# ORacle: Large Vision-Language Models for Knowledge-Guided Holistic OR Domain Modeling

arXiv: https://arxiv.org/abs/2404.07031 · HTML: https://mlsanity.com/paper/2404.07031/

## Key facts

- Cited by 14 papers in the map (data through 14 Oct 2026).
- Placed in Medical vision-language models, one of 16 directions in Multimodal LLMs / vision-language models.
- Builds on 23 of its 27 references that are in the map.
- First posted on arXiv 10 Apr 2024.

## Placed in

- Multimodal LLMs / vision-language models / [Medical vision-language models](https://mlsanity.com/mllm/medical-vision-language-models/)

## Builds on (most cited first, 23 of 23)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [Visual Instruction Tuning](https://mlsanity.com/paper/2304.08485/) (2023)
- [Improved Baselines with Visual Instruction Tuning](https://mlsanity.com/paper/2310.03744/) (2023)
- [Flamingo: a Visual Language Model for Few-Shot Learning](https://mlsanity.com/paper/2204.14198/) (2022)
- [SDXL: Improving Latent Diffusion Models for High-Resolution Image Synthesis](https://mlsanity.com/paper/2307.01952/) (2023)
- [InstructBLIP: Towards General-purpose Vision-Language Models with Instruction Tuning](https://mlsanity.com/paper/2305.06500/) (2023)
- [EndoNet: A Deep Architecture for Recognition Tasks on Laparoscopic Videos](https://mlsanity.com/paper/1602.03012/) (2016)
- [TeCNO: Surgical Phase Recognition with Multi-Stage Temporal Convolutional Networks](https://mlsanity.com/paper/2003.10751/) (2020)
- [Rendezvous: Attention Mechanisms for the Recognition of Surgical Action Triplets in Endoscopic Videos](https://mlsanity.com/paper/2109.03223/) (2021)
- [Surgical Data Science: Enabling Next-Generation Surgery](https://mlsanity.com/paper/1701.06482/) (2017)
- [Highly Accurate Dichotomous Image Segmentation](https://mlsanity.com/paper/2203.03041/) (2022)
- [Kvasir-Instrument: Diagnostic and therapeutic tool segmentation dataset in gastrointestinal endoscopy](https://mlsanity.com/paper/2011.08065/) (2020)
- [4D-OR: Semantic Scene Graphs for OR Domain Modeling](https://mlsanity.com/paper/2203.11937/) (2022)
- [SurgicalGPT: End-to-End Language-Vision GPT for Visual Question Answering in Surgery](https://mlsanity.com/paper/2304.09974/) (2023)
- [Surgical Action Triplet Detection by Mixed Supervised Learning of Instrument-Tissue Interactions](https://mlsanity.com/paper/2307.09548/) (2023)
- [LABRAD-OR: Lightweight Memory Scene Graphs for Accurate Bimodal Reasoning in Dynamic Operating Rooms](https://mlsanity.com/paper/2303.13293/) (2023)
- [Revisiting Distillation for Continual Learning on Visual Question Localized-Answering in Robotic Surgery](https://mlsanity.com/paper/2307.12045/) (2023)
- [POV-Surgery: A Dataset for Egocentric Hand and Tool Pose Estimation During Surgical Activities](https://mlsanity.com/paper/2307.10387/) (2023)
- [Encoding Surgical Videos as Latent Spatiotemporal Graphs for Object and Anatomy-Driven Reasoning](https://mlsanity.com/paper/2312.06829/) (2023)
- [ACT-Net: Anchor-context Action Detection in Surgery Videos](https://mlsanity.com/paper/2310.03377/) (2023)
- [Cross-Dataset Adaptation for Instrument Classification in Cataract Surgery Videos](https://mlsanity.com/paper/2308.04035/) (2023)

## Built on by (most cited first, 14 of 14)

- [MM-OR: A Large Multimodal Operating Room Dataset for Semantic Understanding of High-Intensity Surgical Environments](https://mlsanity.com/paper/2503.02579/) (2025)
- [EgoExOR: An Ego-Exo-Centric Operating Room Dataset for Surgical Activity Understanding](https://mlsanity.com/paper/2505.24287/) (2025)
- [Generalizable Operating Room Expert with Multimodal Enhancement](https://mlsanity.com/paper/2508.08199/) (2025)
- [From large language models to multimodal AI: A scoping review on the potential of generative AI in medicine](https://mlsanity.com/paper/2502.09242/) (2025)
- [Recognizing Surgical Phases Anywhere: Few-Shot Test-time Adaptation and Task-graph Guided Refinement](https://mlsanity.com/paper/2506.20254/) (2025)
- [CAT-SG: A Large Dynamic Scene Graph Dataset for Fine-Grained Understanding of Cataract Surgery](https://mlsanity.com/paper/2506.21813/) (2025)
- [Specialized Foundation Models for Intelligent Operating Rooms](https://mlsanity.com/paper/2505.12890/) (2025)
- [Decoding the Surgical Scene: A Scoping Review of Scene Graphs in Surgery](https://mlsanity.com/paper/2509.20941/) (2025)
- [TwinOR: Photorealistic Digital Twins of Dynamic Operating Rooms for Embodied AI Research](https://mlsanity.com/paper/2511.07412/) (2025)
- [Sterilizable Scene Graph Generation for Operating Rooms](https://mlsanity.com/paper/2608.16469/) (2026)
- [OR-VSKC: Resolving Visual-Semantic Knowledge Conflicts in Operating Rooms with Synthetic Data-Guided Alignment](https://mlsanity.com/paper/2506.22500/) (2025)
- [PanORama: Multiview Consistent Panoptic Segmentation in Operating Rooms](https://mlsanity.com/paper/2603.19920/) (2026)
- [Where are they looking in the operating room?](https://mlsanity.com/paper/2604.20574/) (2026)
- [SAGE-OR: Semi-supervised Adaptive Scene Graph Generation for Operating Rooms](https://mlsanity.com/paper/2608.15336/) (2026)

## Abstract (arXiv)

Every day, countless surgeries are performed worldwide, each within the distinct settings of operating rooms (ORs) that vary not only in their setups but also in the personnel, tools, and equipment used. This inherent diversity poses a substantial challenge for achieving a holistic understanding of the OR, as it requires models to generalize beyond their initial training datasets. To reduce this gap, we introduce ORacle, an advanced vision-language model designed for holistic OR domain modeling, which incorporates multi-view and temporal capabilities and can leverage external knowledge during inference, enabling it to adapt to previously unseen surgical scenarios. This capability is further enhanced by our novel data augmentation framework, which significantly diversifies the training dataset, ensuring ORacle's proficiency in applying the provided knowledge effectively. In rigorous testing, in scene graph generation, and downstream tasks on the 4D-OR dataset, ORacle not only demonstrates state-of-the-art performance but does so requiring less data than existing models. Furthermore, its adaptability is displayed through its ability to interpret unseen views, actions, and appearances of tools and equipment. This demonstrates ORacle's potential to significantly enhance the scalability and affordability of OR domain modeling and opens a pathway for future advancements in surgical data science. We will release our code and data upon acceptance.