Zhicheng He, Xiaohan Xing, Hongqiu Wang, Kun Yuan, Guankun Wang, Yanheng Li, Haoxuan Che, Nassir Navab 等 10 位作者
Multimodal large language models (MLLMs) have shown strong potential in robotic surgery for question answering, scene understanding, and grounded assistance, but their high computational cost limits real clinical deployment. Knowledge distillation provides a practical way to build compact surgical MLLMs, yet direct distillation is not well suited to surgical data because surgical samples vary greatly in difficulty, visual ambiguity, and required clinical context, making uniform teacher-student transfer unstable. In addition, the role of supervision changes during training: early stages require stronger teacher guidance for multimodal alignment, while later stages rely more on task supervision for effective optimization. To address these challenges, we propose SurgPace, a complexity-aware continuous curriculum framework for progressive distillation of surgical vision-language models. SurgPace estimates sample complexity using predictive confidence and Lorentz geometric consistency, and uses the fused score to guide a continuous easy-to-hard training process. We further introduce hierarchical representation alignment, which aligns the student with the teacher at the feature, logit, and probability levels, while gradually shifting the training focus from teacher imitation to task supervision. This design separates sample-level curriculum from objective-level scheduling, leading to more stable and effective distillation. We evaluate SurgPace on Surg-396K, a benchmark built from four public surgical datasets and covering five dialogue paradigms. SurgPace consistently outperforms strong MLLM distillation baselines, demonstrating its effectiveness for building compact, memory-efficient surgical MLLMs with faster decoding under controlled benchmarks. Code is available at https://github.com/hezhicheng2002/SurgPace.
Shifang Zhao, Long Bai, Kun Yuan, Feng Li, Jieming Yu, Wenzhen Dong, Guankun Wang, Mobarakol Islam 等 11 位作者
In surgical instrument segmentation, the increasing variety of instruments over time poses a significant challenge for existing neural networks, as they are unable to effectively learn such incremental tasks and suffer from catastrophic forgetting. When learning new data, the model experiences a sharp performance drop on previously learned data. Although several continual learning methods have been proposed for incremental understanding tasks in surgical scenarios, the issue of data imbalance often leads to a strong bias in the segmentation head, resulting in poor performance. Data imbalance can occur in two forms: (i) class imbalance between new and old data, and (ii) class imbalance within the same time point of data. Such imbalances often cause the dominant classes to take over the training process of continual semantic segmentation (CSS). To address this issue, we propose SurgCSS, a novel plug-and-play CSS framework for surgical instrument segmentation under data imbalance. Specifically, we generate realistic surgical backgrounds through inpainting and blend instrument foregrounds with the generated backgrounds in a class-aware manner to balance the data distribution in various scenarios. We further propose the Class Desensitization Loss by employing contrastive learning to correct edge biases caused by data imbalance. Moreover, we dynamically fuse the weight parameters of the old and new models to achieve a better trade-off between the biased and unbiased model weights. To investigate the data imbalance problem in surgical scenarios, we construct a new benchmark for surgical instrument CSS by integrating datasets. Extensive experiments demonstrate the effectiveness of the proposed framework, achieving significant performance improvement against existing baselines.