Medical Vision Language Models as Policies for Robotic Surgery

Abstract--Vision-based Proximal Policy Optimization (PPO) struggles with visual observation-based robotic laparoscopic surgical tasks due to the high-dimensional nature of visual input, the sparsity of rewards in surgical environments, and the difficulty of extracting task-relevant features from raw visual data. We introduce a simple approach integrating MedFlamingo, a medical domain-specific Vision-Language Model, with PPO. Our method is evaluated on five diverse laparoscopic surgery task environments in LapGym, using only endoscopic visual observations. MedFlamingo PPO outperforms and converges faster compared to both standard vision-based PPO and OpenFlamingo PPO baselines, achieving task success rates exceeding 70% across all environments, with improvements ranging from 66.67% to 1114.29% compared to baseline. By processing task observations and instructions once per episode to generate high-level planning tokens, our method efficiently combines medical expertise with real-time visual feedback. Our results highlight the value of specialized medical knowledge in robotic surgical planning and decision-making.