Surgical Re-enactment for Operating Room Workflow Datasets

The introduction of new technologies, such as surgical robots, is driving the vision of a connected, smart operating room (OR). However, realizing this vision requires a deep understanding of surgical workflows, which relies on realistic datasets capturing the actions of all OR personnel from both full room and surgical field perspectives. Acquiring such data in real ORs is prohibitively challenging due to factors such as ethics committee approvals, limited space for camera installation, and sterility regulations preventing the use of tracking markers. We present a step-by-step methodology for re-enacting complete surgical procedures in a reconstructed OR. This approach enables the creation of repeatable and annotatable workflow datasets for training activity recognition models, generating scene graphs, and formalizing surgical process models. Developed for robot-assisted ophthalmic surgery, our methodology combines expert consultation, structured workflow formalization, OR reconstruction, role-based training, real OR observation, and iterative recording with post-take debriefing. We provide concrete recommendations to allow other research groups to seamlessly adopt this methodology for their own surgical domains.

Reasoning Text-to-Video Retrieval for Operating Room Clips via Action-Driven Digital Twins

Text-to-video retrieval in operating rooms (OR) is an enabling technology for OR safety, as it allows stakeholders to retrieve and inspect recordings of specific events. However, because the most safety-critical events may not follow the common structure, to unlock its full potential text-to-video retrieval must be able to handle implicit queries that require reasoning to identify the right video (e.g., the step right before clipping). However, existing methods rely on global embeddings that cannot reason over such queries. We propose OR3, a text-to-video retrieval method that converts clips into action-driven digital twins (ActDTs), grouping concurrent subject-action-object triplets under non-overlapping temporal intervals. Moreover, rather than cross-modal matching through paired encoders, OR3 performs imagination-based retrieval where an LLM generates hypothetical ActDTs from queries. This enables intra-modal matching via a single encoder trained with ActDT-tailored hard negatives. Finally, evidence-grounded refinement revises imagined ActDTs based on discrepancies with top candidates to capture procedure-specific patterns. We construct a benchmark from MM-OR with 276 implicit queries across four reasoning categories over 386 clips from robotic knee procedures. OR3 achieves 57.6 R@1 and 77.3 R@5, outperforming the strongest baseline. These results demonstrate that OR3 enables fine-grained discrimination between visually similar OR video clips through temporal action reasoning.