AGRO-SUVIDE: Agentic Robotics for Surgical Viscoelastic Debridement

Augmenting the dexterity of human surgeons has the potential to free them from tedious subtasks. We consider debridement (removal of diseased or dead tissue fragments), which is challenging due to imprecision in spatial perception and cable actuation. We develop an augmented dexterity system for surgical debridement that uses visual servoing to align the cable-driven gripper with the target position in the image plane, and then introduces a novel approach to depth control, MACAW: Monocular Adaptive Compact Attention Windows. Across 100 physical trials using the da Vinci Research Kit (dVRK) robot, camera-frame servoing reduced average gripper position offset from 37 to fewer than 5 pixels within 4 optimization steps, taking an average of only 0.39s. MACAW significantly outperforms procedural and learned VLA baselines, achieving a 93% success rate at 11 seconds per fragment, yielding a throughput of 304 fragments per hour. Extending MACAW to a bimanual debridement setup maintains a 92% success rate at an average of 7 seconds per fragment, increasing the throughput to 473 fragments per hour.

Surgical robotic systems are increasingly being adopted as clinical workload rises, motivating autonomous solutions for repetitive manipulation subtasks. Learning-based controllers improve generalization compared with rule-based and analytic approaches, but most are trained for individual tasks and remain difficult to reuse across procedures. Vision-Language-Action (VLA) models provide a unified framework that integrates visual perception, language grounding, and action generation, offering a promising path toward more composable surgical autonomy. However, existing VLA policies rely on fixed-length open-loop action sequences, where changing scene conditions can lead to accumulated errors and potential risks in surgical manipulation. To mitigate this issue, we formulate surgical VLA deployment as an adaptive execution-horizon decision problem and propose Trajectory Divergence Horizon Decision (TDHD), a test-time mechanism that estimates step-wise action reliability by measuring the divergence between two flow-matching-generated trajectories under small noise perturbations and truncates execution using a dual-threshold rule to trigger timely replanning. We further establish a real-world da Vinci-like dual-arm benchmark with synchronized multi-view perception and language instructions, and collect 600 teleoperated demonstrations across needle (reach, pick, regrasp) and tissue (reach, lift, resection) manipulation suites. On real hardware with 20 trials per task setting, TDHD consistently improves performance over the latest VLA baselines: success increases from 55% to 60% for needle manipulation and from 55% to 80% for tissue manipulation, with the largest gains observed in the final manipulation stages. These results highlight the importance of adaptive execution control for reliable deployment of VLA models in surgical robotic manipulation.

Human videos offer a scalable source of demonstrations for dexterous robot manipulation. However, existing human-to-simulation-to-robot (Human2Sim2Robot) pipelines rely on predefined procedures that struggle to accommodate diverse object properties and interactions, particularly those involving articulated and deformable objects. We introduce DexAgent, an agentic Human2Sim2Robot framework that converts a single egocentric human video and a task prompt into physically grounded robot trajectories for policy training. It operates through four stages: semantic understanding of human videos, property-based simulation reconstruction, robot trajectory optimization, and robot data generation. At each stage, DexAgent adapts its approach to the task and object properties by selecting suitable skills from its tool library or developing new ones when needed. Property-specific verifiers assess stage outcomes for physical validity and task-specific requirements and provide feedback for refinement, preventing error propagation through the workflow. This adaptive, verification-guided process allows DexAgent to process diverse objects and long-horizon tasks. In the final stage, DexAgent varies object and robot states in simulation to generate diverse robot trajectories from a single human video, then retextures the rendered observations to facilitate sim-to-real transfer. Newly developed skills and verifiers are retained in its tool library, making it self-evolving to accumulate reusable capabilities. This reduces processing time as DexAgent encounters more human videos. Across eleven real-world tasks, policies trained with DexAgent-generated data achieve a 3.5x higher success rate than competing baselines. Project website: https://dexagent123.github.io/.