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).
Yuqing Feng, Jiawei Ma, Kevin Qinghong Lin +6cs.CV
Surgical procedures unfold as structured and recurring clinical events, whose real-time understanding via intraoperative surgical videos is critical for intraoperative decision-making and support. However, existing video understanding methods force a trade-off: autoregressive video-language models support comprehensive reasoning but are not practical for time-sensitive clinical applications, whereas contrastive models offer low latency but struggle with complex scene understanding. Recently, generative retrieval has been explored for general-domain video understanding, but transferring it to surgery is not trivial because near-identical visual appearances may indicate semantically distinct events, and the terminology involved is highly surgery-specific. To this end, we propose SurgNarrator, a new generative retrieval framework tailored for surgical video understanding. We construct a well-curated surgery-centric vocabulary from surgical captions to define a clinically meaningful retrieval space. We then adapt the pre-trained Qwen3-VL-Embedding-8B to learn discriminative clinical representations with a temporally-aware contrastive objective. During inference, a hierarchical, procedure-aware retrieval strategy narrows the search space to the relevant procedure type, delivering fast and effective responses. Our method is comprehensively evaluated on twelve benchmarks in a zero-shot setting and achieves consistent performance gains over state-of-the-art baselines, while reducing output-stage latency by more than two orders of magnitude compared with the generative baseline.
Surgical vision-language foundation models typically adopt educational materials, such as surgical lecture videos, to transfer surgical knowledge encoded in language into visual representations. These knowledge are multi-dimensional and hierarchical: fine-grained action cues appear in narration, mid-level key steps are summarized in subsection headings, and global procedural context, such as patient history and surgical strategy, is described in abstract texts. Prior work largely collapses these heterogeneous signals into a single flat embedding space, implicitly assuming independence across hierarchy levels. However, this is suboptimal because it ignores cross-level semantic containment, e.g., actions belong to steps, steps compose phases, weakens long-range dependency modeling. To this end, we propose a hyperbolic surgical video-language pre-training framework that explicitly preserves the hierarchical structure by mitigating structural false negatives induced by procedural context and enforcing semantic consistency between parent phases and their constituent child steps. Extensive experiments on multiple surgical benchmarks show consistent gains in zero- and few-shot phase recognition across procedures and institutions.