# Rethinking Text-Promptable Surgical Instrument Segmentation with Robust Framework

arXiv: https://arxiv.org/abs/2411.12199 · HTML: https://mlsanity.com/paper/2411.12199/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 28 of its 32 references that are in the map.
- First posted on arXiv 19 Nov 2024.

## Builds on (most cited first, 28 of 28)

- [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)
- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [PyTorch: An Imperative Style, High-Performance Deep Learning Library](https://mlsanity.com/paper/1912.01703/) (2019)
- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [Swin Transformer: Hierarchical Vision Transformer using Shifted Windows](https://mlsanity.com/paper/2103.14030/) (2021)
- [Segment Anything](https://mlsanity.com/paper/2304.02643/) (2023)
- [Mask R-CNN](https://mlsanity.com/paper/1703.06870/) (2017)
- [Feature Pyramid Networks for Object Detection](https://mlsanity.com/paper/1612.03144/) (2016)
- [Deformable DETR: Deformable Transformers for End-to-End Object Detection](https://mlsanity.com/paper/2010.04159/) (2020)
- [Masked-attention Mask Transformer for Universal Image Segmentation](https://mlsanity.com/paper/2112.01527/) (2021)
- [MAttNet: Modular Attention Network for Referring Expression Comprehension](https://mlsanity.com/paper/1801.08186/) (2018)
- [LAVT: Language-Aware Vision Transformer for Referring Image Segmentation](https://mlsanity.com/paper/2112.02244/) (2021)
- [GRES: Generalized Referring Expression Segmentation](https://mlsanity.com/paper/2306.00968/) (2023)
- [Vision-Language Transformer and Query Generation for Referring Segmentation](https://mlsanity.com/paper/2108.05565/) (2021)
- [2017 Robotic Instrument Segmentation Challenge](https://mlsanity.com/paper/1902.06426/) (2019)
- [Encoder Fusion Network with Co-Attention Embedding for Referring Image Segmentation](https://mlsanity.com/paper/2105.01839/) (2021)
- [SurgicalSAM: Efficient Class Promptable Surgical Instrument Segmentation](https://mlsanity.com/paper/2308.08746/) (2023)
- [Automatic Instrument Segmentation in Robot-Assisted Surgery Using Deep Learning](https://mlsanity.com/paper/1803.01207/) (2018)
- [TernausNet: U-Net with VGG11 Encoder Pre-Trained on ImageNet for Image Segmentation](https://mlsanity.com/paper/1801.05746/) (2018)
- [ISINet: An Instance-Based Approach for Surgical Instrument Segmentation](https://mlsanity.com/paper/2007.05533/) (2020)
- [Incorporating Temporal Prior from Motion Flow for Instrument Segmentation in Minimally Invasive Surgery Video](https://mlsanity.com/paper/1907.07899/) (2019)
- [Towards Robust Referring Image Segmentation](https://mlsanity.com/paper/2209.09554/) (2022)
- [TraSeTR: Track-to-Segment Transformer with Contrastive Query for Instance-level Instrument Segmentation in Robotic Surgery](https://mlsanity.com/paper/2202.08453/) (2022)
- [MATIS: Masked-Attention Transformers for Surgical Instrument Segmentation](https://mlsanity.com/paper/2303.09514/) (2023)
- [Learning Motion Flows for Semi-supervised Instrument Segmentation from Robotic Surgical Video](https://mlsanity.com/paper/2007.02501/) (2020)
- [From Forks to Forceps: A New Framework for Instance Segmentation of Surgical Instruments](https://mlsanity.com/paper/2211.16200/) (2022)
- [Text Promptable Surgical Instrument Segmentation with Vision-Language Models](https://mlsanity.com/paper/2306.09244/) (2023)

## Abstract (arXiv)

Surgical instrument segmentation is an essential component of computer-assisted and robotic surgery systems. Vision-based segmentation models typically produce outputs limited to a predefined set of instrument categories, which restricts their applicability in interactive systems and robotic task automation. Promptable segmentation methods allow selective predictions based on textual prompts. However, they often rely on the assumption that the instruments present in the scene are already known, and prompts are generated accordingly, limiting their ability to generalize to unseen or dynamically emerging instruments. In practical surgical environments, where instrument existence information is not provided, this assumption does not hold consistently, resulting in false-positive segmentation. To address these limitations, we formulate a new task called Robust text-promptable Surgical Instrument Segmentation (R-SIS). Under this setting, prompts are issued for all candidate categories without access to instrument presence information. R-SIS requires distinguishing which prompts refer to visible instruments and generating masks only when such instruments are explicitly present in the scene. This setting reflects practical conditions where uncertainty in instrument presence is inherent. We evaluate existing segmentation methods under the R-SIS protocol using surgical video datasets and observe substantial false-positive predictions in the absence of ground-truth instruments. These findings demonstrate a mismatch between current evaluation protocols and real-world use cases, and support the need for benchmarks that explicitly account for prompt uncertainty and instrument absence.