Surgical Robotics

Accurate grasping point prediction is a key challenge for autonomous tissue manipulation in minimally invasive surgery, particularly in complex and variable procedures such as colorectal interventions. Due to their complexity and prolonged duration, colorectal procedures have been underrepresented in current research. At the same time, they pose a particularly interesting learning environment due to repetitive tissue manipulation, making them a promising entry point for autonomous, machine learning-driven support. Therefore, in this work, we introduce attachment anchors, a structured representation that encodes the local geometric and mechanical relationships between tissue and its anatomical attachments in colorectal surgery. This representation reduces uncertainty in grasping point prediction by normalizing surgical scenes into a consistent local reference frame. We demonstrate that attachment anchors can be predicted from laparoscopic images and incorporated into a grasping framework based on machine learning. Experiments on a dataset of 90 colorectal surgeries demonstrate that attachment anchors improve grasping point prediction compared to image-only baselines. There are particularly strong gains in out-of-distribution settings, including unseen procedures and operating surgeons. These results suggest that attachment anchors are an effective intermediate representation for learning-based tissue manipulation in colorectal surgery.

Robotic-assisted surgery (RAS) is established in clinical practice, and automated surgical skill assessment utilizing multimodal data offers transformative potential for surgical analytics and education. However, developing effective multimodal methods remains challenging due to the task complexity, limited annotated datasets and insufficient techniques for cross-modal information fusion. Existing state-of-the-art relies exclusively on RGB video and only applies on dry-lab settings, failing to address the significant domain gap between controlled simulation and real clinical cases, where the surgical environment together with camera and tissue motion introduce substantial complexities. This work introduces SurgFusion-Net and Divergence Regulated Attention (DRA), an innovative fusion strategy for multimodal surgical skill assessment. We contribute two first-of-their-kind clinical datasets: the RAH-skill dataset containing 279,691 RGB frames from 37 videos of Robot-assisted Hysterectomy (RAH), and the RARP-skill dataset containing 70,661 RGB frames from 33 videos of Robot-Assisted Radical Prostatectomy (RARP). Both datasets include M-GEARS skill annotations, corresponding optical flow and tool segmentation masks. DRA incorporates adaptive dual attention and diversity-promoting multi-head attention to fuse multimodal information, from three modalities, based on surgical context, enhancing assessment accuracy and reliability. Validated on the JIGSAWS benchmark, RAH-skill, and RARP-skill datasets, our approach outperforms recent baselines with SCC improvements of 0.02 in LOSO, 0.04 in LOUO across JIGSAWS tasks, and 0.0538 and 0.0493 gains on RAH-skill and RARP-skill, respectively.

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.

Magnetic actuation enables surgical robots to navigate complex anatomical pathways while reducing tissue trauma and improving surgical precision. However, clinical deployment is limited by the challenges of controlling such systems under fluoroscopic imaging, which provides low frame rate and noisy pose feedback. This paper presents a control framework that remains accurate and stable under such conditions by combining a nonlinear model predictive control (NMPC) framework that directly outputs coil currents, an analytically differentiable magnetic field model based on Zernike polynomials, and a Kalman filter to estimate the robot state. Experimental validation is conducted with two magnetic robots in a 3D-printed fluid workspace and a spine phantom replicating drug delivery in the epidural space. Results show the proposed control method remains highly accurate when feedback is downsampled to 3 Hz with added Gaussian noise (sigma = 2 mm), mimicking clinical fluoroscopy. In the spine phantom experiments, the proposed method successfully executed a drug delivery trajectory with a root mean square (RMS) position error of 1.18 mm while maintaining safe clearance from critical anatomical boundaries.

Self-propelling robotic capsules eliminate shaft looping of conventional colonoscopy, reducing patient discomfort. However, reliably moving within the slippery, viscoelastic environment of the colon remains a significant challenge. We present OSCAR, an ovipositor-inspired self-propelling capsule robot that translates the transport strategy of parasitic wasps into a propulsion mechanism for colonoscopy. OSCAR mechanically encodes the ovipositor-inspired motion pattern through a spring-loaded cam system that drives twelve circumferential sliders in a coordinated, phase-shifted sequence. By tuning the motion profile to maximize the retract phase relative to the advance phase, the capsule creates a controlled friction anisotropy at the interface that generates net forward thrust. We developed an analytical model incorporating a Kelvin-Voigt formulation to capture the viscoelastic stick--slip interactions between the sliders and the tissue, linking the asymmetry between advance and retract phase durations to mean thrust, and slider-reversal synchronization to thrust stability. Comprehensive force characterization experiments in ex-vivo porcine colon revealed a mean steady-state traction force of 0.85 N, closely matching the model. Furthermore, experiments confirmed that thrust generation is speed-independent and scales linearly with the phase asymmetry, in agreement with theoretical predictions, underscoring the capsule's predictable performance and scalability. In locomotion validation experiments, OSCAR demonstrated robust performance, achieving an average speed of 3.08 mm/s, a velocity sufficient to match the cecal intubation times of conventional colonoscopy. By coupling phase-encoded friction anisotropy with a predictive model, OSCAR delivers controllable thrust generation at low normal loads, enabling safer and more robust self-propelling locomotion for robotic capsule colonoscopy.

Endoluminal surgery offers a minimally invasive option for early-stage gastrointestinal and urinary tract cancers but is limited by surgical tools and a steep learning curve. Robotic systems, particularly continuum robots, provide flexible instruments that enable precise tissue resection, potentially improving outcomes. This paper presents a visual perception platform for a continuum robotic system in endoluminal surgery. Our goal is to utilize monocular endoscopic image-based perception algorithms to identify position and orientation of flexible instruments and measure their distances from tissues. We introduce 2D and 3D learning-based perception algorithms and develop a physically-realistic simulator that models flexible instruments dynamics. This simulator generates realistic endoluminal scenes, enabling control of flexible robots and substantial data collection. Using a continuum robot prototype, we conducted module and system-level evaluations. Results show that our algorithms improve control of flexible instruments, reducing manipulation time by over 70% for trajectory-following tasks and enhancing understanding of surgical scenarios, leading to robust endoluminal surgeries.

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 .