Surgical phase recognition plays a critical role in developing intelligent assistance systems for minimally invasive procedures such as Endoscopic Submucosal Dissection (ESD). However, the high visual similarity across different phases and the lack of structural cues in RGB images pose significant challenges. Depth information offers valuable geometric cues that can complement appearance features by providing insights into spatial relationships and anatomical structures. In this paper, we pioneer the use of depth information for surgical phase recognition and propose Geo-RepNet, a geometry-aware convolutional framework that integrates RGB image and depth information to enhance recognition performance in complex surgical scenes. Built upon a re-parameterizable RepVGG backbone, Geo-RepNet incorporates the Depth-Guided Geometric Prior Generation (DGPG) module that extracts geometry priors from raw depth maps, and the Geometry-Enhanced Multi-scale Attention (GEMA) to inject spatial guidance through geometry-aware cross-attention and efficient multi-scale aggregation. To evaluate the effectiveness of our approach, we construct a nine-phase ESD dataset with dense frame-level annotations from real-world ESD videos. Extensive experiments on the proposed dataset demonstrate that Geo-RepNet achieves state-of-the-art performance while maintaining robustness and high computational efficiency under complex and low-texture surgical environments.

The rising demand for mental health care has fueled interest in AI-driven counseling systems. While large language models (LLMs) offer significant potential, current approaches face challenges, including limited understanding of clients' psychological states and counseling stages, reliance on high-quality training data, and privacy concerns associated with commercial deployment. To address these issues, we propose EmoStage, a framework that enhances empathetic response generation by leveraging the inference capabilities of open-source LLMs without additional training data. Our framework introduces perspective-taking to infer clients' psychological states and support needs, enabling the generation of emotionally resonant responses. In addition, phase recognition is incorporated to ensure alignment with the counseling process and to prevent contextually inappropriate or inopportune responses. Experiments conducted in both Japanese and Chinese counseling settings demonstrate that EmoStage improves the quality of responses generated by base models and performs competitively with data-driven methods.

Purpose: Automated Surgical Phase Recognition (SPR) uses Artificial Intelligence (AI) to segment the surgical workflow into its key events, functioning as a building block for efficient video review, surgical education as well as skill assessment. Previous research has focused on short and linear surgical procedures and has not explored if temporal context influences experts' ability to better classify surgical phases. This research addresses these gaps, focusing on Robot-Assisted Partial Nephrectomy (RAPN) as a highly non-linear procedure. Methods: Urologists of varying expertise were grouped and tasked to indicate the surgical phase for RAPN on both single frames and video snippets using a custom-made web platform. Participants reported their confidence levels and the visual landmarks used in their decision-making. AI architectures without and with temporal context as trained and benchmarked on the Cholec80 dataset were subsequently trained on this RAPN dataset. Results: Video snippets and presence of specific visual landmarks improved phase classification accuracy across all groups. Surgeons displayed high confidence in their classifications and outperformed novices, who struggled discriminating phases. The performance of the AI models is comparable to the surgeons in the survey, with improvements when temporal context was incorporated in both cases. Conclusion: SPR is an inherently complex task for expert surgeons and computer vision, where both perform equally well when given the same context. Performance increases when temporal information is provided. Surgical tools and organs form the key landmarks for human interpretation and are expected to shape the future of automated SPR.

While existing recognition approaches excel at identifying current surgical phases, they provide limited foresight into future procedural steps, restricting their intraoperative utility. Similarly, current anticipation methods are constrained to predicting short-term events or singular future occurrences, neglecting the dynamic and sequential nature of surgical workflows. To address these limitations, we propose SWAG (Surgical Workflow Anticipative Generation), a unified framework for phase recognition and long-term anticipation of surgical workflows. SWAG employs two generative decoding methods -- single-pass (SP) and auto-regressive (AR) -- to predict sequences of future surgical phases. A novel prior knowledge embedding mechanism enhances the accuracy of anticipatory predictions. The framework addresses future phase classification and remaining time regression tasks. Additionally, a regression-to-classification (R2C) method is introduced to map continuous predictions to discrete temporal segments. SWAG's performance was evaluated on the Cholec80 and AutoLaparo21 datasets. The single-pass classification model with prior knowledge embeddings (SWAG-SP\*) achieved 53.5\% accuracy in 15-minute anticipation on AutoLaparo21, while the R2C model reached 60.8\% accuracy on Cholec80. SWAG's single-pass regression approach outperformed existing methods for remaining time prediction, achieving weighted mean absolute errors of 0.32 and 0.48 minutes for 2- and 3-minute horizons, respectively. SWAG demonstrates versatility across classification and regression tasks, offering robust tools for real-time surgical workflow anticipation. By unifying recognition and anticipatory capabilities, SWAG provides actionable predictions to enhance intraoperative decision-making.

Surgical phase recognition is critical for assisting surgeons in understanding surgical videos. Existing studies focused more on online surgical phase recognition, by leveraging preceding frames to predict the current frame. Despite great progress, they formulated the task as a series of frame-wise classification, which resulted in a lack of global context of the entire procedure and incoherent predictions. Moreover, besides online analysis, accurate offline surgical phase recognition is also in significant clinical need for retrospective analysis, and existing online algorithms do not fully analyze the entire video, thereby limiting accuracy in offline analysis. To overcome these challenges and enhance both online and offline inference capabilities, we propose a universal Surgical Phase Localization Network, named SurgPLAN++, with the principle of temporal detection. To ensure a global understanding of the surgical procedure, we devise a phase localization strategy for SurgPLAN++ to predict phase segments across the entire video through phase proposals. For online analysis, to generate high-quality phase proposals, SurgPLAN++ incorporates a data augmentation strategy to extend the streaming video into a pseudo-complete video through mirroring, center-duplication, and down-sampling. For offline analysis, SurgPLAN++ capitalizes on its global phase prediction framework to continuously refine preceding predictions during each online inference step, thereby significantly improving the accuracy of phase recognition. We perform extensive experiments to validate the effectiveness, and our SurgPLAN++ achieves remarkable performance in both online and offline modes, which outperforms state-of-the-art methods. The source code is available at https://github.com/lxj22/SurgPLAN-Plus.

Phase recognition in surgical videos is crucial for enhancing computer-aided surgical systems as it enables automated understanding of sequential procedural stages. Existing methods often rely on fixed temporal windows for video analysis to identify dynamic surgical phases. Thus, they struggle to simultaneously capture short-, mid-, and long-term information necessary to fully understand complex surgical procedures. To address these issues, we propose Multi-Scale Transformers for Surgical Phase Recognition (MuST), a novel Transformer-based approach that combines a Multi-Term Frame encoder with a Temporal Consistency Module to capture information across multiple temporal scales of a surgical video. Our Multi-Term Frame Encoder computes interdependencies across a hierarchy of temporal scales by sampling sequences at increasing strides around the frame of interest. Furthermore, we employ a long-term Transformer encoder over the frame embeddings to further enhance long-term reasoning. MuST achieves higher performance than previous state-of-the-art methods on three different public benchmarks.

Surgical phase recognition has gained significant attention due to its potential to offer solutions to numerous demands of the modern operating room. However, most existing methods concentrate on minimally invasive surgery (MIS), leaving surgical phase recognition for open surgery understudied. This discrepancy is primarily attributed to the scarcity of publicly available open surgery video datasets for surgical phase recognition. To address this issue, we introduce a new egocentric open surgery video dataset for phase recognition, named EgoSurgery-Phase. This dataset comprises 15 hours of real open surgery videos spanning 9 distinct surgical phases all captured using an egocentric camera attached to the surgeon's head. In addition to video, the EgoSurgery-Phase offers eye gaze. As far as we know, it is the first real open surgery video dataset for surgical phase recognition publicly available. Furthermore, inspired by the notable success of masked autoencoders (MAEs) in video understanding tasks (e.g., action recognition), we propose a gaze-guided masked autoencoder (GGMAE). Considering the regions where surgeons' gaze focuses are often critical for surgical phase recognition (e.g., surgical field), in our GGMAE, the gaze information acts as an empirical semantic richness prior to guiding the masking process, promoting better attention to semantically rich spatial regions. GGMAE significantly improves the previous state-of-the-art recognition method (6.4% in Jaccard) and the masked autoencoder-based method (3.1% in Jaccard) on EgoSurgery-Phase. The dataset will be released at https://github.com/Fujiry0/EgoSurgery.

Automatic surgical phase recognition is a core technology for modern operating rooms and online surgical video assessment platforms. Current state-of-the-art methods use both spatial and temporal information to tackle the surgical phase recognition task. Building on this idea, we propose the Multi-Scale Action Segmentation Transformer (MS-AST) for offline surgical phase recognition and the Multi-Scale Action Segmentation Causal Transformer (MS-ASCT) for online surgical phase recognition. We use ResNet50 or EfficientNetV2-M for spatial feature extraction. Our MS-AST and MS-ASCT can model temporal information at different scales with multi-scale temporal self-attention and multi-scale temporal cross-attention, which enhances the capture of temporal relationships between frames and segments. We demonstrate that our method can achieve 95.26% and 96.15% accuracy on the Cholec80 dataset for online and offline surgical phase recognition, respectively, which achieves new state-of-the-art results. Our method can also achieve state-of-the-art results on non-medical datasets in the video action segmentation domain.

Surgical phase recognition is crucial to providing surgery understanding in smart operating rooms. Despite great progress in automatic surgical phase recognition, most existing methods are still restricted by two problems. First, these methods cannot capture discriminative visual features for each frame and motion information with simple 2D networks. Second, the frame-by-frame recognition paradigm degrades the performance due to unstable predictions within each phase, termed as phase shaking. To address these two challenges, we propose a Surgical Phase LocAlization Network, named SurgPLAN, to facilitate a more accurate and stable surgical phase recognition with the principle of temporal detection. Specifically, we first devise a Pyramid SlowFast (PSF) architecture to serve as the visual backbone to capture multi-scale spatial and temporal features by two branches with different frame sampling rates. Moreover, we propose a Temporal Phase Localization (TPL) module to generate the phase prediction based on temporal region proposals, which ensures accurate and consistent predictions within each surgical phase. Extensive experiments confirm the significant advantages of our SurgPLAN over frame-by-frame approaches in terms of both accuracy and stability.

Self-supervised learning (SSL) has led to important breakthroughs in computer vision by allowing learning from large amounts of unlabeled data. As such, it might have a pivotal role to play in biomedicine where annotating data requires a highly specialized expertise. Yet, there are many healthcare domains for which SSL has not been extensively explored. One such domain is endoscopy, minimally invasive procedures which are commonly used to detect and treat infections, chronic inflammatory diseases or cancer. In this work, we study the use of a leading SSL framework, namely Masked Siamese Networks (MSNs), for endoscopic video analysis such as colonoscopy and laparoscopy. To fully exploit the power of SSL, we create sizable unlabeled endoscopic video datasets for training MSNs. These strong image representations serve as a foundation for secondary training with limited annotated datasets, resulting in state-of-the-art performance in endoscopic benchmarks like surgical phase recognition during laparoscopy and colonoscopic polyp characterization. Additionally, we achieve a 50% reduction in annotated data size without sacrificing performance. Thus, our work provides evidence that SSL can dramatically reduce the need of annotated data in endoscopy.