The Congress of Neurological Surgeons Self-Assessment for Neurological Surgeons (CNS-SANS) questions are widely used by neurosurgical residents to prepare for written board examinations. Recently, these questions have also served as benchmarks for evaluating large language models' (LLMs) neurosurgical knowledge. This study aims to assess the performance of state-of-the-art LLMs on neurosurgery board-like questions and to evaluate their robustness to the inclusion of distractor statements. A comprehensive evaluation was conducted using 28 large language models. These models were tested on 2,904 neurosurgery board examination questions derived from the CNS-SANS. Additionally, the study introduced a distraction framework to assess the fragility of these models. The framework incorporated simple, irrelevant distractor statements containing polysemous words with clinical meanings used in non-clinical contexts to determine the extent to which such distractions degrade model performance on standard medical benchmarks. 6 of the 28 tested LLMs achieved board-passing outcomes, with the top-performing models scoring over 15.7% above the passing threshold. When exposed to distractions, accurac
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 struggl
Video-based assessment and surgical data science can advance surgical training, research, and quality improvement, yet adoption remains limited by heterogeneous recording formats and privacy concerns linked to video sharing. This work develops, evaluates, and publicly releases Endoshare, a surgeon-friendly application that merges, standardizes, and de-identifies endoscopic videos. Development followed an iterative, user-centered software life cycle. In the analysis phase, an internal survey of four clinicians and four computer scientists, based on 10 usability heuristics, identified early requirements and guided a cross-platform, privacy-by-design architecture. Prototype testing reported high usability for clinicians (4.68 +/- 0.40 out of 5) and for computer scientists (4.03 +/- 0.51 out of 5), with the lowest score (4.00 +/- 0.93 out of 5) relating to label clarity, prompting interface refinement to streamline case selection, video merging, automated out-of-body removal, and filename pseudonymization. In the testing phase, ten surgeons completed an external survey combining the same heuristics with Technology Acceptance Model constructs, reporting high perceived usefulness (5.07 +
Foundation models in video generation are demonstrating remarkable capabilities as potential world models for simulating the physical world. However, their application in high-stakes domains like surgery, which demand deep, specialized causal knowledge rather than general physical rules, remains a critical unexplored gap. To systematically address this challenge, we present SurgVeo, the first expert-curated benchmark for video generation model evaluation in surgery, and the Surgical Plausibility Pyramid (SPP), a novel, four-tiered framework tailored to assess model outputs from basic appearance to complex surgical strategy. On the basis of the SurgVeo benchmark, we task the advanced Veo-3 model with a zero-shot prediction task on surgical clips from laparoscopic and neurosurgical procedures. A panel of four board-certified surgeons evaluates the generated videos according to the SPP. Our results reveal a distinct "plausibility gap": while Veo-3 achieves exceptional Visual Perceptual Plausibility, it fails critically at higher levels of the SPP, including Instrument Operation Plausibility, Environment Feedback Plausibility, and Surgical Intent Plausibility. This work provides the fi
Artificial Intelligence (AI) is transforming medicine, with generative AI models like ChatGPT reshaping perceptions of its potential. This study examines surgeons' awareness, expectations, and involvement with AI in surgery through comparative surveys conducted in 2021 and 2024. Two cross-sectional surveys were distributed globally in 2021 and 2024, the first before an IRCAD webinar and the second during the annual EAES meeting. The surveys assessed demographics, AI awareness, expectations, involvement, and ethics (2024 only). The surveys collected a total of 671 responses from 98 countries, 522 in 2021 and 149 in 2024. Awareness of AI courses rose from 14.5% in 2021 to 44.6% in 2024, while course attendance increased from 12.9% to 23%. Despite this, familiarity with foundational AI concepts remained limited. Expectations for AI's role shifted in 2024, with hospital management gaining relevance. Ethical concerns gained prominence, with 87.2% of 2024 participants emphasizing accountability and transparency. Infrastructure limitations remained the primary obstacle to implementation. Interdisciplinary collaboration and structured training were identified as critical for successful AI
Shared gaze visualizations have been found to enhance collaboration and communication outcomes in diverse HCI scenarios including computer supported collaborative work and learning contexts. Given the importance of gaze in surgery operations, especially when a surgeon trainer and trainee need to coordinate their actions, research on the use of gaze to facilitate intra-operative coordination and instruction has been limited and shows mixed implications. We performed a field observation of 8 surgeries and an interview study with 14 surgeons to understand their visual needs during operations, informing ways to leverage and augment gaze to enhance intra-operative coordination and instruction. We found that trainees have varying needs in receiving visual guidance which are often unfulfilled by the trainers' instructions. It is critical for surgeons to control the timing of the gaze-based visualizations and effectively interpret gaze data. We suggest overlay technologies, e.g., gaze-based summaries and depth sensing, to augment raw gaze in support of surgical coordination and instruction.
The surgical intervention is crucial to patient healthcare, and many studies have developed advanced algorithms to provide understanding and decision-making assistance for surgeons. Despite great progress, these algorithms are developed for a single specific task and scenario, and in practice require the manual combination of different functions, thus limiting the applicability. Thus, an intelligent and versatile surgical assistant is expected to accurately understand the surgeon's intentions and accordingly conduct the specific tasks to support the surgical process. In this work, by leveraging advanced multimodal large language models (MLLMs), we propose a Versatile Surgery Assistant (VS-Assistant) that can accurately understand the surgeon's intention and complete a series of surgical understanding tasks, e.g., surgical scene analysis, surgical instrument detection, and segmentation on demand. Specifically, to achieve superior surgical multimodal understanding, we devise a mixture of projectors (MOP) module to align the surgical MLLM in VS-Assistant to balance the natural and surgical knowledge. Moreover, we devise a surgical Function-Calling Tuning strategy to enable the VS-Assi
Vision language models (VLMs), such as CLIP and OpenCLIP, can encode and reflect stereotypical associations between medical professions and demographic attributes learned from web-scale data. We present an evaluation protocol for healthcare settings that quantifies associated biases and assesses their operational risk. Our methodology (i) defines a taxonomy spanning clinicians and allied healthcare roles (e.g., surgeon, cardiologist, dentist, nurse, pharmacist, technician), (ii) curates a profession-aware prompt suite to probe model behavior, and (iii) benchmarks demographic skew against a balanced face corpus. Empirically, we observe consistent demographic biases across multiple roles and vision models. Our work highlights the importance of bias identification in critical domains such as healthcare as AI-enabled hiring and workforce analytics can have downstream implications for equity, compliance, and patient trust.
During arthroscopic surgeries, surgeons are faced with challenges like cognitive re-projection of the 2D screen output into the 3D operating site or navigation through highly similar tissue. Training of these cognitive processes takes much time and effort for young surgeons, but is necessary and crucial for their education. In this study we want to show how to recognize states of confusion of young surgeons during an arthroscopic surgery, by looking at their eye and head movements and feeding them to a machine learning model. With an accuracy of over 94\% and detection speed of 0.039 seconds, our model is a step towards online diagnostic and training systems for the perceptual-cognitive processes of surgeons during arthroscopic surgeries.
Background: Laparoscopic camera navigation (LCN) is a critical skill, yet its current assessment typically relies on manual rating systems which are time-consuming and difficult to scale. Automated feedback could significantly enhance surgical training by providing immediate, standardized metrics. This study aims to define, clinically evaluate the relevance, and establish the technical readiness of a set of approaches for LCN assessment. Methods: We developed a detailed taxonomy of 14 key aspects of camera navigation, categorized into Framing & Composition, Visibility & Clarity, Orientation & Stability, Motion & Dynamics, and Safety & Awareness. For each aspect, we assessed the technological readiness of automated measurement based on the current state of the art (SoTA) in computer vision (CV). To establish clinical relevance, we designed a survey for practicing laparoscopic surgeons to rate the importance of each aspect on a 5-point Likert scale and to select the five most critical skills. Results: 23 surgeons participated in the survey. Foundational aspects like Field of View, Focus and Centering were rated as most important by surgeons. We present a "Clinical
Robot Assisted Surgeries (RAS) have one of the steepest learning curves of any type of surgery. Because of this, methods to practice RAS outside the operating room have been developed to improve the surgeons skills. These strategies include the incorporation of extended reality simulators into surgical training programs. In this Systematic review, we seek to determine if extended reality simulators can improve the performance of novice surgeons and how their performance compares to the conventional training of surgeons on Surgical robots. Using the PRISMA 2020 guidelines, a systematic review and meta-analysis was performed searching PubMed, Embase, Web of Science, and Cochrane library for studies that compared the performance of novice surgeons that received no additional training, trained with extended reality, or trained with inanimate physical simulators (conventional additional training). We included articles that gauged performance using either GEARS or Time to complete measurements and used SPSS to perform a meta-analysis to compare the performance outcomes of the surgeons after training. Surgeons trained using extended reality completed their surgical tasks statistically sig
Ureteroscopy is the standard of care for diagnosing and treating kidney stones and tumors. However, current ureteroscopes have a limited field of view, requiring significant experience to adequately navigate the renal collecting system. This is evidenced by the fact that inexperienced surgeons have higher rates of missed stones. One-third of patients with residual stones require re-operation within 20 months. In order to aid surgeons to fully explore the kidney, this study presents the Navigated Augmented Reality Visualization for Ureteroscopic Surgery (NAVIUS) system. NAVIUS assists surgeons by providing 3D maps of the target anatomy, real-time scope positions, and preoperative imaging overlays. To enable real-time navigation and visualization, we integrate an electromagnetic tracker-based navigation pipeline with augmented reality visualizations. NAVIUS connects to 3D Slicer and Unity with OpenIGTLink, and uses HoloLens 2 as a holographic interface. We evaluate NAVIUS through a user study where surgeons conducted ureteroscopy on kidney phantoms with and without visual guidance. With our proposed system, we observed that surgeons explored more areas within the collecting system wi
Mapping surgery is fundamental to developing operative guidelines and enabling autonomous robotic surgery. Recent advances in artificial intelligence (AI) have shown promise in mapping the behaviour of surgeons from videos, yet current models remain narrow in scope, capturing limited behavioural components within single procedures, and offer limited translational value, as they remain inaccessible to practising surgeons. Here we introduce Halsted, a vision-language model trained on the Halsted Surgical Atlas (HSA), one of the most comprehensive annotated video libraries grown through an iterative self-labelling framework and encompassing over 650,000 videos across eight surgical specialties. To facilitate benchmarking, we publicly release HSA-27k, a subset of the Halsted Surgical Atlas. Halsted surpasses previous state-of-the-art models in mapping surgical activity while offering greater comprehensiveness and computational efficiency. To bridge the longstanding translational gap of surgical AI, we develop the Halsted web platform (https://halstedhealth.ai/) to provide surgeons anywhere in the world with the previously-unavailable capability of automatically mapping their own proced
In this paper, we study a multi-agent scheduling problem for organising the operations within the operating room department. The head of the surgeon group and individual surgeons are together responsible for the surgeon schedule and surgical case planning. The surgeon head allocates time blocks to individual surgeons, whereas individual surgeons determine the planning of surgical cases independently, which might degrade the schedule quality envisaged by the surgeon head. The bilevel optimisation under study seeks an optimal Nash equilibrium solution -- a surgeon schedule and surgical case plan that optimise the objectives of the surgeon head, while ensuring that no individual surgeon can improve their own objective within the allocated time blocks. We propose a dedicated branch-and-price that adds lazy constraints to the formulation of surgeon-specific pricing problems to ensure an optimal bilevel feasible solution is retrieved. In this way, the surgeon head respects the objective requirements of the individual surgeons and the solution space can be searched efficiently. In the computational experiments, we validate the performance of the proposed algorithm and its dedicated compon
Video recordings of open surgeries are greatly required for education and research purposes. However, capturing unobstructed videos is challenging since surgeons frequently block the camera field of view. To avoid occlusion, the positions and angles of the camera must be frequently adjusted, which is highly labor-intensive. Prior work has addressed this issue by installing multiple cameras on a shadowless lamp and arranging them to fully surround the surgical area. This setup increases the chances of some cameras capturing an unobstructed view. However, manual image alignment is needed in post-processing since camera configurations change every time surgeons move the lamp for optimal lighting. This paper aims to fully automate this alignment task. The proposed method identifies frames in which the lighting system moves, realigns them, and selects the camera with the least occlusion to generate a video that consistently presents the surgical field from a fixed perspective. A user study involving surgeons demonstrated that videos generated by our method were superior to those produced by conventional methods in terms of the ease of confirming the surgical area and the comfort during
Robot-assisted surgery has revolutionized the healthcare industry by providing surgeons with greater precision, reducing invasiveness, and improving patient outcomes. However, the success of these surgeries depends heavily on the robotic system ability to accurately interpret the intentions of the surgical trainee or even surgeons. One critical factor impacting intent recognition is the cognitive workload experienced during the procedure. In our recent research project, we are building an intelligent adaptive system to monitor cognitive workload and improve learning outcomes in robot-assisted surgery. The project will focus on achieving a semantic understanding of surgeon intents and monitoring their mental state through an intelligent multi-modal assistive framework. This system will utilize brain activity, heart rate, muscle activity, and eye tracking to enhance intent recognition, even in mentally demanding situations. By improving the robotic system ability to interpret the surgeons intentions, we can further enhance the benefits of robot-assisted surgery and improve surgery outcomes.
Robot-assisted minimally invasive surgeries offer many advantages but require complex motor tasks that take surgeons years to master. There is currently a lack of knowledge on how surgeons acquire these robotic surgical skills. Toward bridging this gap, a previous study followed surgical residents learning complex surgical dry lab tasks on a surgical robot over six months. Errors are an important measure for training and skill evaluation, but unlike in virtual simulations, in dry lab training, errors are difficult to monitor automatically. Here, we analyzed errors in the ring tower transfer task, in which surgical residents moved a ring along a curved wire as quickly and accurately as possible. We developed an image-processing algorithm using color and size thresholds, optical flow and short time Fourier transforms to detect collision errors and achieved a detection accuracy of approximately 95%. Using the detected errors and task completion time, we found that the residents reduced their completion time and number of errors over the six months, while the percentage of task time spent making errors remained relatively constant on average. This analysis sheds light on the learning p
Large language models (LLMs) achieve remarkable performance across a wide range of tasks, but their deployment is constrained by substantial memory and compute requirements. Low-rank compression via singular value decomposition (SVD) is an effective remedy, but existing methods focus on how to factorize and which components to keep. We introduce SVD-Surgeon, a training-free method that brings the Optimal Brain Surgeon (OBS) framework to the singular-value basis. Treating each singular value as a parameter, it computes a closed-form update of the retained singular values that compensates, to second order in the model loss, for those removed by truncation. The same analysis yields a saliency for choosing which values to prune. As it operates directly on the singular-value factorization, SVD-Surgeon can be layered on top of existing SVD compressors. Applied to SVD-LLM, a leading SVD-based method, it improves the perplexity-compression trade-off on the OPT family and LLaMA 2-7B without any retraining.
Collaborative planning for congenital heart diseases typically involves creating physical heart models through 3D printing, which are then examined by both surgeons and cardiologists. Recent developments in mobile augmented reality (AR) technologies have presented a viable alternative, known for their ease of use and portability. However, there is still a lack of research examining the utilization of multi-user mobile AR environments to support collaborative planning for cardiovascular surgeries. We created ARCollab, an iOS AR app designed for enabling multiple surgeons and cardiologists to interact with a patient's 3D heart model in a shared environment. ARCollab enables surgeons and cardiologists to import heart models, manipulate them through gestures and collaborate with other users, eliminating the need for fabricating physical heart models. Our evaluation of ARCollab's usability and usefulness in enhancing collaboration, conducted with three cardiothoracic surgeons and two cardiologists, marks the first human evaluation of a multi-user mobile AR tool for surgical planning. ARCollab is open-source, available at https://github.com/poloclub/arcollab.
Videos are prominent learning materials to prepare surgical trainees before they enter the operating room (OR). In this work, we explore techniques to enrich the video-based surgery learning experience. We propose Surgment, a system that helps expert surgeons create exercises with feedback based on surgery recordings. Surgment is powered by a few-shot-learning-based pipeline (SegGPT+SAM) to segment surgery scenes, achieving an accuracy of 92\%. The segmentation pipeline enables functionalities to create visual questions and feedback desired by surgeons from a formative study. Surgment enables surgeons to 1) retrieve frames of interest through sketches, and 2) design exercises that target specific anatomical components and offer visual feedback. In an evaluation study with 11 surgeons, participants applauded the search-by-sketch approach for identifying frames of interest and found the resulting image-based questions and feedback to be of high educational value.