# Surgical-LVLM: Learning to Adapt Large Vision-Language Model for Grounded Visual Question Answering in Robotic Surgery

arXiv: https://arxiv.org/abs/2405.10948 · HTML: https://mlsanity.com/paper/2405.10948/

## Key facts

- Cited by 39 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 37 of its 41 references that are in the map.
- First posted on arXiv 22 Mar 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, 30 of 37)

- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [LLaMA: Open and Efficient Foundation Language Models](https://mlsanity.com/paper/2302.13971/) (2023)
- [Judging LLM-as-a-Judge with MT-Bench and Chatbot Arena](https://mlsanity.com/paper/2306.05685/) (2023)
- [Visual Instruction Tuning](https://mlsanity.com/paper/2304.08485/) (2023)
- [BLIP-2: Bootstrapping Language-Image Pre-training with Frozen Image Encoders and Large Language Models](https://mlsanity.com/paper/2301.12597/) (2023)
- [Training data-efficient image transformers & distillation through attention](https://mlsanity.com/paper/2012.12877/) (2020)
- [Improved Baselines with Visual Instruction Tuning](https://mlsanity.com/paper/2310.03744/) (2023)
- [InstructBLIP: Towards General-purpose Vision-Language Models with Instruction Tuning](https://mlsanity.com/paper/2305.06500/) (2023)
- [Qwen-VL: A Versatile Vision-Language Model for Understanding, Localization, Text Reading, and Beyond](https://mlsanity.com/paper/2308.12966/) (2023)
- [Generalized Intersection over Union: A Metric and A Loss for Bounding Box Regression](https://mlsanity.com/paper/1902.09630/) (2019)
- [Flickr30k Entities: Collecting Region-to-Phrase Correspondences for Richer Image-to-Sentence Models](https://mlsanity.com/paper/1505.04870/) (2015)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [VisualBERT: A Simple and Performant Baseline for Vision and Language](https://mlsanity.com/paper/1908.03557/) (2019)
- [VMamba: Visual State Space Model](https://mlsanity.com/paper/2401.10166/) (2024)
- [CogVLM: Visual Expert for Pretrained Language Models](https://mlsanity.com/paper/2311.03079/) (2023)
- [MiniGPT-v2: large language model as a unified interface for vision-language multi-task learning](https://mlsanity.com/paper/2310.09478/) (2023)
- [Ferret: Refer and Ground Anything Anywhere at Any Granularity](https://mlsanity.com/paper/2310.07704/) (2023)
- [VM-UNet: Vision Mamba UNet for Medical Image Segmentation](https://mlsanity.com/paper/2402.02491/) (2024)
- [MIMIC-IT: Multi-Modal In-Context Instruction Tuning](https://mlsanity.com/paper/2306.05425/) (2023)
- [Focal Modulation Networks](https://mlsanity.com/paper/2203.11926/) (2022)
- [2017 Robotic Instrument Segmentation Challenge](https://mlsanity.com/paper/1902.06426/) (2019)
- [MUTAN: Multimodal Tucker Fusion for Visual Question Answering](https://mlsanity.com/paper/1705.06676/) (2017)
- [2018 Robotic Scene Segmentation Challenge](https://mlsanity.com/paper/2001.11190/) (2020)
- [BuboGPT: Enabling Visual Grounding in Multi-Modal LLMs](https://mlsanity.com/paper/2307.08581/) (2023)
- [LLaVA-Grounding: Grounded Visual Chat with Large Multimodal Models](https://mlsanity.com/paper/2312.02949/) (2023)
- [BLOCK: Bilinear Superdiagonal Fusion for Visual Question Answering and Visual Relationship Detection](https://mlsanity.com/paper/1902.00038/) (2019)
- [Surgical-VQA: Visual Question Answering in Surgical Scenes using Transformer](https://mlsanity.com/paper/2206.11053/) (2022)
- [SurgicalGPT: End-to-End Language-Vision GPT for Visual Question Answering in Surgery](https://mlsanity.com/paper/2304.09974/) (2023)

## Built on by (most cited first, 30 of 39)

- [Vision-Language-Action (VLA) Models: Concepts, Progress, Applications and Challenges](https://mlsanity.com/paper/2505.04769/) (2025)
- [ICT: Image-Object Cross-Level Trusted Intervention for Mitigating Object Hallucination in Large Vision-Language Models](https://mlsanity.com/paper/2411.15268/) (2024)
- [OphCLIP: Hierarchical Retrieval-Augmented Learning for Ophthalmic Surgical Video-Language Pretraining](https://mlsanity.com/paper/2411.15421/) (2024)
- [Octopus: Alleviating Hallucination via Dynamic Contrastive Decoding](https://mlsanity.com/paper/2503.00361/) (2025)
- [GP-VLS: A general-purpose vision language model for surgery](https://mlsanity.com/paper/2407.19305/) (2024)
- [Surgical-VQLA++: Adversarial Contrastive Learning for Calibrated Robust Visual Question-Localized Answering in Robotic Surgery](https://mlsanity.com/paper/2408.04958/) (2024)
- [QSVD: Efficient Low-rank Approximation for Unified Query-Key-Value Weight Compression in Low-Precision Vision-Language Models](https://mlsanity.com/paper/2510.16292/) (2025)
- [CoPESD: A Multi-Level Surgical Motion Dataset for Training Large Vision-Language Models to Co-Pilot Endoscopic Submucosal Dissection](https://mlsanity.com/paper/2410.07540/) (2024)
- [EndoBench: A Comprehensive Evaluation of Multi-Modal Large Language Models for Endoscopy Analysis](https://mlsanity.com/paper/2505.23601/) (2025)
- [SurgVidLM: Towards Multi-grained Surgical Video Understanding with Large Language Model](https://mlsanity.com/paper/2506.17873/) (2025)
- [Vision-Language-Action Safety: Threats, Challenges, Evaluations, and Mechanisms](https://mlsanity.com/paper/2604.23775/) (2026)
- [Surgical Scene Understanding in the Era of Foundation AI Models: A Comprehensive Review](https://mlsanity.com/paper/2502.14886/) (2025)
- [INS-MMBench: A Comprehensive Benchmark for Evaluating LVLMs' Performance in Insurance](https://mlsanity.com/paper/2406.09105/) (2024)
- [Enhancing Visual Reliance in Text Generation: A Bayesian Perspective on Mitigating Hallucination in Large Vision-Language Models](https://mlsanity.com/paper/2505.19498/) (2025)
- [Surgery-R1: Advancing Surgical-VQLA with Reasoning Multimodal Large Language Model via Reinforcement Learning](https://mlsanity.com/paper/2506.19469/) (2025)
- [Multimodal Graph Representation Learning for Robust Surgical Workflow Recognition with Adversarial Feature Disentanglement](https://mlsanity.com/paper/2505.01766/) (2025)
- [WSVD: Weighted Low-Rank Approximation for Fast and Efficient Execution of Low-Precision Vision-Language Models](https://mlsanity.com/paper/2604.02570/) (2026)
- [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)
- [A Stereotype Content Analysis on Color-related Social Bias in Large Vision Language Models](https://mlsanity.com/paper/2505.20901/) (2025)
- [EndoARSS: Adapting Spatially-Aware Foundation Model for Efficient Activity Recognition and Semantic Segmentation in Endoscopic Surgery](https://mlsanity.com/paper/2506.06830/) (2025)
- [Benchmarking Direct Preference Optimization for Medical Large Vision-Language Models](https://mlsanity.com/paper/2601.17918/) (2026)
- [Adapting 2D Multi-Modal Large Language Model for 3D CT Image Analysis](https://mlsanity.com/paper/2604.10233/) (2026)
- [DREAM-S: Speculative Decoding with Searchable Drafting and Target-Aware Refinement for Multimodal Generation](https://mlsanity.com/paper/2606.00535/) (2026)
- [V2-SfMLearner: Learning Monocular Depth and Ego-motion for Multimodal Wireless Capsule Endoscopy](https://mlsanity.com/paper/2412.17595/) (2024)
- [Can DeepSeek Reason Like a Surgeon? An Empirical Evaluation for Vision-Language Understanding in Robotic-Assisted Surgery](https://mlsanity.com/paper/2503.23130/) (2025)
- [Generating Natural-Language Surgical Feedback: From Structured Representation to Domain-Grounded Evaluation](https://mlsanity.com/paper/2511.15159/) (2025)
- [NeuroABench: A Multimodal Evaluation Benchmark for Neurosurgical Anatomy Identification](https://mlsanity.com/paper/2512.06921/) (2025)
- [A 4D Representation for Training-Free Agentic Reasoning from Monocular Laparoscopic Video](https://mlsanity.com/paper/2604.00867/) (2026)
- [SurgCoT: Advancing Spatiotemporal Reasoning in Surgical Videos through a Chain-of-Thought Benchmark](https://mlsanity.com/paper/2604.20319/) (2026)

## Abstract (arXiv)

Recent advancements in Surgical Visual Question Answering (Surgical-VQA) and related region grounding have shown great promise for robotic and medical applications, addressing the critical need for automated methods in personalized surgical mentorship. However, existing models primarily provide simple structured answers and struggle with complex scenarios due to their limited capability in recognizing long-range dependencies and aligning multimodal information. In this paper, we introduce Surgical-LVLM, a novel personalized large vision-language model tailored for complex surgical scenarios. Leveraging the pre-trained large vision-language model and specialized Visual Perception LoRA (VP-LoRA) blocks, our model excels in understanding complex visual-language tasks within surgical contexts. In addressing the visual grounding task, we propose the Token-Interaction (TIT) module, which strengthens the interaction between the grounding module and the language responses of the Large Visual Language Model (LVLM) after projecting them into the latent space. We demonstrate the effectiveness of Surgical-LVLM on several benchmarks, including EndoVis-17-VQLA, EndoVis-18-VQLA, and a newly introduced EndoVis Conversations dataset, which sets new performance standards. Our work contributes to advancing the field of automated surgical mentorship by providing a context-aware solution.