The recent SAM 3 and SAM 3D have introduced significant advancements over the predecessor, SAM 2, particularly with the integration of language-based segmentation and enhanced 3D perception capabilities. SAM 3 supports zero-shot segmentation across a wide range of prompts, including point, bounding box, and language-based prompts, allowing for more flexible and intuitive interactions with the model. In this empirical evaluation, we assess the performance of SAM 3 in robot-assisted surgery, benchmarking its zero-shot segmentation with point and bounding box prompts and exploring its effectiveness in dynamic video tracking, alongside its newly introduced language prompt segmentation. While language prompts show potential, their performance in the surgical domain is currently suboptimal, highlighting the need for further domain-specific training. Additionally, we investigate SAM 3D's depth reconstruction abilities, demonstrating its capacity to process surgical scene data and reconstruct 3D anatomical structures from 2D images. Through comprehensive testing on the MICCAI EndoVis 2017 and En-doVis 2018 benchmarks, SAM 3 shows clear improvements over SAM and SAM 2 in both image and video segmentation under spatial prompts, while the zero-shot evaluations of SAM 3D on SCARED, StereoMIS, and EndoNeRF indicate strong monocular depth estimation and realistic 3D instrument reconstruction, yet also reveal remaining limitations in complex, highly dynamic surgical scenes.

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.

The growing popularity of robotic minimally invasive surgeries has made deep learning-based surgical training a key area of research. A thorough understanding of the surgical scene components is crucial, which semantic segmentation models can help achieve. However, most existing work focuses on surgical tools and overlooks anatomical objects. Additionally, current state-of-the-art (SOT A) models struggle to balance capturing high-level contextual features and low-level edge features. We propose a Feature-Adaptive Spatial Localization model (FASL-Seg), designed to capture features at multiple levels of detail through two distinct processing streams, namely a Low-Level Feature Projection (LLFP) and a High-Level Feature Projection (HLFP) stream, for varying feature resolutions - enabling precise segmentation of anatomy and surgical instruments. We evaluated FASL-Seg on surgical segmentation benchmark datasets EndoVis18 and EndoVis17 on three use cases. The FASL-Seg model achieves a mean Intersection over Union (mIoU) of 72.71% on parts and anatomy segmentation in EndoVis18, improving on SOT A by 5%. It further achieves a mIoU of 85.61% and 72.78% in EndoVis18 and EndoVis17 tool type segmentation, respectively, outperforming SOT A overall performance, with comparable per-class SOT A results in both datasets and consistent performance in various classes for anatomy and instruments, demonstrating the effectiveness of distinct processing streams for varying feature resolutions.

Despite this recognised importance, existing automatic surgical instrument segmentation faces significant challenges. First, with fast-paced advances in MIS, there is a surge in the variety of surgical instruments from different vendors. This is however compounded with the lack of a comprehensive and large-scale dataset dedicated to the learning of surgical instrument segmentation.

Abstract-- 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. Microsurgery(MS) is a surgical technique that manipulates blood vessels as small as 1-2 mm in diameter and plays a critical role in lymphedema treatment and soft tissue reconstruction [1], [2], [3]. While MS enables highly precise procedures with improved patient outcomes, it also demands exceptional dexterity and accuracy, as even minor errors can lead to complications [4]. Thus, robot-assisted surgery has emerged to improve stability and accuracy in microsurgery [5]. However, effective robotic assistance relies on accurate real-time segmentation of critical structures such as microvessels, needles, and wires [6]. Therefore, it is crucial to develop advanced segmentation methods tailored to the unique challenges of MS environments for enhanced robotic assistance in MS.

Accurate surgical instrument segmentation is essential in cataract surgery for tasks such as skill assessment and workflow optimization. However, limited annotated data makes it difficult to develop fully automatic models. Prompt-based methods like SAM2 offer flexibility yet remain highly sensitive to the point prompt placement, often leading to inconsistent segmentations. We address this issue by introducing RP-SAM2, which incorporates a novel shift block and a compound loss function to stabilize point prompts. Our approach reduces annotator reliance on precise point positioning while maintaining robust segmentation capabilities. Experiments on the Cataract1k dataset demonstrate that RP-SAM2 improves segmentation accuracy, with a 2% mDSC gain, a 21.36% reduction in mHD95, and decreased variance across random single-point prompt results compared to SAM2. Additionally, on the CaDIS dataset, pseudo masks generated by RP-SAM2 for fine-tuning SAM2's mask decoder outperformed those generated by SAM2.

Biomedical image segmentation is crucial for accurately diagnosing and analyzing various diseases. However, Convolutional Neural Networks (CNNs) and Transformers, the most commonly used architectures for this task, struggle to effectively capture long-range dependencies due to the inherent locality of CNNs and the computational complexity of Transformers. To address this limitation, we introduce TTT-Unet, a novel framework that integrates Test-Time Training (TTT) layers into the traditional U-Net architecture for biomedical image segmentation. TTT-Unet dynamically adjusts model parameters during the testing time, enhancing the model's ability to capture both local and long-range features. We evaluate TTT-Unet on multiple medical imaging datasets, including 3D abdominal organ segmentation in CT and MR images, instrument segmentation in endoscopy images, and cell segmentation in microscopy images. The results demonstrate that TTT-Unet consistently outperforms state-of-the-art CNN-based and Transformer-based segmentation models across all tasks.

Surgical instrument segmentation is instrumental to minimally invasive surgeries and related applications. Most previous methods formulate this task as single-frame-based instance segmentation while ignoring the natural temporal and stereo attributes of a surgical video. As a result, these methods are less robust against the appearance variation through temporal motion and view change. In this work, we propose a novel LACOSTE model that exploits Location-Agnostic COntexts in Stereo and TEmporal images for improved surgical instrument segmentation. Leveraging a query-based segmentation model as core, we design three performance-enhancing modules. Firstly, we design a disparity-guided feature propagation module to enhance depth-aware features explicitly. To generalize well for even only a monocular video, we apply a pseudo stereo scheme to generate complementary right images. Secondly, we propose a stereo-temporal set classifier, which aggregates stereo-temporal contexts in a universal way for making a consolidated prediction and mitigates transient failures. Finally, we propose a location-agnostic classifier to decouple the location bias from mask prediction and enhance the feature semantics. We extensively validate our approach on three public surgical video datasets, including two benchmarks from EndoVis Challenges and one real radical prostatectomy surgery dataset GraSP. Experimental results demonstrate the promising performances of our method, which consistently achieves comparable or favorable results with previous state-of-the-art approaches.

Personalized federated learning (PFL) for surgical instrument segmentation (SIS) is a promising approach. It enables multiple clinical sites to collaboratively train a series of models in privacy, with each model tailored to the individual distribution of each site. Existing PFL methods rarely consider the personalization of multi-headed self-attention, and do not account for appearance diversity and instrument shape similarity, both inherent in surgical scenes. We thus propose PFedSIS, a novel PFL method with visual trait priors for SIS, incorporating global-personalized disentanglement (GPD), appearance-regulation personalized enhancement (APE), and shape-similarity global enhancement (SGE), to boost SIS performance in each site. GPD represents the first attempt at head-wise assignment for multi-headed self-attention personalization. To preserve the unique appearance representation of each site and gradually leverage the inter-site difference, APE introduces appearance regulation and provides customized layer-wise aggregation solutions via hypernetworks for each site's personalized parameters. The mutual shape information of instruments is maintained and shared via SGE, which enhances the cross-style shape consistency on the image level and computes the shape-similarity contribution of each site on the prediction level for updating the global parameters. PFedSIS outperforms state-of-the-art methods with +1.51% Dice, +2.11% IoU, -2.79 ASSD, -15.55 HD95 performance gains. The corresponding code and models will be released at https://github.com/wzjialang/PFedSIS.