# Agentic Surgical AI: Surgeon Style Fingerprinting and Privacy Risk Quantification via Discrete Diffusion in a Vision-Language-Action Framework

arXiv: https://arxiv.org/abs/2506.08185 · HTML: https://mlsanity.com/paper/2506.08185/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Diffusion and flow policies for robotics, one of 14 directions in Diffusion models.
- Builds on 14 of its 22 references that are in the map.
- First posted on arXiv 9 Jun 2025.

## Placed in

- Diffusion models / [Diffusion and flow policies for robotics](https://mlsanity.com/diffusion/diffusion-and-flow-policies-for-robotics/)
- LLM agents and tool use / [Medical and scientific domain agents](https://mlsanity.com/agents/medical-and-scientific-domain-agents/)

## Builds on (most cited first, 14 of 14)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [BERT: Pre-training of Deep Bidirectional Transformers for Language Understanding](https://mlsanity.com/paper/1810.04805/) (2018)
- [Sentence-BERT: Sentence Embeddings using Siamese BERT-Networks](https://mlsanity.com/paper/1908.10084/) (2019)
- [XGBoost: A Scalable Tree Boosting System](https://mlsanity.com/paper/1603.02754/) (2016)
- [Membership Inference Attacks against Machine Learning Models](https://mlsanity.com/paper/1610.05820/) (2016)
- [Extracting Training Data from Large Language Models](https://mlsanity.com/paper/2012.07805/) (2020)
- [MiniLM: Deep Self-Attention Distillation for Task-Agnostic Compression of Pre-Trained Transformers](https://mlsanity.com/paper/2002.10957/) (2020)
- [Segmental Spatiotemporal CNNs for Fine-grained Action Segmentation](https://mlsanity.com/paper/1602.02995/) (2016)
- [Video-based surgical skill assessment using 3D convolutional neural networks](https://mlsanity.com/paper/1903.02306/) (2019)
- [Gesture Recognition in Robotic Surgery: a Review](https://mlsanity.com/paper/2102.00027/) (2021)
- [Recognition and Prediction of Surgical Gestures and Trajectories Using Transformer Models in Robot-Assisted Surgery](https://mlsanity.com/paper/2212.01683/) (2022)
- [VidLPRO: A underlineVideo-underlineLanguage underlinePre-training Framework for underlineRobotic and Laparoscopic Surgery](https://mlsanity.com/paper/2409.04732/) (2024)
- [From Decision to Action in Surgical Autonomy: Multi-Modal Large Language Models for Robot-Assisted Blood Suction](https://mlsanity.com/paper/2408.07806/) (2024)

## Abstract (arXiv)

Surgeons exhibit distinct operating styles shaped by training, experience, and motor behavior-yet most surgical AI systems overlook this personalization signal. We propose a novel agentic modeling approach for surgeon-specific behavior prediction in robotic surgery, combining a discrete diffusion framework with a vision-language-action (VLA) pipeline. Gesture prediction is framed as a structured sequence denoising task, conditioned on multimodal inputs including surgical video, intent language, and personalized embeddings of surgeon identity and skill. These embeddings are encoded through natural language prompts using third-party language models, allowing the model to retain individual behavioral style without exposing explicit identity. We evaluate our method on the JIGSAWS dataset and demonstrate that it accurately reconstructs gesture sequences while learning meaningful motion fingerprints unique to each surgeon. To quantify the privacy implications of personalization, we perform membership inference attacks and find that more expressive embeddings improve task performance but simultaneously increase susceptibility to identity leakage. These findings demonstrate that while personalized embeddings improve performance, they also increase vulnerability to identity leakage, revealing the importance of balancing personalization with privacy risk in surgical modeling. Code is available at: https://github.com/huixin-zhan-ai/Surgeon_style_fingerprinting.