# HecVL: Hierarchical Video-Language Pretraining for Zero-shot Surgical Phase Recognition

arXiv: https://arxiv.org/abs/2405.10075 · HTML: https://mlsanity.com/paper/2405.10075/

## Key facts

- Cited by 42 papers in the map (data through 14 Oct 2026).
- Builds on 20 of its 24 references that are in the map.
- First posted on arXiv 16 May 2024.

## Builds on (most cited first, 20 of 20)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [Representation Learning with Contrastive Predictive Coding](https://mlsanity.com/paper/1807.03748/) (2018)
- [Mask R-CNN](https://mlsanity.com/paper/1703.06870/) (2017)
- [DeepLab: Semantic Image Segmentation with Deep Convolutional Nets, Atrous Convolution, and Fully Connected CRFs](https://mlsanity.com/paper/1606.00915/) (2016)
- [An Empirical Investigation of Catastrophic Forgetting in Gradient-Based Neural Networks](https://mlsanity.com/paper/1312.6211/) (2013)
- [Segment Everything Everywhere All at Once](https://mlsanity.com/paper/2304.06718/) (2023)
- [End-to-End Learning of Visual Representations from Uncurated Instructional Videos](https://mlsanity.com/paper/1912.06430/) (2019)
- [ClinicalBERT: Modeling Clinical Notes and Predicting Hospital Readmission](https://mlsanity.com/paper/1904.05342/) (2019)
- [EndoNet: A Deep Architecture for Recognition Tasks on Laparoscopic Videos](https://mlsanity.com/paper/1602.03012/) (2016)
- [Generalized Decoding for Pixel, Image, and Language](https://mlsanity.com/paper/2212.11270/) (2022)
- [A Unified Sequence Interface for Vision Tasks](https://mlsanity.com/paper/2206.07669/) (2022)
- [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)
- [AutoLaparo: A New Dataset of Integrated Multi-tasks for Image-guided Surgical Automation in Laparoscopic Hysterectomy](https://mlsanity.com/paper/2208.02049/) (2022)
- [Foundation Model for Endoscopy Video Analysis via Large-scale Self-supervised Pre-train](https://mlsanity.com/paper/2306.16741/) (2023)
- [Learning Multi-modal Representations by Watching Hundreds of Surgical Video Lectures](https://mlsanity.com/paper/2307.15220/) (2023)
- [MAtch, eXpand and Improve: Unsupervised Finetuning for Zero-Shot Action Recognition with Language Knowledge](https://mlsanity.com/paper/2303.08914/) (2023)
- [Challenges in Multi-centric Generalization: Phase and Step Recognition in Roux-en-Y Gastric Bypass Surgery](https://mlsanity.com/paper/2312.11250/) (2023)
- [Multi-frame Collaboration for Effective Endoscopic Video Polyp Detection via Spatial-Temporal Feature Transformation](https://mlsanity.com/paper/2107.03609/) (2021)

## Built on by (most cited first, 30 of 42)

- [Procedure-Aware Surgical Video-language Pretraining with Hierarchical Knowledge Augmentation](https://mlsanity.com/paper/2410.00263/) (2024)
- [OphNet: A Large-Scale Video Benchmark for Ophthalmic Surgical Workflow Understanding](https://mlsanity.com/paper/2406.07471/) (2024)
- [OphCLIP: Hierarchical Retrieval-Augmented Learning for Ophthalmic Surgical Video-Language Pretraining](https://mlsanity.com/paper/2411.15421/) (2024)
- [LEMON: A Large Endoscopic MONocular Dataset and Foundation Model for Perception in Surgical Settings](https://mlsanity.com/paper/2503.19740/) (2025)
- [SurgLaVi: Large-Scale Hierarchical Dataset for Surgical Vision-Language Representation Learning](https://mlsanity.com/paper/2509.10555/) (2025)
- [VidLPRO: A underlineVideo-underlineLanguage underlinePre-training Framework for underlineRobotic and Laparoscopic Surgery](https://mlsanity.com/paper/2409.04732/) (2024)
- [Ophora: A Large-Scale Data-Driven Text-Guided Ophthalmic Surgical Video Generation Model](https://mlsanity.com/paper/2505.07449/) (2025)
- [Surgical Scene Understanding in the Era of Foundation AI Models: A Comprehensive Review](https://mlsanity.com/paper/2502.14886/) (2025)
- [SurgXBench: Explainable Vision-Language Model Benchmark for Surgery](https://mlsanity.com/paper/2505.10764/) (2025)
- [Recognizing Surgical Phases Anywhere: Few-Shot Test-time Adaptation and Task-graph Guided Refinement](https://mlsanity.com/paper/2506.20254/) (2025)
- [Text-driven Adaptation of Foundation Models for Few-shot Surgical Workflow Analysis](https://mlsanity.com/paper/2501.09555/) (2025)
- [Multimodal Graph Representation Learning for Robust Surgical Workflow Recognition with Adversarial Feature Disentanglement](https://mlsanity.com/paper/2505.01766/) (2025)
- [Adaptation of Multi-modal Representation Models for Multi-task Surgical Computer Vision](https://mlsanity.com/paper/2507.05020/) (2025)
- [EyePCR: A Comprehensive Benchmark for Fine-Grained Perception, Knowledge Comprehension and Clinical Reasoning in Ophthalmic Surgery](https://mlsanity.com/paper/2509.15596/) (2025)
- [CliPPER: Contextual Video-Language Pretraining on Long-form Intraoperative Surgical Procedures for Event Recognition](https://mlsanity.com/paper/2603.24539/) (2026)
- [Recognize Any Surgical Object: Unleashing the Power of Weakly-Supervised Data](https://mlsanity.com/paper/2501.15326/) (2025)
- [fine-CLIP: Enhancing Zero-Shot Fine-Grained Surgical Action Recognition with Vision-Language Models](https://mlsanity.com/paper/2503.19670/) (2025)
- [Multi-modal Representations for Fine-grained Multi-label Critical View of Safety Recognition](https://mlsanity.com/paper/2507.05007/) (2025)
- [Surg-R1: A Hierarchical Reasoning Foundation Model for Scalable and Interpretable Surgical Decision Support with Multi-Center Clinical Validation](https://mlsanity.com/paper/2603.12430/) (2026)
- [SurgSigma: A Spectrum of Large-Scale Multimodal Data and Foundation Models for Surgical Intelligence](https://mlsanity.com/paper/2603.16822/) (2026)
- [SurgAtlas: A Large-Scale Surgical Video-Language Dataset with 2,391 Hours of Open and Minimally Invasive Surgery](https://mlsanity.com/paper/2606.25905/) (2026)
- [Challenging Vision-Language Models with Surgical Data: A New Dataset and Broad Benchmarking Study](https://mlsanity.com/paper/2506.06232/) (2025)
- [TrajPred: Trajectory-Conditioned Joint Embedding Prediction for Surgical Instrument-Tissue Interaction Recognition in Vision-Language Models](https://mlsanity.com/paper/2603.06999/) (2026)
- [An Approach to Enriching Surgical Video Datasets for Fine-Grained Spatial-Temporal Understanding of Vision-Language Models](https://mlsanity.com/paper/2604.00784/) (2026)
- [SurgOnAir: Hierarchy-Aware Real-Time Surgical Video Commentary](https://mlsanity.com/paper/2605.21132/) (2026)
- [HyperVLP: Enhancing Hierarchical Surgical Video-Language Pre-training in Hyperbolic Space](https://mlsanity.com/paper/2606.31245/) (2026)
- [Large-Small Model Collaboration for Zero-Shot Surgical Phase Recognition](https://mlsanity.com/paper/2608.22879/) (2026)
- [Bridging Vision and Language for Robust Context-Aware Surgical Point Tracking: The VL-SurgPT Dataset and Benchmark](https://mlsanity.com/paper/2511.12026/) (2025)
- [Multimodal Optimal Transport for Training-free Temporal Segmentation in Surgical Robotics](https://mlsanity.com/paper/2602.24138/) (2026)
- [From Phase Grounding to Intelligent Surgical Narratives](https://mlsanity.com/paper/2603.05732/) (2026)

## Abstract (arXiv)

Natural language could play an important role in developing generalist surgical models by providing a broad source of supervision from raw texts. This flexible form of supervision can enable the model's transferability across datasets and tasks as natural language can be used to reference learned visual concepts or describe new ones. In this work, we present HecVL, a novel hierarchical video-language pretraining approach for building a generalist surgical model. Specifically, we construct a hierarchical video-text paired dataset by pairing the surgical lecture video with three hierarchical levels of texts: at clip-level, atomic actions using transcribed audio texts; at phase-level, conceptual text summaries; and at video-level, overall abstract text of the surgical procedure. Then, we propose a novel fine-to-coarse contrastive learning framework that learns separate embedding spaces for the three video-text hierarchies using a single model. By disentangling embedding spaces of different hierarchical levels, the learned multi-modal representations encode short-term and long-term surgical concepts in the same model. Thanks to the injected textual semantics, we demonstrate that the HecVL approach can enable zero-shot surgical phase recognition without any human annotation. Furthermore, we show that the same HecVL model for surgical phase recognition can be transferred across different surgical procedures and medical centers. The code is available at https://github.com/CAMMA-public/SurgVLP