SurgCast: Action-Conditioned Future Skeletons for Controllable Surgical World Models

Reliable surgical planning requires models to anticipate not only how instruments will move, but also how the operative visual state will evolve together with such motion. Existing approaches typically treat future scene generation and instrument trajectory prediction as two separate tasks. Scene-only models cannot directly evaluate the accuracy of future instrument motion at the trajectory level, while trajectory-only models fail to capture the visual consequences of instrument movement, leaving the consistency between predicted trajectories and future scene evolution unaddressed. Jointly forecasting both provides a more complete account of surgical action-scene dynamics by enabling explicit trajectory-level evaluation while simultaneously modeling the corresponding visual evolution. To bridge this gap, we present a preliminary joint visual-trajectory world-action model that simultaneously forecasts future visual states and instrument trajectories from historical surgical observations. Specifically, we encode historical video frames and tool trajectories into latent representations, which are processed by a temporal-spatial encoder and subsequently decoded through separate visual-state and trajectory prediction heads. Based on this preliminary architecture, a chunked autoregressive rollout is repeatedly applied to predict fifteen future steps. The chunked strategy consistently outperforms direct one-shot prediction across all evaluated horizons, improving first-segment PSNR from 18.86 to 23.11 dB and reducing ADE from 45.77 to 22.22 pixels. These results demonstrate the initial feasibility of joint visual-motion forecasting. However, we observe progressive visual degradation and accumulated trajectory errors over longer prediction horizons, which remain important challenges for future surgical world-action modeling.

Scaling robot policy learning for autonomous surgery is challenging, as expert demonstrations are expensive and in vivo exploration poses substantial safety risks. Surgical world models address this by generating realistic, action-conditioned future frames from an initial observation, but existing methods exhibit two persistent failure modes: spatial interaction incoherence, where visible instrument contact fails to induce spatially consistent tissue deformation, and temporal fidelity collapse, where prediction errors compound across autoregressive rollouts and progressively corrupt visual quality. We present SurgVista, a surgical world model that mitigates both failures through two training recipes. Deformation Consistency Regularization extracts scene-point trajectories from training videos and enforces cross-frame coherence through latent contrastive learning, strengthening physically consistent instrument-tissue dynamics. Drift Adaptation Training mitigates long-horizon drift by perturbing conditioning frames with online prediction residuals and photometric augmentations calibrated to long-horizon drift statistics, sustaining visual fidelity over extended rollouts. To enable rigorous evaluation, we further introduce SurgWorld-Bench, featuring diverse procedure types, long-range rollouts, and decoupled metrics for instrument-motion accuracy and tissue-response fidelity. Extensive experiments show that SurgVista consistently outperforms state-of-the-art methods across visual quality, temporal consistency, and interaction fidelity, with gains widening as the prediction horizon grows.

Reliable surgical planning requires models that move beyond recognizing the current surgical step or imitating expert demonstrations, and instead anticipate how instrument motion reshapes subsequent operative states. Most surgical video understanding methods focus on recognizing phases, actions, or workflow states, while providing limited support for explicitly modeling instrument motion. Conversely, existing tool motion prediction methods can forecast instrument trajectories, but they generally do not capture the coupled evolution of future surgical video states. World models offer a natural framework for jointly modeling visual state transitions and instrument motion dynamics. However, existing surgical world model studies remain largely centered on visual generation quality, relying on generation-oriented metrics such as FVD and CD-FVD. These metrics are poorly aligned with instrument motion planning, as they do not directly measure whether predicted trajectories are geometrically accurate, temporally coherent, or actionable for downstream planning. This limitation is partly structural, since the field lacks public datasets and standardized evaluation protocols that provide the benchmarking infrastructure needed to assess motion-centric capabilities in surgical world models. In this paper, we introduce SurgWMBench, a vision-based benchmark for short-horizon surgical motion planning and dynamics prediction. Given intraoperative image sequences and historical instrument trajectory, SurgWMBench evaluates both near-future instrument motion prediction and stability under continuous rollout or input perturbations.