset annotations and annotation platform are publicly available at: https://github.com/TimJaspers0801/ATLAS.
Ronald L. P. D. de Jong, Tim J. M. Jaspers, Raf A. H. Vervoort +9
Robotic ultrasound has advanced local image-driven control, contact regulation, and view optimization, yet current systems lack the anatomical understanding needed to determine what to scan, where to begin, and how to adapt to individual patient anatomy. These gaps make systems still reliant on expert intervention to initiate scanning. Here we present SAMe, a semantic anatomy mapping engine that provides robotic ultrasound with an explicit anatomical prior layer. SAMe addresses scan initiation as a target-to-anatomy-to-action process: it grounds under-specified clinical complaints into structured target organs, instantiates a patient-specific anatomical representation for the grounded targets from a single external body image, and translates this representation into control-facing 6-DoF probe initialization states without any additional registration using preoperative CT or MRI. The anatomical representation maintained by SAMe is explicit, lightweight (single-organ inference in 0.08s), and compatible with downstream control by design. Across semantic grounding, anatomical instantiation, and real-robot evaluation, SAMe shows strong performance across the full initialization pipeline. In real-robot experiments, centroid-based SAMe initialization outperformed the body-keypoint-based heuristic baseline under a budget-matched single-target setting for both liver (86.7% versus 46.7%) and kidney (80.0% versus 73.3%) initialization. Furthermore, The trial-level organ-hit rate reached 97.3% for liver and 83.3% for kidney when multiple candidate targets were available. These results establish an explicit anatomical prior layer that addresses scan initialization and is designed to support broader downstream autonomous scanning pipelines, providing the anatomical foundation for complaint-driven, anatomically informed robotic ultrasonography.
Surgical automation is being increasingly studied, yet bridging visual scene understanding with autonomous action planning remains a fundamental challenge. While much research effort has been made on scene perception (e.g., tool recognition and scene segmentation), understanding and predicting actionable possibilities for surgical automation is still underexplored. In this paper, we introduce surgical affordance prediction, which identifies actionable regions for fundamental surgical actions from visual data. Specifically, a novel adaptive feature fusion framework is proposed that leverages the complementary strengths of a self-supervised vision transformer encoder for its superior semantic understanding and a large-scale generative model encoder for its spatially-aware capability. Furthermore, we introduce a hierarchical prompt learning mechanism to adapt to varying procedural contexts. Finally, a scene-guided attention decoder is proposed to focus on critical surgical areas while suppressing background distractions. To validate the effectiveness, we established a new dataset, derived from publicly available surgical datasets with affordance annotations for three basic surgical actions: aspiration, clipping, and retraction. Extensive experiments demonstrate that our approach achieves state-of-the-art performance. Moreover, we validate our framework's applicability for downstream automation on a realistic lung and prostate phantom, and results show that the predicted affordance maps successfully enable autonomous surgical actions.