Daily Papers

Learning a policy with great generalization to unseen environments remains challenging but critical in visual reinforcement learning. Despite the success of augmentation combination in the supervised learning generalization, naively applying it to visual RL algorithms may damage the training efficiency, suffering from serve performance degradation. In this paper, we first conduct qualitative analysis and illuminate the main causes: (i) high-variance gradient magnitudes and (ii) gradient conflicts existed in various augmentation methods. To alleviate these issues, we propose a general policy gradient optimization framework, named Conflict-aware Gradient Agreement Augmentation (CG2A), and better integrate augmentation combination into visual RL algorithms to address the generalization bias. In particular, CG2A develops a Gradient Agreement Solver to adaptively balance the varying gradient magnitudes, and introduces a Soft Gradient Surgery strategy to alleviate the gradient conflicts. Extensive experiments demonstrate that CG2A significantly improves the generalization performance and sample efficiency of visual RL algorithms.

The multi-task learning (MTL) paradigm aims to simultaneously learn multiple tasks within a single model capturing higher-level, more general hidden patterns that are shared by the tasks. In deep learning, a significant challenge in the backpropagation training process is the design of advanced optimisers to improve the convergence speed and stability of the gradient descent learning rule. In particular, in multi-task deep learning (MTDL) the multitude of tasks may generate potentially conflicting gradients that would hinder the concurrent convergence of the diverse loss functions. This challenge arises when the gradients of the task objectives have either different magnitudes or opposite directions, causing one or a few to dominate or to interfere with each other, thus degrading the training process. Gradient surgery methods address the problem explicitly dealing with conflicting gradients by adjusting the overall gradient trajectory. This work introduces a novel gradient surgery method, the Similarity-Aware Momentum Gradient Surgery (SAM-GS), which provides an effective and scalable approach based on a gradient magnitude similarity measure to guide the optimisation process. The SAM-GS surgery adopts gradient equalisation and modulation of the first-order momentum. A series of experimental tests have shown the effectiveness of SAM-GS on synthetic problems and MTL benchmarks. Gradient magnitude similarity plays a crucial role in regularising gradient aggregation in MTDL for the optimisation of the learning process.

While deep learning and deep reinforcement learning (RL) systems have demonstrated impressive results in domains such as image classification, game playing, and robotic control, data efficiency remains a major challenge. Multi-task learning has emerged as a promising approach for sharing structure across multiple tasks to enable more efficient learning. However, the multi-task setting presents a number of optimization challenges, making it difficult to realize large efficiency gains compared to learning tasks independently. The reasons why multi-task learning is so challenging compared to single-task learning are not fully understood. In this work, we identify a set of three conditions of the multi-task optimization landscape that cause detrimental gradient interference, and develop a simple yet general approach for avoiding such interference between task gradients. We propose a form of gradient surgery that projects a task's gradient onto the normal plane of the gradient of any other task that has a conflicting gradient. On a series of challenging multi-task supervised and multi-task RL problems, this approach leads to substantial gains in efficiency and performance. Further, it is model-agnostic and can be combined with previously-proposed multi-task architectures for enhanced performance.

Beyond minimizing a single training loss, many deep learning estimation pipelines rely on an auxiliary objective to quantify and encourage desirable properties of the model (e.g. performance on another dataset, robustness, agreement with a prior). Although the simplest approach to incorporating an auxiliary loss is to sum it with the training loss as a regularizer, recent works have shown that one can improve performance by blending the gradients beyond a simple sum; this is known as gradient surgery. We cast the problem as a constrained minimization problem where the auxiliary objective is minimized among the set of minimizers of the training loss. To solve this bilevel problem, we follow a parameter update direction that combines the training loss gradient and the orthogonal projection of the auxiliary gradient to the training gradient. In a setting where gradients come from mini-batches, we explain how, using a moving average of the training loss gradients, we can carefully maintain this critical orthogonality property. We demonstrate that our method, Bloop, can lead to much better performances on NLP and vision experiments than other gradient surgery methods without EMA.

Reconstruction of the soft tissues in robotic surgery from endoscopic stereo videos is important for many applications such as intra-operative navigation and image-guided robotic surgery automation. Previous works on this task mainly rely on SLAM-based approaches, which struggle to handle complex surgical scenes. Inspired by recent progress in neural rendering, we present a novel framework for deformable tissue reconstruction from binocular captures in robotic surgery under the single-viewpoint setting. Our framework adopts dynamic neural radiance fields to represent deformable surgical scenes in MLPs and optimize shapes and deformations in a learning-based manner. In addition to non-rigid deformations, tool occlusion and poor 3D clues from a single viewpoint are also particular challenges in soft tissue reconstruction. To overcome these difficulties, we present a series of strategies of tool mask-guided ray casting, stereo depth-cueing ray marching and stereo depth-supervised optimization. With experiments on DaVinci robotic surgery videos, our method significantly outperforms the current state-of-the-art reconstruction method for handling various complex non-rigid deformations. To our best knowledge, this is the first work leveraging neural rendering for surgical scene 3D reconstruction with remarkable potential demonstrated. Code is available at: https://github.com/med-air/EndoNeRF.

Dynamic reconstruction of deformable tissues in endoscopic video is a key technology for robot-assisted surgery. Recent reconstruction methods based on neural radiance fields (NeRFs) have achieved remarkable results in the reconstruction of surgical scenes. However, based on implicit representation, NeRFs struggle to capture the intricate details of objects in the scene and cannot achieve real-time rendering. In addition, restricted single view perception and occluded instruments also propose special challenges in surgical scene reconstruction. To address these issues, we develop SurgicalGaussian, a deformable 3D Gaussian Splatting method to model dynamic surgical scenes. Our approach models the spatio-temporal features of soft tissues at each time stamp via a forward-mapping deformation MLP and regularization to constrain local 3D Gaussians to comply with consistent movement. With the depth initialization strategy and tool mask-guided training, our method can remove surgical instruments and reconstruct high-fidelity surgical scenes. Through experiments on various surgical videos, our network outperforms existing method on many aspects, including rendering quality, rendering speed and GPU usage. The project page can be found at https://surgicalgaussian.github.io.

Medical image registration is a critical task that estimates the spatial correspondence between pairs of images. However, current traditional and deep-learning-based methods rely on similarity measures to generate a deforming field, which often results in disproportionate volume changes in dissimilar regions, especially in tumor regions. These changes can significantly alter the tumor size and underlying anatomy, which limits the practical use of image registration in clinical diagnosis. To address this issue, we have formulated image registration with tumors as a constraint problem that preserves tumor volumes while maximizing image similarity in other normal regions. Our proposed strategy involves a two-stage process. In the first stage, we use similarity-based registration to identify potential tumor regions by their volume change, generating a soft tumor mask accordingly. In the second stage, we propose a volume-preserving registration with a novel adaptive volume-preserving loss that penalizes the change in size adaptively based on the masks calculated from the previous stage. Our approach balances image similarity and volume preservation in different regions, i.e., normal and tumor regions, by using soft tumor masks to adjust the imposition of volume-preserving loss on each one. This ensures that the tumor volume is preserved during the registration process. We have evaluated our strategy on various datasets and network architectures, demonstrating that our method successfully preserves the tumor volume while achieving comparable registration results with state-of-the-art methods. Our codes is available at: https://dddraxxx.github.io/Volume-Preserving-Registration/.

The softmax function is crucial in Transformer attention, which normalizes each row of the attention scores with summation to one, achieving superior performances over other alternative functions. However, the softmax function can face a gradient vanishing issue when some elements of the attention scores approach extreme values, such as probabilities close to one or zero. In this paper, we propose Self-Adjust Softmax (SA-Softmax) to address this issue by modifying softmax(x) to x cdot softmax(x) and its normalized variant (x - min(x_{min,0))}{max(0,x_{max})-min(x_{min},0)} cdot softmax(x). We theoretically show that SA-Softmax provides enhanced gradient properties compared to the vanilla softmax function. Moreover, SA-Softmax Attention can be seamlessly integrated into existing Transformer models to their attention mechanisms with minor adjustments. We conducted experiments to evaluate the empirical performance of Transformer models using SA-Softmax compared to the vanilla softmax function. These experiments, involving models with up to 2.7 billion parameters, are conducted across diverse datasets, language tasks, and positional encoding methods.

While significant research progress has been made in robot learning for control, unique challenges arise when simultaneously co-optimizing morphology. Existing work has typically been tailored for particular environments or representations. In order to more fully understand inherent design and performance tradeoffs and accelerate the development of new breeds of soft robots, a comprehensive virtual platform with well-established tasks, environments, and evaluation metrics is needed. In this work, we introduce SoftZoo, a soft robot co-design platform for locomotion in diverse environments. SoftZoo supports an extensive, naturally-inspired material set, including the ability to simulate environments such as flat ground, desert, wetland, clay, ice, snow, shallow water, and ocean. Further, it provides a variety of tasks relevant for soft robotics, including fast locomotion, agile turning, and path following, as well as differentiable design representations for morphology and control. Combined, these elements form a feature-rich platform for analysis and development of soft robot co-design algorithms. We benchmark prevalent representations and co-design algorithms, and shed light on 1) the interplay between environment, morphology, and behavior; 2) the importance of design space representations; 3) the ambiguity in muscle formation and controller synthesis; and 4) the value of differentiable physics. We envision that SoftZoo will serve as a standard platform and template an approach toward the development of novel representations and algorithms for co-designing soft robots' behavioral and morphological intelligence.

In the realm of robot-assisted minimally invasive surgery, dynamic scene reconstruction can significantly enhance downstream tasks and improve surgical outcomes. Neural Radiance Fields (NeRF)-based methods have recently risen to prominence for their exceptional ability to reconstruct scenes but are hampered by slow inference speed, prolonged training, and inconsistent depth estimation. Some previous work utilizes ground truth depth for optimization but is hard to acquire in the surgical domain. To overcome these obstacles, we present Endo-4DGS, a real-time endoscopic dynamic reconstruction approach that utilizes 3D Gaussian Splatting (GS) for 3D representation. Specifically, we propose lightweight MLPs to capture temporal dynamics with Gaussian deformation fields. To obtain a satisfactory Gaussian Initialization, we exploit a powerful depth estimation foundation model, Depth-Anything, to generate pseudo-depth maps as a geometry prior. We additionally propose confidence-guided learning to tackle the ill-pose problems in monocular depth estimation and enhance the depth-guided reconstruction with surface normal constraints and depth regularization. Our approach has been validated on two surgical datasets, where it can effectively render in real-time, compute efficiently, and reconstruct with remarkable accuracy.

The lack of labeled datasets in 3D vision for surgical scenes inhibits the development of robust 3D reconstruction algorithms in the medical domain. Despite the popularity of Neural Radiance Fields and 3D Gaussian Splatting in the general computer vision community, these systems have yet to find consistent success in surgical scenes due to challenges such as non-stationary lighting and non-Lambertian surfaces. As a result, the need for labeled surgical datasets continues to grow. In this work, we introduce a differentiable rendering framework for material and lighting estimation from endoscopic images and known geometry. Compared to previous approaches that model lighting and material jointly as radiance, we explicitly disentangle these scene properties for robust and photorealistic novel view synthesis. To disambiguate the training process, we formulate domain-specific properties inherent in surgical scenes. Specifically, we model the scene lighting as a simple spotlight and material properties as a bidirectional reflectance distribution function, parameterized by a neural network. By grounding color predictions in the rendering equation, we can generate photorealistic images at arbitrary camera poses. We evaluate our method with various sequences from the Colonoscopy 3D Video Dataset and show that our method produces competitive novel view synthesis results compared with other approaches. Furthermore, we demonstrate that synthetic data can be used to develop 3D vision algorithms by finetuning a depth estimation model with our rendered outputs. Overall, we see that the depth estimation performance is on par with fine-tuning with the original real images.

Soft robots have gained increased popularity in recent years due to their adaptability and compliance. In this paper, we use a digital twin model of cable-driven soft robots to learn control parameters in simulation. In doing so, we take advantage of differentiable rendering as a way to instruct robots to complete tasks such as point reach, gripping an object, and obstacle avoidance. This approach simplifies the mathematical description of such complicated tasks and removes the need for landmark points and their tracking. Our experiments demonstrate the applicability of our method.

Differentiable architecture search (DARTS) yields highly efficient gradient-based neural architecture search (NAS) by relaxing the discrete operation selection to optimize continuous architecture parameters that maps NAS from the discrete optimization to a continuous problem. DARTS then remaps the relaxed supernet back to the discrete space by one-off post-search pruning to obtain the final architecture (finalnet). Some emerging works argue that this remap is inherently prone to mismatch the network between training and evaluation which leads to performance discrepancy and even model collapse in extreme cases. We propose to close the gap between the relaxed supernet in training and the pruned finalnet in evaluation through utilizing small temperature to sparsify the continuous distribution in the training phase. To this end, we first formulate sparse-noisy softmax to get around gradient saturation. We then propose an exponential temperature schedule to better control the outbound distribution and elaborate an entropy-based adaptive scheme to finally achieve the enhancement. We conduct extensive experiments to verify the efficiency and efficacy of our method.

SoftMax is a ubiquitous ingredient of modern machine learning algorithms. It maps an input vector onto a probability simplex and reweights the input by concentrating the probability mass at large entries. Yet, as a smooth approximation to the Argmax function, a significant amount of probability mass is distributed to other, residual entries, leading to poor interpretability and noise. Although sparsity can be achieved by a family of SoftMax variants, they often require an alternative loss function and do not preserve multi-modality. We show that this trade-off between multi-modality and sparsity limits the expressivity of SoftMax as well as its variants. We provide a solution to this tension between objectives by proposing a piece-wise differentiable function, termed MultiMax, which adaptively modulates the output distribution according to input entry range. Through comprehensive analysis and evaluation, we show that MultiMax successfully produces a distribution that supresses irrelevant entries while preserving multimodality, with benefits in image classification, language modeling and machine translation. The code is available at https://github.com/ZhouYuxuanYX/MultiMax.

The skeleton of a digital image is a compact representation of its topology, geometry, and scale. It has utility in many computer vision applications, such as image description, segmentation, and registration. However, skeletonization has only seen limited use in contemporary deep learning solutions. Most existing skeletonization algorithms are not differentiable, making it impossible to integrate them with gradient-based optimization. Compatible algorithms based on morphological operations and neural networks have been proposed, but their results often deviate from the geometry and topology of the true medial axis. This work introduces the first three-dimensional skeletonization algorithm that is both compatible with gradient-based optimization and preserves an object's topology. Our method is exclusively based on matrix additions and multiplications, convolutional operations, basic non-linear functions, and sampling from a uniform probability distribution, allowing it to be easily implemented in any major deep learning library. In benchmarking experiments, we prove the advantages of our skeletonization algorithm compared to non-differentiable, morphological, and neural-network-based baselines. Finally, we demonstrate the utility of our algorithm by integrating it with two medical image processing applications that use gradient-based optimization: deep-learning-based blood vessel segmentation, and multimodal registration of the mandible in computed tomography and magnetic resonance images.

Vision transformers (ViTs) have pushed the state-of-the-art for visual perception tasks. The self-attention mechanism underpinning the strength of ViTs has a quadratic complexity in both computation and memory usage. This motivates the development of approximating the self-attention at linear complexity. However, an in-depth analysis in this work reveals that existing methods are either theoretically flawed or empirically ineffective for visual recognition. We identify that their limitations are rooted in the inheritance of softmax-based self-attention during approximations, that is, normalizing the scaled dot-product between token feature vectors using the softmax function. As preserving the softmax operation challenges any subsequent linearization efforts. By this insight, a family of Softmax-Free Transformers (SOFT) are proposed. Specifically, a Gaussian kernel function is adopted to replace the dot-product similarity, enabling a full self-attention matrix to be approximated under low-rank matrix decomposition. For computational robustness, we estimate the Moore-Penrose inverse using an iterative Newton-Raphson method in the forward process only, while calculating its theoretical gradients only once in the backward process. To further expand applicability (e.g., dense prediction tasks), an efficient symmetric normalization technique is introduced. Extensive experiments on ImageNet, COCO, and ADE20K show that our SOFT significantly improves the computational efficiency of existing ViT variants. With linear complexity, much longer token sequences are permitted by SOFT, resulting in superior trade-off between accuracy and complexity. Code and models are available at https://github.com/fudan-zvg/SOFT.

Automated detection and segmentation of surgical devices, such as catheters or wires, in X-ray fluoroscopic images have the potential to enhance image guidance in minimally invasive heart surgeries. In this paper, we present a convolutional neural network model that integrates a resnet architecture with multiple prediction heads to achieve real-time, accurate localization of electrodes on catheters and catheter segmentation in an end-to-end deep learning framework. We also propose a multi-task learning strategy in which our model is trained to perform both accurate electrode detection and catheter segmentation simultaneously. A key challenge with this approach is achieving optimal performance for both tasks. To address this, we introduce a novel multi-level dynamic resource prioritization method. This method dynamically adjusts sample and task weights during training to effectively prioritize more challenging tasks, where task difficulty is inversely proportional to performance and evolves throughout the training process. Experiments on both public and private datasets have demonstrated that the accuracy of our method surpasses the existing state-of-the-art methods in both single segmentation task and in the detection and segmentation multi-task. Our approach achieves a good trade-off between accuracy and efficiency, making it well-suited for real-time surgical guidance applications.

Physical simulators have been widely used in robot planning and control. Among them, differentiable simulators are particularly favored, as they can be incorporated into gradient-based optimization algorithms that are efficient in solving inverse problems such as optimal control and motion planning. Simulating deformable objects is, however, more challenging compared to rigid body dynamics. The underlying physical laws of deformable objects are more complex, and the resulting systems have orders of magnitude more degrees of freedom and therefore they are significantly more computationally expensive to simulate. Computing gradients with respect to physical design or controller parameters is typically even more computationally challenging. In this paper, we propose a real-time, differentiable hybrid Lagrangian-Eulerian physical simulator for deformable objects, ChainQueen, based on the Moving Least Squares Material Point Method (MLS-MPM). MLS-MPM can simulate deformable objects including contact and can be seamlessly incorporated into inference, control and co-design systems. We demonstrate that our simulator achieves high precision in both forward simulation and backward gradient computation. We have successfully employed it in a diverse set of control tasks for soft robots, including problems with nearly 3,000 decision variables.

Restart techniques are common in gradient-free optimization to deal with multimodal functions. Partial warm restarts are also gaining popularity in gradient-based optimization to improve the rate of convergence in accelerated gradient schemes to deal with ill-conditioned functions. In this paper, we propose a simple warm restart technique for stochastic gradient descent to improve its anytime performance when training deep neural networks. We empirically study its performance on the CIFAR-10 and CIFAR-100 datasets, where we demonstrate new state-of-the-art results at 3.14% and 16.21%, respectively. We also demonstrate its advantages on a dataset of EEG recordings and on a downsampled version of the ImageNet dataset. Our source code is available at https://github.com/loshchil/SGDR

We introduce Soft Anisotropic Diagrams (SAD), an explicit and differentiable image representation parameterized by a set of adaptive sites in the image plane. In SAD, each site specifies an anisotropic metric and an additively weighted distance score, and we compute pixel colors as a softmax blend over a small per-pixel top-K subset of sites. We induce a soft anisotropic additively weighted Voronoi partition (i.e., an Apollonius diagram) with learnable per-site temperatures, preserving informative gradients while allowing clear, content-aligned boundaries and explicit ownership. Such a formulation enables efficient rendering by maintaining a per-query top-K map that approximates nearest neighbors under the same shading score, allowing GPU-friendly, fixed-size local computation. We update this list using our top-K propagation scheme inspired by jump flooding, augmented with stochastic injection to provide probabilistic global coverage. Training follows a GPU-first pipeline with gradient-weighted initialization, Adam optimization, and adaptive budget control through densification and pruning. Across standard benchmarks, SAD consistently outperforms Image-GS and Instant-NGP at matched bitrate. On Kodak, SAD reaches 46.0 dB PSNR with 2.2 s encoding time (vs. 28 s for Image-GS), and delivers 4-19 times end-to-end training speedups over state-of-the-art baselines. We demonstrate the effectiveness of SAD by showcasing the seamless integration with differentiable pipelines for forward and inverse problems, efficiency of fast random access, and compact storage.

In recent years, artificial intelligence has significantly advanced medical image segmentation. Nonetheless, challenges remain, including efficient 3D medical image processing across diverse modalities and handling data variability. In this work, we introduce Hierarchical Soft Mixture-of-Experts (HoME), a two-level token-routing layer for efficient long-context modeling, specifically designed for 3D medical image segmentation. Built on the Mamba Selective State Space Model (SSM) backbone, HoME enhances sequential modeling through adaptive expert routing. In the first level, a Soft Mixture-of-Experts (SMoE) layer partitions input sequences into local groups, routing tokens to specialized per-group experts for localized feature extraction. The second level aggregates these outputs through a global SMoE layer, enabling cross-group information fusion and global context refinement. This hierarchical design, combining local expert routing with global expert refinement, enhances generalizability and segmentation performance, surpassing state-of-the-art results across datasets from the three most widely used 3D medical imaging modalities and varying data qualities. The code is publicly available at https://github.com/gmum/MambaHoME.

In this paper, we propose a novel text promptable surgical instrument segmentation approach to overcome challenges associated with diversity and differentiation of surgical instruments in minimally invasive surgeries. We redefine the task as text promptable, thereby enabling a more nuanced comprehension of surgical instruments and adaptability to new instrument types. Inspired by recent advancements in vision-language models, we leverage pretrained image and text encoders as our model backbone and design a text promptable mask decoder consisting of attention- and convolution-based prompting schemes for surgical instrument segmentation prediction. Our model leverages multiple text prompts for each surgical instrument through a new mixture of prompts mechanism, resulting in enhanced segmentation performance. Additionally, we introduce a hard instrument area reinforcement module to improve image feature comprehension and segmentation precision. Extensive experiments on EndoVis2017 and EndoVis2018 datasets demonstrate our model's superior performance and promising generalization capability. To our knowledge, this is the first implementation of a promptable approach to surgical instrument segmentation, offering significant potential for practical application in the field of robotic-assisted surgery.

Recent advances in multimodal large language models (LLMs) have highlighted their potential for medical and surgical applications. However, existing surgical datasets predominantly adopt a Visual Question Answering (VQA) format with heterogeneous taxonomies and lack support for pixel-level segmentation, limiting consistent evaluation and applicability. We present SurgMLLMBench, a unified multimodal benchmark explicitly designed for developing and evaluating interactive multimodal LLMs for surgical scene understanding, including the newly collected Micro-surgical Artificial Vascular anastomosIS (MAVIS) dataset. It integrates pixel-level instrument segmentation masks and structured VQA annotations across laparoscopic, robot-assisted, and micro-surgical domains under a unified taxonomy, enabling comprehensive evaluation beyond traditional VQA tasks and richer visual-conversational interactions. Extensive baseline experiments show that a single model trained on SurgMLLMBench achieves consistent performance across domains and generalizes effectively to unseen datasets. SurgMLLMBench will be publicly released as a robust resource to advance multimodal surgical AI research, supporting reproducible evaluation and development of interactive surgical reasoning models.

Intraoperative Cone Beam Computed Tomography (CBCT) provides a reliable 3D anatomical context essential for interventional planning. However, its static nature fails to provide continuous monitoring of soft-tissue deformations induced by respiration, probe pressure, and surgical manipulation, leading to navigation discrepancies. We propose a deformation-aware CBCT updating framework that leverages robotic ultrasound as a dynamic proxy to infer tissue motion and update static CBCT slices in real time. Starting from calibration-initialized alignment with linear correlation of linear combination (LC2)-based rigid refinement, our method establishes accurate multimodal correspondence. To capture intraoperative dynamics, we introduce the ultrasound correlation UNet (USCorUNet), a lightweight network trained with optical flow-guided supervision to learn deformation-aware correlation representations, enabling accurate, real-time dense deformation field estimation from ultrasound streams. The inferred deformation is spatially regularized and transferred to the CBCT reference to produce deformation-consistent visualizations without repeated radiation exposure. We validate the proposed approach through deformation estimation and ultrasound-guided CBCT updating experiments. Results demonstrate real-time end-to-end CBCT slice updating and physically plausible deformation estimation, enabling dynamic refinement of static CBCT guidance during robotic ultrasound-assisted interventions. The source code is publicly available at https://github.com/anonymous-codebase/us-cbct-demo.

In this work, we develop new optimization algorithms that use approximate second-order information combined with the gradient regularization technique to achieve fast global convergence rates for both convex and non-convex objectives. The key innovation of our analysis is a novel notion called Gradient-Normalized Smoothness, which characterizes the maximum radius of a ball around the current point that yields a good relative approximation of the gradient field. Our theory establishes a natural intrinsic connection between Hessian approximation and the linearization of the gradient. Importantly, Gradient-Normalized Smoothness does not depend on the specific problem class of the objective functions, while effectively translating local information about the gradient field and Hessian approximation into the global behavior of the method. This new concept equips approximate second-order algorithms with universal global convergence guarantees, recovering state-of-the-art rates for functions with H\"older-continuous Hessians and third derivatives, quasi-self-concordant functions, as well as smooth classes in first-order optimization. These rates are achieved automatically and extend to broader classes, such as generalized self-concordant functions. We demonstrate direct applications of our results for global linear rates in logistic regression and softmax problems with approximate Hessians, as well as in non-convex optimization using Fisher and Gauss-Newton approximations.

Recent advances in Vision Transformers (ViTs) have significantly enhanced medical image segmentation by facilitating the learning of global relationships. However, these methods face a notable challenge in capturing diverse local and global long-range sequential feature representations, particularly evident in whole-body CT (WBCT) scans. To overcome this limitation, we introduce Swin Soft Mixture Transformer (Swin SMT), a novel architecture based on Swin UNETR. This model incorporates a Soft Mixture-of-Experts (Soft MoE) to effectively handle complex and diverse long-range dependencies. The use of Soft MoE allows for scaling up model parameters maintaining a balance between computational complexity and segmentation performance in both training and inference modes. We evaluate Swin SMT on the publicly available TotalSegmentator-V2 dataset, which includes 117 major anatomical structures in WBCT images. Comprehensive experimental results demonstrate that Swin SMT outperforms several state-of-the-art methods in 3D anatomical structure segmentation, achieving an average Dice Similarity Coefficient of 85.09%. The code and pre-trained weights of Swin SMT are publicly available at https://github.com/MI2DataLab/SwinSMT.

Model-free deep reinforcement learning (RL) algorithms have been successfully applied to a range of challenging sequential decision making and control tasks. However, these methods typically suffer from two major challenges: high sample complexity and brittleness to hyperparameters. Both of these challenges limit the applicability of such methods to real-world domains. In this paper, we describe Soft Actor-Critic (SAC), our recently introduced off-policy actor-critic algorithm based on the maximum entropy RL framework. In this framework, the actor aims to simultaneously maximize expected return and entropy. That is, to succeed at the task while acting as randomly as possible. We extend SAC to incorporate a number of modifications that accelerate training and improve stability with respect to the hyperparameters, including a constrained formulation that automatically tunes the temperature hyperparameter. We systematically evaluate SAC on a range of benchmark tasks, as well as real-world challenging tasks such as locomotion for a quadrupedal robot and robotic manipulation with a dexterous hand. With these improvements, SAC achieves state-of-the-art performance, outperforming prior on-policy and off-policy methods in sample-efficiency and asymptotic performance. Furthermore, we demonstrate that, in contrast to other off-policy algorithms, our approach is very stable, achieving similar performance across different random seeds. These results suggest that SAC is a promising candidate for learning in real-world robotics tasks.

Gradient methods have become mainstream techniques for Bi-Level Optimization (BLO) in learning fields. The validity of existing works heavily rely on either a restrictive Lower- Level Strong Convexity (LLSC) condition or on solving a series of approximation subproblems with high accuracy or both. In this work, by averaging the upper and lower level objectives, we propose a single loop Bi-level Averaged Method of Multipliers (sl-BAMM) for BLO that is simple yet efficient for large-scale BLO and gets rid of the limited LLSC restriction. We further provide non-asymptotic convergence analysis of sl-BAMM towards KKT stationary points, and the comparative advantage of our analysis lies in the absence of strong gradient boundedness assumption, which is always required by others. Thus our theory safely captures a wider variety of applications in deep learning, especially where the upper-level objective is quadratic w.r.t. the lower-level variable. Experimental results demonstrate the superiority of our method.

Modern medical image registration approaches predict deformations using deep networks. These approaches achieve state-of-the-art (SOTA) registration accuracy and are generally fast. However, deep learning (DL) approaches are, in contrast to conventional non-deep-learning-based approaches, anatomy-specific. Recently, a universal deep registration approach, uniGradICON, has been proposed. However, uniGradICON focuses on monomodal image registration. In this work, we therefore develop multiGradICON as a first step towards universal *multimodal* medical image registration. Specifically, we show that 1) we can train a DL registration model that is suitable for monomodal *and* multimodal registration; 2) loss function randomization can increase multimodal registration accuracy; and 3) training a model with multimodal data helps multimodal generalization. Our code and the multiGradICON model are available at https://github.com/uncbiag/uniGradICON.

Recent advances in robot-assisted surgery have resulted in progressively more precise, efficient, and minimally invasive procedures, sparking a new era of robotic surgical intervention. This enables doctors, in collaborative interaction with robots, to perform traditional or minimally invasive surgeries with improved outcomes through smaller incisions. Recent efforts are working toward making robotic surgery more autonomous which has the potential to reduce variability of surgical outcomes and reduce complication rates. Deep reinforcement learning methodologies offer scalable solutions for surgical automation, but their effectiveness relies on extensive data acquisition due to the absence of prior knowledge in successfully accomplishing tasks. Due to the intensive nature of simulated data collection, previous works have focused on making existing algorithms more efficient. In this work, we focus on making the simulator more efficient, making training data much more accessible than previously possible. We introduce Surgical Gym, an open-source high performance platform for surgical robot learning where both the physics simulation and reinforcement learning occur directly on the GPU. We demonstrate between 100-5000x faster training times compared with previous surgical learning platforms. The code is available at: https://github.com/SamuelSchmidgall/SurgicalGym.

Research on autonomous surgery has largely focused on simple task automation in controlled environments. However, real-world surgical applications demand dexterous manipulation over extended durations and generalization to the inherent variability of human tissue. These challenges remain difficult to address using existing logic-based or conventional end-to-end learning approaches. To address this gap, we propose a hierarchical framework for performing dexterous, long-horizon surgical steps. Our approach utilizes a high-level policy for task planning and a low-level policy for generating robot trajectories. The high-level planner plans in language space, generating task-level or corrective instructions that guide the robot through the long-horizon steps and correct for the low-level policy's errors. We validate our framework through ex vivo experiments on cholecystectomy, a commonly-practiced minimally invasive procedure, and conduct ablation studies to evaluate key components of the system. Our method achieves a 100\% success rate across eight unseen ex vivo gallbladders, operating fully autonomously without human intervention. This work demonstrates step-level autonomy in a surgical procedure, marking a milestone toward clinical deployment of autonomous surgical systems.

Multi-organ segmentation is a critical yet challenging task due to complex anatomical backgrounds, blurred boundaries, and diverse morphologies. This study introduces the Gradient-aware Adaptive Momentum Evolution Deep Snake (GAMED-Snake) model, which establishes a novel paradigm for contour-based segmentation by integrating gradient-based learning with adaptive momentum evolution mechanisms. The GAMED-Snake model incorporates three major innovations: First, the Distance Energy Map Prior (DEMP) generates a pixel-level force field that effectively attracts contour points towards the true boundaries, even in scenarios with complex backgrounds and blurred edges. Second, the Differential Convolution Inception Module (DCIM) precisely extracts comprehensive energy gradients, significantly enhancing segmentation accuracy. Third, the Adaptive Momentum Evolution Mechanism (AMEM) employs cross-attention to establish dynamic features across different iterations of evolution, enabling precise boundary alignment for diverse morphologies. Experimental results on four challenging multi-organ segmentation datasets demonstrate that GAMED-Snake improves the mDice metric by approximately 2% compared to state-of-the-art methods. Code will be available at https://github.com/SYSUzrc/GAMED-Snake.

The field of computer vision applied to videos of minimally invasive surgery is ever-growing. Workflow recognition pertains to the automated recognition of various aspects of a surgery: including which surgical steps are performed; and which surgical instruments are used. This information can later be used to assist clinicians when learning the surgery; during live surgery; and when writing operation notes. The Pituitary Vision (PitVis) 2023 Challenge tasks the community to step and instrument recognition in videos of endoscopic pituitary surgery. This is a unique task when compared to other minimally invasive surgeries due to the smaller working space, which limits and distorts vision; and higher frequency of instrument and step switching, which requires more precise model predictions. Participants were provided with 25-videos, with results presented at the MICCAI-2023 conference as part of the Endoscopic Vision 2023 Challenge in Vancouver, Canada, on 08-Oct-2023. There were 18-submissions from 9-teams across 6-countries, using a variety of deep learning models. A commonality between the top performing models was incorporating spatio-temporal and multi-task methods, with greater than 50% and 10% macro-F1-score improvement over purely spacial single-task models in step and instrument recognition respectively. The PitVis-2023 Challenge therefore demonstrates state-of-the-art computer vision models in minimally invasive surgery are transferable to a new dataset, with surgery specific techniques used to enhance performance, progressing the field further. Benchmark results are provided in the paper, and the dataset is publicly available at: https://doi.org/10.5522/04/26531686.

Accurate segmentation of tubular, network-like structures, such as vessels, neurons, or roads, is relevant to many fields of research. For such structures, the topology is their most important characteristic; particularly preserving connectedness: in the case of vascular networks, missing a connected vessel entirely alters the blood-flow dynamics. We introduce a novel similarity measure termed centerlineDice (short clDice), which is calculated on the intersection of the segmentation masks and their (morphological) skeleta. We theoretically prove that clDice guarantees topology preservation up to homotopy equivalence for binary 2D and 3D segmentation. Extending this, we propose a computationally efficient, differentiable loss function (soft-clDice) for training arbitrary neural segmentation networks. We benchmark the soft-clDice loss on five public datasets, including vessels, roads and neurons (2D and 3D). Training on soft-clDice leads to segmentation with more accurate connectivity information, higher graph similarity, and better volumetric scores.

Foundation models have revolutionized computer vision by achieving vastly superior performance across diverse tasks through large-scale pretraining on extensive datasets. However, their application in surgical computer vision has been limited. This study addresses this gap by introducing SurgeNetXL, a novel surgical foundation model that sets a new benchmark in surgical computer vision. Trained on the largest reported surgical dataset to date, comprising over 4.7 million video frames, SurgeNetXL achieves consistent top-tier performance across six datasets spanning four surgical procedures and three tasks, including semantic segmentation, phase recognition, and critical view of safety (CVS) classification. Compared with the best-performing surgical foundation models, SurgeNetXL shows mean improvements of 2.4, 9.0, and 12.6 percent for semantic segmentation, phase recognition, and CVS classification, respectively. Additionally, SurgeNetXL outperforms the best-performing ImageNet-based variants by 14.4, 4.0, and 1.6 percent in the respective tasks. In addition to advancing model performance, this study provides key insights into scaling pretraining datasets, extending training durations, and optimizing model architectures specifically for surgical computer vision. These findings pave the way for improved generalizability and robustness in data-scarce scenarios, offering a comprehensive framework for future research in this domain. All models and a subset of the SurgeNetXL dataset, including over 2 million video frames, are publicly available at: https://github.com/TimJaspers0801/SurgeNet.

Purpose: A profound education of novice surgeons is crucial to ensure that surgical interventions are effective and safe. One important aspect is the teaching of technical skills for minimally invasive or robot-assisted procedures. This includes the objective and preferably automatic assessment of surgical skill. Recent studies presented good results for automatic, objective skill evaluation by collecting and analyzing motion data such as trajectories of surgical instruments. However, obtaining the motion data generally requires additional equipment for instrument tracking or the availability of a robotic surgery system to capture kinematic data. In contrast, we investigate a method for automatic, objective skill assessment that requires video data only. This has the advantage that video can be collected effortlessly during minimally invasive and robot-assisted training scenarios. Methods: Our method builds on recent advances in deep learning-based video classification. Specifically, we propose to use an inflated 3D ConvNet to classify snippets, i.e., stacks of a few consecutive frames, extracted from surgical video. The network is extended into a Temporal Segment Network during training. Results: We evaluate the method on the publicly available JIGSAWS dataset, which consists of recordings of basic robot-assisted surgery tasks performed on a dry lab bench-top model. Our approach achieves high skill classification accuracies ranging from 95.1% to 100.0%. Conclusions: Our results demonstrate the feasibility of deep learning-based assessment of technical skill from surgical video. Notably, the 3D ConvNet is able to learn meaningful patterns directly from the data, alleviating the need for manual feature engineering. Further evaluation will require more annotated data for training and testing.

Soft Actor-Critic is a state-of-the-art reinforcement learning algorithm for continuous action settings that is not applicable to discrete action settings. Many important settings involve discrete actions, however, and so here we derive an alternative version of the Soft Actor-Critic algorithm that is applicable to discrete action settings. We then show that, even without any hyperparameter tuning, it is competitive with the tuned model-free state-of-the-art on a selection of games from the Atari suite.

Advances in artificial intelligence (AI) for surgical quality assessment promise to democratize access to expertise, with applications in training, guidance, and accreditation. This study presents the SAGES Critical View of Safety (CVS) Challenge, the first AI competition organized by a surgical society, using the CVS in laparoscopic cholecystectomy, a universally recommended yet inconsistently performed safety step, as an exemplar of surgical quality assessment. A global collaboration across 54 institutions in 24 countries engaged hundreds of clinicians and engineers to curate 1,000 videos annotated by 20 surgical experts according to a consensus-validated protocol. The challenge addressed key barriers to real-world deployment in surgery, including achieving high performance, capturing uncertainty in subjective assessment, and ensuring robustness to clinical variability. To enable this scale of effort, we developed EndoGlacier, a framework for managing large, heterogeneous surgical video and multi-annotator workflows. Thirteen international teams participated, achieving up to a 17\% relative gain in assessment performance, over 80\% reduction in calibration error, and a 17\% relative improvement in robustness over the state-of-the-art. Analysis of results highlighted methodological trends linked to model performance, providing guidance for future research toward robust, clinically deployable AI for surgical quality assessment.

Convolutional neural network training can suffer from diverse issues like exploding or vanishing gradients, scaling-based weight space symmetry and covariant-shift. In order to address these issues, researchers develop weight regularization methods and activation normalization methods. In this work we propose a weight soft-regularization method based on the Oblique manifold. The proposed method uses a loss function which pushes each weight vector to have a norm close to one, i.e. the weight matrix is smoothly steered toward the so-called Oblique manifold. We evaluate our method on the very popular CIFAR-10, CIFAR-100 and ImageNet 2012 datasets using two state-of-the-art architectures, namely the ResNet and wide-ResNet. Our method introduces negligible computational overhead and the results show that it is competitive to the state-of-the-art and in some cases superior to it. Additionally, the results are less sensitive to hyperparameter settings such as batch size and regularization factor.

Turning the weights to zero when training a neural network helps in reducing the computational complexity at inference. To progressively increase the sparsity ratio in the network without causing sharp weight discontinuities during training, our work combines soft-thresholding and straight-through gradient estimation to update the raw, i.e. non-thresholded, version of zeroed weights. Our method, named ST-3 for straight-through/soft-thresholding/sparse-training, obtains SoA results, both in terms of accuracy/sparsity and accuracy/FLOPS trade-offs, when progressively increasing the sparsity ratio in a single training cycle. In particular, despite its simplicity, ST-3 favorably compares to the most recent methods, adopting differentiable formulations or bio-inspired neuroregeneration principles. This suggests that the key ingredients for effective sparsification primarily lie in the ability to give the weights the freedom to evolve smoothly across the zero state while progressively increasing the sparsity ratio. Source code and weights available at https://github.com/vanderschuea/stthree

Gradient regularization (GR) is a method that penalizes the gradient norm of the training loss during training. While some studies have reported that GR can improve generalization performance, little attention has been paid to it from the algorithmic perspective, that is, the algorithms of GR that efficiently improve the performance. In this study, we first reveal that a specific finite-difference computation, composed of both gradient ascent and descent steps, reduces the computational cost of GR. Next, we show that the finite-difference computation also works better in the sense of generalization performance. We theoretically analyze a solvable model, a diagonal linear network, and clarify that GR has a desirable implicit bias to so-called rich regime and finite-difference computation strengthens this bias. Furthermore, finite-difference GR is closely related to some other algorithms based on iterative ascent and descent steps for exploring flat minima. In particular, we reveal that the flooding method can perform finite-difference GR in an implicit way. Thus, this work broadens our understanding of GR for both practice and theory.

Organ at risk (OAR) segmentation is a critical process in radiotherapy treatment planning such as head and neck tumors. Nevertheless, in clinical practice, radiation oncologists predominantly perform OAR segmentations manually on CT scans. This manual process is highly time-consuming and expensive, limiting the number of patients who can receive timely radiotherapy. Additionally, CT scans offer lower soft-tissue contrast compared to MRI. Despite MRI providing superior soft-tissue visualization, its time-consuming nature makes it infeasible for real-time treatment planning. To address these challenges, we propose a method called SegReg, which utilizes Elastic Symmetric Normalization for registering MRI to perform OAR segmentation. SegReg outperforms the CT-only baseline by 16.78% in mDSC and 18.77% in mIoU, showing that it effectively combines the geometric accuracy of CT with the superior soft-tissue contrast of MRI, making accurate automated OAR segmentation for clinical practice become possible. See project website https://steve-zeyu-zhang.github.io/SegReg

Medical visual grounding serves as a crucial foundation for fine-grained multimodal reasoning and interpretable clinical decision support. Despite recent advances in reinforcement learning (RL) for grounding tasks, existing approaches such as Group Relative Policy Optimization~(GRPO) suffer from severe reward sparsity when directly applied to medical images, primarily due to the inherent difficulty of localizing small or ambiguous regions of interest, which is further exacerbated by the rigid and suboptimal nature of fixed IoU-based reward schemes in RL. This leads to vanishing policy gradients and stagnated optimization, particularly during early training. To address this challenge, we propose MedLoc-R1, a performance-aware reward scheduling framework that progressively tightens the reward criterion in accordance with model readiness. MedLoc-R1 introduces a sliding-window performance tracker and a multi-condition update rule that automatically adjust the reward schedule from dense, easily obtainable signals to stricter, fine-grained localization requirements, while preserving the favorable properties of GRPO without introducing auxiliary networks or additional gradient paths. Experiments on three medical visual grounding benchmarks demonstrate that MedLoc-R1 consistently improves both localization accuracy and training stability over GRPO-based baselines. Our framework offers a general, lightweight, and effective solution for RL-based grounding in high-stakes medical applications. Code \& checkpoints are available at {https://github.com/MembrAI/MedLoc-R1}.

Accurate segmentation of thin structures is critical for microsurgical scene understanding but remains challenging due to resolution loss, low contrast, and class imbalance. We propose Microsurgery Instrument Segmentation for Robotic Assistance(MISRA), a segmentation framework that augments RGB input with luminance channels, integrates skip attention to preserve elongated features, and employs an Iterative Feedback Module(IFM) for continuity restoration across multiple passes. In addition, we introduce a dedicated microsurgical dataset with fine-grained annotations of surgical instruments including thin objects, providing a benchmark for robust evaluation Dataset available at https://huggingface.co/datasets/KIST-HARILAB/MISAW-Seg. Experiments demonstrate that MISRA achieves competitive performance, improving the mean class IoU by 5.37% over competing methods, while delivering more stable predictions at instrument contacts and overlaps. These results position MISRA as a promising step toward reliable scene parsing for computer-assisted and robotic microsurgery.

Endoscopic procedures are essential for diagnosing and treating internal diseases, and multi-modal large language models (MLLMs) are increasingly applied to assist in endoscopy analysis. However, current benchmarks are limited, as they typically cover specific endoscopic scenarios and a small set of clinical tasks, failing to capture the real-world diversity of endoscopic scenarios and the full range of skills needed in clinical workflows. To address these issues, we introduce EndoBench, the first comprehensive benchmark specifically designed to assess MLLMs across the full spectrum of endoscopic practice with multi-dimensional capacities. EndoBench encompasses 4 distinct endoscopic scenarios, 12 specialized clinical tasks with 12 secondary subtasks, and 5 levels of visual prompting granularities, resulting in 6,832 rigorously validated VQA pairs from 21 diverse datasets. Our multi-dimensional evaluation framework mirrors the clinical workflow--spanning anatomical recognition, lesion analysis, spatial localization, and surgical operations--to holistically gauge the perceptual and diagnostic abilities of MLLMs in realistic scenarios. We benchmark 23 state-of-the-art models, including general-purpose, medical-specialized, and proprietary MLLMs, and establish human clinician performance as a reference standard. Our extensive experiments reveal: (1) proprietary MLLMs outperform open-source and medical-specialized models overall, but still trail human experts; (2) medical-domain supervised fine-tuning substantially boosts task-specific accuracy; and (3) model performance remains sensitive to prompt format and clinical task complexity. EndoBench establishes a new standard for evaluating and advancing MLLMs in endoscopy, highlighting both progress and persistent gaps between current models and expert clinical reasoning. We publicly release our benchmark and code.

Accurate recognition of anatomical structures is essential for safe and effective minimally invasive surgery (MIS), yet it remains underexplored in surgical computer vision due to limited annotated data and methods tailored primarily to natural scenes. In this work, we present a combined dataset and model framework to advance anatomy-aware perception in MIS. First, we introduce ATLAS-120k, a large-scale clip-level semantic segmentation dataset comprising over 120,000 annotated frames from 100 surgical videos spanning 14 procedures and multiple modalities, including laparoscopic and robot-assisted surgery. The dataset captures substantial procedural variability and was created using a scalable annotation pipeline that integrates expert manual labeling, automated propagation, iterative refinement, and surgeon verification to ensure high-quality annotations. Second, we propose ATLAS (Anatomy Recognition with Context Learning using Foundation Representations), a video semantic segmentation model specifically designed for surgical anatomy recognition. Unlike conventional approaches that emphasize object tracking, ATLAS leverages foundation-model embeddings together with lightweight temporal reasoning to incorporate contextual cues such as procedure type, surgical phase, and short-term visual memory. This design enables temporally consistent and accurate predictions while maintaining real-time feasibility. Together, the dataset and model establish a practical foundation for robust surgical scene understanding and support the development of clinically applicable guidance systems for minimally invasive surgery. The models, dataset annotations and annotation platform are publicly available at: https://github.com/TimJaspers0801/ATLAS.

Sparse training is emerging as a promising avenue for reducing the computational cost of training neural networks. Several recent studies have proposed pruning methods using learnable thresholds to efficiently explore the non-uniform distribution of sparsity inherent within the models. In this paper, we propose Gradient Annealing (GA), where gradients of masked weights are scaled down in a non-linear manner. GA provides an elegant trade-off between sparsity and accuracy without the need for additional sparsity-inducing regularization. We integrated GA with the latest learnable pruning methods to create an automated sparse training algorithm called AutoSparse, which achieves better accuracy and/or training/inference FLOPS reduction than existing learnable pruning methods for sparse ResNet50 and MobileNetV1 on ImageNet-1K: AutoSparse achieves (2x, 7x) reduction in (training,inference) FLOPS for ResNet50 on ImageNet at 80% sparsity. Finally, AutoSparse outperforms sparse-to-sparse SotA method MEST (uniform sparsity) for 80% sparse ResNet50 with similar accuracy, where MEST uses 12% more training FLOPS and 50% more inference FLOPS.

Customizing an LLM judge to a specific task or domain often involves optimizing its prompt across multiple evaluation criteria simultaneously. Textual gradient methods automate this for a single judge criterion, however they produce natural-language critiques, not numerical vectors. Thus, the conflict-resolution toolkit of multi-task learning (PCGrad, MGDA) doesn't apply to the multi-objective textual gradient setting. We test five decomposition modes of textual gradient optimizers by varying how much cross-task information the loss, gradient and optimizer LLMs share. In 6 of 10 configurations, we observe that optimization never improves over the initial prompt. Gradient specificity drops by 59% (from 9.0 to 3.7) when the gradient LLM processes multiple criteria jointly. Separately, we observe that naively combining per-task instructions into a single prompt degrades Spearman's rho by -5.3%. These results identify two separable failure modes: optimization-time gradient dilution and inference-time instruction interference, which together constrain the design space for multi-objective judge customization using textual feedback.

Model-free deep reinforcement learning (RL) algorithms have been demonstrated on a range of challenging decision making and control tasks. However, these methods typically suffer from two major challenges: very high sample complexity and brittle convergence properties, which necessitate meticulous hyperparameter tuning. Both of these challenges severely limit the applicability of such methods to complex, real-world domains. In this paper, we propose soft actor-critic, an off-policy actor-critic deep RL algorithm based on the maximum entropy reinforcement learning framework. In this framework, the actor aims to maximize expected reward while also maximizing entropy. That is, to succeed at the task while acting as randomly as possible. Prior deep RL methods based on this framework have been formulated as Q-learning methods. By combining off-policy updates with a stable stochastic actor-critic formulation, our method achieves state-of-the-art performance on a range of continuous control benchmark tasks, outperforming prior on-policy and off-policy methods. Furthermore, we demonstrate that, in contrast to other off-policy algorithms, our approach is very stable, achieving very similar performance across different random seeds.

Surgical scene segmentation is critical in computer-assisted surgery and is vital for enhancing surgical quality and patient outcomes. Recently, referring surgical segmentation is emerging, given its advantage of providing surgeons with an interactive experience to segment the target object. However, existing methods are limited by low efficiency and short-term tracking, hindering their applicability in complex real-world surgical scenarios. In this paper, we introduce ReSurgSAM2, a two-stage surgical referring segmentation framework that leverages Segment Anything Model 2 to perform text-referred target detection, followed by tracking with reliable initial frame identification and diversity-driven long-term memory. For the detection stage, we propose a cross-modal spatial-temporal Mamba to generate precise detection and segmentation results. Based on these results, our credible initial frame selection strategy identifies the reliable frame for the subsequent tracking. Upon selecting the initial frame, our method transitions to the tracking stage, where it incorporates a diversity-driven memory mechanism that maintains a credible and diverse memory bank, ensuring consistent long-term tracking. Extensive experiments demonstrate that ReSurgSAM2 achieves substantial improvements in accuracy and efficiency compared to existing methods, operating in real-time at 61.2 FPS. Our code and datasets will be available at https://github.com/jinlab-imvr/ReSurgSAM2.

Recent Artificial Intelligence (AI) models have matched or exceeded human experts in several benchmarks of biomedical task performance, but have lagged behind on surgical image-analysis benchmarks. Since surgery requires integrating disparate tasks -- including multimodal data integration, human interaction, and physical effects -- generally-capable AI models could be particularly attractive as a collaborative tool if performance could be improved. On the one hand, the canonical approach of scaling architecture size and training data is attractive, especially since there are millions of hours of surgical video data generated per year. On the other hand, preparing surgical data for AI training requires significantly higher levels of professional expertise, and training on that data requires expensive computational resources. These trade-offs paint an uncertain picture of whether and to-what-extent modern AI could aid surgical practice. In this paper, we explore this question through a case study of surgical tool detection using state-of-the-art AI methods available in 2026. We demonstrate that even with multi-billion parameter models and extensive training, current Vision Language Models fall short in the seemingly simple task of tool detection in neurosurgery. Additionally, we show scaling experiments indicating that increasing model size and training time only leads to diminishing improvements in relevant performance metrics. Thus, our experiments suggest that current models could still face significant obstacles in surgical use cases. Moreover, some obstacles cannot be simply ``scaled away'' with additional compute and persist across diverse model architectures, raising the question of whether data and label availability are the only limiting factors. We discuss the main contributors to these constraints and advance potential solutions.

We introduce a general method for improving the convergence rate of gradient-based optimizers that is easy to implement and works well in practice. We demonstrate the effectiveness of the method in a range of optimization problems by applying it to stochastic gradient descent, stochastic gradient descent with Nesterov momentum, and Adam, showing that it significantly reduces the need for the manual tuning of the initial learning rate for these commonly used algorithms. Our method works by dynamically updating the learning rate during optimization using the gradient with respect to the learning rate of the update rule itself. Computing this "hypergradient" needs little additional computation, requires only one extra copy of the original gradient to be stored in memory, and relies upon nothing more than what is provided by reverse-mode automatic differentiation.

Gradient inversion attacks aim to reconstruct local training data from intermediate gradients exposed in the federated learning framework. Despite successful attacks, all previous methods, starting from reconstructing a single data point and then relaxing the single-image limit to batch level, are only tested under hard label constraints. Even for single-image reconstruction, we still lack an analysis-based algorithm to recover augmented soft labels. In this work, we change the focus from enlarging batchsize to investigating the hard label constraints, considering a more realistic circumstance where label smoothing and mixup techniques are used in the training process. In particular, we are the first to initiate a novel algorithm to simultaneously recover the ground-truth augmented label and the input feature of the last fully-connected layer from single-input gradients, and provide a necessary condition for any analytical-based label recovery methods. Extensive experiments testify to the label recovery accuracy, as well as the benefits to the following image reconstruction. We believe soft labels in classification tasks are worth further attention in gradient inversion attacks.

In this paper, we study a class of composite optimization problems whose objective function is given by the summation of a general smooth and nonsmooth component, together with a relatively simple nonsmooth term. While restart strategies are commonly employed in first-order methods to achieve optimal convergence under strong convexity, they introduce structural complexity and practical overhead, making algorithm design and nesting cumbersome. To address this, we propose a restart-free stochastic gradient sliding algorithm that eliminates the need for explicit restart phases when the simple nonsmooth component is strongly convex. Through a novel and carefully designed parameter selection strategy, we prove that the proposed algorithm achieves an ε-solution with only O(log(1ε)) gradient evaluations for the smooth component and O(1ε) stochastic subgradient evaluations for the nonsmooth component, matching the optimal complexity of existing multi-phase (restart-based) methods. Moreover, for the case where the nonsmooth component is structured, allowing the overall problem to be reformulated as a bilinear saddle-point problem, we develop a restart-free accelerated stochastic gradient sliding algorithm. We show that the resulting method requires only O(log(1ε)) gradient computations for the smooth component while preserving an overall iteration complexity of O(1{sqrtε}) for solving the corresponding saddle-point problems. Our work thus provides simpler, restart-f

Precise camera tracking, high-fidelity 3D tissue reconstruction, and real-time online visualization are critical for intrabody medical imaging devices such as endoscopes and capsule robots. However, existing SLAM (Simultaneous Localization and Mapping) methods often struggle to achieve both complete high-quality surgical field reconstruction and efficient computation, restricting their intraoperative applications among endoscopic surgeries. In this paper, we introduce EndoGSLAM, an efficient SLAM approach for endoscopic surgeries, which integrates streamlined Gaussian representation and differentiable rasterization to facilitate over 100 fps rendering speed during online camera tracking and tissue reconstructing. Extensive experiments show that EndoGSLAM achieves a better trade-off between intraoperative availability and reconstruction quality than traditional or neural SLAM approaches, showing tremendous potential for endoscopic surgeries. The project page is at https://EndoGSLAM.loping151.com

submucosal dissection (ESD) enables rapid resection of large lesions, minimizing recurrence rates and improving long-term overall survival. Despite these advantages, ESD is technically challenging and carries high risks of complications, necessitating skilled surgeons and precise instruments. Recent advancements in Large Visual-Language Models (LVLMs) offer promising decision support and predictive planning capabilities for robotic systems, which can augment the accuracy of ESD and reduce procedural risks. However, existing datasets for multi-level fine-grained ESD surgical motion understanding are scarce and lack detailed annotations. In this paper, we design a hierarchical decomposition of ESD motion granularity and introduce a multi-level surgical motion dataset (CoPESD) for training LVLMs as the robotic Co-Pilot of Endoscopic Submucosal Dissection. CoPESD includes 17,679 images with 32,699 bounding boxes and 88,395 multi-level motions, from over 35 hours of ESD videos for both robot-assisted and conventional surgeries. CoPESD enables granular analysis of ESD motions, focusing on the complex task of submucosal dissection. Extensive experiments on the LVLMs demonstrate the effectiveness of CoPESD in training LVLMs to predict following surgical robotic motions. As the first multimodal ESD motion dataset, CoPESD supports advanced research in ESD instruction-following and surgical automation. The dataset is available at https://github.com/gkw0010/CoPESD{https://github.com/gkw0010/CoPESD.}}

High-fidelity reconstruction of deformable tissues from endoscopic videos remains challenging due to the limitations of existing methods in capturing subtle color variations and modeling global deformations. While 3D Gaussian Splatting (3DGS) enables efficient dynamic reconstruction, its fixed per-Gaussian color assignment struggles with intricate textures, and linear deformation modeling fails to model consistent global deformation. To address these issues, we propose ColorGS, a novel framework that integrates spatially adaptive color encoding and enhanced deformation modeling for surgical scene reconstruction. First, we introduce Colored Gaussian Primitives, which employ dynamic anchors with learnable color parameters to adaptively encode spatially varying textures, significantly improving color expressiveness under complex lighting and tissue similarity. Second, we design an Enhanced Deformation Model (EDM) that combines time-aware Gaussian basis functions with learnable time-independent deformations, enabling precise capture of both localized tissue deformations and global motion consistency caused by surgical interactions. Extensive experiments on DaVinci robotic surgery videos and benchmark datasets (EndoNeRF, StereoMIS) demonstrate that ColorGS achieves state-of-the-art performance, attaining a PSNR of 39.85 (1.5 higher than prior 3DGS-based methods) and superior SSIM (97.25\%) while maintaining real-time rendering efficiency. Our work advances surgical scene reconstruction by balancing high fidelity with computational practicality, critical for intraoperative guidance and AR/VR applications.

Precise lesion resection depends on accurately identifying fine-grained anatomical structures. While many coarse-grained segmentation (CGS) methods have been successful in large-scale segmentation (e.g., organs), they fall short in clinical scenarios requiring fine-grained segmentation (FGS), which remains challenging due to frequent individual variations in small-scale anatomical structures. Although recent Mamba-based models have advanced medical image segmentation, they often rely on fixed manually-defined scanning orders, which limit their adaptability to individual variations in FGS. To address this, we propose ASM-UNet, a novel Mamba-based architecture for FGS. It introduces adaptive scan scores to dynamically guide the scanning order, generated by combining group-level commonalities and individual-level variations. Experiments on two public datasets (ACDC and Synapse) and a newly proposed challenging biliary tract FGS dataset, namely BTMS, demonstrate that ASM-UNet achieves superior performance in both CGS and FGS tasks. Our code and dataset are available at https://github.com/YqunYang/ASM-UNet.

We deal with the problem of gradient estimation for stochastic differentiable relaxations of algorithms, operators, simulators, and other non-differentiable functions. Stochastic smoothing conventionally perturbs the input of a non-differentiable function with a differentiable density distribution with full support, smoothing it and enabling gradient estimation. Our theory starts at first principles to derive stochastic smoothing with reduced assumptions, without requiring a differentiable density nor full support, and we present a general framework for relaxation and gradient estimation of non-differentiable black-box functions f:R^ntoR^m. We develop variance reduction for gradient estimation from 3 orthogonal perspectives. Empirically, we benchmark 6 distributions and up to 24 variance reduction strategies for differentiable sorting and ranking, differentiable shortest-paths on graphs, differentiable rendering for pose estimation, as well as differentiable cryo-ET simulations.

Data diversity and volume are crucial to the success of training deep learning models, while in the medical imaging field, the difficulty and cost of data collection and annotation are especially huge. Specifically in robotic surgery, data scarcity and imbalance have heavily affected the model accuracy and limited the design and deployment of deep learning-based surgical applications such as surgical instrument segmentation. Considering this, we rethink the surgical instrument segmentation task and propose a one-to-many data generation solution that gets rid of the complicated and expensive process of data collection and annotation from robotic surgery. In our method, we only utilize a single surgical background tissue image and a few open-source instrument images as the seed images and apply multiple augmentations and blending techniques to synthesize amounts of image variations. In addition, we also introduce the chained augmentation mixing during training to further enhance the data diversities. The proposed approach is evaluated on the real datasets of the EndoVis-2018 and EndoVis-2017 surgical scene segmentation. Our empirical analysis suggests that without the high cost of data collection and annotation, we can achieve decent surgical instrument segmentation performance. Moreover, we also observe that our method can deal with novel instrument prediction in the deployment domain. We hope our inspiring results will encourage researchers to emphasize data-centric methods to overcome demanding deep learning limitations besides data shortage, such as class imbalance, domain adaptation, and incremental learning. Our code is available at https://github.com/lofrienger/Single_SurgicalScene_For_Segmentation.

We introduce an inference-time scene optimization algorithm utilizing triangle soup, a collection of disconnected translucent triangle primitives, as the representation for the geometry and appearance of a scene. Unlike full-rank Gaussian kernels, triangles are a natural, locally-flat proxy for surfaces that can be connected to achieve highly complex geometry. When coupled with per-vertex Spherical Harmonics (SH), triangles provide a rich visual representation without incurring an expensive increase in primitives. We leverage our new representation to incorporate optimization objectives and enforce spatial regularization directly on the underlying primitives. The main differentiator of our approach is the definition and enforcement of soft connectivity forces between triangles during optimization, encouraging explicit, but soft, surface continuity in 3D. Experiments on representative 3D reconstruction and novel view synthesis datasets show improvements in geometric accuracy compared to current state-of-the-art algorithms without sacrificing visual fidelity.

As deep learning models gain attraction in medical data, ensuring transparent and trustworthy decision-making is essential. In skin cancer diagnosis, while advancements in lesion detection and classification have improved accuracy, the black-box nature of these methods poses challenges in understanding their decision processes, leading to trust issues among physicians. This study leverages the CLIP (Contrastive Language-Image Pretraining) model, trained on different skin lesion datasets, to capture meaningful relationships between visual features and diagnostic criteria terms. To further enhance transparency, we propose a method called MedGrad E-CLIP, which builds on gradient-based E-CLIP by incorporating a weighted entropy mechanism designed for complex medical imaging like skin lesions. This approach highlights critical image regions linked to specific diagnostic descriptions. The developed integrated pipeline not only classifies skin lesions by matching corresponding descriptions but also adds an essential layer of explainability developed especially for medical data. By visually explaining how different features in an image relates to diagnostic criteria, this approach demonstrates the potential of advanced vision-language models in medical image analysis, ultimately improving transparency, robustness, and trust in AI-driven diagnostic systems.

Medical image registration is an active research topic and forms a basis for many medical image analysis tasks. Although image registration is a rather general concept specialized methods are usually required to target a specific registration problem. The development and implementation of such methods has been tough so far as the gradient of the objective has to be computed. Also, its evaluation has to be performed preferably on a GPU for larger images and for more complex transformation models and regularization terms. This hinders researchers from rapid prototyping and poses hurdles to reproduce research results. There is a clear need for an environment which hides this complexity to put the modeling and the experimental exploration of registration methods into the foreground. With the "Autograd Image Registration Laboratory" (AIRLab), we introduce an open laboratory for image registration tasks, where the analytic gradients of the objective function are computed automatically and the device where the computations are performed, on a CPU or a GPU, is transparent. It is meant as a laboratory for researchers and developers enabling them to rapidly try out new ideas for registering images and to reproduce registration results which have already been published. AIRLab is implemented in Python using PyTorch as tensor and optimization library and SimpleITK for basic image IO. Therefore, it profits from recent advances made by the machine learning community concerning optimization and deep neural network models. The presented draft of this paper outlines AIRLab with first code snippets and performance analyses. A more exhaustive introduction will follow as a final version soon.

The softmax (also called softargmax) function is widely used in machine learning models to normalize real-valued scores into a probability distribution. To avoid floating-point overflow, the softmax function is conventionally implemented in three passes: the first pass to compute the normalization constant, and two other passes to compute outputs from normalized inputs. We analyze two variants of the Three-Pass algorithm and demonstrate that in a well-optimized implementation on HPC-class processors performance of all three passes is limited by memory bandwidth. We then present a novel algorithm for softmax computation in just two passes. The proposed Two-Pass algorithm avoids both numerical overflow and the extra normalization pass by employing an exotic representation for intermediate values, where each value is represented as a pair of floating-point numbers: one representing the "mantissa" and another representing the "exponent". Performance evaluation demonstrates that on out-of-cache inputs on an Intel Skylake-X processor the new Two-Pass algorithm outperforms the traditional Three-Pass algorithm by up to 28% in AVX512 implementation, and by up to 18% in AVX2 implementation. The proposed Two-Pass algorithm also outperforms the traditional Three-Pass algorithm on Intel Broadwell and AMD Zen 2 processors. To foster reproducibility, we released an open-source implementation of the new Two-Pass Softmax algorithm and other experiments in this paper as a part of XNNPACK library at GitHub.com/google/XNNPACK.

Convolutional neural networks (CNNs) are widely used for high-stakes applications like medicine, often surpassing human performance. However, most explanation methods rely on post-hoc attribution, approximating the decision-making process of already trained black-box models. These methods are often sensitive, unreliable, and fail to reflect true model reasoning, limiting their trustworthiness in critical applications. In this work, we introduce SoftCAM, a straightforward yet effective approach that makes standard CNN architectures inherently interpretable. By removing the global average pooling layer and replacing the fully connected classification layer with a convolution-based class evidence layer, SoftCAM preserves spatial information and produces explicit class activation maps that form the basis of the model's predictions. Evaluated on three medical datasets, SoftCAM maintains classification performance while significantly improving both the qualitative and quantitative explanation compared to existing post-hoc methods. Our results demonstrate that CNNs can be inherently interpretable without compromising performance, advancing the development of self-explainable deep learning for high-stakes decision-making. The code is available at https://github.com/kdjoumessi/SoftCAM

Growing evidence indicates that only a sparse subset from a pool of sensory neurons is active for the encoding of visual stimuli at any instant in time. Traditionally, to replicate such biological sparsity, generative models have been using the ell_1 norm as a penalty due to its convexity, which makes it amenable to fast and simple algorithmic solvers. In this work, we use biological vision as a test-bed and show that the soft thresholding operation associated to the use of the ell_1 norm is highly suboptimal compared to other functions suited to approximating ell_q with 0 leq q < 1 (including recently proposed Continuous Exact relaxations), both in terms of performance and in the production of features that are akin to signatures of the primary visual cortex. We show that ell_1 sparsity produces a denser code or employs a pool with more neurons, i.e. has a higher degree of overcompleteness, in order to maintain the same reconstruction error as the other methods considered. For all the penalty functions tested, a subset of the neurons develop orientation selectivity similarly to V1 neurons. When their code is sparse enough, the methods also develop receptive fields with varying functionalities, another signature of V1. Compared to other methods, soft thresholding achieves this level of sparsity at the expense of much degraded reconstruction performance, that more likely than not is not acceptable in biological vision. Our results indicate that V1 uses a sparsity inducing regularization that is closer to the ell_0 pseudo-norm rather than to the ell_1 norm.

The widespread use of vector graphics creates a significant demand for vectorization methods. While recent learning-based techniques have shown their capability to create vector images of clear topology, filling these primitives with gradients remains a challenge. In this paper, we propose a segmentation-guided vectorization framework to convert raster images into concise vector graphics with radial gradient fills. With the guidance of an embedded gradient-aware segmentation subroutine, our approach progressively appends gradient-filled B\'ezier paths to the output, where primitive parameters are initiated with our newly designed initialization technique and are optimized to minimize our novel loss function. We build our method on a differentiable renderer with traditional segmentation algorithms to develop it as a model-free tool for raster-to-vector conversion. It is tested on various inputs to demonstrate its feasibility, independent of datasets, to synthesize vector graphics with improved visual quality and layer-wise topology compared to prior work.

We introduce DIFFTACTILE, a physics-based differentiable tactile simulation system designed to enhance robotic manipulation with dense and physically accurate tactile feedback. In contrast to prior tactile simulators which primarily focus on manipulating rigid bodies and often rely on simplified approximations to model stress and deformations of materials in contact, DIFFTACTILE emphasizes physics-based contact modeling with high fidelity, supporting simulations of diverse contact modes and interactions with objects possessing a wide range of material properties. Our system incorporates several key components, including a Finite Element Method (FEM)-based soft body model for simulating the sensing elastomer, a multi-material simulator for modeling diverse object types (such as elastic, elastoplastic, cables) under manipulation, a penalty-based contact model for handling contact dynamics. The differentiable nature of our system facilitates gradient-based optimization for both 1) refining physical properties in simulation using real-world data, hence narrowing the sim-to-real gap and 2) efficient learning of tactile-assisted grasping and contact-rich manipulation skills. Additionally, we introduce a method to infer the optical response of our tactile sensor to contact using an efficient pixel-based neural module. We anticipate that DIFFTACTILE will serve as a useful platform for studying contact-rich manipulations, leveraging the benefits of dense tactile feedback and differentiable physics. Code and supplementary materials are available at the project website https://difftactile.github.io/.

In recent years, the application of machine learning to minimally invasive surgery (MIS) has attracted considerable interest. Datasets are critical to the use of such techniques. This paper presents a unique dataset recorded during ex vivo pseudo-cholecystectomy procedures on pig livers using the da Vinci Research Kit (dVRK). Unlike existing datasets, it addresses a critical gap by providing comprehensive kinematic data, recordings of all pedal inputs, and offers a time-stamped record of the endoscope's movements. This expanded version also includes segmentation and keypoint annotations of images, enhancing its utility for computer vision applications. Contributed by seven surgeons with varied backgrounds and experience levels that are provided as a part of this expanded version, the dataset is an important new resource for surgical robotics research. It enables the development of advanced methods for evaluating surgeon skills, tools for providing better context awareness, and automation of surgical tasks. Our work overcomes the limitations of incomplete recordings and imprecise kinematic data found in other datasets. To demonstrate the potential of the dataset for advancing automation in surgical robotics, we introduce two models that predict clutch usage and camera activation, a 3D scene reconstruction example, and the results from our keypoint and segmentation models.

Wasserstein gradient flow has emerged as a promising approach to solve optimization problems over the space of probability distributions. A recent trend is to use the well-known JKO scheme in combination with input convex neural networks to numerically implement the proximal step. The most challenging step, in this setup, is to evaluate functions involving density explicitly, such as entropy, in terms of samples. This paper builds on the recent works with a slight but crucial difference: we propose to utilize a variational formulation of the objective function formulated as maximization over a parametric class of functions. Theoretically, the proposed variational formulation allows the construction of gradient flows directly for empirical distributions with a well-defined and meaningful objective function. Computationally, this approach replaces the computationally expensive step in existing methods, to handle objective functions involving density, with inner loop updates that only require a small batch of samples and scale well with the dimension. The performance and scalability of the proposed method are illustrated with the aid of several numerical experiments involving high-dimensional synthetic and real datasets.

Over the past decade, computer vision applications in minimally invasive surgery have rapidly increased. Despite this growth, the impact of surgical computer vision remains limited compared to other medical fields like pathology and radiology, primarily due to the scarcity of representative annotated data. Whereas transfer learning from large annotated datasets such as ImageNet has been conventionally the norm to achieve high-performing models, recent advancements in self-supervised learning (SSL) have demonstrated superior performance. In medical image analysis, in-domain SSL pretraining has already been shown to outperform ImageNet-based initialization. Although unlabeled data in the field of surgical computer vision is abundant, the diversity within this data is limited. This study investigates the role of dataset diversity in SSL for surgical computer vision, comparing procedure-specific datasets against a more heterogeneous general surgical dataset across three different downstream surgical applications. The obtained results show that using solely procedure-specific data can lead to substantial improvements of 13.8%, 9.5%, and 36.8% compared to ImageNet pretraining. However, extending this data with more heterogeneous surgical data further increases performance by an additional 5.0%, 5.2%, and 2.5%, suggesting that increasing diversity within SSL data is beneficial for model performance. The code and pretrained model weights are made publicly available at https://github.com/TimJaspers0801/SurgeNet.

It is desired to equip robots with the capability of interacting with various soft materials as they are ubiquitous in the real world. While physics simulations are one of the predominant methods for data collection and robot training, simulating soft materials presents considerable challenges. Specifically, it is significantly more costly than simulating rigid objects in terms of simulation speed and storage requirements. These limitations typically restrict the scope of studies on soft materials to small and bounded areas, thereby hindering the learning of skills in broader spaces. To address this issue, we introduce UBSoft, a new simulation platform designed to support unbounded soft environments for robot skill acquisition. Our platform utilizes spatially adaptive resolution scales, where simulation resolution dynamically adjusts based on proximity to active robotic agents. Our framework markedly reduces the demand for extensive storage space and computation costs required for large-scale scenarios involving soft materials. We also establish a set of benchmark tasks in our platform, including both locomotion and manipulation tasks, and conduct experiments to evaluate the efficacy of various reinforcement learning algorithms and trajectory optimization techniques, both gradient-based and sampling-based. Preliminary results indicate that sampling-based trajectory optimization generally achieves better results for obtaining one trajectory to solve the task. Additionally, we conduct experiments in real-world environments to demonstrate that advancements made in our UBSoft simulator could translate to improved robot interactions with large-scale soft material. More videos can be found at https://vis-www.cs.umass.edu/ubsoft/.

Transformer-based video diffusion models (VDMs) deliver state-of-the-art video generation quality but are constrained by the quadratic cost of self-attention, making long sequences and high resolutions computationally expensive. While linear attention offers sub-quadratic complexity, prior attempts fail to match the expressiveness of softmax attention without costly retraining. We introduce Attention Surgery, an efficient framework for linearizing or hybridizing attention in pretrained VDMs without training from scratch. Inspired by recent advances in language models, our method combines a novel hybrid attention mechanism-mixing softmax and linear tokens-with a lightweight distillation and fine-tuning pipeline requiring only a few GPU-days. Additionally, we incorporate a cost-aware block-rate strategy to balance expressiveness and efficiency across layers. Applied to Wan2.1 1.3B, a state-of-the-art DiT-based VDM, Attention Surgery achieves the first competitive sub-quadratic attention video diffusion models, reducing attention cost by up to 40\% in terms of FLOPs, while maintaining generation quality as measured on the standard VBench and VBench-2.0 benchmarks.

Realistic surgical simulation plays a crucial role in training novice surgeons and in the development of autonomous agents. World models can scale such simulation environments to realistic and diverse procedures by predicting future patient states conditioned on current observations and surgical actions. However, current state-of-the-art approaches often fail to satisfy key criteria required for clinical applicability, including visual realism, physically grounded interactions, and the ability to simulate scenarios beyond the training distribution. Hence, we introduce SWoMo, a neuro-symbolic world model for cataract surgery simulation that decouples motion generation from visual realism. The symbolic component, consisting of a rule-based simulator and scene graph representations, models motion dynamics and tool-tissue interactions, while a diffusion model produces realistic visual appearance, including textures and tissue deformations. We propose an inverse pairing strategy that reconstructs real surgical videos in the simulator to obtain paired simulated and real videos, which are then used to train our video diffusion model for the reverse objective of sim-to-real translation. Our experiments show both qualitative and quantitative improvements over prior work. We demonstrate that our simulator further satisfies the key criteria, including generalisation to unseen interaction geometries, improvements in downstream phase detection, and unsupervised video style transfer. The code, data, and model weights are available at: https://ssharvienkumar.github.io/SWoMo/

Recent approximations to backpropagation (BP) have mitigated many of BP's computational inefficiencies and incompatibilities with biology, but important limitations still remain. Moreover, the approximations significantly decrease accuracy in benchmarks, suggesting that an entirely different approach may be more fruitful. Here, grounded on recent theory for Hebbian learning in soft winner-take-all networks, we present multilayer SoftHebb, i.e. an algorithm that trains deep neural networks, without any feedback, target, or error signals. As a result, it achieves efficiency by avoiding weight transport, non-local plasticity, time-locking of layer updates, iterative equilibria, and (self-) supervisory or other feedback signals -- which were necessary in other approaches. Its increased efficiency and biological compatibility do not trade off accuracy compared to state-of-the-art bio-plausible learning, but rather improve it. With up to five hidden layers and an added linear classifier, accuracies on MNIST, CIFAR-10, STL-10, and ImageNet, respectively reach 99.4%, 80.3%, 76.2%, and 27.3%. In conclusion, SoftHebb shows with a radically different approach from BP that Deep Learning over few layers may be plausible in the brain and increases the accuracy of bio-plausible machine learning. Code is available at https://github.com/NeuromorphicComputing/SoftHebb.

We present a new loss function for joint disparity and uncertainty estimation in deep stereo matching. Our work is motivated by the need for precise uncertainty estimates and the observation that multi-task learning often leads to improved performance in all tasks. We show that this can be achieved by requiring the distribution of uncertainty to match the distribution of disparity errors via a KL divergence term in the network's loss function. A differentiable soft-histogramming technique is used to approximate the distributions so that they can be used in the loss. We experimentally assess the effectiveness of our approach and observe significant improvements in both disparity and uncertainty prediction on large datasets.

Vision-language pre-training (VLP) offers unique advantages for surgery by aligning language with surgical videos, enabling workflow understanding and transfer across tasks without relying on expert-labeled datasets. However, progress in surgical VLP remains constrained by the limited scale, procedural diversity, semantic quality, and hierarchical structure of existing datasets. In this work, we present SurgLaVi, the largest and most diverse surgical vision-language dataset to date, comprising nearly 240k clip-caption pairs from more than 200 procedures, and comprising hierarchical levels at phase-, step-, and task-level. At the core of SurgLaVi lies a fully automated pipeline that systematically generates fine-grained transcriptions of surgical videos and segments them into coherent procedural units. To ensure high-quality annotations, it applies dual-modality filtering to remove irrelevant and noisy samples. Within this framework, the resulting captions are enriched with contextual detail, producing annotations that are both semantically rich and easy to interpret. To ensure accessibility, we release SurgLaVi-eta, an open-source derivative of 113k clip-caption pairs constructed entirely from public data, which is over four times larger than existing surgical VLP datasets. To demonstrate the value of SurgLaVi datasets, we introduce SurgCLIP, a CLIP-style video-text contrastive framework with dual encoders, as a representative base model. SurgCLIP achieves consistent improvements across phase, step, action, and tool recognition, surpassing prior state-of-the-art methods, often by large margins. These results validate that large-scale, semantically rich, and hierarchically structured datasets directly translate into stronger and more generalizable representations, establishing SurgLaVi as a key resource for developing surgical foundation models.

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.

There are two widely known issues with properly training Recurrent Neural Networks, the vanishing and the exploding gradient problems detailed in Bengio et al. (1994). In this paper we attempt to improve the understanding of the underlying issues by exploring these problems from an analytical, a geometric and a dynamical systems perspective. Our analysis is used to justify a simple yet effective solution. We propose a gradient norm clipping strategy to deal with exploding gradients and a soft constraint for the vanishing gradients problem. We validate empirically our hypothesis and proposed solutions in the experimental section.

Training stable biological foundation models requires rethinking attention mechanisms: we find that using sigmoid attention as a drop in replacement for softmax attention a) produces better learned representations: on six diverse single-cell datasets, sigmoid achieves 25% higher cell-type separation, better cell-type cohesion metrics, and lower validation loss, b) faster training, models with sigmoid attention train up to 10% faster than their softmax counterparts, and c) more stable training by eliminating inherent sources of instability in softmax attention. We establish that sigmoid attention has globally bounded derivatives (leq 0.25) as opposed to softmax, and a diagonal Jacobian structure in contrast with softmax's dense coupling, which together help alleviate training instabilities. In stress tests on 160M-parameter bidirectional attention models trained without gradient clipping on 8K-token sequences, softmax diverges catastrophically, with gradients exploding by four orders of magnitude, while sigmoid remains stable. Finally, we implement and open-source TritonSigmoid, an efficient GPU kernel that achieves 515 TFLOPS on H100 GPUs, outperforming both FlashAttention-2 and FlashSigmoid, with native padding support, which is essential for biological sequences. Our results establish sigmoid attention as both theoretically grounded and empirically superior for biological foundation models. Code is available at https://github.com/MSDLLCpapers/triton-sigmoid

Computer-assisted minimally invasive surgery has great potential in benefiting modern operating theatres. The video data streamed from the endoscope provides rich information to support context-awareness for next-generation intelligent surgical systems. To achieve accurate perception and automatic manipulation during the procedure, learning based technique is a promising way, which enables advanced image analysis and scene understanding in recent years. However, learning such models highly relies on large-scale, high-quality, and multi-task labelled data. This is currently a bottleneck for the topic, as available public dataset is still extremely limited in the field of CAI. In this paper, we present and release the first integrated dataset (named AutoLaparo) with multiple image-based perception tasks to facilitate learning-based automation in hysterectomy surgery. Our AutoLaparo dataset is developed based on full-length videos of entire hysterectomy procedures. Specifically, three different yet highly correlated tasks are formulated in the dataset, including surgical workflow recognition, laparoscope motion prediction, and instrument and key anatomy segmentation. In addition, we provide experimental results with state-of-the-art models as reference benchmarks for further model developments and evaluations on this dataset. The dataset is available at https://autolaparo.github.io.

We investigate how both the adaptation of a generic foundation model via transfer learning and the integration of complementary modalities from the operating room (OR) can support surgical data science. To this end, we use V-JEPA as the single-modality foundation of a multimodal model for minimally invasive surgery support. We analyze how the model's downstream performance can benefit (a) from finetuning on unlabeled surgical video data and (b) from providing additional time-resolved data streams from the OR in a multimodal setup. In an in-house dataset of liver surgery videos, we analyze the tasks of predicting hospital length of stay and postoperative complications. In videos of the public HeiCo dataset, we analyze the task of surgical phase recognition. As a baseline, we apply pretrained V-JEPA to all tasks. We then finetune it on unlabeled, held-out videos to investigate its change in performance after domain adaptation. Following the idea of modular decision support networks, we integrate additional data streams from the OR by training a separate encoder to form a shared representation space with V-JEPA's embeddings. Our experiments show that finetuning on domain-specific data increases model performance. On the in-house data, integrating additional time-resolved data likewise benefits the model. On the HeiCo data, accuracy of the pretrained video-only, single-modality baseline setup is on par with the top-performing submissions of the EndoVis2017 challenge, while finetuning on domain-specific data increases accuracy further. Our results thus demonstrate how surgical data science can leverage public, generic foundation models. Likewise, they indicate the potential of domain adaptation and of integrating suitable complementary data streams from the OR. To support further research, we release our code and model weights at https://github.com/DigitalSurgeryLab-Basel/ML-CDS-2025.

We explore whether surgical manipulation tasks can be learned on the da Vinci robot via imitation learning. However, the da Vinci system presents unique challenges which hinder straight-forward implementation of imitation learning. Notably, its forward kinematics is inconsistent due to imprecise joint measurements, and naively training a policy using such approximate kinematics data often leads to task failure. To overcome this limitation, we introduce a relative action formulation which enables successful policy training and deployment using its approximate kinematics data. A promising outcome of this approach is that the large repository of clinical data, which contains approximate kinematics, may be directly utilized for robot learning without further corrections. We demonstrate our findings through successful execution of three fundamental surgical tasks, including tissue manipulation, needle handling, and knot-tying.

Gradient-based optimization has been critical to the success of machine learning, updating a single set of parameters to minimize a single loss. A growing number of applications rely on a generalization of this, where we have a bilevel or nested optimization of which subsets of parameters update on different objectives nested inside each other. We focus on motivating examples of hyperparameter optimization and generative adversarial networks. However, naively applying classical methods often fails when we look at solving these nested problems on a large scale. In this thesis, we build tools for nested optimization that scale to deep learning setups.

In this work, we develop an open-source surgical simulation environment that includes a realistic model obtained by MRI-scanning a physical phantom, for the purpose of training and evaluating a Learning from Demonstration (LfD) algorithm for autonomous suturing. The LfD algorithm utilizes Dynamic Movement Primitives (DMP) and Locally Weighted Regression (LWR), but focuses on the needle trajectory, rather than the instruments, to obtain better generality with respect to needle grasps. We conduct a user study to collect multiple suturing demonstrations and perform a comprehensive analysis of the ability of the LfD algorithm to generalize from a demonstration at one location in one phantom to different locations in the same phantom and to a different phantom. Our results indicate good generalization, on the order of 91.5%, when learning from more experienced subjects, indicating the need to integrate skill assessment in the future.

High-resolution imaging is crucial for enhancing visual clarity and enabling precise computer-assisted guidance in minimally invasive surgery (MIS). Despite the increasing adoption of 4K endoscopic systems, there remains a significant gap in publicly available native 4K datasets tailored specifically for robotic-assisted MIS. We introduce SurgiSR4K, the first publicly accessible surgical imaging and video dataset captured at a native 4K resolution, representing realistic conditions of robotic-assisted procedures. SurgiSR4K comprises diverse visual scenarios including specular reflections, tool occlusions, bleeding, and soft tissue deformations, meticulously designed to reflect common challenges faced during laparoscopic and robotic surgeries. This dataset opens up possibilities for a broad range of computer vision tasks that might benefit from high resolution data, such as super resolution (SR), smoke removal, surgical instrument detection, 3D tissue reconstruction, monocular depth estimation, instance segmentation, novel view synthesis, and vision-language model (VLM) development. SurgiSR4K provides a robust foundation for advancing research in high-resolution surgical imaging and fosters the development of intelligent imaging technologies aimed at enhancing performance, safety, and usability in image-guided robotic surgeries.

Recent advances in diffusion models bring state-of-the-art performance on image generation tasks. However, empirical results from previous research in diffusion models imply an inverse correlation between density estimation and sample generation performances. This paper investigates with sufficient empirical evidence that such inverse correlation happens because density estimation is significantly contributed by small diffusion time, whereas sample generation mainly depends on large diffusion time. However, training a score network well across the entire diffusion time is demanding because the loss scale is significantly imbalanced at each diffusion time. For successful training, therefore, we introduce Soft Truncation, a universally applicable training technique for diffusion models, that softens the fixed and static truncation hyperparameter into a random variable. In experiments, Soft Truncation achieves state-of-the-art performance on CIFAR-10, CelebA, CelebA-HQ 256x256, and STL-10 datasets.

Robotic surgical systems rely heavily on high-quality visual feedback for precise teleoperation; yet, surgical smoke from energy-based devices significantly degrades endoscopic video feeds, compromising the human-robot interface and surgical outcomes. This paper presents RGA-Net (Reciprocal Gating and Attention-fusion Network), a novel deep learning framework specifically designed for smoke removal in robotic surgery workflows. Our approach addresses the unique challenges of surgical smoke-including dense, non-homogeneous distribution and complex light scattering-through a hierarchical encoder-decoder architecture featuring two key innovations: (1) a Dual-Stream Hybrid Attention (DHA) module that combines shifted window attention with frequency-domain processing to capture both local surgical details and global illumination changes, and (2) an Axis-Decomposed Attention (ADA) module that efficiently processes multi-scale features through factorized attention mechanisms. These components are connected via reciprocal cross-gating blocks that enable bidirectional feature modulation between encoder and decoder pathways. Extensive experiments on the DesmokeData and LSD3K surgical datasets demonstrate that RGA-Net achieves superior performance in restoring visual clarity suitable for robotic surgery integration. Our method enhances the surgeon-robot interface by providing consistently clear visualization, laying a technical foundation for alleviating surgeons' cognitive burden, optimizing operation workflows, and reducing iatrogenic injury risks in minimally invasive procedures. These practical benefits could be further validated through future clinical trials involving surgeon usability assessments. The proposed framework represents a significant step toward more reliable and safer robotic surgical systems through computational vision enhancement.

Breast-conserving surgery (BCS) aims to completely remove malignant lesions while maximizing healthy tissue preservation. Intraoperative margin assessment is essential to achieve a balance between thorough cancer resection and tissue conservation. A deep ultraviolet fluorescence scanning microscope (DUV-FSM) enables rapid acquisition of whole surface images (WSIs) for excised tissue, providing contrast between malignant and normal tissues. However, breast cancer classification with DUV WSIs is challenged by high resolutions and complex histopathological features. This study introduces a DUV WSI classification framework using a patch-level vision transformer (ViT) model, capturing local and global features. Grad-CAM++ saliency weighting highlights relevant spatial regions, enhances result interpretability, and improves diagnostic accuracy for benign and malignant tissue classification. A comprehensive 5-fold cross-validation demonstrates the proposed approach significantly outperforms conventional deep learning methods, achieving a classification accuracy of 98.33%.

Over the past few years, softmax and SGD have become a commonly used component and the default training strategy in CNN frameworks, respectively. However, when optimizing CNNs with SGD, the saturation behavior behind softmax always gives us an illusion of training well and then is omitted. In this paper, we first emphasize that the early saturation behavior of softmax will impede the exploration of SGD, which sometimes is a reason for model converging at a bad local-minima, then propose Noisy Softmax to mitigating this early saturation issue by injecting annealed noise in softmax during each iteration. This operation based on noise injection aims at postponing the early saturation and further bringing continuous gradients propagation so as to significantly encourage SGD solver to be more exploratory and help to find a better local-minima. This paper empirically verifies the superiority of the early softmax desaturation, and our method indeed improves the generalization ability of CNN model by regularization. We experimentally find that this early desaturation helps optimization in many tasks, yielding state-of-the-art or competitive results on several popular benchmark datasets.

Surgical simulation plays a pivotal role in training novice surgeons, accelerating their learning curve and reducing intra-operative errors. However, conventional simulation tools fall short in providing the necessary photorealism and the variability of human anatomy. In response, current methods are shifting towards generative model-based simulators. Yet, these approaches primarily focus on using increasingly complex conditioning for precise synthesis while neglecting the fine-grained human control aspect. To address this gap, we introduce SG2VID, the first diffusion-based video model that leverages Scene Graphs for both precise video synthesis and fine-grained human control. We demonstrate SG2VID's capabilities across three public datasets featuring cataract and cholecystectomy surgery. While SG2VID outperforms previous methods both qualitatively and quantitatively, it also enables precise synthesis, providing accurate control over tool and anatomy's size and movement, entrance of new tools, as well as the overall scene layout. We qualitatively motivate how SG2VID can be used for generative augmentation and present an experiment demonstrating its ability to improve a downstream phase detection task when the training set is extended with our synthetic videos. Finally, to showcase SG2VID's ability to retain human control, we interact with the Scene Graphs to generate new video samples depicting major yet rare intra-operative irregularities.

Brain tumor growth is unique to each glioma patient and extends beyond what is visible in imaging scans, infiltrating surrounding brain tissue. Understanding these hidden patient-specific progressions is essential for effective therapies. Current treatment plans for brain tumors, such as radiotherapy, typically involve delineating a uniform margin around the visible tumor on pre-treatment scans to target this invisible tumor growth. This "one size fits all" approach is derived from population studies and often fails to account for the nuances of individual patient conditions. We present the GliODIL framework, which infers the full spatial distribution of tumor cell concentration from available multi-modal imaging, leveraging a Fisher-Kolmogorov type physics model to describe tumor growth. This is achieved through the newly introduced method of Optimizing the Discrete Loss (ODIL), where both data and physics-based constraints are softly assimilated into the solution. Our test dataset comprises 152 glioblastoma patients with pre-treatment imaging and post-treatment follow-ups for tumor recurrence monitoring. By blending data-driven techniques with physics-based constraints, GliODIL enhances recurrence prediction in radiotherapy planning, challenging traditional uniform margins and strict adherence to the Fisher-Kolmogorov partial differential equation (PDE) model, which is adapted for complex cases.

Surgical procedures are inherently complex and risky, requiring extensive expertise and constant focus to navigate evolving intraoperative scenes. Computer-assisted systems such as surgical visual question answering (VQA) offer promises for education and intraoperative support. Current surgical VQA research largely focuses on static frame analysis, overlooking rich temporal semantics. Surgical video question answering is further challenged by low visual contrast, its highly knowledge-driven nature, diverse analytical needs spanning scattered temporal windows, and the hierarchy from basic perception to high-level intraoperative assessment. To address these challenges, we propose SurgTEMP, a multimodal LLM framework featuring (i) a query-guided token selection module that builds hierarchical visual memory (spatial and temporal memory banks) and (ii) a Surgical Competency Progression (SCP) training scheme. Together, they enable effective modeling of variable-length surgical videos while preserving procedure-relevant cues and temporal coherence, and better support diverse downstream assessment tasks. To support model development, we introduce CholeVidQA-32K, a surgical video question answering dataset comprising 32K open-ended QA pairs and 3,855 video segments (approximately 128 h total) from laparoscopic cholecystectomy. The dataset is organized into a three-level hierarchy -- Perception, Assessment, and Reasoning -- spanning 11 tasks from instrument/action/anatomy perception to Critical View of Safety (CVS), intraoperative difficulty, skill proficiency, and adverse event assessment. In comprehensive evaluations against state-of-the-art open-source multimodal and video LLMs (fine-tuned and zero-shot), SurgTEMP achieves substantial performance improvements, advancing the state of video-based surgical VQA. The project page is available at: https://camma-public.github.io/SurgTEMP/

We consider the training of the first layer of vision models and notice the clear relationship between pixel values and gradient update magnitudes: the gradients arriving at the weights of a first layer are by definition directly proportional to (normalized) input pixel values. Thus, an image with low contrast has a smaller impact on learning than an image with higher contrast, and a very bright or very dark image has a stronger impact on the weights than an image with moderate brightness. In this work, we propose performing gradient descent on the embeddings produced by the first layer of the model. However, switching to discrete inputs with an embedding layer is not a reasonable option for vision models. Thus, we propose the conceptual procedure of (i) a gradient descent step on first layer activations to construct an activation proposal, and (ii) finding the optimal weights of the first layer, i.e., those weights which minimize the squared distance to the activation proposal. We provide a closed form solution of the procedure and adjust it for robust stochastic training while computing everything efficiently. Empirically, we find that TrAct (Training Activations) speeds up training by factors between 1.25x and 4x while requiring only a small computational overhead. We demonstrate the utility of TrAct with different optimizers for a range of different vision models including convolutional and transformer architectures.

The integration of artificial intelligence in image-guided interventions holds transformative potential, promising to extract 3D geometric and quantitative information from conventional 2D imaging modalities during complex procedures. Achieving this requires the rapid and precise alignment of 2D intraoperative images (e.g., X-ray) with 3D preoperative volumes (e.g., CT, MRI). However, current 2D/3D registration methods fail across the broad spectrum of procedures dependent on X-ray guidance: traditional optimization techniques require custom parameter tuning for each subject, whereas neural networks trained on small datasets do not generalize to new patients or require labor-intensive manual annotations, increasing clinical burden and precluding application to new anatomical targets. To address these challenges, we present xvr, a fully automated framework for training patient-specific neural networks for 2D/3D registration. xvr uses physics-based simulation to generate abundant high-quality training data from a patient's own preoperative volumetric imaging, thereby overcoming the inherently limited ability of supervised models to generalize to new patients and procedures. Furthermore, xvr requires only 5 minutes of training per patient, making it suitable for emergency interventions as well as planned procedures. We perform the largest evaluation of a 2D/3D registration algorithm on real X-ray data to date and find that xvr robustly generalizes across a diverse dataset comprising multiple anatomical structures, imaging modalities, and hospitals. Across surgical tasks, xvr achieves submillimeter-accurate registration at intraoperative speeds, improving upon existing methods by an order of magnitude. xvr is released as open-source software freely available at https://github.com/eigenvivek/xvr.

Dynamic garment reconstruction from monocular video is an important yet challenging task due to the complex dynamics and unconstrained nature of the garments. Recent advancements in neural rendering have enabled high-quality geometric reconstruction with image/video supervision. However, implicit representation methods that use volume rendering often provide smooth geometry and fail to model high-frequency details. While template reconstruction methods model explicit geometry, they use vertex displacement for deformation, which results in artifacts. Addressing these limitations, we propose NGD, a Neural Gradient-based Deformation method to reconstruct dynamically evolving textured garments from monocular videos. Additionally, we propose a novel adaptive remeshing strategy for modelling dynamically evolving surfaces like wrinkles and pleats of the skirt, leading to high-quality reconstruction. Finally, we learn dynamic texture maps to capture per-frame lighting and shadow effects. We provide extensive qualitative and quantitative evaluations to demonstrate significant improvements over existing SOTA methods and provide high-quality garment reconstructions.

Using backpropagation to compute gradients of objective functions for optimization has remained a mainstay of machine learning. Backpropagation, or reverse-mode differentiation, is a special case within the general family of automatic differentiation algorithms that also includes the forward mode. We present a method to compute gradients based solely on the directional derivative that one can compute exactly and efficiently via the forward mode. We call this formulation the forward gradient, an unbiased estimate of the gradient that can be evaluated in a single forward run of the function, entirely eliminating the need for backpropagation in gradient descent. We demonstrate forward gradient descent in a range of problems, showing substantial savings in computation and enabling training up to twice as fast in some cases.

Endoscopic Submucosal Dissection (ESD) is a minimally invasive procedure initially developed for early gastric cancer treatment and has expanded to address diverse gastrointestinal lesions. While computer-assisted surgery (CAS) systems enhance ESD precision and safety, their efficacy hinges on accurate real-time surgical phase recognition, a task complicated by ESD's inherent complexity, including heterogeneous lesion characteristics and dynamic tissue interactions. Existing video-based phase recognition algorithms, constrained by inefficient temporal context modeling, exhibit limited performance in capturing fine-grained phase transitions and long-range dependencies. To overcome these limitations, we propose SPRMamba, a novel framework integrating a Mamba-based architecture with a Scaled Residual TranMamba (SRTM) block to synergize long-term temporal modeling and localized detail extraction. SPRMamba further introduces the Hierarchical Sampling Strategy to optimize computational efficiency, enabling real-time processing critical for clinical deployment. Evaluated on the ESD385 dataset and the cholecystectomy benchmark Cholec80, SPRMamba achieves state-of-the-art performance (87.64% accuracy on ESD385, +1.0% over prior methods), demonstrating robust generalizability across surgical workflows. This advancement bridges the gap between computational efficiency and temporal sensitivity, offering a transformative tool for intraoperative guidance and skill assessment in ESD surgery. The code is accessible at https://github.com/Zxnyyyyy/SPRMamba.

Medical vision-language models (VLMs) have shown increasing potential for clinical image interpretation, including lesion detection and report generation. However, their practical utility remains limited by insufficient sensitivity to subtle lesions, whose visual evidence is often sparse, low-contrast, and embedded within complex anatomical context. As local visual tokens are aggregated, these weak lesion cues can become underrepresented in global image representations, making them difficult for medical VLMs to recognize. Existing efforts to improve lesion sensitivity mainly rely on medical-domain vision-encoder pre-training, clinical-term-guided alignment, or trainable pathological representation enhancement. Although effective, these approaches usually require additional training or model-specific adaptation and may overfit to particular disease morphologies, limiting their applicability to frozen medical VLMs. To address these limitations, we propose EasyLens, a training-free plug-and-play subtle-lesion representation amplifier for medical VLMs. EasyLens first constructs EasyBank, a pathology-anatomy prototype space that provides lesion-related prototypes and anatomy-aware normal references for comparing suspicious patches against both pathological and normal anatomical patterns. To avoid blindly amplifying normal tissues, EasyTag selects lesion-relevant patches through counterfactual prototype reasoning. To counteract the dilution of subtle lesion cues in global image representations, EasyAmplifier strengthens the selected lesion-relevant patch representations through morphology-guided residual enhancement, thereby increasing their contribution to the global image embedding. Experiments on multiple medical image datasets and frozen medical VLM backbones show that EasyLens improves subtle-lesion detection and outperforms existing encoder-enhancement baselines.

Non-maximum suppression is an integral part of the object detection pipeline. First, it sorts all detection boxes on the basis of their scores. The detection box M with the maximum score is selected and all other detection boxes with a significant overlap (using a pre-defined threshold) with M are suppressed. This process is recursively applied on the remaining boxes. As per the design of the algorithm, if an object lies within the predefined overlap threshold, it leads to a miss. To this end, we propose Soft-NMS, an algorithm which decays the detection scores of all other objects as a continuous function of their overlap with M. Hence, no object is eliminated in this process. Soft-NMS obtains consistent improvements for the coco-style mAP metric on standard datasets like PASCAL VOC 2007 (1.7% for both R-FCN and Faster-RCNN) and MS-COCO (1.3% for R-FCN and 1.1% for Faster-RCNN) by just changing the NMS algorithm without any additional hyper-parameters. Using Deformable-RFCN, Soft-NMS improves state-of-the-art in object detection from 39.8% to 40.9% with a single model. Further, the computational complexity of Soft-NMS is the same as traditional NMS and hence it can be efficiently implemented. Since Soft-NMS does not require any extra training and is simple to implement, it can be easily integrated into any object detection pipeline. Code for Soft-NMS is publicly available on GitHub (http://bit.ly/2nJLNMu).

While reinforcement learning for large language model alignment has progressed rapidly in recent years, transferring these paradigms to high-stakes medical question answering reveals a fundamental paradigm mismatch. Reinforcement Learning from Human Feedback relies on preference annotations that are prohibitively expensive and often fail to reflect the absolute correctness of medical facts. Reinforcement Learning from Verifiable Rewards lacks effective automatic verifiers and struggles to handle complex clinical contexts. Meanwhile, medical alignment requires the simultaneous optimization of correctness, safety, and compliance, yet multi-objective heterogeneous reward signals are prone to scale mismatch and optimization conflicts.To address these challenges, we propose a robust medical alignment paradigm. We first construct a holistic multi-dimensional medical alignment matrix that decomposes alignment objectives into four categories: fundamental capabilities, expert knowledge, online feedback, and format specifications. Within each category, we establish a closed loop of where observable metrics inform attributable diagnosis, which in turn drives optimizable rewards, thereby providing fine-grained, high-resolution supervision signals for subsequent iterative optimization. To resolve gradient domination and optimization instability problem caused by heterogeneous signals, we further propose a unified optimization mechanism. This mechanism employs Reference-Frozen Normalization to align reward scales and implements a Tri-Factor Adaptive Dynamic Weighting strategy to achieve collaborative optimization that is weakness-oriented, risk-prioritized, and redundancy-reducing. Experimental results demonstrate the effectiveness of our proposed paradigm in real-world medical scenario evaluations, establishing a new paradigm for complex alignment in vertical domains.

Reinforcement Learning with Verifiable Rewards (RLVR) is increasingly viewed as a tree pruning mechanism. However, we identify a systemic pathology termed Recursive Space Contraction (RSC), an irreversible collapse driven by the combined dynamics of positive sharpening and negative squeezing, where the sampling probability of valid alternatives vanishes. While Kullback-Leibler (KL) regularization aims to mitigate this, it imposes a rigid Shape Matching constraint that forces the policy to mimic the reference model's full density, creating a gradient conflict with the sharpening required for correctness. We propose Anchored Policy Optimization (APO), shifting the paradigm from global Shape Matching to Support Coverage. By defining a Safe Manifold based on the reference model's high-confidence support, APO permits aggressive sharpening for efficiency while selectively invoking a restorative force during error correction to prevent collapse. We theoretically derive that APO serves as a gradient-aligned mechanism to maximize support coverage, enabling an Elastic Recovery that re-inflates valid branches. Empirical evaluations on mathematical benchmarks demonstrate that APO breaks the accuracy-diversity trade-off, significantly improving Pass@1 while restoring the Pass@K diversity typically lost by standard policy gradient methods.

Endoscopic surgery relies on two-dimensional views, posing challenges for surgeons in depth perception and instrument manipulation. While Monocular Visual Simultaneous Localization and Mapping (MVSLAM) has emerged as a promising solution, its implementation in endoscopic procedures faces significant challenges due to hardware limitations, such as the use of a monocular camera and the absence of odometry sensors. This study presents BodySLAM, a robust deep learning-based MVSLAM approach that addresses these challenges through three key components: CycleVO, a novel unsupervised monocular pose estimation module; the integration of the state-of-the-art Zoe architecture for monocular depth estimation; and a 3D reconstruction module creating a coherent surgical map. The approach is rigorously evaluated using three publicly available datasets (Hamlyn, EndoSLAM, and SCARED) spanning laparoscopy, gastroscopy, and colonoscopy scenarios, and benchmarked against four state-of-the-art methods. Results demonstrate that CycleVO exhibited competitive performance with the lowest inference time among pose estimation methods, while maintaining robust generalization capabilities, whereas Zoe significantly outperformed existing algorithms for depth estimation in endoscopy. BodySLAM's strong performance across diverse endoscopic scenarios demonstrates its potential as a viable MVSLAM solution for endoscopic applications.

We introduce softpick, a rectified, not sum-to-one, drop-in replacement for softmax in transformer attention mechanisms that eliminates attention sink and massive activations. Our experiments with 340M parameter models demonstrate that softpick maintains performance parity with softmax on standard benchmarks while achieving 0% sink rate. The softpick transformer produces hidden states with significantly lower kurtosis (340 vs 33,510) and creates sparse attention maps (46.97% sparsity). Models using softpick consistently outperform softmax when quantized, with particularly pronounced advantages at lower bit precisions. Our analysis and discussion shows how softpick has the potential to open new possibilities for quantization, low-precision training, sparsity optimization, pruning, and interpretability. Our code is available at https://github.com/zaydzuhri/softpick-attention.

While multi-task learning based automatic radiology report generation (RRG) is widely adopted to ensure clinical consistency, most focus on architectural designs yet remain limited to coarse linear scalarization strategies. These strategies cannot effectively balance the hard constraints of discriminative clinical supervision with the smoothness requirements of report generation. To address these problems, we analyze the failure mechanism of linear scalarization from the perspective of gradient dynamics, utilizing the stochastic differential equation (SDE) framework to characterize it as a "Double Dilemma" of drift term deviation and diffusion term decay. Based on this, we propose a backbone-agnostic optimizer named Conflict-Averse Magnitude-Enhanced Gradient Descent (CAME-Grad). Through conflict-averse direction rectification and magnitude-enhanced energy injection, the algorithm not only ensures geometric validity, but also avoids local optimal solutions. Then, the adaptive gradient fusion mechanism is used to establish a dynamic balance between the theoretical optimal direction and the task-specific inductive bias. Experiments show that as a universal plug-and-play optimizer, CAME-Grad brings substantial and consistent improvements across eight diverse RRG methods, elevating overall clinical efficacy performance by an average of 2.3% on MIMIC-CXR and 1.9% on IU X-Ray. Our code is available at https://github.com/vpsg-research/CAME-Grad.

This work proposes aesthetic gradients, a method to personalize a CLIP-conditioned diffusion model by guiding the generative process towards custom aesthetics defined by the user from a set of images. The approach is validated with qualitative and quantitative experiments, using the recent stable diffusion model and several aesthetically-filtered datasets. Code is released at https://github.com/vicgalle/stable-diffusion-aesthetic-gradients

This paper addresses the challenge of grading visual features in lumbar spine MRI using Deep Learning. Such a method is essential for the automatic quantification of structural changes in the spine, which is valuable for understanding low back pain. Multiple recent studies investigated different architecture designs, and the most recent success has been attributed to the use of transformer architectures. In this work, we argue that with a well-tuned three-stage pipeline comprising semantic segmentation, localization, and classification, convolutional networks outperform the state-of-the-art approaches. We conducted an ablation study of the existing methods in a population cohort, and report performance generalization across various subgroups. Our code is publicly available to advance research on disc degeneration and low back pain.

Intra-fraction motion in radiotherapy is commonly modeled using deformable image registration (DIR). However, existing methods often struggle to balance speed and accuracy, limiting their applicability in clinical scenarios. This study introduces a novel approach that harnesses Neural Graphics Primitives (NGP) to optimize the displacement vector field (DVF). Our method leverages learned primitives, processed as splats, and interpolates within space using a shallow neural network. Uniquely, it enables self-supervised optimization at an ultra-fast speed, negating the need for pre-training on extensive datasets and allowing seamless adaptation to new cases. We validated this approach on the 4D-CT lung dataset DIR-lab, achieving a target registration error (TRE) of 1.15\pm1.15 mm within a remarkable time of 1.77 seconds. Notably, our method also addresses the sliding boundary problem, a common challenge in conventional DIR methods.

Advances in endoscopy use in surgeries face challenges like inadequate lighting. Deep learning, notably the Denoising Diffusion Probabilistic Model (DDPM), holds promise for low-light image enhancement in the medical field. However, DDPMs are computationally demanding and slow, limiting their practical medical applications. To bridge this gap, we propose a lightweight DDPM, dubbed LighTDiff. It adopts a T-shape model architecture to capture global structural information using low-resolution images and gradually recover the details in subsequent denoising steps. We further prone the model to significantly reduce the model size while retaining performance. While discarding certain downsampling operations to save parameters leads to instability and low efficiency in convergence during the training, we introduce a Temporal Light Unit (TLU), a plug-and-play module, for more stable training and better performance. TLU associates time steps with denoised image features, establishing temporal dependencies of the denoising steps and improving denoising outcomes. Moreover, while recovering images using the diffusion model, potential spectral shifts were noted. We further introduce a Chroma Balancer (CB) to mitigate this issue. Our LighTDiff outperforms many competitive LLIE methods with exceptional computational efficiency.

Optimization analyses for cross-entropy training rely on local Taylor models of the loss to predict whether a proposed step will decrease the objective. These surrogates are reliable only inside the Taylor convergence radius of the true loss along the update direction. That radius is set not by real-line curvature alone but by the nearest complex singularity. For cross-entropy, the softmax partition function F=sum_j exp(z_j) has complex zeros -- ``ghosts of softmax'' -- that induce logarithmic singularities in the loss and cap this radius. To make this geometry usable, we derive closed-form expressions under logit linearization along the proposed update direction. In the binary case, the exact radius is ρ^*=δ^2+ π^2/Δ_a. In the multiclass case, we obtain the lower bound ρ_a=π/Δ_a, where Δ_a=max_k a_k-min_k a_k is the spread of directional logit derivatives a_k=nabla z_kcdot v. This bound costs one Jacobian-vector product and reveals what makes a step fragile: samples that are both near a decision flip and highly sensitive to the proposed direction tighten the radius. The normalized step size r=τ/ρ_a separates safe from dangerous updates. Across six tested architectures and multiple step directions, no model fails for r<1, yet collapse appears once rge 1. Temperature scaling confirms the mechanism: normalizing by ρ_a shrinks the onset-threshold spread from standard deviation 0.992 to 0.164. A controller that enforces τleρ_a survives learning-rate spikes up to 10{,} 000times in our tests, where gradient clipping still collapses. Together, these results identify a geometric constraint on cross-entropy optimization that operates through Taylor convergence rather than Hessian curvature.

Foundation models in video generation are demonstrating remarkable capabilities as potential world models for simulating the physical world. However, their application in high-stakes domains like surgery, which demand deep, specialized causal knowledge rather than general physical rules, remains a critical unexplored gap. To systematically address this challenge, we present SurgVeo, the first expert-curated benchmark for video generation model evaluation in surgery, and the Surgical Plausibility Pyramid (SPP), a novel, four-tiered framework tailored to assess model outputs from basic appearance to complex surgical strategy. On the basis of the SurgVeo benchmark, we task the advanced Veo-3 model with a zero-shot prediction task on surgical clips from laparoscopic and neurosurgical procedures. A panel of four board-certified surgeons evaluates the generated videos according to the SPP. Our results reveal a distinct "plausibility gap": while Veo-3 achieves exceptional Visual Perceptual Plausibility, it fails critically at higher levels of the SPP, including Instrument Operation Plausibility, Environment Feedback Plausibility, and Surgical Intent Plausibility. This work provides the first quantitative evidence of the chasm between visually convincing mimicry and causal understanding in surgical AI. Our findings from SurgVeo and the SPP establish a crucial foundation and roadmap for developing future models capable of navigating the complexities of specialized, real-world healthcare domains.

Gradient descent is the method of choice for training large artificial intelligence systems. As these systems become larger, a better understanding of the mechanisms behind gradient training would allow us to alleviate compute costs and help steer these systems away from harmful behaviors. To that end, we suggest utilizing the circuit perspective brought forward by mechanistic interpretability. After laying out our intuition, we illustrate how it enables us to design a curriculum for efficient learning in a controlled setting. The code is available at https://github.com/facebookresearch/pal.

The field of surgical computer vision has undergone considerable breakthroughs in recent years with the rising popularity of deep neural network-based methods. However, standard fully-supervised approaches for training such models require vast amounts of annotated data, imposing a prohibitively high cost; especially in the clinical domain. Self-Supervised Learning (SSL) methods, which have begun to gain traction in the general computer vision community, represent a potential solution to these annotation costs, allowing to learn useful representations from only unlabeled data. Still, the effectiveness of SSL methods in more complex and impactful domains, such as medicine and surgery, remains limited and unexplored. In this work, we address this critical need by investigating four state-of-the-art SSL methods (MoCo v2, SimCLR, DINO, SwAV) in the context of surgical computer vision. We present an extensive analysis of the performance of these methods on the Cholec80 dataset for two fundamental and popular tasks in surgical context understanding, phase recognition and tool presence detection. We examine their parameterization, then their behavior with respect to training data quantities in semi-supervised settings. Correct transfer of these methods to surgery, as described and conducted in this work, leads to substantial performance gains over generic uses of SSL - up to 7.4% on phase recognition and 20% on tool presence detection - as well as state-of-the-art semi-supervised phase recognition approaches by up to 14%. Further results obtained on a highly diverse selection of surgical datasets exhibit strong generalization properties. The code is available at https://github.com/CAMMA-public/SelfSupSurg.

Advancements in computer-assisted surgical procedures heavily rely on accurate visual data interpretation from camera systems used during surgeries. Traditional open-access datasets focusing on surgical procedures are often limited by their small size, typically consisting of fewer than 100 videos with less than 100K images. To address these constraints, a new dataset called Surg-3M has been compiled using a novel aggregation pipeline that collects high-resolution videos from online sources. Featuring an extensive collection of over 4K surgical videos and more than 3 million high-quality images from multiple procedure types, Surg-3M offers a comprehensive resource surpassing existing alternatives in size and scope, including two novel tasks. To demonstrate the effectiveness of this dataset, we present SurgFM, a self-supervised foundation model pretrained on Surg-3M that achieves impressive results in downstream tasks such as surgical phase recognition, action recognition, and tool presence detection. Combining key components from ConvNeXt, DINO, and an innovative augmented distillation method, SurgFM exhibits exceptional performance compared to specialist architectures across various benchmarks. Our experimental results show that SurgFM outperforms state-of-the-art models in multiple downstream tasks, including significant gains in surgical phase recognition (+8.9pp, +4.7pp, and +3.9pp of Jaccard in AutoLaparo, M2CAI16, and Cholec80), action recognition (+3.1pp of mAP in CholecT50) and tool presence detection (+4.6pp of mAP in Cholec80). Moreover, even when using only half of the data, SurgFM outperforms state-of-the-art models in AutoLaparo and achieves state-of-the-art performance in Cholec80. Both Surg-3M and SurgFM have significant potential to accelerate progress towards developing autonomous robotic surgery systems.

Ensuring reliable confidence scores from deep networks is of pivotal importance in critical decision-making systems, notably in the medical domain. While recent literature on calibrating deep segmentation networks has led to significant progress, their uncertainty is usually modeled by leveraging the information of individual pixels, which disregards the local structure of the object of interest. In particular, only the recent Spatially Varying Label Smoothing (SVLS) approach addresses this issue by softening the pixel label assignments with a discrete spatial Gaussian kernel. In this work, we first present a constrained optimization perspective of SVLS and demonstrate that it enforces an implicit constraint on soft class proportions of surrounding pixels. Furthermore, our analysis shows that SVLS lacks a mechanism to balance the contribution of the constraint with the primary objective, potentially hindering the optimization process. Based on these observations, we propose a principled and simple solution based on equality constraints on the logit values, which enables to control explicitly both the enforced constraint and the weight of the penalty, offering more flexibility. Comprehensive experiments on a variety of well-known segmentation benchmarks demonstrate the superior performance of the proposed approach.

Depth estimation plays a crucial role in various tasks within endoscopic surgery, including navigation, surface reconstruction, and augmented reality visualization. Despite the significant achievements of foundation models in vision tasks, including depth estimation, their direct application to the medical domain often results in suboptimal performance. This highlights the need for efficient adaptation methods to adapt these models to endoscopic depth estimation. We propose Endoscopic Depth Any Camera (EndoDAC) which is an efficient self-supervised depth estimation framework that adapts foundation models to endoscopic scenes. Specifically, we develop the Dynamic Vector-Based Low-Rank Adaptation (DV-LoRA) and employ Convolutional Neck blocks to tailor the foundational model to the surgical domain, utilizing remarkably few trainable parameters. Given that camera information is not always accessible, we also introduce a self-supervised adaptation strategy that estimates camera intrinsics using the pose encoder. Our framework is capable of being trained solely on monocular surgical videos from any camera, ensuring minimal training costs. Experiments demonstrate that our approach obtains superior performance even with fewer training epochs and unaware of the ground truth camera intrinsics. Code is available at https://github.com/BeileiCui/EndoDAC.

In this paper, by introducing Generalized Bernstein condition, we propose the first Obig(sqrt{p}{nepsilon}big) high probability excess population risk bound for differentially private algorithms under the assumptions G-Lipschitz, L-smooth, and Polyak-{\L}ojasiewicz condition, based on gradient perturbation method. If we replace the properties G-Lipschitz and L-smooth by alpha-H{\"o}lder smoothness (which can be used in non-smooth setting), the high probability bound comes to Obig(n^{-alpha{1+2alpha}}big) w.r.t n, which cannot achieve Oleft(1/nright) when alphain(0,1]. To solve this problem, we propose a variant of gradient perturbation method, max{1,g-Normalized Gradient Perturbation} (m-NGP). We further show that by normalization, the high probability excess population risk bound under assumptions alpha-H{\"o}lder smooth and Polyak-{\L}ojasiewicz condition can achieve Obig(sqrt{p}{nepsilon}big), which is the first Oleft(1/nright) high probability excess population risk bound w.r.t n for differentially private algorithms under non-smooth conditions. Moreover, we evaluate the performance of the new proposed algorithm m-NGP, the experimental results show that m-NGP improves the performance of the differentially private model over real datasets. It demonstrates that m-NGP improves the utility bound and the accuracy of the DP model on real datasets simultaneously.

Autonomous surgical procedures, in particular minimal invasive surgeries, are the next frontier for Artificial Intelligence research. However, the existing challenges include precise identification of the human anatomy and the surgical settings, and modeling the environment for training of an autonomous agent. To address the identification of human anatomy and the surgical settings, we propose a deep learning based semantic segmentation algorithm to identify and label the tissues and organs in the endoscopic video feed of the human torso region. We present an annotated dataset, m2caiSeg, created from endoscopic video feeds of real-world surgical procedures. Overall, the data consists of 307 images, each of which is annotated for the organs and different surgical instruments present in the scene. We propose and train a deep convolutional neural network for the semantic segmentation task. To cater for the low quantity of annotated data, we use unsupervised pre-training and data augmentation. The trained model is evaluated on an independent test set of the proposed dataset. We obtained a F1 score of 0.33 while using all the labeled categories for the semantic segmentation task. Secondly, we labeled all instruments into an 'Instruments' superclass to evaluate the model's performance on discerning the various organs and obtained a F1 score of 0.57. We propose a new dataset and a deep learning method for pixel level identification of various organs and instruments in a endoscopic surgical scene. Surgical scene understanding is one of the first steps towards automating surgical procedures.

Deep neural networks with repeated architectural blocks, such as transformers, often exhibit structured relationships across layers that emerge during training. Motivated by this observation, we introduce Depth-wise Gradient Augmentation, a general optimization paradigm in which the update applied to each layer is obtained by transforming the collection of block-wise optimizer updates along the depth dimension. Within this framework, we study Gradient Smoothing, a family of depth-wise smoothing methods, and instantiate it with a simple local Window Smoothing operator. The resulting method operates directly on block-wise updates produced by arbitrary base optimizers (e.g., SGD, Adam, Muon), incurs minimal computational overhead, and is compatible with existing optimization pipelines. We evaluate Gradient Smoothing across a diverse set of architectures and training regimes, including language model pretraining, RL post-training of LLMs for reasoning, diffusion modeling, and image classification with Vision Transformers. Across these settings, Gradient Smoothing consistently improves optimization and generalization performance without modifying model architectures or training objectives. We further show that it promotes more structured representation evolution across depth, consistent with its interpretation as a structured depth-wise preconditioning method. Together, these results establish Depth-wise Gradient Augmentation as a promising framework for exploiting cross-depth structure in optimization and demonstrate Gradient Smoothing as a simple and broadly applicable instantiation.

Esophageal cancer is among the most common types of cancer worldwide. It is traditionally treated using open esophagectomy, but in recent years, robot-assisted minimally invasive esophagectomy (RAMIE) has emerged as a promising alternative. However, robot-assisted surgery can be challenging for novice surgeons, as they often suffer from a loss of spatial orientation. Computer-aided anatomy recognition holds promise for improving surgical navigation, but research in this area remains limited. In this study, we developed a comprehensive dataset for semantic segmentation in RAMIE, featuring the largest collection of vital anatomical structures and surgical instruments to date. Handling this diverse set of classes presents challenges, including class imbalance and the recognition of complex structures such as nerves. This study aims to understand the challenges and limitations of current state-of-the-art algorithms on this novel dataset and problem. Therefore, we benchmarked eight real-time deep learning models using two pretraining datasets. We assessed both traditional and attention-based networks, hypothesizing that attention-based networks better capture global patterns and address challenges such as occlusion caused by blood or other tissues. The benchmark includes our RAMIE dataset and the publicly available CholecSeg8k dataset, enabling a thorough assessment of surgical segmentation tasks. Our findings indicate that pretraining on ADE20k, a dataset for semantic segmentation, is more effective than pretraining on ImageNet. Furthermore, attention-based models outperform traditional convolutional neural networks, with SegNeXt and Mask2Former achieving higher Dice scores, and Mask2Former additionally excelling in average symmetric surface distance.