Despite significant advancements in robotic systems and surgical data science, ensuring safe and optimal execution in robot-assisted minimally invasive surgery (RMIS) remains a complex challenge. Current surgical error detection methods involve two parts: identifying surgical gestures and then detecting errors within each gesture clip. These methods seldom consider the rich contextual and semantic information inherent in surgical videos, limiting their performance due to reliance on accurate gesture identification. Motivated by the chain-of-thought prompting in natural language processing, this letter presents a novel and real-time end-to-end error detection framework, Chain-of-Thought (COG) prompting, leveraging contextual information from surgical videos. This encompasses two reasoning modules designed to mimic the decision-making processes of expert surgeons. Concretely, we first design a Gestural-Visual Reasoning module, which utilizes transformer and attention architectures for gesture prompting, while the second, a Multi-Scale Temporal Reasoning module, employs a multi-stage temporal convolutional network with both slow and fast paths for temporal information extraction. We extensively validate our method on the public benchmark RMIS dataset JIGSAWS. Our method encapsulates the reasoning processes inherent to surgical activities enabling it to outperform the state-of-the-art by 4.6% in F1 score, 4.6% in Accuracy, and 5.9% in Jaccard index while processing each frame in 6.69 milliseconds on average, demonstrating the great potential of our approach in enhancing the safety and efficacy of RMIS procedures and surgical education. The code will be available.

Automated detection of surgical errors can improve robotic-assisted surgery. Despite promising progress, existing methods still face challenges in capturing rich temporal context to establish long-term dependencies while maintaining computational efficiency. In this paper, we propose a novel hierarchical model named SEDMamba, which incorporates the selective state space model (SSM) into surgical error detection, facilitating efficient long sequence modelling with linear complexity. SEDMamba enhances selective SSM with bottleneck mechanism and fine-to-coarse temporal fusion (FCTF) to detect and temporally localize surgical errors in long videos. The bottleneck mechanism compresses and restores features within their spatial dimension, thereby reducing computational complexity. FCTF utilizes multiple dilated 1D convolutional layers to merge temporal information across diverse scale ranges, accommodating errors of varying durations. Besides, we deploy an established observational clinical human reliability assessment tool (OCHRA) to annotate the errors of suturing tasks in an open-source radical prostatectomy dataset (SAR-RARP50), constructing the first frame-level in-vivo surgical error detection dataset to support error detection in real-world scenarios. Experimental results demonstrate that our SEDMamba outperforms state-of-the-art methods with at least 1.82% AUC and 3.80% AP performance gain with significantly reduced computational complexity.