# Memory-Augmented Multimodal LLMs for Surgical VQA via Self-Contained Inquiry

arXiv: https://arxiv.org/abs/2411.10937 · HTML: https://mlsanity.com/paper/2411.10937/

## Key facts

- Cited by 6 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 35 of its 47 references that are in the map.
- First posted on arXiv 17 Nov 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 35)

- [BERT: Pre-training of Deep Bidirectional Transformers for Language Understanding](https://mlsanity.com/paper/1810.04805/) (2018)
- [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)
- [BLIP-2: Bootstrapping Language-Image Pre-training with Frozen Image Encoders and Large Language Models](https://mlsanity.com/paper/2301.12597/) (2023)
- [Flamingo: a Visual Language Model for Few-Shot Learning](https://mlsanity.com/paper/2204.14198/) (2022)
- [MiniGPT-4: Enhancing Vision-Language Understanding with Advanced Large Language Models](https://mlsanity.com/paper/2304.10592/) (2023)
- [Visual Genome: Connecting Language and Vision Using Crowdsourced Dense Image Annotations](https://mlsanity.com/paper/1602.07332/) (2016)
- [VQA: Visual Question Answering](https://mlsanity.com/paper/1505.00468/) (2015)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [SLAKE: A Semantically-Labeled Knowledge-Enhanced Dataset for Medical Visual Question Answering](https://mlsanity.com/paper/2102.09542/) (2021)
- [EndoNet: A Deep Architecture for Recognition Tasks on Laparoscopic Videos](https://mlsanity.com/paper/1602.03012/) (2016)
- [PMC-VQA: Visual Instruction Tuning for Medical Visual Question Answering](https://mlsanity.com/paper/2305.10415/) (2023)
- [Stacked Attention Networks for Image Question Answering](https://mlsanity.com/paper/1511.02274/) (2015)
- [Rendezvous: Attention Mechanisms for the Recognition of Surgical Action Triplets in Endoscopic Videos](https://mlsanity.com/paper/2109.03223/) (2021)
- [MUTAN: Multimodal Tucker Fusion for Visual Question Answering](https://mlsanity.com/paper/1705.06676/) (2017)
- [Multi-modal Factorized Bilinear Pooling with Co-Attention Learning for Visual Question Answering](https://mlsanity.com/paper/1708.01471/) (2017)
- [xGen-MM (BLIP-3): A Family of Open Large Multimodal Models](https://mlsanity.com/paper/2408.08872/) (2024)
- [Multi-Modal Masked Autoencoders for Medical Vision-and-Language Pre-Training](https://mlsanity.com/paper/2209.07098/) (2022)
- [Beyond Bilinear: Generalized Multimodal Factorized High-order Pooling for Visual Question Answering](https://mlsanity.com/paper/1708.03619/) (2017)
- [Fusion of Detected Objects in Text for Visual Question Answering](https://mlsanity.com/paper/1908.05054/) (2019)
- [Overcoming Data Limitation in Medical Visual Question Answering](https://mlsanity.com/paper/1909.11867/) (2019)
- [BLOCK: Bilinear Superdiagonal Fusion for Visual Question Answering and Visual Relationship Detection](https://mlsanity.com/paper/1902.00038/) (2019)
- [RULE: Reliable Multimodal RAG for Factuality in Medical Vision Language Models](https://mlsanity.com/paper/2407.05131/) (2024)
- [Surgical-VQA: Visual Question Answering in Surgical Scenes using Transformer](https://mlsanity.com/paper/2206.11053/) (2022)
- [EHRXQA: A Multi-Modal Question Answering Dataset for Electronic Health Records with Chest X-ray Images](https://mlsanity.com/paper/2310.18652/) (2023)
- [SurgicalGPT: End-to-End Language-Vision GPT for Visual Question Answering in Surgery](https://mlsanity.com/paper/2304.09974/) (2023)
- [Surgical-VQLA: Transformer with Gated Vision-Language Embedding for Visual Question Localized-Answering in Robotic Surgery](https://mlsanity.com/paper/2305.11692/) (2023)
- [Advancing Surgical VQA with Scene Graph Knowledge](https://mlsanity.com/paper/2312.10251/) (2023)
- [LLaVA-Surg: Towards Multimodal Surgical Assistant via Structured Surgical Video Learning](https://mlsanity.com/paper/2408.07981/) (2024)

## Built on by (most cited first, 6 of 6)

- [A Survey of Context Engineering for Large Language Models](https://mlsanity.com/paper/2507.13334/) (2025)
- [A Survey on Agentic Multimodal Large Language Models](https://mlsanity.com/paper/2510.10991/) (2025)
- [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)
- [PathMem: Toward Cognition-Aligned Memory Transformation for Pathology MLLMs](https://mlsanity.com/paper/2603.09943/) (2026)
- [SurgNarrator: A Generative Retrieval Framework for Surgical Video Understanding](https://mlsanity.com/paper/2608.04676/) (2026)

## Abstract (arXiv)

Comprehensively understanding surgical scenes in Surgical Visual Question Answering (Surgical VQA) requires reasoning over multiple objects. Previous approaches address this task using cross-modal fusion strategies to enhance reasoning ability. However, these methods often struggle with limited scene understanding and question comprehension, and some rely on external resources (e.g., pre-extracted object features), which can introduce errors and generalize poorly across diverse surgical environments. To address these challenges, we propose SCAN, a simple yet effective memory-augmented framework that leverages Multimodal LLMs to improve surgical context comprehension via Self-Contained Inquiry. SCAN operates autonomously, generating two types of memory for context augmentation: Direct Memory (DM), which provides multiple candidates (or hints) to the final answer, and Indirect Memory (IM), which consists of self-contained question-hint pairs to capture broader scene context. DM directly assists in answering the question, while IM enhances understanding of the surgical scene beyond the immediate query. Reasoning over these object-aware memories enables the model to accurately interpret images and respond to questions. Extensive experiments on three publicly available Surgical VQA datasets demonstrate that SCAN achieves state-of-the-art performance, offering improved accuracy and robustness across various surgical scenarios.