TTDF: A Two-Stage Framework for Reliable Surgical Phase Transition Detection

Surgical video phase recognition is a fundamental task in computer-assisted intervention, supporting workflow understanding, intraoperative guidance, and surgical quality assessment. Although recent visual-temporal models have achieved promising progress, accurate and temporally coherent phase recognition remains challenging due to local visual ambiguity, transient prediction noise, and insufficient use of procedural semantics. To address these challenges, we propose HTT-Net, a Hierarchical Text-guided Transition modeling Network for surgical video phase recognition. The key idea is to introduce structured surgical semantic knowledge into phase-aware segment construction and semantic refinement. Specifically, we construct a hierarchical surgical semantic memory with intra-phase descriptions, inter-phase transition descriptions, and fine-grained semantic units. Based on this memory, the proposed Transition-Aware Segment Construction (TAS-Con) organizes frame-level evidence into coherent segment representations and handles boundary clips with inter-phase transition descriptions. Furthermore, we introduce Transition-Aware Segment Calibration (TAS-Calib), which calibrates phase-aware segment representations through hierarchical surgical semantics and improves discrimination under visual ambiguity without dense frame-level vision-language fusion. Experiments on Cholec80 and LCRS-100 demonstrate the effectiveness of HTT-Net for robust surgical video phase recognition.

Online Surgical Phase Recognition (SPR) models can reach high frame-wise accuracy, yet their predictions often lack temporal stability, fragmenting workflow understanding and reducing the reliability of downstream assistance. We show that this instability is not random noise but arises from two mechanisms: early misclassifications corrupt temporal feature states and propagate forward to form error cascades, and phase transitions follow evidence-accumulation dynamics whereas most online SPR systems rely on memoryless frame-wise decisions, making them sensitive to transient confidence fluctuations. We propose a unified Train-Inference-Evaluation framework that explicitly stabilizes temporal inference dynamics using model-agnostic, plug-and-play components. For training, the Temporal Error-Cascade (TEC) loss suppresses error onset and mitigates forward error propagation by stabilizing temporal feature evolution. For inference, the Evidence-Gated Transition Predictor (EGTP) enforces evidence-driven state transitions, allowing phase changes only when accumulated evidence exceeds a confidence boundary. For evaluation, we introduce the Temporal Fragmentation Index (TFI), a reliability-aware metric that quantifies instability-induced temporal disagreement beyond conventional frame-wise and token-based measures. Experiments on Cholec80 and AutoLaparo across three representative backbones show that the proposed framework substantially improves temporal stability and reduces prediction fragmentation, while maintaining or modestly improving frame-wise performance.

Online surgical phase recognition (SPR) underpins context-aware operating-room systems and requires committing to a prediction at every frame from past context alone. Surgical video poses three demands that natural-video recognizers do not jointly address: procedures span tens of thousands of frames, time flows non-uniformly as long routine stretches are punctuated by brief phase-defining transitions, and the visual domain is narrow so backbone features are strongly correlated across channels. Existing recognizers either let per-frame cost grow with elapsed length, or hold cost bounded but advance state at a uniform rate with channel-independent dynamics, leaving the latter two demands unaddressed. We present SurgicalMamba, a causal SPR model built on Mamba2's structured state-space duality (SSD) that holds per-frame cost at O(d). It introduces three SSD-compatible components that jointly address these demands: a dual-path SSD block that separates long- and short-term regimes at the level of recurrent state; intensity-modulated stepping, a continuous-time time-warp that adapts the slow path's effective rate to phase-relevant information; and state regramming, a per-chunk Cayley rotation that opens cross-channel mixing in the otherwise axis-aligned SSM recurrence. The learned rotation planes inherit a phase-aligned structure without any direct supervision, offering an interpretable internal signature of surgical workflow. Across seven public SPR benchmarks, SurgicalMamba reaches state-of-the-art accuracy and phase-level Jaccard under strict online evaluation: 94.6%/82.7% on Cholec80 (+0.7 pp/+2.2 pp over the strongest prior) and 89.5%/68.9% on AutoLaparo (+1.7 pp/+2.0 pp), at 238.74 fps on a single GPU. Ablations isolate the contribution of each component. The code is publicly available at https://github.com/sukjuoh/Surgical-Mamba.