Surgical Robotics

Flexible endoscopic continuum manipulators offer high dexterity and access to complex anatomy, but nonlinear hysteresis limits feedforward control accuracy. Closed-loop control can compensate for these errors but requires accurate six-degree-of-freedom (6D) end-effector pose feedback. We present MarUco, a markerless 6D pose estimation framework for closed-loop control using only stereo vision during operation. A photorealistic pseudo-rigid-body simulation pipeline generates large-scale annotated training data without manual labeling. A multifeature fusion network integrates masks, keypoints, heatmaps, and bounding boxes from both stereo views to estimate an initial pose, followed by a learned single-pass render-and-compare module that refines the pose without iterative optimization. Kinematics-free hand-eye calibration estimates camera-to-robot-base extrinsics, and self-supervised adaptation uses unlabeled real stereo pairs to mitigate sim-to-real pose error. Across 1,000 real samples, MarUco achieves translation and rotation errors of 0.78 $\pm$ 0.50 mm and 3.07 $\pm$ 1.25°, respectively, with a total processing time of 52.4 ms per stereo pair. In closed-loop experiments over eight reference paths, MarUco achieves a mean terminal translation error of 1.8 mm, an 88% reduction relative to uncompensated open-loop control. To the best of our knowledge, this is the first markerless position-based visual servoing framework for continuum manipulators.

Electromagnetic navigation systems (eMNS) enable a number of magnetically guided surgical procedures. A challenge in magnetically manipulating surgical tools is that the effective workspace of an eMNS is often severely constrained by power and thermal limits. We show that system-level control design significantly expands this workspace by reducing the currents needed to achieve a desired motion. We identified five key system approaches that enable this expansion: (i) motion-centric torque/force objectives, (ii) energy-optimal current allocation, (iii) real-time pose estimation, (iv) dynamic feedback, and (v) high-bandwidth eMNS components. As a result, we stabilize a 3D inverted pendulum on an eight-coil OctoMag eMNS with significantly lower currents (0.1-0.2 A vs. 8-14 A), by replacing a field-centric field-alignment strategy with a motion-centric torque/force-based approach. We generalize to multi-agent control by simultaneously stabilizing two inverted pendulums within a shared workspace, exploiting magnetic-field nonlinearity and coil redundancy for independent actuation. A structured analysis compares the electromagnetic workspaces of both paradigms and examines current-allocation strategies that map motion objectives to coil currents. Cross-platform evaluation of the clinically oriented Navion eMNS further demonstrates substantial workspace expansion by maintaining stable balancing at distances up to 50 cm from the coils. The results demonstrate that feedback is a practical path to scalable, efficient, and clinically relevant magnetic manipulation.

In computer- and robot-assisted orthopedic surgery (CAOS), patient-specific surgical plans derived from preoperative imaging define target locations and implant trajectories. During surgery, these plans must be accurately transferred, relying on precise cross-registration between preoperative and intraoperative data. However, substantial modality heterogeneity across imaging modalities makes this registration challenging and error-prone. Robust, automatic, and modality-agnostic bone surface registration is therefore clinically important. We propose NeuralBoneReg, a self-supervised, surface-based framework that registers bone surfaces using 3D point clouds as a modality-agnostic representation. NeuralBoneReg includes two modules: an implicit neural unsigned distance field (UDF) that learns the preoperative bone model, and an MLP-based registration module that performs global initialization and local refinement by generating transformation hypotheses to align the intraoperative point cloud with the neural UDF. Unlike SOTA supervised methods, NeuralBoneReg operates in a self-supervised manner, without requiring inter-subject training data. We evaluated NeuralBoneReg against baseline methods on two publicly available multi-modal datasets: a CT-ultrasound dataset of the fibula and tibia (UltraBones100k) and a CT-RGB-D dataset of spinal vertebrae (SpineDepth). The evaluation also includes a newly introduced CT-ultrasound dataset of cadaveric subjects containing femur and pelvis (UltraBones-Hip), which will be made publicly available. NeuralBoneReg matches or surpasses existing methods across all datasets, achieving mean RRE/RTE of 1.83°/2.02 mm on UltraBones100k, 1.90°/1.56 mm on UltraBones-Hip, and 3.78°/2.80 mm on SpineDepth. These results demonstrate strong generalizability across anatomies and modalities, providing robust and accurate cross-modal alignment for CAOS.

Robotic laparoscopic surgery has gained increasing attention in recent years for its potential to deliver more efficient and precise minimally invasive procedures. However, adoption of surgical robotic platforms remains largely confined to high-resource medical centers, exacerbating healthcare disparities in rural and low-resource regions. To close this gap, a range of solutions has been explored, from remote mentorship to fully remote telesurgery. Yet, the practical deployment of surgical robotic systems to underserved communities remains an unsolved challenge. Humanoid systems offer a promising path toward deployability, as they can directly operate in environments designed for humans without extensive infrastructure modifications -- including operating rooms. In this work, we introduce LapSurgie, the first humanoid-robot-based laparoscopic teleoperation framework. The system leverages an inverse-mapping strategy for manual-wristed laparoscopic instruments that abides to remote center-of-motion constraints, enabling precise hand-to-tool control of off-the-shelf surgical laparoscopic tools without additional setup requirements. A control console equipped with a stereo vision system provides real-time visual feedback. Finally, a comprehensive user study across platforms demonstrates the effectiveness of the proposed framework and provides initial evidence for the feasibility of deploying humanoid robots in laparoscopic procedures.

Innovations in digital intelligence are transforming robotic surgery with more informed decision-making. Real-time awareness of surgical instrument presence and actions (e.g., cutting tissue) is essential for such systems. Yet, despite decades of research, most machine learning models for this task are trained on small datasets and still struggle to generalize. Recently, vision-Language Models (VLMs) have brought transformative advances in reasoning across visual and textual modalities. Their unprecedented generalization capabilities suggest great potential for advancing intelligent robotic surgery. However, surgical VLMs remain under-explored, and existing models show limited performance, highlighting the need for benchmark studies to assess their capabilities and limitations and to inform future development. To this end, we benchmark the zero-shot performance of several advanced VLMs on two public robotic-assisted laparoscopic datasets for instrument and action classification. Beyond standard evaluation, we integrate explainable AI to visualize VLM attention and uncover causal explanations behind their predictions. This provides a previously underexplored perspective in this field for evaluating the reliability of model predictions. We also propose several explainability analysis-based metrics to complement standard evaluations. Our analysis reveals that surgical VLMs, despite domain-specific training, often rely on weak contextual cues rather than clinically relevant visual evidence, highlighting the need for stronger visual and reasoning supervision in surgical applications.

Computed tomography (CT)-guided needle biopsies are critical for diagnosing a range of conditions, including lung cancer, but present challenges such as limited in-bore space, prolonged procedure times, and radiation exposure. Robotic assistance offers a promising solution by improving needle trajectory accuracy, reducing radiation exposure, and enabling real-time adjustments. In our previous work, we introduced a robotic platform designed for accurate needle insertion within the confined CT bore. However, its performance in clinical settings is restricted by limited dexterity and a constrained workspace. In this study, we present an 11-degree-of-freedom (DOF) robotic system that integrates a 6-DOF robotic base with an improved 5-DOF cable-driven end-effector, yielding a significantly expanded workspace and enhanced dexterity. To leverage the hyper-redundant degrees of freedom, we introduce a weighted inverse kinematics controller, along with a null-space control strategy to optimize maneuverability and dexterity. By using a task-oriented weight matrix as a hyperparameter, the system provides a two-stage priority scheme fit for both large-scale movement and fine in-bore adjustments. In clinically relevant simulated scenarios, the system demonstrates a consistent 97% reachability rate across various human models. In addition, the task-oriented weight-matrix policy is extensively explored in five representative subtasks seen during needle biopsy through both simulation and real-world experiments, demonstrating superior tracking accuracy and enhanced manipulability for CT-guided procedures.

Robotic-assisted surgery (RAS) is central to modern surgery, driving the need for intelligent systems with accurate scene understanding. Most existing surgical AI methods rely on isolated, task-specific models, leading to fragmented pipelines with limited interpretability and no unified understanding of RAS scene. Vision-Language Models (VLMs) offer strong zero-shot reasoning, but struggle with hallucinations, domain gaps and weak task-interdependency modeling. To address the lack of unified data for RAS scene understanding, we introduce SurgCoTBench, the first reasoning-focused benchmark in RAS, covering 14256 QA pairs with frame-level annotations across five major surgical tasks. Building on SurgCoTBench, we propose SurgRAW, a clinically aligned Chain-of-Thought (CoT) driven agentic workflow for zero-shot multi-task reasoning in surgery. SurgRAW employs a hierarchical reasoning workflow where an orchestrator divides surgical scene understanding into two reasoning streams and directs specialized agents to generate task-level reasoning, while higher-level agents capture workflow interdependencies or ground output clinically. Specifically, we propose a panel discussion mechanism to ensure task-specific agents collaborate synergistically and leverage on task interdependencies. Similarly, we incorporate a retrieval-augmented generation module to enrich agents with surgical knowledge and alleviate domain gaps in general VLMs. We design task-specific CoT prompts grounded in surgical domain to ensure clinically aligned reasoning, reduce hallucinations and enhance interpretability. Extensive experiments show that SurgRAW surpasses mainstream VLMs and agentic systems and outperforms a supervised model by 14.61% accuracy. Dataset and code is available at https://github.com/jinlab-imvr/SurgRAW.git .