arXiv subjects

Pietro Mascagni

Publications and source records attributed to Pietro Mascagni.

At least 19 recordsLinked to original sources

arXiv2026

A Surgical Foundation Model Reveals Task-Dependent Label Efficiency

Developing label-efficient models is a central challenge in surgical AI due to the high cost and scarcity of expert annotation. While self-supervised foundation models adapt well to new tasks with minimal data, how label efficiency varies across different surgical tasks remains largely unexplored. Here, we introduce SURGE, a surgical foundation model trained on SurgSpectrum-30M+, the largest pretraining dataset comprising over 30 million frames, with checkpoints released to enable further research. We systematically evaluate label efficiency across 5 task categories and 15 benchmarks. These range from temporal and spatial scene understanding to fine-grained reasoning tied to instrument-anatomy interactions and safety-critical maneuvers. SURGE outperforms prior state-of-the-art on all benchmarks, even surpassing task-specific models on complex reasoning tasks. Crucially, we reveal a task-dependent scaling behavior: while scene understanding tasks saturate with minimal supervision, fine-grained reasoning tasks continue improving with substantially larger annotation budgets, providing a blueprint for allocating expert effort in complex domains. Code: https://github.com/CAMMA-public/SURGE

cs.CV↗

arXiv2026

SurgTEMP: Temporal-Aware Surgical Video Question Answering with Text-guided Visual Memory for Laparoscopic Cholecystectomy

Surgical procedures are inherently complex and risky, requiring extensive expertise and constant focus to navigate evolving intraoperative scenes. Computer-assisted systems such as surgical visual question answering (VQA) offer promises for education and intraoperative support. Current surgical VQA research largely focuses on static frame analysis, overlooking rich temporal semantics. Surgical video question answering is further challenged by low visual contrast, its highly knowledge-driven nature, diverse analytical needs spanning scattered temporal windows, and the hierarchy from basic perception to high-level intraoperative assessment. To address these challenges, we propose SurgTEMP, a multimodal LLM framework featuring (i) a query-guided token selection module that builds hierarchical visual memory (spatial and temporal memory banks) and (ii) a Surgical Competency Progression (SCP) training scheme. Together, they enable effective modeling of variable-length surgical videos while preserving procedure-relevant cues and temporal coherence, and better support diverse downstream assessment tasks. To support model development, we introduce CholeVidQA-32K, a surgical video question answering dataset comprising 32K open-ended QA pairs and 3,855 video segments (approximately 128 h total) from laparoscopic cholecystectomy. The dataset is organized into a three-level hierarchy -- Perception, Assessment, and Reasoning -- spanning 11 tasks from instrument/action/anatomy perception to Critical View of Safety (CVS), intraoperative difficulty, skill proficiency, and adverse event assessment. In comprehensive evaluations against state-of-the-art open-source multimodal and video LLMs (fine-tuned and zero-shot), SurgTEMP achieves substantial performance improvements, advancing the state of video-based surgical VQA. The project page is available at: https://camma-public.github.io/SurgTEMP/

cs.CV↗

arXiv2026

Artificial Intelligence for Workflow Analysis in Colorectal Surgery: A Multicentric, Cross-Procedural Development and Generalization Study

Minimally invasive colorectal surgeries (MIS-CRS) are characterised by significant variability and inconsistent outcomes. ColoWorkflow, a tool for the video-based assessment (VBA) of MIS-CRS workflow, was recently validated. However, manual VBA is time-consuming, limiting implementation. This study presents AI-ColoWorkflow, a deep learning model for automated surgical workflow analysis across MIS-CRS. Operative videos of MIS-CRS were collected from 4 centres and a publicly available dataset. Phases and steps were manually annotated according to ColoWorkflow. A deep learning model combining a fine-tuned DINOv3 vision transformer for per-frame visual feature extraction with a hierarchical multi-stage temporal convolutional network was jointly optimized for phase and step recognition. The model trained on pooled multicentric data, namely AI-ColoWorkflow was compared against centre-specific and procedure-specific models on a held-out test set. The following metrics were used for evaluation: macro F1 score, balanced accuracy, precision, and recall. AI-ColoWorkflow achieved a macro F1 of 73.01% $\pm$ 10.27 (balanced accuracy 73.43%) for phase recognition and 39.82% $\pm$ 7.06 (balanced accuracy 38.65%) for step recognition. The global model outperformed centre- and procedure-specific models in most experiments except procedure-specific step recognition. In the generalization analysis, mean F1 was 48.42% for phase recognition. AI-ColoWorkflow can reliably recognize MIS-CRS phases. A single model trained on pooled, multicentric, multi-procedural data generalises at least as well as and often better than centre- or procedure-specific models for phase recognition in MIS-CRS, while procedure-specific step models retain advantages for certain procedure types, motivating hybrid training strategies for future surgical AI development.

cs.CV↗

arXiv2026

Current validation practice undermines surgical AI development

Surgical data science (SDS) is rapidly advancing, yet clinical adoption of artificial intelligence (AI) in surgery remains limited, with inadequate validation as an important contributing factor. Existing validation practices often neglect the temporal and hierarchical structure of intraoperative videos, yielding misleading or clinically irrelevant results. We introduce a comprehensive catalogue of validation pitfalls in AI-based surgical video analysis, derived from a multi-stage Delphi process with 92 international experts. Pitfalls span three categories: (1) data, (2) metric selection/configuration, and (3) aggregation and reporting. A systematic review of surgical AI papers reveals that these pitfalls are widespread. Experiments on surgical video datasets show that ignoring temporal and hierarchical data structures can understate uncertainty, obscure critical failure modes, and alter algorithm rankings. To address these shortcomings, we provide consensus-based best practices compiled. Together, this work provides an evidence-based framework for rigorous validation of surgical video analysis algorithms, guiding benchmarking, reporting, regulatory review, and clinical translation.

q-bio.OT↗

arXiv2026

Optimizing Human-Machine Interface for Real-Time AI Support in the Operating Room: the CVS Copilot

Artificial intelligence (AI) systems for automated Critical View of Safety (CVS) assessment in laparoscopic cholecystectomy are nearing clinical translation. Beyond algorithmic performance, clinical safety and effectiveness depend on the quality of the human-machine interface (HMI). This work examines how AI-generated predictions should be presented and controlled intraoperatively. Seventeen surgeons, including residents, attending surgeons, and professors, took part in a mixed-methods, user-centered design study to optimize an intraoperative HMI for AI-assisted safe laparoscopic cholecystectomy. Interviews explored interaction modalities, timing of assistance, visualization strategies, and control mechanisms across surgical roles, and were analyzed using reflexive thematic analysis and human-factors heuristics. Most surgeons (16/17) supported the use of AI for intraoperative decision support while rejecting autonomous decision-making. Attendings preferred minimal AI feedback at decisive moments (13/14), whereas residents favored optional guidance (3/3) with confidence indicators and on-demand anatomical overlays. Across interviews, surgeons consistently prioritized visual, surgeon-controlled, minimally intrusive displays, with the strongest support for a minimal overlay (16/17) and on-demand anatomical segmentation (13/17). Recurrent concerns included persistent overlays, haptic feedback, and numeric confidence displays, although these were not uniformly raised across the cohort. These findings informed the design of CVS Copilot, a surgeon-controlled, role-adaptive HMI that provides AI-based CVS assessment with minimal default visualization and optional overlays.

cs.HC↗

arXiv2026

GEN-Guard: Correcting Generalization Failures for Deployable Federated Surgical AI

Federated Learning (FL) in surgical video AI enables collaborative model training without sharing sensitive data. However, standard evaluation practices - selecting the "best" global model based only on validation data from participating hospitals - can lead to suboptimal deployment choices. We identify this critical failure mode as performance leakage, where the selected model overfits internal federation data and fails to generalize to unseen institutions. We propose GEN-Guard, a practical post-hoc framework to detect and correct generalization failures in federated surgical AI. It integrates Generalization Detection via Client-Blocked Evaluation (CBE), which validates performance on isolated client distributions to prevent performance leakage, and Generalization Correction through Disagreement-Aware Distillation (DAD), which learns adaptive feature-level corrections for cross-institutional robustness. Both components operate after standard FL convergence while providing robust support for zero-shot adaptation to unseen environments. We first quantify the severity of performance leakage, observing Model Selection Failures (MSFs) exceeding 80% under standard evaluation. GEN-Guard is evaluated on two multi-center clinical challenges: surgical phase recognition in laparoscopic cholecystectomy and polyp segmentation in colonoscopy. Across both datasets, GEN-Guard consistently corrects these failures, improving in-federation F1 scores by up to 2 points, unseen-institution performance by up to 3 points, and worst-case institutional performance by 3-9 points. Performance leakage represents a systematic and previously under-recognized risk in federated surgical AI. GEN-Guard provides a practical solution for detecting and correcting such failures. By improving cross-institutional robustness and zero-shot generalization, it strengthens the reliability of FL for real-world surgical deployment.

cs.CV↗

arXiv2026

AI for Quality Assurance in the Operating Room

Surgical outcomes depend not only on patient factors and postoperative care but are also strongly influenced by the quality of the operation itself. Yet, for much of mod-ern surgery, intraoperative quality has been assessed indirectly through outcomes and operative reports. The increase in minimally invasive procedures inherently guided by endoscopic video, together with advances in artificial intelligence, creates an unprecedented opportunity to systematically observe, measure, and improve surgi-cal care. This chapter introduces AI-enabled Surgical Quality Assurance as a frame-work for using surgical data to support continuous assessment and improvement in the operating room. We first review existing approaches to surgical safety, from sys-tem-level interventions to procedure-specific standards. We then describe how AI can transform intraoperative video into clinically meaningful information, including recog-nition of anatomy, instruments, workflow, surgical actions, quality criteria, adverse events, and critical moments. Finally, we outline the major challenges that must be addressed before these systems can deliver routine clinical value, including representa-tive data collection, robust validation, workflow integration, regulation, liability, pri-vacy, and equitable access. Rather than replacing surgical judgment, AI for quality assurance should be understood as a set of tools for augmenting the surgical team, scaling expert review, and helping surgery evolve toward a learning system in which intraoperative care is continuously observed, assessed, and improved.

cs.CY↗

arXiv2026

The SAGES Critical View of Safety Challenge: A Global Benchmark for AI-Assisted Surgical Quality Assessment

Advances in artificial intelligence (AI) for surgical quality assessment promise to democratize access to expertise, with applications in training, guidance, and accreditation. This study presents the SAGES Critical View of Safety (CVS) Challenge, the first AI competition organized by a surgical society, using the CVS in laparoscopic cholecystectomy, a universally recommended yet inconsistently performed safety step, as an exemplar of surgical quality assessment. A global collaboration across 54 institutions in 24 countries engaged hundreds of clinicians and engineers to curate 1,000 videos annotated by 20 surgical experts according to a consensus-validated protocol. The challenge addressed key barriers to real-world deployment in surgery, including achieving high performance, capturing uncertainty in subjective assessment, and ensuring robustness to clinical variability. To enable this scale of effort, we developed EndoGlacier, a framework for managing large, heterogeneous surgical video and multi-annotator workflows. Thirteen international teams participated, achieving up to a 17% relative gain in assessment performance, over 80% reduction in calibration error, and a 17% relative improvement in robustness over the state-of-the-art. Analysis of results highlighted methodological trends linked to model performance, providing guidance for future research toward robust, clinically deployable AI for surgical quality assessment.

cs.CV↗

arXiv2026

Expert Consensus-based Video-Based Assessment Tool for Workflow Analysis in Minimally Invasive Colorectal Surgery: Development and Validation of ColoWorkflow

Minimally invasive colorectal surgery is characterized by procedural variability, a difficult learning curve, and complications that impact quality and outcomes. Video-based assessment (VBA) offers an opportunity to generate data-driven insights to reduce variability, optimize training, and improve surgical performance. However, existing tools for workflow analysis remain difficult to standardize and implement. This study aims to develop and validate a VBA tool for workflow analysis across minimally invasive colorectal procedures. A Delphi process was conducted to achieve consensus on generalizable workflow descriptors. The resulting framework informed the development of a new VBA tool, ColoWorkflow. Independent raters then applied ColoWorkflow to a multicentre video dataset of laparoscopic and robotic colorectal surgery (CRS). Applicability and inter-rater reliability were evaluated. Consensus was achieved for 10 procedure-agnostic phases and 34 procedure-specific steps describing CRS workflows. ColoWorkflow was developed and applied to 54 colorectal operative videos (left and right hemicolectomies, sigmoid and rectosigmoid resections, and total proctocolectomies) from five centres. The tool demonstrated broad applicability, with all but one label utilized. Inter-rater reliability was moderate, with mean Cohen's K of 0.71 for phases and 0.66 for steps. Most discrepancies arose at phase transitions and step boundary definitions. ColoWorkflow is the first consensus-based, validated VBA tool for comprehensive workflow analysis in minimally invasive CRS. It establishes a reproducible framework for video-based performance assessment, enabling benchmarking across institutions and supporting the development of artificial intelligence-driven workflow recognition. Its adoption may standardize training, accelerate competency acquisition, and advance data-informed surgical quality improvement.

cs.CV↗

arXiv2025

Artificial Intelligence for the Assessment of Peritoneal Carcinosis during Diagnostic Laparoscopy for Advanced Ovarian Cancer

Advanced Ovarian Cancer (AOC) is often diagnosed at an advanced stage with peritoneal carcinosis (PC). Fagotti score (FS) assessment at diagnostic laparoscopy (DL) guides treatment planning by estimating surgical resectability, but its subjective and operator-dependent nature limits reproducibility and widespread use. Videos of patients undergoing DL with concomitant FS assessments at a referral center were retrospectively collected and divided into a development dataset, for data annotation, AI training and evaluation, and an independent test dataset, for internal validation. In the development dataset, FS-relevant frames were manually annotated for anatomical structures and PC. Deep learning models were trained to automatically identify FS-relevant frames, segment structures and PC, and predict video-level FS and indication to surgery (ItS). AI performance was evaluated using Dice score for segmentation, F1-scores for anatomical stations (AS) and ItS prediction, and root mean square error (RMSE) for final FS estimation. In the development dataset, the segmentation model trained on 7,311 frames, achieved Dice scores of 70$\pm$3% for anatomical structures and 56$\pm$3% for PC. Video-level AS classification achieved F1-scores of 74$\pm$3% and 73$\pm$4%, FS prediction showed normalized RMSE values of 1.39$\pm$0.18 and 1.15$\pm$0.08, and ItS reached F1-scores of 80$\pm$8% and 80$\pm$2% in the development (n=101) and independent test datasets (n=50), respectively. This is the first AI model to predict the feasibility of cytoreductive surgery providing automated FS estimation from DL videos. Its reproducible and reliable performance across datasets suggests that AI can support surgeons through standardized intraoperative tumor burden assessment and clinical decision-making in AOC.

eess.IV↗

arXiv2025

Endoshare: A Publicly Available, Surgeons-Friendly Solution to De-Identify and Manage Surgical Videos

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 +/- 1.75 out of 7), ease of use (5.15 +/- 1.71 out of 7), heuristic usability (4.38 +/- 0.48 out of 5), and strong recommendation likelihood (9.20 +/- 0.79 out of 10). A performance assessment across different hardware and configurations showed that processing time increased proportionally with video duration and was consistently lower in fast mode. Endoshare is a publicly available solution to manage surgical videos, with potential to support training, research, and quality improvement. Compliance certification and broader interoperability validation are needed to establish it as a reliable tool for surgical video management. The software is available at https://camma-public.github.io/Endoshare

cs.CV↗

arXiv2025

Jumpstarting Surgical Computer Vision

Consensus amongst researchers and industry points to a lack of large, representative annotated datasets as the biggest obstacle to progress in the field of surgical data science. Advances in Self-Supervised Learning (SSL) represent a solution, reducing the dependence on large labeled datasets by providing task-agnostic initializations. However, the robustness of current self-supervised learning methods to domain shifts remains unclear, limiting our understanding of its utility for leveraging diverse sources of surgical data. Shifting the focus from methods to data, we demonstrate that the downstream value of SSL-based initializations is intricately intertwined with the composition of pre-training datasets. These results underscore an important gap that needs to be filled as we scale self-supervised approaches toward building general-purpose "foundation models" that enable diverse use-cases within the surgical domain. Through several stages of controlled experimentation, we develop recommendations for pretraining dataset composition evidenced through over 300 experiments spanning 20 pre-training datasets, 9 surgical procedures, 7 centers (hospitals), 3 labeled-data settings, 3 downstream tasks, and multiple runs. Using the approaches here described, we outperform state-of-the-art pre-trainings on two public benchmarks for phase recognition: up to 2.2% on Cholec80 and 5.1% on AutoLaparo.

cs.CV↗

arXiv2025

CycleSAM: Few-Shot Surgical Scene Segmentation with Cycle- and Scene-Consistent Feature Matching

Surgical image segmentation is highly challenging, primarily due to scarcity of annotated data. Generalist prompted segmentation models like the Segment-Anything Model (SAM) can help tackle this task, but because they require image-specific visual prompts for effective performance, their use is limited to improving data annotation efficiency. Recent approaches extend SAM to automatic segmentation by using a few labeled reference images to predict point prompts; however, they rely on feature matching pipelines that lack robustness to out-of-domain data like surgical images. To tackle this problem, we introduce CycleSAM, an improved visual prompt learning approach that employs a data-efficient training phase and enforces a series of soft constraints to produce high-quality feature similarity maps. CycleSAM label-efficiently addresses domain gap by leveraging surgery-specific self-supervised feature extractors, then adapts the resulting features through a short parameter-efficient training stage, enabling it to produce informative similarity maps. CycleSAM further filters the similarity maps with a series of consistency constraints before robustly sampling diverse point prompts for each object instance. In our experiments on four diverse surgical datasets, we find that CycleSAM outperforms existing few-shot SAM approaches by a factor of 2-4x in both 1-shot and 5-shot settings, while also achieving strong performance gains over traditional linear probing, parameter-efficient adaptation, and pseudo-labeling methods.

cs.CV↗

arXiv2025

Multi-modal Representations for Fine-grained Multi-label Critical View of Safety Recognition

The Critical View of Safety (CVS) is crucial for safe laparoscopic cholecystectomy, yet assessing CVS criteria remains a complex and challenging task, even for experts. Traditional models for CVS recognition depend on vision-only models learning with costly, labor-intensive spatial annotations. This study investigates how text can be harnessed as a powerful tool for both training and inference in multi-modal surgical foundation models to automate CVS recognition. Unlike many existing multi-modal models, which are primarily adapted for multi-class classification, CVS recognition requires a multi-label framework. Zero-shot evaluation of existing multi-modal surgical models shows a significant performance gap for this task. To address this, we propose CVS-AdaptNet, a multi-label adaptation strategy that enhances fine-grained, binary classification across multiple labels by aligning image embeddings with textual descriptions of each CVS criterion using positive and negative prompts. By adapting PeskaVLP, a state-of-the-art surgical foundation model, on the Endoscapes-CVS201 dataset, CVS-AdaptNet achieves 57.6 mAP, improving over the ResNet50 image-only baseline (51.5 mAP) by 6 points. Our results show that CVS-AdaptNet's multi-label, multi-modal framework, enhanced by textual prompts, boosts CVS recognition over image-only methods. We also propose text-specific inference methods, that helps in analysing the image-text alignment. While further work is needed to match state-of-the-art spatial annotation-based methods, this approach highlights the potential of adapting generalist models to specialized surgical tasks. Code: https://github.com/CAMMA-public/CVS-AdaptNet

cs.CV↗

arXiv2025

Learning from Sparse Point Labels for Dense Carcinosis Localization in Advanced Ovarian Cancer Assessment

Learning from sparse labels is a challenge commonplace in the medical domain. This is due to numerous factors, such as annotation cost, and is especially true for newly introduced tasks. When dense pixel-level annotations are needed, this becomes even more unfeasible. However, being able to learn from just a few annotations at the pixel-level, while extremely difficult and underutilized, can drive progress in studies where perfect annotations are not immediately available. This work tackles the challenge of learning the dense prediction task of keypoint localization from a few point annotations in the context of 2d carcinosis keypoint localization from laparoscopic video frames for diagnostic planning of advanced ovarian cancer patients. To enable this, we formulate the problem as a sparse heatmap regression from a few point annotations per image and propose a new loss function, called Crag and Tail loss, for efficient learning. Our proposed loss function effectively leverages positive sparse labels while minimizing the impact of false negatives or missed annotations. Through an extensive ablation study, we demonstrate the effectiveness of our approach in achieving accurate dense localization of carcinosis keypoints, highlighting its potential to advance research in scenarios where dense annotations are challenging to obtain.

cs.CV↗

arXiv2025

Learning Multi-modal Representations by Watching Hundreds of Surgical Video Lectures

Recent advancements in surgical computer vision applications have been driven by vision-only models, which do not explicitly integrate the rich semantics of language into their design. These methods rely on manually annotated surgical videos to predict a fixed set of object categories, limiting their generalizability to unseen surgical procedures and downstream tasks. In this work, we put forward the idea that the surgical video lectures available through open surgical e-learning platforms can provide effective vision and language supervisory signals for multi-modal representation learning without relying on manual annotations. We address the surgery-specific linguistic challenges present in surgical video lectures by employing multiple complementary automatic speech recognition systems to generate text transcriptions. We then present a novel method, SurgVLP - Surgical Vision Language Pre-training, for multi-modal representation learning. Extensive experiments across diverse surgical procedures and tasks demonstrate that the multi-modal representations learned by SurgVLP exhibit strong transferability and adaptability in surgical video analysis. Furthermore, our zero-shot evaluations highlight SurgVLP's potential as a general-purpose foundation model for surgical workflow analysis, reducing the reliance on extensive manual annotations for downstream tasks, and facilitating adaptation methods such as few-shot learning to build a scalable and data-efficient solution for various downstream surgical applications. The [training code](https://github.com/CAMMA-public/PeskaVLP) and [weights](https://github.com/CAMMA-public/SurgVLP) are public.

cs.CV↗

arXiv2025

Surgeons Awareness, Expectations, and Involvement with Artificial Intelligence: a Survey Pre and Post the GPT Era

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 adoption. Optimism about AI's transformative potential remained high, with 79.9% of respondents believing AI would positively impact surgery and 96.6% willing to integrate AI into their clinical practice. Surgeons' perceptions of AI are evolving, driven by the rise of generative AI and advancements in surgical data science. While enthusiasm for integration is strong, knowledge gaps and infrastructural challenges persist. Addressing these through education, ethical frameworks, and infrastructure development is essential.

cs.CY↗

arXiv2025

Surgical Text-to-Image Generation

Acquiring surgical data for research and development is significantly hindered by high annotation costs and practical and ethical constraints. Utilizing synthetically generated images could offer a valuable alternative. In this work, we explore adapting text-to-image generative models for the surgical domain using the CholecT50 dataset, which provides surgical images annotated with action triplets (instrument, verb, target). We investigate several language models and find T5 to offer more distinct features for differentiating surgical actions on triplet-based textual inputs, and showcasing stronger alignment between long and triplet-based captions. To address challenges in training text-to-image models solely on triplet-based captions without additional inputs and supervisory signals, we discover that triplet text embeddings are instrument-centric in the latent space. Leveraging this insight, we design an instrument-based class balancing technique to counteract data imbalance and skewness, improving training convergence. Extending Imagen, a diffusion-based generative model, we develop Surgical Imagen to generate photorealistic and activity-aligned surgical images from triplet-based textual prompts. We assess the model on quality, alignment, reasoning, and knowledge, achieving FID and CLIP scores of 3.7 and 26.8% respectively. Human expert survey shows that participants were highly challenged by the realistic characteristics of the generated samples, demonstrating Surgical Imagen's effectiveness as a practical alternative to real data collection.

cs.CV↗