Surgical Robotics

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.

Autonomous endoscopic navigation can reduce clinicians' operational burden, yet robust control remains challenging due to tissue deformation, transient occlusions, and rapidly changing viewpoints. Existing learning-based policies typically predict actions from current observations without explicitly modeling future dynamics, limiting their robustness and reliability in safety-critical settings. World Action Models (WAMs) offer a promising alternative by coupling predictive visual dynamics with action generation, but extending them to robotic endoscopy remains challenging due to limited training data, restricted viewpoint diversity, deformable anatomy, and high inference latency. We present EndoWAM, which is, to our knowledge, the first WAM for generalizable robotic endoscopic navigation. EndoWAM introduces future grounding, which predicts task-relevant target regions in future observations from intermediate denoising features of a video world model. Specifically, EndoWAM couples a lightweight diffusion transformer for future target-region prediction with a discrete action expert through a shared predictive representation. This design injects target-aware supervision into predictive dynamics modeling, improving robustness to visual degradation and viewpoint changes while enabling real-time control in a single denoising pass. We further introduce EndoMotion, a robotic endoscopic motion dataset spanning three anatomically distinct procedures: ureteroscopy, esophagoscopy, and endoscopic retrograde cholangiopancreatography (ERCP). EndoWAM consistently outperforms all baselines and alternative grounding strategies, while demonstrating strong zero-shot generalization to unseen viewpoints, environments, and targets. These results establish EndoWAM as a predictive, target-grounded framework for accurate, generalizable, and long-horizon navigation in visually constrained endoscopic environments.

Reconstructing dynamic surgical scenes is crucial for robot-assisted minimally invasive surgery; however, it continues to be difficult because of tissue deformation, occlusions, specular reflections, and restricted viewpoints. In this study, we introduce Endo-NeRF++, a neural rendering framework that accounts for uncertainty in the reconstruction of dynamic surgical scenes. Expanding on EndoNeRF, the suggested approach incorporates multi-resolution hash-grid encoding, temporal feature merging, and uncertainty-informed adaptive sampling to enhance reconstruction accuracy and temporal coherence in deformable endoscopic scenes.The multi-resolution hash-grid representation within the framework effectively captures both coarse and fine anatomical details, while temporal feature blending ensures stable reconstruction during tissue deformation and surgical tool occlusions. Additionally, uncertainty-driven adaptive sampling assigns more samples to uncertain areas to enhance rendering quality and geometric coherence. Experiments on robotic surgical video sequences demonstrate that the proposed uncertainty-guided adaptive sampling improves PSNR by up to 1.22dB (4.3%), increases SSIM by up to 5.3%, and reduces LPIPS by up to 55.1% compared with the EndoNeRF baseline.

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.

Fenestrated/Branched endovascular aneurysm repair (FEVAR/BEVAR) require surgeons to navigate catheters and guidewires into various branches of the abdominal aorta, before deploying stent grafts to alleviate pressure on the aneurysm. Previous clinical studies suggests that surgeons continue to struggle with vessel access using standard commercial instruments, prolonging the procedural time and inducing further complications. In this work, we present two contributions to solving this problem: 1) A bespoke 2-segment steerable catheter, consisting of 4 degrees of freedom to enhance dexterity. 2) An expandable, modular tendon-driven actuation platform that can accommodate for the redundancies introduced in our system. To fabricate the catheter, we capitalized on thermal fiber drawing, a technique that creates high-aspect ratio devices at scale, and processed the catheter with laser micro-machining to soften its tip. We evaluated the system using simulations, where we investigated the catheter's bending stiffness, then its steerability with in-vitro experiments in vascular phantoms. This handheld, robotic steerable catheter system has the potential to shorten the length of future endovascular surgeries, and give clinicians the tools to resolve challenging clinical cases.

An endovascular intervention begins with a skilled clinician manually navigating a long, slender wire, called a guidewire, to the target location within the vasculature. Due to factors, such as vessel tortuosity and lack of steerability at the guidewire tip, manual navigation of a guidewire could be challenging, potentially resulting in vessel damage, perforation, dissection, and occlusion, as well as postsurgical complications, such as thrombosis. This work details the development of a handheld actuation mechanism for tendon-driven robotic guidewires by utilizing the aforementioned spooling mechanism. Incorporating the compact spooling mechanism into a handheld device enables clinicians to leverage both motorized guidewire steering and manual rotation and translation, if desired. The proposed device is designed such that, while holding the device, the clinician can execute feeding, rotation, and bending motions for up to 1.5 m of the robotically steerable guidewire using a joystick and momentary switch on the handle. Furthermore, the proposed device is demonstrated through navigation in an anatomically accurate phantom aorta model.

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.

Steerable catheters are the primary tool for cardiac electrophysiology (EP) procedures including radiofrequency ablation, where the tip must be positioned precisely at target tissue while maintaining controlled, stable contact. The central control problem is therefore not merely tip tracking and not merely force regulation; it is the regulation of \emph{catheter--tissue interaction dynamics}. The interaction state must encode how the tip moves relative to tissue, how persistent friction and contact forces bias that motion, and how safety limits reshape what motion is physically allowable. Existing methods regulate these interaction dynamics through different mechanisms. Classical impedance control~\cite{hogan1985} shapes the tip port as a virtual mechanical impedance $Z(s) = M_d s^2 + D_d s + K_d$, providing passive compliance without an explicit contact model. Three complementary design requirements motivate the present formulation: \textbf{(i)}~an explicit force-related constraint, \textbf{(ii)}~compensation for steady error under persistent loading, and \textbf{(iii)}~a prediction model that can incorporate trajectory and actuator information.

Safe navigation within the spinal subarachnoid space is constrained by its narrow, compliant, and delicate anatomy. Conventional catheters and continuum robots rely on proximal pushing, generating friction and shear along the tissue device interface that limit distal controllability and increase the risk of neural injury. Here, we present a 2 mm diameter eversion-growing robotic platform that enables friction minimised extension and steering within the human spinal subarachnoid space, validated through computational modelling, phantom experiments, and intact human cadaver studies. The robot integrates a miniature endoscope for real time intrathecal visualisation and advances by pressure driven tip eversion, localising motion to the distal tip while minimising translational sliding of the deployed body. Phantom experiments demonstrated reductions of 65.2% in mean interaction force and 48.0% in peak interaction force compared with matched push-based insertion. Physics based modelling showed that eversion based growth redistributed tissue loading, reducing local stress concentrations and interfacial shear relative to conventional insertion. In an intact human cadaver, the system achieved 150 mm of controlled intrathecal extension with concurrent fluoroscopic and endoscopic visualisation, providing access across multiple vertebral levels from a standard lumbar entry point. Postprocedural laminectomy and durotomy revealed no observable macroscopic disruption of the dura mater or surrounding neural structures. These results provide the first mechanically characterised and multimodally validated demonstration of eversion-based robotic navigation in intact human spinal anatomy, establishing a quantitative and procedural foundation for future intrathecal interventions. Further validation in larger anatomical cohorts and under physiological conditions will be required before clinical translation.

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/

Surgical tissue retraction requires effective manipulation planning under partial and noisy perception. We study state estimation for deformable tissue retraction, where only sparse observations of the tissue surface are available at decision time. We propose a learned state estimator that reconstructs the full deformable mesh state from 40 noisy vertex observations. The estimator combines a multilayer perceptron with a low-dimensional PCA latent representation and is trained using geometry-aware regularization that encourages smooth and physically plausible deformations. We evaluate the approach in a 2D deformable sheet simulation using single-step and multi-step retraction planning. Results show that the learned estimator achieves 98.1% of oracle performance in multi-step retraction while supporting efficient inference. These results demonstrate that learned, geometry-regularized state estimation can support effective deformable manipulation under realistic perception constraints.

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.

Robot-assisted endovascular intervention can potentially reduce radiation exposure, improve surgeon ergonomics, enable telesurgery, support active assistance and autonomy, and enhance procedural precision. However, existing systems often suffer from limited procedural coverage because constrained patient-side setups, restricted flexibility, and complex instrument exchange hinder clinical workflow integration. This work presents a compact robotic system for endovascular interventions that enables continuous translational and rotational manipulation of standard endovascular instruments. The system consists of two alternating carts with pneumatically actuated membrane grippers integrated into rotating gripper gears. Its top-loading design allows rapid exchange of instruments such as guidewires and catheters without changing the robotic setup. A leader-follower control strategy enables continuous motion despite the finite stroke of each cart. The system was evaluated in motion-tracking experiments with guidewires and catheters and in an in vitro vascular phantom. The motion-tracking experiments showed generally smooth translational and rotational motion profiles. Across all tested guidewire and catheter experiments, the mean relative tracking errors were 3.6% for translational motion and 4.1% for rotational motion. In the vascular phantom, robot-assisted navigation reached the target in most trials, demonstrating the feasibility of the proposed manipulation concept under in vitro conditions. The presented robotic system demonstrates technical feasibility for continuous manipulation of standard endovascular instruments in bench-top and in vitro experiments. The compact top-loading design may ease instrument exchange and clinical workflow integration. Future work will focus on improving gripping performance, actuation speed, force feedback, and evaluation in more clinically realistic settings.

Conventional colonoscopy remains limited by patient discomfort and procedural risks, motivating research into compliant robotic alternatives. Eversion robots, which advance via pressure-driven tip growth, eliminate sliding friction against the colon wall and offer a less intrusive approach to traversal. However, no existing design simultaneously satisfies all clinical requirements. This paper benchmarks four recent eversion robot architectures against the key anatomical and clinical constraints of colonoscopy, including colon length, minimum luminal diameter, bending angle, and working-channel needs. We identify the central trade-offs each design reveals, particularly the difficulty of integrating steering and payload delivery without sacrificing the soft, low-friction behaviour that makes eversion robots attractive. We then provide design guidance across material selection, steering strategy, and payload delivery, and highlight open problems for clinical translation.

Mechanical thrombectomy (MT) is a time-critical intervention for acute ischemic stroke; however, access remains limited due to a shortage of neuroradiologists and specialized centers. Reinforcement learning (RL) offers potential to automate endovascular navigation and improve accessibility, yet current models lack standardized frameworks to assess navigation difficulty for model training and evaluation. This study aims to identify vascular metrics associated with navigation difficulty and to develop an automated pipeline for quantitative vascular feature extraction, enabling future complexity grading. Vascular trees were segmented from computed tomography angiograms from 61 patients, and vascular metrics including aortic arch type, presence of bovine arch, vessel length, tortuosity, take-off angle, number of reverse curves, were measured using a custom pipeline. A Soft Actor-Critic RL algorithm was used for 120 s autonomous navigation. Outcomes were analyzed using both mixed effects linear and logistic regression. On the left side, the presence of a bovine arch and aortic arch type II/III increased navigation time by 30.19 s and 37.92 s, respectively, while greater tortuosity (\b{eta} = 118.20) further prolonged the procedure and reduced success probability. On the right side, type II/III arches extended procedure time by 45.94 s, while each additional reverse curve was associated with 3.96 s longer navigation time and lower probability of success. These findings demonstrate for the first time that MT agent navigation difficulty is strongly influenced by vascular geometry. The proposed automated pipeline enables objective and quantitative characterization of vascular features, providing a foundation for future development of standardized complexity grading and RL model evaluation, without aiming to demonstrate clinically generalizable autonomous navigation.

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.

Objective: To evaluate robotic controller interfaces for interventional neuroradiology procedures in-vitro incorporating a force-sensing platform to assess safety. Methods: A custom endovascular robot, device-mimicking controller, and sensorized neurovascular phantom were developed. Ten interventional neuroradiologists (4 novices, 6 experts) performed simulated navigations using four control modalities: device-mimicking controllers with and without haptic feedback, joystick-based input, and manual navigation. Navigation time, peak vessel-wall forces, incorrect catheterisations, and prolapse events were assessed, alongside user analyses. Results: Manual navigation was fastest (mean 47.7 s) compared to haptic-on (248.7 s), haptic-off (314.7 s), and joystick (392.6 s) modalities (p<0.001). Regardless of controller type, vessel-wall forces were below the 0.70 N puncture threshold; therefore all modalities were considered safe. Joystick produced significantly more prolapse events than manual control (1.56 vs 0.13; p=0.018). Operator experience was relevant to performance: experts made fewer incorrect catheterisations than novices (0.25 vs 0.62; p=0.035) and applied less vessel-wall force (p<0.0005); these effects were sustained across controllers but accentuated when haptics were on. Users perceived haptic on and haptic off as similarly intuitive, and more intuitive than joystick (p=0.033). Conclusion: Device-mimicking robotic controllers outperform joystick interfaces on most metrics; haptic feedback shows promising but non-significant performance benefits.

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.

Endovascular interventions are high-stakes procedures requiring precise device operation within complex and tortuous vascular anatomies. Autonomous endovascular navigation has the potential to standardize procedural quality and reduce the performance variability inherent in manual operation. Although Reinforcement Learning (RL) approaches have demonstrated promise in enabling autonomy in endovascular intervention, they often struggle with explicit constraint satisfaction and safety guarantees. To address these challenges, a learning-based expert strategy is introduced, enhancing procedural consistency in autonomous endovascular intervention by explicitly decoupling high-level strategic decision-making from low-level procedural execution. The proposed framework replicates the expert clinical decision-making process: a strategic RL policy generates global navigation intents, which are subsequently refined through an expert-informed execution module. This module ensures that robot movements strictly adhere to expert operational norms, real-time kinematic limits, and vessel safety constraints. Experimental evaluation across high-fidelity 3D simulations and a real-world robotic platform demonstrates that the proposed framework not only outperforms baseline policies but also effectively replicates expert-level proficiency. The framework achieves a high navigation success rate (> 96%) and a 29.3% reduction in operational steps, which translates to enhanced operative efficiency and minimized device-vessel interaction. Furthermore, a 13% reduction in trajectory variance indicates superior procedural standardization, aligning autonomous behavior with established clinical norms. These results underscore its potential to enhance the predictability, safety, and consistency of robotic endovascular interventions.

Robotic-assisted endovascular interventions demand accurate, stable, and context-aware guidewire navigation in complex and patient-specific vascular anatomies. Despite recent advances in robotic precision and learning-based control, existing autonomous navigation methods remain limited by their reliance on static reward functions and the lack of explicit procedural reasoning regarding anatomical context and task progression. To address these challenges, this paper proposes a vision-language procedural reasoning (VL-PR) framework for autonomous guidewire navigation. The framework integrates a multimodal large language model (MLLM) as a procedural reasoning module that interprets real-time visual observations to infer high-level navigation contexts. Instead of generating low-level control commands, the inferred procedural insights enable context-aware reward adaptation by dynamically adjusting the importance of reward components across different navigation phases. This approach allows a single policy to resolve competing objectives and handle complex transitions while preserving a consistent global task goal. Experiments on a physical robotic platform across diverse vascular scenarios demonstrate enhanced task reliability and streamlined navigational efficiency, highlighting the advantages over static-reward methods and offering a scalable solution for complex and multi-task robotic endovascular procedures.

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.

Endoscopic retrograde cholangiopancreatography (ERCP) demands precise endoscopic navigation and stable biliary cannulation within a narrow monocular field characterized by specular reflections, partial occlusions, and frequent tissue contact. Although recent robotic systems and vision-based assistance techniques improve operator ergonomics and provide perceptual cues, their performance degrades under pronounced anatomical variability and safety-critical visual artifacts, which hinders reliable autonomy in cannulation-grade procedures. Here, we present BiliVLA, a scene-aware Vision-Language-Action (VLA) framework that formulates biliary endoscopic navigation as an instruction-conditioned visuomotor learning problem. Given an endoscopic observation and a stage-specific language instruction, BiliVLA jointly predicts the target category, a grounded bounding box, and a discrete three-degree-of-freedom (3-DoF) motor command for a continuum endoscope. The proposed framework incorporates scene-aware supervision to improve semantic target consistency and safety-aware recovery supervision to induce conservative retreat behaviors under luminal wall contact. A key component of BiliVLA is a two-stage training paradigm that combines grounding-enhanced supervised fine-tuning (SFT) with Group Relative Policy Optimization (GRPO), thereby improving action reliability and decision consistency during closed-loop navigation. Across three ERCP subtasks, BiliVLA achieves the best overall performance in physical phantom experiments, with a total mIoU of 0.9625, an overall action precision of 91.96%, and an overall success rate (SR) of 84.85%. These results indicate that integrating semantic grounding, scene-aware learning, and reward-guided optimization strengthens perception--action alignment and enables more robust autonomous biliary endoscopic navigation.

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.