Surgical spatio-temporal grounding (STG) requires locating, at each video time specified by a procedural question, the object that the question asks about. Existing approaches face a trade-off: vision language models understand the question context but produce imprecise coordinates, whereas open-set detectors provide localized candidate boxes whose confidence does not reflect which box answers the question. We introduce RefineRank, which closes this gap at the candidate-box level. A compact trainable module, RefineNet, combines the language and regional features of a frozen medical vision language model with the proposals of a frozen open-set detector: it predicts a bounded coordinate correction and a quality score for every candidate box, and a fixed decoding rule returns the original or refined box with the highest score. On the MedVidBench Official Rankings (Verified), RefineRank records 0.421 STG mIoU, the highest displayed STG score, while its global multi-metric rank is 11. In a controlled evaluation on separate training and evaluation videos, coordinate correction raises the candidate oracle upper bound from 0.6772 to 0.7302, and ranking the joint pool of original and refined candidates by their RefineNet scores improves STG mIoU from 0.2719 to 0.4534, whereas separately trained selectors over the same pool reach at most 0.4186. These results show that a small box-level module can reconcile question understanding with precise localization without retraining either backbone. Code is available at [https://github.com/linzhe001/RefineRank](https://github.com/linzhe001/RefineRank).
Spatio-temporal grounding in long videos requires precise temporal localization and robust object tracking conditioned on natural-language queries. While recent vision-language models (VLMs) show strong reasoning ability, directly applying frame-by-frame inference to long sequences is computationally expensive and unstable. We propose a practical pipeline that shifts from frame-level to second-level tracking and performs cross-second smoothing to preserve continuity while reducing sequence length. To improve reasoning supervision, we synthesize chain-of-thought style trajectories using advanced multimodal models for temporal localization and target selection, and replace generated spatio-temporal coordinates with ground-truth annotations to avoid noisy supervision. We further optimize the policy with reinforcement learning using a verifier based on $t\_\mathrm{IoU}+mv\_\mathrm{IoU}$. Experiments across multiple FPS settings show that our method achieves a strong trade-off between efficiency and localization quality.