# SAP-Bench: Benchmarking Multimodal Large Language Models in Surgical Action Planning

arXiv: https://arxiv.org/abs/2506.07196 · HTML: https://mlsanity.com/paper/2506.07196/

## Key facts

- Cited by 1 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 24 of its 29 references that are in the map.
- First posted on arXiv 8 Jun 2025.

## Placed in

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

## Builds on (most cited first, 24 of 24)

- [MMBench: Is Your Multi-modal Model an All-around Player?](https://mlsanity.com/paper/2307.06281/) (2023)
- [MMMU: A Massive Multi-discipline Multimodal Understanding and Reasoning Benchmark for Expert AGI](https://mlsanity.com/paper/2311.16502/) (2023)
- [MM-Vet: Evaluating Large Multimodal Models for Integrated Capabilities](https://mlsanity.com/paper/2308.02490/) (2023)
- [SEED-Bench: Benchmarking Multimodal LLMs with Generative Comprehension](https://mlsanity.com/paper/2307.16125/) (2023)
- [Cambrian-1: A Fully Open, Vision-Centric Exploration of Multimodal LLMs](https://mlsanity.com/paper/2406.16860/) (2024)
- [When and why vision-language models behave like bags-of-words, and what to do about it?](https://mlsanity.com/paper/2210.01936/) (2022)
- [Med-Flamingo: a Multimodal Medical Few-shot Learner](https://mlsanity.com/paper/2307.15189/) (2023)
- [Visual Spatial Reasoning](https://mlsanity.com/paper/2205.00363/) (2022)
- [Q-Bench: A Benchmark for General-Purpose Foundation Models on Low-level Vision](https://mlsanity.com/paper/2309.14181/) (2023)
- [Rendezvous: Attention Mechanisms for the Recognition of Surgical Action Triplets in Endoscopic Videos](https://mlsanity.com/paper/2109.03223/) (2021)
- [Exploring scalable medical image encoders beyond text supervision](https://mlsanity.com/paper/2401.10815/) (2024)
- [VL-CheckList: Evaluating Pre-trained Vision-Language Models with Objects, Attributes and Relations](https://mlsanity.com/paper/2207.00221/) (2022)
- [MedReason: Eliciting Factual Medical Reasoning Steps in LLMs via Knowledge Graphs](https://mlsanity.com/paper/2504.00993/) (2025)
- [Draw-and-Understand: Leveraging Visual Prompts to Enable MLLMs to Comprehend What You Want](https://mlsanity.com/paper/2403.20271/) (2024)
- [EgoPlan-Bench: Benchmarking Multimodal Large Language Models for Human-Level Planning](https://mlsanity.com/paper/2312.06722/) (2023)
- [What Matters in Training a GPT4-Style Language Model with Multimodal Inputs?](https://mlsanity.com/paper/2307.02469/) (2023)
- [Comparative Validation of Machine Learning Algorithms for Surgical Workflow and Skill Analysis with the HeiChole Benchmark](https://mlsanity.com/paper/2109.14956/) (2021)
- [Equivariant Similarity for Vision-Language Foundation Models](https://mlsanity.com/paper/2303.14465/) (2023)
- [Pixel-Wise Recognition for Holistic Surgical Scene Understanding](https://mlsanity.com/paper/2401.11174/) (2024)
- [PALM: Predicting Actions through Language Models](https://mlsanity.com/paper/2311.17944/) (2023)
- [Palm: Predicting Actions through Language Models @ Ego4D Long-Term Action Anticipation Challenge 2023](https://mlsanity.com/paper/2306.16545/) (2023)
- [SurgRAW: Multi-Agent Workflow with Chain of Thought Reasoning for Robotic Surgical Video Analysis](https://mlsanity.com/paper/2503.10265/) (2025)
- [CODIS: Benchmarking Context-Dependent Visual Comprehension for Multimodal Large Language Models](https://mlsanity.com/paper/2402.13607/) (2024)
- [Privacy-Preserving Synthetic Continual Semantic Segmentation for Robotic Surgery](https://mlsanity.com/paper/2402.05860/) (2024)

## Built on by (most cited first, 1 of 1)

- [SurgGoal: Rethinking Surgical Planning Evaluation via Goal-Satisfiability](https://mlsanity.com/paper/2601.10455/) (2026)

## Abstract (arXiv)

Effective evaluation is critical for driving advancements in MLLM research. The surgical action planning (SAP) task, which aims to generate future action sequences from visual inputs, demands precise and sophisticated analytical capabilities. Unlike mathematical reasoning, surgical decision-making operates in life-critical domains and requires meticulous, verifiable processes to ensure reliability and patient safety. This task demands the ability to distinguish between atomic visual actions and coordinate complex, long-horizon procedures, capabilities that are inadequately evaluated by current benchmarks. To address this gap, we introduce SAP-Bench, a large-scale, high-quality dataset designed to enable multimodal large language models (MLLMs) to perform interpretable surgical action planning. Our SAP-Bench benchmark, derived from the cholecystectomy procedures context with the mean duration of 1137.5s, and introduces temporally-grounded surgical action annotations, comprising the 1,226 clinically validated action clips (mean duration: 68.7s) capturing five fundamental surgical actions across 74 procedures. The dataset provides 1,152 strategically sampled current frames, each paired with the corresponding next action as multimodal analysis anchors. We propose the MLLM-SAP framework that leverages MLLMs to generate next action recommendations from the current surgical scene and natural language instructions, enhanced with injected surgical domain knowledge. To assess our dataset's effectiveness and the broader capabilities of current models, we evaluate seven state-of-the-art MLLMs (e.g., OpenAI-o1, GPT-4o, QwenVL2.5-72B, Claude-3.5-Sonnet, GeminiPro2.5, Step-1o, and GLM-4v) and reveal critical gaps in next action prediction performance.