Hieu D. Pham, Dang P. M. Cao, Thanh Trung Huynhcs.CV
Surgical segmentation networks can fail silently under acquisition degradation: predicted masks may be wrong even when model confidence remains high. Existing deployment-time monitors rely primarily on uncertainty estimates and can therefore miss confident failures. We present TCSR-Monitor (Temporal Conformal Surgical Risk Monitor), a post-hoc failure-monitoring framework that combines confidence with observable shape, temporal-consistency, and image-quality cues. TCSR-Monitor wraps a frozen segmentation model, requires no model internals, and operates without ground truth at deployment. We also introduce a validation protocol to assess whether alarms remain credible under distribution shift. On EndoVis 2017, leave-one-corruption-out evaluation shows that TCSR-Monitor generalizes to unseen acquisition degradations and substantially outperforms confidence-based baselines. A circularity control confirms that it predicts segmentation failure rather than simply detecting corrupted images. Mondrian conformal calibration balances miss-rates across degradation severities, but a single global threshold still produces false alarms on up to 40% of correctly segmented frames at moderate corruption. Zero-shot transfer to SAM2 demonstrates feature portability, although entropy outperforms the transferred monitor at both evaluated thresholds. Overall, reliable monitoring under acquisition degradation benefits from complementary observable signals beyond confidence alone, but substantial false-alarm and transfer limitations remain.
Efficient surgical segmentation empowers clinical diagnosis, intraoperative monitoring, and downstream robotic pipelines for reconstruction and simulation. Although prompt-driven foundation models like Segment Anything Model 3 (SAM3) achieve strong segmentation performance on natural images, surgical data exhibits domain gaps against its pre-training data, resulting in degraded segmentation accuracy. Furthermore, existing medical SAM methods require full-parameter fine-tuning, incurring heavy computational consumption and low efficiency. To address these limitations, this work proposes a parameter-efficient Low-Rank Adaptation (LoRA) adaptation of SAM3 for surgical concept segmentation. We inject low-rank adapters into the prompt encoder, detector and tracker while fully freezing the vision backbone, which only optimizes 0.98% of the total model parameters and supports training on a single consumer GPU. Comprehensive experiments demonstrate that our method consistently outperforms zero-shot SAM3 and other mainstream baselines, and the generated segmentation results can be directly deployed to support downstream robotic surgical scene reconstruction and physical simulation pipelines.