Robot-Assisted Minimally Invasive Surgery

Closed-loop evaluation of surgical robots requires tissue that deforms, can be grasped and lifted, and reproduces the anatomy in which the robot will operate. We present a simulator in which this tissue is reconstructed from a fixed-view RGB-D recording of the surgical field, composited to remove the instruments, closed into watertight volumes and tetrahedralised; the pipeline was applied unchanged to three specimens of two species (thirteen organs, 146,061 tetrahedra, no inverted elements). For one specimen, the organs are placed in a bimanual cell in which two Franka FR3 arms operate motorised instruments through 6 mm trocars. The core contribution is the numerical and contact design that keeps this cell stable: implicit integration, simulation meshes separate from collision meshes, numerical guards, and a grasp constraint captured at the live tissue pose. In 45 repeated grasp-lifts, a friction grasp held the tissue in 0 of 15 trials and each constraint grasp in 13 of 15; on displaced tissue, a rest-pose constraint produced one-step snaps of up to 17.8 mm, which live-pose capture eliminates. Against the recording, front-surface depth error is 1.33 to 1.41 mm, organ silhouette IoU is 0.80, and in five grasp-lifts reproduced from video the landmark displacement RMSE is 11.8 mm against 14.2 mm for a static prediction. Biofidelity is not claimed; the environment is intended for closed-loop feasibility, safety, contact and policy screening.

Most minimally invasive surgery is still performed with hand-held laparoscopic instruments, and the surgeon's instrument kinematics are lost when the operation ends; only the endoscope video is kept. This paper presents an end-to-end pipeline that captures this motion in the operating room and uses it to train a surgical robot policy, validated on live animals. We introduce a surgical instrument-state logger that mounts on the shaft of a standard laparoscopic instrument and recovers its pose and jaw state from an inertial sensor, a time-of-flight sensor and a Hall sensor, with no external camera or tracker. A data pipeline measures the latency of every sensor channel against a robot ground truth and aligns the channels before forming observation-action pairs. On these demonstrations we train a diffusion policy with a fine-tuned DINOv3 backbone, selecting its design by closed-loop rollouts in a physics simulator reconstructed from depth maps of an ex-vivo rabbit appendix. The policy is then retrained on 849 in-vivo demonstrations from four live rabbits and deployed on four additional live rabbits with electrosurgery armed. With the surgeon selecting the surgical phase, the policy completed the appendectomy in three of the four animals. The results show that demonstrations recorded from a surgeon's own instruments are sufficient to train, select and deploy a bimanual surgical policy in vivo. The robot serves only as the timing reference for sensor calibration and as the executor, and collects no demonstrations. Both demonstration corpora are released to support future surgical robot learning research.

Current robot-assisted minimally-invasive surgery (RMIS) platforms provide a fixed console for the surgeon to view stereo endoscopic images and teleoperate instruments inside the patient. Several researchers have proposed the use of a head-mounted display (HMD) as a portable console, with video pass-through rendering of the endoscope images which, like the fixed console, restricts the operator to a single endoscopic viewpoint and limits depth perception. We present a digital twin-driven virtual reality (VR) teleoperation platform, where the digital twin is created from markerless perception of the surgical environment and streamed for display on the HMD. This overcomes the limitations of video pass-through by providing multi-view rendering and natural motion-parallax cues, enabling decoupling of the user's hand posture from strict instrument alignment. The system utilizes VR hand controllers to increase the teleoperation workspace and to improve the robustness and stability of instrument control compared to the hand tracking approach adopted by most prior systems. A 15-participant user study on the da Vinci Research Kit (dVRK) shows that our VR platform significantly outperforms a state-of-the-art HoloLens 2 mixed reality baseline, reducing path length by 86% and jerk by 95%, while achieving depth perception confidence comparable to or exceeding the traditional console across all conditions.

Robot foundation models learn manipulation from large demonstration corpora, but surgery is missing from those corpora: across the 780-hour Open-H surgical collection, one dataset carries synchronized force and none covers an aesthetic procedure. Liposuction is the hard case, because the instrument works under the skin and the surgeon operates by feel and by judgment. Humynex Robotics builds curated expert datasets for this kind of procedure. HumynexSurg-1 is the first release: a master liposuction surgeon performing on porcine abdominal tissue while narrating every decision, recorded with synchronized suction pressure, six-axis hand force/torque, top-down RGB-D video, side video and a lavalier microphone -- 14 episodes, 42,738 frames, 35.6 minutes, 356 utterances of which 95% compile into a liposuction-specific label schema. The capture follows a patent-pending sensing plan organized around the quantities a policy needs, so a channel captured today by a model can be upgraded to a sensor tomorrow without changing the data format. This release captures the instrument motion as a tool-hand track in the side video and provides the force channel as state; the funded capture adds a measured 6-DoF handle pose, a validated force channel, ultrasound imaging of the fat layer, and palpation sensing. As a proof of concept, NVIDIA Isaac GR00T N1.7 fine-tunes on the dataset with no custom code in under an hour per run and learns the recorded sessions; scaling probes on the same episodes show where further gains come from: every new session lowers the error on an unseen session. The dataset, its label schema, its quality-assurance reports and its evaluation protocol are the product; the next capture, many short sessions across fat regions with the sensors named here, is what the probes point to.

Excessive force may damage tissue and increase the risk of anastomotic leakage in robotic colorectal surgery. Although the da Vinci 5 provides force sensing, this capability is unavailable on earlier da Vinci systems and many other surgical robotic platforms. In this work, we present a vision-based pipeline for estimating 3D interaction forces from soft-tissue deformation in stereo endoscopic video. We dynamically reconstruct the tissue point cloud in an object-centered coordinate frame, track tissue points with geometric constraints, and predict the 3D force vector with a neural network. We progressively evaluate the pipeline on rubber-glove phantoms, ex vivo porcine colons, and in vivo colorectal surgical video sequences. Under varying tissue orientations and positions within the endoscopic view, as well as different camera viewpoints, the proposed method achieves average root mean square error (RMSEs) of 0.77 N and 1.30 N on the phantom and porcine colon, respectively. Compared with the camera-frame representation, the object-centered representation reduces average RMSE by 51.3% and 56.7%, while geometry-constrained tracking reduces RMSE by 19.8% and 25.3% compared with CoTracker. We further qualitatively demonstrate the feasibility of vision-based force estimation on an in vivo colorectal surgical sequence, as a step toward clinical translation of vision-based, sensorless force estimation.

Autonomous soft-tissue cancer surgery has been limited to interventions on organ surfaces, because current systems cannot perceive and adapt to anatomy once it deforms or is cut. We introduce the first vision-guided autonomous system capable of performing complete tumor resections for partial nephrectomy. Our system integrates conditional occupancy networks, trained entirely in a physics-based simulation, that infer full 3-D anatomy (tumor, margin tissue, and kidney) from single-view partial point clouds. These occupancy networks maintain intraoperative tracking even as tissue is cut and deformed, enabling adaptive planning and execution. The surgical platform combines a depth camera for capturing surface point clouds, dual robotic arms for electrosurgical cutting and vacuum-based tissue manipulation, and an autonomous control strategy for tumor resection. In patient-derived hydrogel phantoms under an open partial nephrectomy setting, the robot performed eight consecutive autonomous tumor resections comprising 77 electrosurgical cuts, with all cuts achieving negative surgical margins and 1.61 $\pm$ 0.48 mm mean absolute margin error. This work demonstrates, for the first time, a foundation for supervised autonomous closed-loop, imaging-driven, margin-negative tumor removal in phantoms.

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.

Input devices for robotic microsurgery are frequently described as preserving the surgeon's trained technique, but the claim is rarely measured. We compared manual and teleoperated intraocular instrument motion with the trocar constraint, the instrument, the eye model and the tracking source common to both conditions, so that the control interface was the only factor varied. Prior comparisons cannot hold the instrument fixed, because a robotic instrument is not the tool used manually. Sixteen participants performed a navigation task on a commercial ophthalmic simulator by hand and through a three-degree-of-freedom input device commanding a five-joint robot. Task outcome was equal but at ceiling: every participant acquired all five targets under both interfaces with no retinal or lens injury. Execution differed on every measure. Teleoperated trials took three times as long at a quarter of the median speed, covered less than half the angular working range, and were broken into 3.5 times as many separate movements. Completion time and movement fragmentation improved substantially across four trials of practice and had not plateaued; the measures set by the configured rate ceiling and joint limit changed the least. Finger activity doubled and pinch variability tripled, so reducing instrument degrees of freedom redistributed manual effort rather than reducing it. The interface preserves the outcome and reshapes the execution.

Robotic ophthalmic surgery offers high precision but introduces a "sensory gap" by decoupling the surgeon from their instrument, resulting in a loss of tactile feedback. This paper presents a novel haptic feedback system for subretinal injection tasks leveraging Scene Graphs (SG). The system bridges the sensory gap by analyzing a physically simulated intraoperative Optical Coherence Tomography (iOCT) feed to construct a real-time surgical SG. The SG serves as a semantic abstraction layer for the surgical scene, which is then utilized by a deterministic, rule-based engine to generate state-dependent haptic feedback on a robotic input device. The system was evaluated in a user study (N=16) using an anthropomorphic head phantom and a custom-built surgical robot. Results demonstrate that the SG-driven haptic feedback improved surgical precision, reducing needle alignment error by 14% (p = 0.044) and improving System Usability Scale (SUS) scores by 8% (p = 0.015), while maintaining comparable task completion times. A needle trajectory analysis revealed the emergence of a safer "Align-then-Approach" strategy, in which our haptic negative reinforcement prompted users to fine-tune the tool's trajectory before approaching the retinal target. This work suggests that SGs can effectively serve as the direct computational foundation for real-time, safety-enhancing context-aware haptic feedback in robotic microsurgery.

Sparse outcome feedback limits what robots can learn from unsuccessful attempts at complex manipulation. Failed multi-stage surgical attempts can contain grasps, lifts, or transfers worth reusing. In sparse-reward reinforcement learning, terminal rewards collapse such attempts to the same outcome, while scalar vision-language model (VLM) ratings reveal neither what progress merits credit nor when it occurred. We introduce phase-and-first-arrival feedback: one VLM query per recorded episode identifies the furthest visually verified task phase and when that phase is first reached, allowing the learner to reuse partial behavior and localize credit. We instantiate it in SurgPhaseBench, a phase-structured suite spanning rigid and deformable tasks, and evaluate it in simulation and hardware. Across five simulated tasks, our method reaches 75.2% mean success, compared with 52.1% for a reward based on Contrastive Language-Image Pre-training (CLIP) using the same visual input; the advantage persists when only the feedback representation changes. On hardware, the same record supports autonomous block picking and slip recovery. Together, these results show that trajectory-level visual supervision can preserve partial progress while providing the temporal credit needed for sparse-reward control.

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.

We introduce CRESSim-Neo, a batched GPU simulation engine for surgical robotics and robot learning. CRESSim-Neo combines position-based simulation of rigid bodies, deformable tissues, fluids, and strands with batched rendering, surgery-specific sensing, and a GPU-resident data pipeline. The engine supports applications including tissue manipulation, fluid suction, suturing, cable-driven robots, and ultrasound image synthesis. Direct access to physics and rendering buffers enables GPU-resident robot learning and zero-copy PyTorch integration using DLPack. We demonstrate CRESSim-Neo across rigid-body, deformable-body, and fluid simulation tasks, including vision-based and surgical robot-learning scenarios. On an NVIDIA RTX 4090, the engine achieves up to 2.03 million environment steps per second for 8192 parallel CartPole environments, and scales to batched surgical scenarios involving tissue deformation, fluid interaction, and ultrasound sensing. Overall, CRESSim-Neo provides a unified and scalable platform for surgical simulation, synthetic data generation, and surgical robot learning.

Long-horizon surgical robot manipulation is challenging because task rewards are sparse, while meaningful interaction changes occur at irregular intervals. Existing world-model agents typically imagine at primitive-step resolution, leaving variable-duration task progress implicit. Manually specified stages can provide intermediate structure, but their task specific boundaries are difficult to align with state-dependent interaction transitions. We propose S2-HWM, a Sparse Event-Structured Hierarchical World Model that learns sparse event evidence from primitive latent trajectories to coordinate an event-level manager and a primitive-step worker. The event evidence schedules manager goal updates, and each selected latent goal conditions the worker's primitive actions until the next update. The learned event evidence also forms variable-duration segments for an Event Transition Model (ETM), which predicts the next?boundary stochastic state, segment duration, and accumulated segment reward. Chaining these event-level predictions provides a variable-duration continuation beyond the primitive imagination horizon for manager learning, while the worker retains primitive-step actor-critic learning. On a SurRoL-based PegTransfer task, S2-HWM achieves a success rate of 98.7%, outperforming the flat GAS DreamerV3 baseline by 22.7 percentage points.

Learning reliable surgical manipulation policies is bottlenecked by the scarcity of action-labeled demonstrations: teleoperated surgical robot (e.g., dVRK) trajectories with synchronized kinematics are costly to collect, while surgical tasks demand precise contact handling, long-horizon reasoning, and bimanual coordination. Endoscopic video is comparatively inexpensive and abundant relative to synchronized video--kinematics trajectories, and a natural way to exploit it is to learn world models of surgical scenes. However, existing surgical world models use video primarily for simulation or policy evaluation, and rarely translate the learned dynamics into closed-loop control. This gap raises our central question: under a fixed budget of action-labeled demonstrations, does action-free video pretraining improve closed-loop surgical manipulation? To answer it, we introduce the Surgical World-Action Model (Surgical WAM), a unified generative model built on Cosmos Policy that jointly predicts future endoscopic observations and executable surgical robot action chunks. Surgical WAM first learns surgical visual dynamics from action-free video and is then fine-tuned on the fixed action-labeled budget; at deployment, it acts as a closed-loop, receding-horizon controller that executes a short prefix of each predicted action chunk and replans from the resulting observation. On a suite of four simulated surgical manipulation tasks, video pretraining improves the average success rate from 63.5% to 77.8%, including an absolute gain of 20 percentage points on PegTransfer, with the largest improvements on contact-rich and bimanual tasks. These results demonstrate that action-free video provides transferable visual dynamics priors for learning surgical robot control with limited action supervision, positioning data-efficient video pretraining as a practical path toward scaling up surgical robot learning.

Soft robotic systems are well suited for developing devices for biomedical applications. A bio-mimicking robotic soft esophagus (RoSE) is developed as an in vitro testing device of endoprosthetic stents for dysphagia management. Endoprosthetic stent placement is an immediate and cost-effective therapy for dysphagia caused by malignant esophageal strictures from esophageal cancer. However, later stage complications, like stent migration, could weaken swallow efficacy in the esophagus. The stent radial force (RF) on the esophageal wall is pivotal in avoiding stent migration. Due to limited randomized controlled trials in patients, stent design and stenting guidelines remain incomplete. To address this knowledge deficit, we investigate RoSE by implanting two stents (A and B) of different radial stiffness characteristics, to measure stent RF and its effect on migration. Endoscopic manometry under peristalsis is also performed to study the impact of stenting and stent dysfunction on intra-bolus pressure signatures (IBPSs) and swallowing efficacy. Each implanted stent undergoes experiments with varied peristalsis velocity, wavelength, and bolus concentrations. The results show that stiffer stent B has a higher RF, whereas stent A maintains a lower RF profile due to lesser stiffness. High RF is necessary to minimize migration under prolonged peristaltic contractions in RoSE. For manometry, stent A slightly increases IBPS, but stiffer stent B significantly decreases IBPS, especially for higher-concentration boluses. If a stiffer stent buckles, it can reduce swallow efficacy and cause recurrent dysphagia. RoSE is therefore an innovative soft robotic platform for testing endoprosthetic stents and addressing clinical challenges in stent evaluation.

Strictures caused by esophageal cancer can narrow down the esophageal lumen, leading to dysphagia. Palliation of dysphagia has driven the development of a Robotic Soft Esophagus (RoSE), which provides a novel in vitro platform for esophageal stent testing and food viscosity studies. In RoSE, peristaltic wave generation and control were done in an open-loop manner since the conduit lacked visibility and embedded sensing capability. Hence, in this work, RoSE version 2.0 (RoSEv2.0) is designed with embedded Time Of Flight (TOF) and pressure sensors to measure conduit displacement and air pressure, respectively, for modeling and control. Model Predictive Control (MPC) of RoSEv2.0 is implemented to govern the peristalsis and air pressure profile autonomously. The implemented MPC used Sparse Identification Nonlinear Dynamics with Control (SINDYC) models to estimate the future states of ROSEv2.0. The dynamic models are discovered from the TOF and pressure sensor data. Peristalsis waves of speed 20 mm/s, wavelength 75 mm, and amplitudes 5, 7.5, and 10 mm were successfully generated by the MPC. Additionally, RoSEv2.0 with the MPC was employed to perform stent migration testing with various food bolus consistencies. The major contribution claimed in this paper is the application of SINDYC-based MPC to solve the closed-loop control problem of RoSE for achieving desired peristaltic waves.

Hallucinations are a major concern for the integration of artificial intelligence into medicine, although less explored in the realm of medical image processing. Unlike problems in natural text understanding and reasoning therewith, determining whether or not predictions derived from biomedical images and signals is less intuitively clear. This article suggests that topological errors could constitute hallucinations in a way that can be more readily measured and thus regulated. Certain of these properties for certain types of problems, such as biomedical signal segmentation, can be rephrased as linear temporal logic predicates, a number of which can be explicitly enforced using probabilistic graphical models. Our simulations show the potential of these explicitly constrained predicates for the case of automatic surgical phase recognition in robot-assisted hysterectomy, improving accuracy by approximately 10% while removing the vast majority of topological errors, suggesting that mathematical guarantees of correctness can supplement other empirical forms of regulating machine learning in medical image computing and computer-assisted interventions.

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.

Autonomous laparoscopic camera control requires continuous understanding of the surgeon's operative intent in dynamic surgical scenes, where the target operative region is not a stable physical object but a latent and temporally evolving attention state. In this work, we present Surgical Latent Attention Tracking (SurgLAT), a causal online framework for latent surgical attention modeling and autonomous laparoscopic view control. SurgLAT uses a frozen DINOv3 encoder and a state-conditioned spatial token mixer to extract operative evidence under a memory-guided spatial prior, while a selective causal latent memory module jointly models short-term motion continuity and long-horizon surgical intent evolution through dynamic retrieval of current, recent, and historical latent states. The learned latent surgical attention state is decoded into a probabilistic attention heatmap and operative region for downstream endoscope guidance. Beyond perception, we further introduce a robotic deployment framework with explicit laparoscopic Remote Center of Motion (RCM) constrained control based on virtual-axis formulation, together with redundancy-aware null-space initialization for stable and smooth manipulator motion. We validate the full system on real laparoscopic surgical videos and a physical robotic laparoscope platform. Experimental results demonstrate robust online operative-region tracking and stable autonomous endoscopy adjustment under occlusion, rapid motion, and target transitions, highlighting the effectiveness of latent surgical intent modeling for surgical autonomy.

Difficulty in haptic feedback for surgical robots has been a long-term problem for decades. In recent years, learning-based force estimation from robot states suggests desirable accuracy without the necessity of extra sensors. However, challenges remain in obtaining representative training data in which the robot moves in the workspace under various external forces. In this work, a parallel motor-cable system is developed. With six motor-cable units installed around the robot workspace, cables with controllable tension connected to the robot end-effector can provide the desired external force without interfering with the movement of the surgical robot. The development of the system includes motor-unit hardware, control software, sensor drivers, simulations, and more. Preliminary experiments suggest an accuracy of force actuation with errors less than 1 N.

Significance. Accurate intraoperative depth perception is important for autonomous and semi-autonomous robotic laparoscopic surgery. Conventional fringe projection profilometry can achieve millimeter-scale accuracy but often requires multi-shot acquisition, digital-micromirror-device projection, and projector-camera synchronization, complicating integration into compact laparoscopic systems. Aim. To develop a synchronization-free, single-shot depth-sensing platform using a passive LED-illuminated binary mask and a VQ-VAE prior with a custom U-Net depth head. Approach. A compact projection module was coupled to one channel of a dual-channel laparoscope, while the second channel imaged the fringe-illuminated target. A Zivid 3D camera acquired reference depth for 722 paired phantom images. Zivid depth maps were reprojected into the SSLE image frame for supervised training and evaluation. The VQ-VAE encoded each input into a discrete latent representation, and a latent-space U-Net predicted depth without a separate mask-prediction branch. Results. Using a fixed train/validation/test split, the proposed model achieved an MAE of 3.70 mm, AbsRel of 0.0326, delta=1.1 accuracy of 0.962, and delta=1.1^2 accuracy of 0.970. It achieved lower MAE than the dual U-Net MaskNet + DepthNet baseline and outperformed off-the-shelf monocular depth models in MAE, AbsRel, and threshold accuracy. The pipeline operated at 26.0 Hz over 301 consecutive frames on an NVIDIA A100 GPU. Conclusions. The LED-illuminated binary-pattern platform with latent-space depth reconstruction enables synchronization-free, video-rate endoscopic depth estimation. Results demonstrate Zivid-referenced phantom reconstruction without an explicit segmentation stage, while emphasizing the importance of dataset size and SSLE-Zivid calibration accuracy.

In robot-assisted surgery, Forbidden Region Active Constraints (FRAC) represent a control strategy that helps maintain task safety by generating anisotropic haptic guidance to surgeons. However, several challenges need to be overcome before FRAC can benefit teleoperative surgery in a clinical setting. These challenges include the ability to allow for dynamic tissue deformation, maintain energetic passivity, and speed of implementation, among others. In this study, we propose the pipeline design for an energy dissipative FRAC strategy, which accommodates the dynamic tissue deformation caused by respiratory movements, by utilizing a depth sensing camera. The proposed FRAC strategy adopts a fine mesh representation, with a total number of 122,806 polygons in the case study presented, while running at 43.48Hz. We designed in vitro trajectory tracking experiments conducted by a "virtual" surgeon to aid quantitative assessment of the method, including its effectiveness in maintaining task safety, which was confirmed by successfully maintaining a pre-defined safety distance across all trials. We also conducted comparative studies to investigate the robustness and time-efficiency of our method against other FRAC methods that rely on simple geometry AC representations. We demonstrate that our method provides a more robust and effective guidance overall, while maintaining comparable, if not lower, time costs.

Surgical gauze is an essential part of surgical procedures, primarily used for controlling bleeding and absorbing bodily fluids. The post-surgical retention of gauze can lead to serious complications and necessitate additional surgery for its removal. Despite the clinical significance, research on gauze segmentation using real-world surgical data remains underexplored, owing in part to the scarcity of annotated datasets. In this work, we investigate the use of deep learning methods for gauze segmentation in robot-assisted minimally invasive abdominal surgeries, utilizing an in-house surgical dataset prepared at a university hospital. The training data reflects realistic surgical settings and captures extensive diversity in spatial, morphological, and visual attributes across three different gauze categories. We evaluate several widely used segmentation architectures, including CNN-based, transformer-based, and hybrid architectures, to establish a proof-of-concept for gauze segmentation in a realistic clinical setting. In addition, we investigate the influence of sub-optimally annotated, auto-tracked segmentation masks as a strategy to address data scarcity and improve performance. Our results demonstrate the efficacy of real-world training data in countering the main challenge reported by prior works, the trade-off between blood presence and gauze detection. The incorporation of auto-tracked annotations yields performance enhancements, particularly in generic surgical scenarios. The integration of effective segmentation approaches can benefit robot-guided surgical procedures and various downstream applications by providing precise delineation of foreign objects, thereby enhancing patient safety and surgical outcomes.

Imitation learning has shown increasing promise for autonomous robotic surgery, yet safe deployment remains challenging due to the safety-critical nature of surgical tasks and the complexity and variability of surgical environments. Failure detection is therefore an essential safeguard, but its development remains difficult due to the challenges of scarce failure data, highly variable manipulation dynamics, and the need to balance missed detections against disruptive false alarms. To address these challenges, we introduce FoMo-FD (Flow-Matching World Model for Failure Detection), a failure detection method that learns nominal short-horizon visual dynamics with an action-conditioned flow-matching world model. FoMo-FD scores the inverse-transport nonconformity of observed endpoint latents, enabling window-level detection of visual-action inconsistencies without requiring failure demonstrations. Detection thresholds are obtained by conformal calibration on successful executions, yielding task-specific alarms without assuming future failure types. We evaluate FoMo-FD on four surgically relevant manipulation tasks with twenty failure modes across simulation and real-world experiments using the da Vinci Research Kit (dVRK). Results show that FoMo-FD outperforms observation-level anomaly baselines and a prediction-error variant of the same world model, with the wrist-camera view achieving the strongest performance, including a 96.6% failure detection rate (FDR) at a 1.3% false alarm rate (FAR).

Recent advances in robotics research have created a strong demand for high-performance simulators. Surgical robotics simulation faces unique challenges due to the need to model diverse objects, such as rigid instruments, soft tissue, and fluids. While many studies simulate sutures or soft tissue independently, only a few have considered the complete soft-tissue suturing scenario, including the contact between sutures and deformable tissue during suture insertion. Building on previous work, this paper presents a novel suturing simulation environment using sutures modelled by position-based dynamics (PBD) and soft bodies modelled by the material point method (MPM) while considering two-way contact with frictional and drag forces. We introduce a contact coupling method between the PBD suture and the MPM soft tissue, enabling visually plausible suture-tissue interactions. The simulator is optimized for GPU execution with parallel scenes using multiple CUDA streams, and we present a Reinforcement Learning (RL) environment for autonomous suturing sub-tasks, including needle insertion, driving, and extraction. Using ML-Agents, RL agents trained in the simulator show stable learning and achieve 80% and 68% success rates in needle insertion and extraction, respectively, under the strictest distance threshold.

Suture-needle pickup is necessary for autonomous suturing, as a needle can be unexpectedly dropped or strategically released to adjust the grasping configuration. Current methods for autonomous needle pickup typically guide a robot to move straight toward the needle and grasp it, limited to conditions where the needle is observable and directly approachable. In addition, grasping the needle lying on tissue can lead to the robot pinching nearby tissue or the needle jumping around due to its slippery surface, posing potential safety issues. This work proposes an autonomous framework that uses a suture thread as an assistive tool for indirect needle pickup, avoiding unnecessary tool-tissue contact and enabling pickup even when the needle is occluded or inaccessible. The framework spans the entire workflow, including thread and tissue reconstruction, safe grasp-point selection, stable thread lifting, and bimanual thread-following until securing needle grasping. The robot policies account for visual uncertainty to maximize robustness in real-world environments. We evaluate the proposed framework on a da Vinci Research Kit under various real-world conditions. The results demonstrate robust performance even with a challenging thread configuration or a non-approachable needle, closing the gap in applying autonomous robot policies to unstructured suturing environments.

Extended Reality (XR) is increasingly used in human-robot interaction to communicate robot intent, planned motion, reachability, and state. We argue that XR should also be understood as a mediation layer for situated human control in human-robot teaming. Situated human control denotes the human collaborator's ability to understand, shape, authorize, and interrupt robot action within the concrete physical, social, and temporal context in which that action unfolds. We ground this perspective in scenarios from robot-assisted bedside nursing, multi-arm supervisory control, and collaborative assembly under divided attention. Across these scenarios, robot autonomy must remain inspectable and adjustable as people move, goals change, sensing is incomplete, control roles shift, and plans become invalid. We identify four mediation functions connecting human intent and robot autonomy, robot plans and human judgment, levels of shared control, and team roles, handover, and recovery. Building on these functions, we derive six design dimensions: joint action possibilities, socio-physical constraints, uncertainty and plan validity, multimodal control and correction, roles, handover, and accountability, and anticipatory recovery. The paper outlines a research agenda for XR systems that make robot autonomy more actionable and accountable in dynamic shared environments.

The introduction of new technologies, such as surgical robots, is driving the vision of a connected, smart operating room (OR). However, realizing this vision requires a deep understanding of surgical workflows, which relies on realistic datasets capturing the actions of all OR personnel from both full room and surgical field perspectives. Acquiring such data in real ORs is prohibitively challenging due to factors such as ethics committee approvals, limited space for camera installation, and sterility regulations preventing the use of tracking markers. We present a step-by-step methodology for re-enacting complete surgical procedures in a reconstructed OR. This approach enables the creation of repeatable and annotatable workflow datasets for training activity recognition models, generating scene graphs, and formalizing surgical process models. Developed for robot-assisted ophthalmic surgery, our methodology combines expert consultation, structured workflow formalization, OR reconstruction, role-based training, real OR observation, and iterative recording with post-take debriefing. We provide concrete recommendations to allow other research groups to seamlessly adopt this methodology for their own surgical domains.

Tracheostomy requires precise localization of the tracheal incision site; however, conventional manual palpation is subjective and often unreliable, while ultrasound utility remains operator-dependent. This work presents a learning-based framework for hierarchical tracheal anatomy understanding, designed specifically for ultrasound-guided robotic systems. We propose a two-stage perception pipeline integrating a YOLOv8n localization backbone with a sparse, prompt-optimized SAM2 decoder to achieve high-fidelity segmentation from sparse surgical annotations. Our hybrid training strategy, bridging curated laboratory data with unconstrained sequences, ensures clinical robustness. Experimental benchmarks demonstrate that this decoupled architecture effectively balances generalization, precision, and efficiency. The YOLOv8n and SAM2 framework achieves a consistent Mean Dice Similarity Coefficient (DSC) of 0.777 across both controlled and generalized domains. This significantly outperforms U-Net baselines, which often suffer from anatomical fragmentation and performance degradation (Generalization DSC $\le$ 0.494). By constraining mask decoding to targeted, sparse regions of interest, our model achieves a throughput of 6.92 FPS, which is vital for closed-loop robotic teleoperation. This study confirms that a robust hierarchical understanding of tracheal anatomy can be derived by coupling lightweight localization with foundation-scale visual models. Our framework establishes a scalable foundation for standardized, autonomous surgical assistance, effectively navigating the variability of real-world ultrasound to enhance the safety and precision of robotic-assisted tracheostomy.

Autonomous robotic craniotomy requires continuous regulation of tool-tissue interactions to mitigate mechanical overload and thermal damage while maintaining surgical efficiency. However, this process is inherently partially observable due to unknown, time-varying tissue properties and the inability to directly measure cutting temperatures under physical occlusion. To address these challenges, we propose RL-MACRO, a cybernetic closed-loop intelligence framework that couples multimodal perception, adaptive decision-making, and robotic execution. This framework empowers the surgical robot to autonomously perceive inaccessible states from partial sensory feedback and dynamically optimize its behaviors under uncertain environment. A CNN-LSTM observer first fuses force and sound feedback to reconstruct the hidden temperature state (R^2=0.939, MAE = 1.717 deg C). This reconstructed temperature, alongside multi-sensor features, forms the belief state for an offline Implicit Q-Learning (IQL) policy. A novel dual-head Actor dynamically coordinates the feed rate, spindle speed, and cutting depth to optimize efficiency within strict safety bounds. These decisions are seamlessly translated into spatial motions via online trajectory re-planning and velocity servoing. Experiments on bovine ribs and six ex vivo goat skulls validate the system's robust perception, adaptive recovery from force/temperature excursions, and smooth execution on irregular surfaces, establishing a data-driven cybernetic paradigm for safe and efficient autonomous bone cutting.

Manual craniotomy is a high-risk, skill-dependent procedure associated with surgeon fatigue and potential dural injury. While robotic approaches have improved safety, existing open-loop systems rely solely on preoperative images and cannot compensate for intraoperative registration errors or tissue deformation. To address this, we propose a human-inspired closed-loop robotic craniotomy framework that intelligently integrates preoperative planning with intraoperative execution. An adaptive dual-contour fusion algorithm is employed to generate trajectories that conform to complex cranial geometries while maintaining a consistent tool-bone relative pose. For intraoperative perception, a multimodal two-stage cross-modal attention block (CMA)-temporal convolutional network (TCN)-Transformer network combined with an adaptive Bayesian filter fuses force and acoustic signals to achieve robust breakthrough detection under varying bone conditions. Upon detection, an in-situ projection-based trajectory adjustment strategy dynamically compensates for depth deviations, enabling safe residual bone isolation. Experiments on bovine ribs show a breakthrough prediction accuracy of 97%, a detection latency of 0.048 +/- 0.097 s, and a maximum overshoot of 0.29 mm. All four ex vivo cranial experiments were successfully completed without dural injury. These results demonstrate that the proposed cybernetic framework enables safe and autonomous craniotomy with highly effective closed-loop control.

With growing surgeon shortages, automating surgical sub-tasks such as tissue dissection offers a promising step toward reducing workload and expanding patient access. Prior work has relied on hand-crafted incision policies that cannot quantify uncertainty or has relied on simulation-based methods that require strong modeling assumptions. We instead view tissue attachment identification as an inherently probabilistic problem and propose a Bayesian approach that avoids explicit tissue modeling. Our method uses a Sequential Bayesian Hilbert Map (SBHM) to represent the likelihood that each tissue point is attached to the underlying resection surface. An ensemble of learned classifiers predicts attachment likelihoods from spatial data acquired during robotic tissue retraction, with each classifier serving as a noisy information source to update the SBHM. To plan the next retraction, we devise Bayesian Retraction Optimization (BRO) to select the most informative action under safety constraints. As the SBHM refines over time, regions with high attachment likelihood are selectively incised. We validate our method in simulation across diverse tissue geometries and acquisition strategies, and demonstrate zero-shot transfer to real robotic dissection experiments.

Robot-assisted minimally invasive surgery (RMIS) offers major benefits over open and conventional laparoscopic procedures, yet it still lacks tactile feedback for palpation while operating under strict requirements to preserve reliable vision for navigation and safety. In practice, visual feedback is indispensable, and tactile solutions that cannot coexist with vision are difficult to translate into RMIS tools. To address both needs, we introduce MVP-Tac, a compact, vision-based tactile sensor that provides co-located vision and tactile sensing. MVP-Tac uses reflective photoelastic imaging: a thin photoelastic elastomer produces stress-dependent interferograms under contact that are captured by an embedded camera through a miniaturized reflective polariscope. A semi-transparent membrane and controllable illumination enable switching between visual mode and tactile mode, enabling tactile perception without sacrificing vision. We validate MVP-Tac through force calibration in the 0 to 2 N range and demonstrate its potential for tumor palpation via video-based hardness classification on tissue phantoms, achieving 97% accuracy for exposed-tumor classification and 92% accuracy for subdermal-tumor classification. Finally, we conduct a simulated colonoscopy to validate both visual and tactile modalities in a constrained lumen, including vision-guided 3D photomapping of the luminal wall and in situ hardness classification of localized nodules. Overall, MVP-Tac provides a practical path toward restoring clinically useful palpation in RMIS while maintaining essential visual feedback. The design, fabrication, and firmware of MVP-Tac are open-sourced at https://mvp-tac.github.io/

Accurate 3D--2D liver registration, which aligns preoperative 3D models to partial, view-dependent intraoperative surface observations, is critical for AR-guided laparoscopic surgery but remains challenging due to severe occlusion, limited visibility, and the lack of 3D ground-truth supervision. Existing landmark-free approaches perform partial-to-complete geometric alignment, yet robust self-supervision under extreme partial visibility remains difficult. We propose Vis2Reg, a visibility-aware registration framework that explicitly constrains deformation using mask-consistent visible regions. We introduce a visibility-aware self-supervision that derives a visible-domain 3D supervision signal from intraoperative masks, enabled by differentiable point rasterization and mask-guided back-projection. This formulation improves robustness under severe occlusion while maintaining fully self-supervised learning. Vis2Reg combines a robust geometric rigid initialization module with an implicit neural deformation field for stable alignment. Vis2Reg achieves a Dice score of 92.6% and a Chamfer Distance of 1.43 mm on real intraoperative datasets, with 111 ms per-frame inference time, demonstrating both accuracy and practical efficiency.

Purpose: Marker-based tracking of surgical robots is occlusion-prone in cluttered operating rooms. We evaluate stereo differentiable rendering for marker-free, real-time robot pose tracking, potentially improving safety, reducing setup time, and enabling multi-robot interaction. Methods: We extend the markerless pose estimation framework roboreg to online dynamic tracking via (i) sequential optimisation that propagates pose estimates across frames with motion-adaptive hyperparameter tuning, and (ii) CUDA stream parallelisation of segmentation and optimisation, combined with CUDA-graph accelerated segmentation. We evaluate on 38 unobstructed and 5 occluded displacement sequences with static start/end ground-truth calibrations and dynamic marker-based reference tracking. Results: We achieve real-time 1080p tracking at 30 fps (up from 14 fps for vanilla roboreg), matching the camera frame rate. Accuracy reaches 1.7 cm / 0.6 deg against static ground truth and 1.2 cm mean 3D error over 27,460 frames against the marker-based reference (1.53 cm over 1,242 occluded frames). Our method outperforms FoundationPose by 11% in dynamic estimation (63% under occlusion) and 250% in static estimation, with 6x faster inference. Conclusions: Stereo differentiable rendering enables real-time, high-resolution marker-free surgical robot tracking, on par with marker-based approaches and surpassing foundation-model baselines.

Gaussian splatting is the current state-of-the-art for dense, deformable 3D anatomy reconstruction in robot-assisted minimally invasive surgery (RAMIS); however, most pipelines are offline and depend on accurate camera trajectory priors (often from robotic kinematics), limiting applicability when priors are missing or noisy. To address these limitations, we propose Track2Map, an online 3D Gaussian Splatting pipeline that jointly optimizes camera trajectory and 3D deformable scene representation directly from surgical video. Track2Map is therefore capable of robust 3D reconstructions when camera trajectory priors are either absent or noisy, and due to its online nature it effectively works as a Simultaneous Localisation and Mapping (SLAM) method. To stabilize optimization in the presence of tissue motion and ambiguous visual cues, we introduce a track-anchored deformation initialization using dense 2D point tracks. Track statistics are further utilized to disentangle camera motion from scene deformation by detecting static camera periods and reducing drift during incremental mapping. Experiments on StereoMIS show improved reconstruction quality and camera trajectory against competing SLAM methods, as well as compared to non-SLAM methods that utilize camera trajectory priors. The code is available at https://track2map.github.io/.

Recent advances in actuation, control and learning have rapidly pushed humanoid robots from a distant vision towards near-term real-world deployment. Healthcare is a particularly pressing domain, in which staffing shortages and increasing care demand are widening the gap between clinical workload and available skilled labour. Although current automation has largely focused on digital and logistical tasks, much hospital work remains embodied, requiring mobility, manipulation and safe interaction in human-designed environments. Humanoid form factors offer unique potential, particularly for assisting with surgical tasks. Traditionally, robotic systems for surgery are purpose-built platforms such as Intuitive Surgical's da Vinci Surgical System, and it remains unclear how close current humanoid systems are to meeting the precision, control and safety requirements of minimally invasive surgery. Here we present a systematic evaluation of contemporary humanoid technology for laparoscopic surgical tasks. We develop a humanoid-based laparoscopic teleoperation framework using general-purpose instruments and assess its abilities through benchtop characterization, dry-laboratory user studies spanning diverse surgical experience levels and in vivo porcine studies. Across these evaluations, we quantify technical feasibility, task performance and clinical readiness relative to established surgical platforms. Together, our study provides an evidence-based assessment of current humanoid abilities and limitations for surgical applications, highlighting both their promise and key technical challenges that must be addressed before clinical deployment.

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.

Vision-Language-Action (VLA) models represent a promising direction for embodied intelligence in surgical robotics. Despite the prevalence of VLA benchmarks for general robotics, standardized evaluation platforms specifically designed for surgical contexts remain absent. To address this limitation, we present SurgVLA-Bench, the first comprehensive benchmark for evaluating VLA models in laparoscopic surgical robotics. Leveraging the SurRoL simulation platform, we construct a hierarchical task taxonomy ranging from atomic actions to complete surgical procedures, complemented by a multi-dimensional evaluation framework assessing action accuracy and semantic consistency. We then systematically evaluate two representative paradigms, including autoregressive models such as OpenVLA, and flow matching models such as $π_{0}$, $π_{0.5}$, and SmolVLA. Our experiments show that autoregressive models tend to excel in semantic understanding, while flow matching models often achieve higher task precision but may face generalization trade-offs. However, even the best-performing models remain far from satisfactory, as the constrained endoscopic field of view, restricted viewing angles, and frequent occlusions persist as fundamental physical bottlenecks. The code and data are available at https://github.com/VCL-HNU/SurgVLA

Robot-assisted minimally invasive surgery improves surgical precision but introduces complexity, making technical error detection essential for ensuring patient safety. Current executional error detection methods using video data often overlook fine-grained contextual descriptions of activities and error types within the hierarchical structure of surgical procedures. They also under-utilize complementary multimodal information. We propose a unified framework for executional error detection that leverages multimodal input, including video, kinematics, and descriptive textual prompts. Through activity prompting, we integrate descriptive language in gesture-level activities, instrument-object interactions, and error definitions. We also introduce activity-aware visual embeddings derived from vision encoders pretrained on surgical activity labels to compare the effectiveness of contrastive language-image embeddings with traditional image-based embeddings for error detection. By seamlessly integrating kinematic data with video and textual modalities, our framework significantly improves error detection performance. Achieving up to 5% and 16.6% F1 score improvements over state-of-the-art baselines on the JIGSAWS and SAR-RARP50 datasets, respectively, we demonstrate the value of combining curated textual prompts with multimodal data for accurate error detection.

Background: Laparoscopic camera navigation (LCN) is a critical skill, yet its current assessment typically relies on manual rating systems which are time-consuming and difficult to scale. Automated feedback could significantly enhance surgical training by providing immediate, standardized metrics. This study aims to define, clinically evaluate the relevance, and establish the technical readiness of a set of approaches for LCN assessment. Methods: We developed a detailed taxonomy of 14 key aspects of camera navigation, categorized into Framing & Composition, Visibility & Clarity, Orientation & Stability, Motion & Dynamics, and Safety & Awareness. For each aspect, we assessed the technological readiness of automated measurement based on the current state of the art (SoTA) in computer vision (CV). To establish clinical relevance, we designed a survey for practicing laparoscopic surgeons to rate the importance of each aspect on a 5-point Likert scale and to select the five most critical skills. Results: 23 surgeons participated in the survey. Foundational aspects like Field of View, Focus and Centering were rated as most important by surgeons. We present a "Clinical Importance vs. CV Technological Readiness" matrix, identifying high-priority targets for development--aspects that are both clinically crucial and technologically ready to measure. Conclusion: This work establishes a foundational framework for quantifying LCN skills. By aligning surgeon priorities with CV capabilities, we provide a clear roadmap for automatic skill assessment. This foundation enables the development of AI-driven assistance tools that can accelerate the learning curve for surgical assistants and potentially improve surgical safety and efficiency.

In robot-assisted laparoscopic minimally invasive surgery (MIS), accurate enforcement of the remote center of motion (RCM) constraint is critical for safe and stable automatic field-of-view (FoV) adjustment. Although control-based RCM strategies are widely adopted due to their flexibility and cost-effectiveness, systematic comparison of different RCM formulations and image-based visual servoing (IBVS) frameworks remains challenging due to the lack of a unified and reproducible benchmark. This paper presents an open-source simulation framework integrating three representative RCM modeling approaches and six IBVS-based control architectures within a unified velocity-level formulation, enabling controlled and consistent evaluation. Through structured case studies, the framework reveals key structural sensitivities arising from modeling and controller interactions, including the impact of tangent-plane definition, constraint dimensionality, open- versus closed-loop enforcement, and robustness near kinematic singularities. All resources are released and demostrations are provided in the supplementary video, providing a reproducible foundation for RCM-constrained visual servoing research.

Robot-Assisted Surgery is integral to modern minimally invasive procedures, with automation emerging as the next frontier to enhance precision and reduce surgeon fatigue. This evolution is largely impeded by the inherent kinematic inaccuracies of surgical robots, where unreliable internal sensors lead to significant control errors. While previous methods attempted to mitigate these issues through complex model-based calibration, they often suffer from high cost and limited effectiveness. This work utilises a learning-policy to actively compensate for hardware inaccuracies using closed-loop visual feedback that was trained from a teacher-student learning framework. The policy can fuse unreliable internal readings with precise external visual data, allowing it to correct for kinematic errors in real time without needing a perfect physical model. The learned policy was successfully deployed on the da Vinci Research Kit, where experiments validated the fundamental feasibility of using external vision to overcome internal sensor deficits. This research provides a foundational and reliable control methodology, paving the way for more advanced and robust surgical automation.

In minimally invasive surgical robotics, catheter-scale Fiber Bragg Grating (FBG) sensors are promising due to their ability to estimate multi-dimensional forces by multiplexing several optical channels. However, deploying these compact multi-channel sensors introduces two critical engineering challenges: inherent nonlinear cross-axis coupling during complex deformations, and intermittent channel dropouts caused by fiber fractures in constrained workspaces. These compounding issues severely degrade force estimation. Existing fault-tolerant approaches rely on combinatorial model banks, which scale exponentially with the channel count and demand prohibitively expensive per-pattern calibration. In this paper, we propose a unified, self-supervised mask-aware Transformer that explicitly models channel availability to enable graceful degradation under diverse and dynamic sensor failures. The encoder is pretrained via masked-channel reconstruction on unlabeled data streams and fine-tuned for force regression using a balanced clean-and-corrupted-view objective alongside a dynamic corruption curriculum. Furthermore, a parallel uncertainty head, trained via heteroscedastic Gaussian negative log-likelihood, predicts per-axis confidence in a single forward pass, circumventing the overhead of multi-pass ensembles. Evaluated on a catheter-scale 8-channel FBG dataset, our single unified model achieves a nominal Root Mean Square Error (RMSE) of 0.0066N and degrades gracefully to 0.0126N under severe 4-channel failures. This significantly outperforms a comprehensive model bank of 255 per-pattern neural networks (0.0154~N at 4-channel loss) while eliminating pattern-specific calibration.

Visual Question Answering (VQA) in robotic surgery, referred to as surgical VQA, requires high-level understanding of complex surgical scenes and the integration of visual perception with language reasoning, with the potential to support surgical training and intraoperative decision-making. Recent Vision-Language Models (VLMs) have shown promising performance through parameter-efficient fine-tuning; however, most existing approaches rely on coarse visual grounding, typically limited to bounding boxes, which fails to capture the fine-grained spatial structure of surgical objects. In this work, we propose a unified framework that jointly performs pixel-level segmentation and visual question answering within a single framework. Our approach integrates a VLM with a Segment Anything Model (SAM)-based decoder and represents scene elements as object tokens generated by the VLM. These object tokens guide answer prediction and are further projected to the SAM-based decoder to produce segmentation masks. By optimizing the object token embeddings through both segmentation and question answering objectives, the model learns spatially grounded representations that enhance visual reasoning while providing explicit pixel-level grounding. We evaluate the proposed method on the private RAMIE (Robot-Assisted Minimally Invasive Esophagectomy) dataset and the public EndoVis18 dataset, where it consistently outperforms baseline methods for surgical VQA. These results demonstrate that incorporating context-aware object tokens into vision-language models improves fine-grained surgical scene understanding.

Partial-to-full registration remains challenging due to varying overlap ratios, fluctuating point densities, and the presence of noise. While transformers have shown strong potential for point cloud processing, prior methods typically confine them to global context aggregation, overlooking fine-grained local geometry crucial for accurate correspondence. We propose \emph{GAPR-Net}, a learning-based point cloud registration framework with a coarse-to-fine architecture that combines convolution and transformer modules, in which local and global information is fused between the partial and full point clouds using a cross-attention mechanism. To achieve this, a transformation-invariant point-wise geometric feature representation is proposed, which can robustly capture relative geometric features for individual points with respect to their neighboring points. To evaluate the effectiveness of the proposed approach, experiments are conducted on four geometrically distinct bones, including the tibia, femur, pelvis, and thoracic cartilage. The overall registration recall reaches 94.2%, the method results in a low RMSE of 1.992 mm and $R^2$ values of 0.908 and 0.974 for rotation and translation, respectively. The results demonstrate that the proposed method effectively addresses the partial-to-full point cloud registration problem. The proposed method enables highly accurate 3D point cloud registration using partial observation, providing a critical foundation for precise surgical navigation and robotic interventions in computer-assisted surgery. The code will be accessed after the double-blind review process.

In this paper, we address the development of an adaptive assistance system for robot-assisted laparoscopic surgery, specifically for delicate tasks such as Resection and Dissection. Even if Virtual Fixtures offer significant advantages for guiding a surgeon's movements, conventional Virtual Fixtures are often defined by fixed geometries, lacking the flexibility to adapt to the surgical workflow or the surgeon's immediate intent. To address these limitations, we propose a novel framework for an adaptive and anisotropic virtual fixture. In addition, we introduce an intuitive control interface that modulates the fixture's geometry in real-time based on the surgeon's intent, inferred from EMG signals. This approach allows the surgeon to dynamically expand or disengage the constraint by contracting their forearm muscles, enabling seamless transitions between precise guided motion and free repositioning of the tool. Experimental results from a pilot user study, based on a standardized surgical training task, demonstrate the effectiveness of the proposed method. The system showed significant improvements in task accuracy and movement consistency, alongside a reduction in perceived cognitive load, effort, and frustration.

Advanced surgical robotics has made robot-assisted endoscopic submucosal dissection (ESD) a promising approach for the en-bloc resection of large lesions, with the potential to reduce recurrence and improve long-term outcomes. However, the technical complexity and risk of complications in ESD demand stable and precise visual guidance to maintain an accurate dissection corridor and a safe tissue margin. Dense confidence fields provide an effective representation for this purpose by describing both the preferred dissection region and its spatial transition to surrounding tissue. However, reliable confidence field estimation remains challenging in dynamic endoscopic scenes due to smoke, specular highlights, tissue deformation, weak texture, and the thin geometric structure of the target region. To address these challenges, we formulate dissection guidance as a geometry-aware confidence field estimation problem and propose GeoCFNet, a geometry-aware confidence field network built on a pretrained DINOv3 backbone. GeoCFNet integrates a Token-Differentiated Fusion module to aggregate class-token context with dense patch representations, a SegFormer decoder for confidence regression, and Geometry-Aware Spatial Regularization (GASR) to preserve spatial coherence and local geometric transitions. Experimental results show that GeoCFNet achieves RMSE 0.0480, PSNR 27.1995, SSIM 0.3397, and CC 0.2466, indicating accurate and geometrically stable confidence field estimation for robot-assisted ESD guidance.

High-risk applications in robotics, such as robot-assisted surgery, present unique challenges. These systems must be both highly precise and interpretable in order to be deployed in environments with very low tolerance for error or unsafe exploration. We present the first robotic system to demonstrate autonomous clip positioning on a physical phantom in laparoscopic surgery, one of the most common interventions in general surgery. After segmentation of a colorless point cloud from a single camera, target positions for the clips are extracted using spline interpolation, and can then be adjusted by the human operator. The segmentation model is trained on only 60 hand-labeled real point clouds, reflecting data scarcity in the surgical domain. We overcome this with a combination of pre-training on 128,000 synthetic point clouds and two novel data augmentation techniques. The motion of the end-effector to each target is visualized for the operator, satisfying the unique motion constraints of minimally-invasive surgery while ensuring that the robot's actions are verifiable and interpretable. In real robot experiments, our system localizes targets with the required precision of 0.75mm at a 95% success rate and executes autonomous clip positioning with a 100% success rate. We provide insights that are applicable to many other surgical and non-surgical tasks that require identifying and navigating to a precise target. Source code and project page: https://github.com/balazsgyenes/kirurc

Learning-based policies are being considered to augment the dexterity of human surgeons in robot-assisted surgery. Can the end-to-end mapping from visual observations to robot actions be vulnerable to adversarial attacks, potentially leading to patient injury? In this paper, we present the first study of adversarial threats to learning-based policies in surgical robotics. We investigate two threat modes: (a) disruptive attacks, where imperceptible visual perturbations interrupt policy execution, and (b) steering attacks, where such perturbations steer policy actions toward attacker-specified directions. We formulate three adversarial attack methods, each with increasing access to policy information, and evaluate their impact on two surgical subtasks: debridement and suturing. Our evaluation covers three end-to-end policy architectures: ACT, Diffusion Policy, and Pi0. In addition, we introduce a new class of photometric adversarial attacks that mimic natural visual changes, such as lighting variations, to generate effective yet visually plausible perturbations. Results from 560 physical experiments using phantoms for debridement and suturing suggest that state-of-the-art policies can be significantly disrupted, resulting in an average 61% reduction in surgical subtask success rates. Project page: https://sites.google.com/view/adversary-surgery

In this paper, we present a robotic ultrasound acquisition system that integrates stereo vision, touch-based feedback, and expert-informed strategies to perform autonomous and adaptive abdominal scans. The system records freehand motion and force data from expert radiologists, creating a framework to capture transducer motion, applied forces, and anatomical scanning strategies. This expert data is replayed to replicate characteristic scans with the robot, forming a foundation for further autonomous capabilities. Using stereo vision, the system generates three-dimensional topography maps of the patient's abdomen, which are refined through stiffness measurements at key points to delineate the rib cage boundary. These combined techniques enable the robot to execute two distinct scanning paths: an upward-angled sweep beneath the rib cage to visualize structures near the upper abdomen and a perpendicular sweep across soft tissue regions. A compliant, torque-controlled seven degree-of-freedom robotic manipulator is controlled to maintain consistent probe contact through closed-loop force control over the varied anatomical surfaces. Physical experiments demonstrate that the system achieves high-quality imaging comparable to expert scans while dynamically adapting to patient-specific topographies. Furthermore, the robotic system surpasses expert capabilities by enabling three-dimensional volume acquisition, which enhances diagnostic potential and provides volumetric data for advanced analyses. This work highlights the integration of expert knowledge into autonomous robotic systems and underscores the potential of combining perception-based autonomy with physical reasoning for enhanced diagnostic performance.

The handling and assembly of instruments during surgery imposes high cognitive demands on scrub nurses, particularly when instruments are unfamiliar. We present a supporting guidance system for surgical instrumentation that combines multi-camera 6D pose estimation with augmented reality in-situ visualization on a head-mounted display without the requirement for additional markers. Pose estimation and consecutive camera calibration are achieved through known objects. The 6D pose estimation network is trained purely on synthetic data, aiming for better generalizability and real-world applicability. The AR guidance displays tooltip localization cues and step-wise assembly animations. Via gaze-based selection and a foot pedal, users can switch between assembly steps in intraoperative use. In a technical evaluation, our approach outperforms state-of-art 6D pose estimation. A user study with 29 scrub nurses was conducted in a surgical simulation of knee arthroplasty, comparing the system against a paper manual. AR guidance significantly reduced the perceived workload compared. Objectively, AR guidance reduced task completion time by 21.3% (4.76 minutes). Specifically, scrub nurses less experienced with the instrument set benefited when using the system. Error frequencies were comparable between conditions. Qualitative feedback highlighted improved process clarity, reduced information overload, and perceived independence. To summarize, our marker-free multi-camera AR guidance approach for surgical instruments can, subjectively and objectively, improve intraoperative instrumentation performance, particularly for untrained scrub nurses.

Robot-Assisted Minimally Invasive Surgery (RAMIS) enhances surgeon dexterity, with newer platforms leveraging haptic feedback to further improve performance. Such force information has broader potential to inform performance assessment, tactile localization, and surgical autonomy. This motivates the need for accessible approaches to integrating force sensing into RAMIS tools. This work presents a method for integrating a six-axis commercial force sensor into the distal end of a standard cable-driven surgical instrument, enabling end-effector force measurement while preserving the original mechanical functionality of the device. The proposed design emphasizes reproducibility and accessibility for research applications, requiring no specialized manufacturing tools. A transformer neural network integrates force sensor measurements with robot state information to aid estimation of applied forces at the end-effector, compensating for internal cable forces arising from actuation. Our proposed approach achieved normalized errors below 6%, and generalized to unseen conditions better than purely proximal data-driven sensing approaches. High internal cable forces caused sensor saturation and reduced axial force observability, which can degrade performance along the tool's major axis and under higher load conditions. Given current levels of performance, the balance of system integrability and performance enables applications and research into timely topics of haptic feedback, skill assessment, and force-informed autonomy in RAMIS. Videos and code are available at https://enhanced-telerobotics.github.io/shaft_force_sensing/.

This study presents the first evaluation of general-purpose imitation learning for surgeon-robot collaborative assistance in open surgery, targeting suture following: the grab-pull-release motion an assistant performs at every stitch. We collect 160 teleoperated demonstrations (32,374 frames) on an open-source robot arm, benchmark four architecturally diverse imitation learning policies (ACT, Diffusion Policy, SmolVLA, $π_0$) across 28 trained models evaluated in 32 configurations along three clinically motivated dimensions: dataset size, camera viewpoint, and background variation. Our results demonstrate that under ideal conditions, the four policies achieve $50$-$75\%$ task success, with depth error as the dominant failure mode across all architectures. Among all policies, $π_0$ achieves the strongest results with a pretrained vision-language backbone, demonstrating superior data efficiency, greater robustness to background variation, and smoother trajectories compatible with surgical workflow. When deployed in a surgeon-robot suturing trial, $π_0$ yields a $92\%$ stitch completion rate. These findings establish collaborative robotic assistance in open surgery as a feasible target for imitation learning and highlight depth perception and end-effector design as key priorities for clinical translation.

Surgical instrument pose estimation provides crucial information for promising applications, including autonomous robotic surgery, skill assessment, and standardization of surgical workflow. However, this task remains highly challenging due to high precision requirements, frequent occlusions, textureless instruments, scarcity of depth information and very limited annotated data. These constraints often lead to unsatisfactory performance when employing general object pose estimation approaches to surgical scenarios. To address these issues, we first construct a new dataset SynSurg6D, to alleviate the data shortage in this task. We further propose SurfSurg6D, a dense-correspondence framework tailored for surgical instrument pose estimation. Experimental results on the SurgRIPE, EndoVis2018 and SurgPose datasets demonstrate that the introduction of our generated dataset SynSurg6D is able to diversify the pose distributions, thus enhancing the performance of existing approaches. Furthermore, SurfSurg6D outperforms existing methods, providing a robust solution for precise and efficient RGB-only pose estimation.

We present a kinematic and transmission-aware design framework for a serial spherical mechanism with an additional translational degree of freedom for microsurgery. The first contribution is an analytical workspace formulation that provides geometric insight into reachable motion and enables rapid selection of rotation axis orientations without numerical optimization. The second contribution is a dynamics-informed methodology for mechanisms driven by self-locking transmissions, supporting evaluation of torque requirements for a prescribed workspace geometry. The framework is accompanied by an open-source software package for friction identification and inverse dynamics analysis. Experiments on a purpose-built robotic tool for vitreoretinal surgery validate the predictive capability of the models and demonstrate their practical utility for engineering design.

Understanding surgical workflow in real time is fundamental for intelligent surgical embodiment, where AI systems continuously perceive and respond as surgery proceeds. In the operating room, critical decisions depend on subtle, moment-to-moment changes, such as fine instrument movements and evolving tissue states, where even slight perceptual delays can limit assistance or compromise safety. Yet existing methods remain offline or operate at coarse temporal scales, generating descriptions only after processing clips, preventing immediate reaction. We address this by proposing SurgOnAir, a streaming vision-language model that processes frames sequentially without future access and progressively generates narration tokens as visual input arrives. SurgOnAir achieves fine-grained frame-to-token generation, enabling instant responsiveness to evolving surgical dynamics. Built upon our curated hierarchical dataset SurgOnAir-11k spanning action-, step-, and phase-level supervision, the model is trained to produce multi-level textual responses that reflect the inherent hierarchy of surgical procedures. Furthermore, special transition tokens are generated to explicitly mark state changes, allowing SurgOnAir to capture and signal key workflow transitions as they occur. Experiments show that SurgOnAir enables real-time understanding through a single vision-language model that unifies streaming across multiple hierarchies of the surgical workflow, generating superior and hierarchy-aware narrations. Code and dataset will be public.

In various surgical procedures, regions of interest (ROIs) such as organs or lesions are often occluded by overlying tissues, requiring surgeons to achieve adequate exposure for precise intervention. However, the irregular geometry, nonlinear biomechanical properties of overlying tissues, and limited intraoperative visibility of the ROI pose significant challenges to the autonomous execution of tissue retraction. To address this, we formulate a realistic model of the tissue retraction task and propose a learning-based adaptive control framework for achieving ROI exposure. The method optimizes control inputs online by monitoring changes in the visual boundary of the tissue, while leveraging a deep deformation estimation model trained on simulation data to identify the optimal grasping point and ensure the convergence and safety of the adaptive controller. Through simulations and real-world experiments on different deformable materials, it has been demonstrated that this framework exhibits zero-shot adaptation to similar tasks and can complete the autonomous retraction process, from initial grasp selection to full ROI exposure. Therefore, it has the potential to be applied in actual surgical assistance scenarios.

Flexible endoscopic robots enable minimally invasive access through natural orifices, but their control accuracy is limited by configuration-dependent hysteresis in the tendon-sheath mechanisms (TSMs). Tendon-sheath friction and tendon elasticity induce a systematic discrepancy between the proximal actuation input and distal output, and this discrepancy varies with the insertion tube configuration. To address this challenge, this paper proposes the Self-Sensing Tendon Loop (SSTL), a double-pass tendon loop routed through the insertion tube and wrapped around a distal pulley, and returned to the proximal end. The loop structure allows both the input and output tensions of the SSTL to be measured proximally, thereby providing an input-output tension profile without requiring distal force or fiber-optic sensors. Because the SSTL shares the same routing path as the actuation TSM, the two TSMs exhibit strongly correlated hysteresis behaviors. From the SSTL tension profile, a learning-based mapping estimates the configuration-dependent hysteresis parameters of the actuation TSM, which are then used by a feedforward controller to compensate for actuation hysteresis. We validate the proposed method by tracking actuation tendon tension under three different insertion tube configurations. Across sinusoidal and random trajectories, the proposed method reduces average RMSE by 88.1% compared with the uncompensated baseline, achieving 97.8% of the performance of direct identification, which requires direct measurement of the input and output tension profile of the actuation TSM.

In robot-assisted minimally invasive surgery, high-fidelity dynamic endoscopic scene reconstruction and simulation are crucial to enhancing downstream tasks and advancing surgical outcomes. However, existing methods primarily focus on visual reconstruction, lacking physics-based descriptions of the scene required for realistic simulation. We propose a unified framework that achieves physics-aware reconstruction and physical simulation of endoscopic scenes through Multi-modal Large Language Models (MLLMs)-guided Gaussian Splatting. Our approach utilizes 4D Gaussian Splatting (4DGS) integrated with pre-trained segmentation and depth estimation to represent deformable tissues and tools. To achieve automatic inference of physical properties, we introduce an object-wise material field that initializes material parameters via MLLM and refines them through a differentiable Material Point Method (MPM) under joint supervision from rendered images and optical flow. Validated on both open-source and in-house datasets, our framework achieves superior simulation fidelity and physical accuracy compared to state-of-the-art methods, underscoring its potential to advance robot-assisted surgical applications.