Abstract--Surgical suturing is a high-precision task that impacts patient healing and scarring. Suturing skill varies widely between surgeons, highlighting the need for robot assistance. Previous robot suturing works, such as STITCH 1.0 [1], struggle to fully close wounds due to inaccurate needle tracking and poor thread management. T o address these challenges, we present STITCH 2.0, an elevated augmented dexterity pipeline with seven improvements including: improved EKF needle pose estimation, new thread untangling methods, and an automated 3D suture alignment algorithm. Experimental results over 15 trials find that STITCH 2.0 on average achieves 74.4% wound closure with 4.87 sutures per trial, representing 66% more sutures in 38% less time compared to the previous baseline. When two human interventions are allowed, STITCH 2.0 averages six sutures with 100% wound closure rate. URGICAL robots have revolutionized minimally invasive surgery, with Intuitive Surgical's da Vinci system performing over 2.6 million procedures in 2024 [2]. While these procedures require complete human control, recent advances in artificial intelligence (AI) present opportunities for surgical robot autonomy. However, the high-risk nature of surgery raises safety concerns for fully autonomous AI systems.

Traditional surgical skill acquisition relies heavily on expert feedback, yet direct access is limited by faculty availability and variability in subjective assessments. While trainees can practice independently, the lack of personalized, objective, and quantitative feedback reduces the effectiveness of self-directed learning. Recent advances in computer vision and machine learning have enabled automated surgical skill assessment, demonstrating the feasibility of automatic competency evaluation. However, it is unclear whether such Artificial Intelligence (AI)-driven feedback can contribute to skill acquisition. Here, we examine the effectiveness of explainable AI (XAI)-generated feedback in surgical training through a human-AI study. We create a simulation-based training framework that utilizes XAI to analyze videos and extract surgical skill proxies related to primitive actions. Our intervention provides automated, user-specific feedback by comparing trainee performance to expert benchmarks and highlighting deviations from optimal execution through understandable proxies for actionable guidance. In a prospective user study with medical students, we compare the impact of XAI-guided feedback against traditional video-based coaching on task outcomes, cognitive load, and trainees' perceptions of AI-assisted learning. Results showed improved cognitive load and confidence post-intervention. While no differences emerged between the two feedback types in reducing performance gaps or practice adjustments, trends in the XAI group revealed desirable effects where participants more closely mimicked expert practice. This work encourages the study of explainable AI in surgical education and the development of data-driven, adaptive feedback mechanisms that could transform learning experiences and competency assessment.

Craniosynostosis is a medical condition that affects the growth of babies' heads, caused by an early fusion of cranial sutures. In recent decades, surgical treatments for craniosynostosis have significantly improved, leading to reduced invasiveness, faster recovery, and less blood loss. At Great Ormond Street Hospital (GOSH), the main surgical treatment for patients diagnosed with sagittal craniosynostosis (SC) is spring assisted cranioplasty (SAC). This procedure involves a 15x15 mm2 osteotomy, where two springs are inserted to induce distraction. Despite the numerous advantages of this surgical technique for patients, the outcome remains unpredictable due to the lack of efficient preoperative planning tools. The surgeon's experience and the baby's age are currently relied upon to determine the osteotomy location and spring selection. Previous tools for predicting the surgical outcome of SC relied on finite element modeling (FEM), which involved computed tomography (CT) imaging and required engineering expertise and lengthy calculations. The main goal of this research is to develop a real-time prediction tool for the surgical outcome of patients, eliminating the need for CT scans to minimise radiation exposure during preoperative planning. The proposed methodology involves creating personalised synthetic skulls based on three-dimensional (3D) photographs, incorporating population average values of suture location, skull thickness, and soft tissue properties. A machine learning (ML) surrogate model is employed to achieve the desired surgical outcome. The resulting multi-output support vector regressor model achieves a R2 metric of 0.95 and MSE and MAE below 0.13. Furthermore, in the future, this model could not only simulate various surgical scenarios but also provide optimal parameters for achieving a maximum cranial index (CI).

Objective motor skill assessment plays a critical role in fields such as surgery, where proficiency is vital for certification and patient safety. Existing assessment methods, however, rely heavily on subjective human judgment, which introduces bias and limits reproducibility. While recent efforts have leveraged kinematic data and neural imaging to provide more objective evaluations, these approaches often overlook the dynamic neural mechanisms that differentiate expert and novice performance. This study proposes a novel method for motor skill assessment based on dynamic directed functional connectivity (dFC) as a neural biomarker. By using electroencephalography (EEG) to capture brain dynamics and employing an attention-based Long Short-Term Memory (LSTM) model for non-linear Granger causality analysis, we compute dFC among key brain regions involved in psychomotor tasks. Coupled with hierarchical task analysis (HTA), our approach enables subtask-level evaluation of motor skills, offering detailed insights into neural coordination that underpins expert proficiency. A convolutional neural network (CNN) is then used to classify skill levels, achieving greater accuracy and specificity than established performance metrics in laparoscopic surgery. This methodology provides a reliable, objective framework for assessing motor skills, contributing to the development of tailored training protocols and enhancing the certification process.

Vascular anastomosis, the surgical connection of blood vessels, is essential in procedures such as organ transplants and reconstructive surgeries. The precision required limits accessibility due to the extensive training needed, with manual suturing leading to variable outcomes and revision rates up to 7.9%. Existing robotic systems, while promising, are either fully teleoperated or lack the capabilities necessary for autonomous vascular anastomosis. We present the Micro Smart Tissue Autonomous Robot (micro-STAR), an autonomous robotic system designed to perform vascular anastomosis on small-diameter vessels. The micro-STAR system integrates a novel suturing tool equipped with Optical Coherence Tomography (OCT) fiber-optic sensor and a microcamera, enabling real-time tissue detection and classification. Our system autonomously places sutures and manipulates tissue with minimal human intervention. In an ex vivo study, micro-STAR achieved outcomes competitive with experienced surgeons in terms of leak pressure, lumen reduction, and suture placement variation, completing 90% of sutures without human intervention. This represents the first instance of a robotic system autonomously performing vascular anastomosis on real tissue, offering significant potential for improving surgical precision and expanding access to high-quality care.

Multimodal large language models (LLMs) have achieved notable success across various domains, while research in the medical field has largely focused on unimodal images. Meanwhile, current general-domain multimodal models for videos still lack the capabilities to understand and engage in conversations about surgical videos. One major contributing factor is the absence of datasets in the surgical field. In this paper, we create a new dataset, Surg-QA, consisting of 102,000 surgical video-instruction pairs, the largest of its kind so far. To build such a dataset, we propose a novel two-stage question-answer generation pipeline with LLM to learn surgical knowledge in a structured manner from the publicly available surgical lecture videos. The pipeline breaks down the generation process into two stages to significantly reduce the task complexity, allowing us to use a more affordable, locally deployed open-source LLM than the premium paid LLM services. It also mitigates the risk of LLM hallucinations during question-answer generation, thereby enhancing the overall quality of the generated data. We further train LLaVA-Surg, a novel vision-language conversational assistant capable of answering open-ended questions about surgical videos, on this Surg-QA dataset, and conduct comprehensive evaluations on zero-shot surgical video question-answering tasks. We show that LLaVA-Surg significantly outperforms all previous general-domain models, demonstrating exceptional multimodal conversational skills in answering open-ended questions about surgical videos. We will release our code, model, and the instruction-tuning dataset.

We present STITCH: an augmented dexterity pipeline that performs Suture Throws Including Thread Coordination and Handoffs. STITCH iteratively performs needle insertion, thread sweeping, needle extraction, suture cinching, needle handover, and needle pose correction with failure recovery policies. We introduce a novel visual 6D needle pose estimation framework using a stereo camera pair and new suturing motion primitives. We compare STITCH to baselines, including a proprioception-only and a policy without visual servoing. In physical experiments across 15 trials, STITCH achieves an average of 2.93 sutures without human intervention and 4.47 sutures with human intervention. See https://sites.google.com/berkeley.edu/stitch for code and supplemental materials.

Accurate 3D sensing of suturing thread is a challenging problem in automated surgical suturing because of the high state-space complexity, thinness and deformability of the thread, and possibility of occlusion by the grippers and tissue. In this work we present a method for tracking surgical thread in 3D which is robust to occlusions and complex thread configurations, and apply it to autonomously perform the surgical suture "tail-shortening" task: pulling thread through tissue until a desired "tail" length remains exposed. The method utilizes a learned 2D surgical thread detection network to segment suturing thread in RGB images. It then identifies the thread path in 2D and reconstructs the thread in 3D as a NURBS spline by triangulating the detections from two stereo cameras. Once a 3D thread model is initialized, the method tracks the thread across subsequent frames. Experiments suggest the method achieves a 1.33 pixel average reprojection error on challenging single-frame 3D thread reconstructions, and an 0.84 pixel average reprojection error on two tracking sequences. On the tail-shortening task, it accomplishes a 90% success rate across 20 trials. Supplemental materials are available at https://sites.google.com/berkeley.edu/autolab-surgical-thread/ .

While robotic laparoscopic surgical systems do make certain procedures safer and less invasive, those systems are still operated by human surgeons. Now, however, a surgical robot has performed a delicate operation entirely on its own. Known as the Smart Tissue Autonomous Robot (STAR), the robotic-arm-equipped device was designed by researchers at Johns Hopkins University. Back in 2016, when operating on pigs, STAR was shown to be equal to or better than experienced surgeons at performing a procedure known as an intestinal anastomosis – this involved painstakingly suturing together the two severed ends of a small intestine. At the time, however, the robot had to access the intestine via a large external incision, and still required some guidance from humans.

Purpose: Mitral valve repair is a complex minimally invasive surgery of the heart valve. In this context, suture detection from endoscopic images is a highly relevant task that provides quantitative information to analyse suturing patterns, assess prosthetic configurations and produce augmented reality visualisations. Facial or anatomical landmark detection tasks typically contain a fixed number of landmarks, and use regression or fixed heatmap-based approaches to localize the landmarks. However in endoscopy, there are a varying number of sutures in every image, and the sutures may occur at any location in the annulus, as they are not semantically unique. Method: In this work, we formulate the suture detection task as a multi-instance deep heatmap regression problem, to identify entry and exit points of sutures. We extend our previous work, and introduce the novel use of a 2D Gaussian layer followed by a differentiable 2D spatial Soft-Argmax layer to function as a local non-maximum suppression. Results: We present extensive experiments with multiple heatmap distribution functions and two variants of the proposed model. In the intra-operative domain, Variant 1 showed a mean F1 of +0.0422 over the baseline. Similarly, in the simulator domain, Variant 1 showed a mean F1 of +0.0865 over the baseline. Conclusion: The proposed model shows an improvement over the baseline in the intra-operative and the simulator domains. The data is made publicly available within the scope of the MICCAI AdaptOR2021 Challenge https://adaptor2021.github.io/, and the code at https://github.com/Cardio-AI/suture-detection-pytorch/. DOI:10.1007/s11548-021-02523-w. The link to the open access article can be found here: https://link.springer.com/article/10.1007%2Fs11548-021-02523-w