Multi-modal Representations for Fine-grained Multi-label Critical View of Safety Recognition

The Critical View of Safety (CVS) is crucial for safe laparoscopic cholecystectomy, yet assessing CVS criteria remains a complex and challenging task, even for experts. Traditional models for CVS recognition depend on vision-only models learning with costly, labor-intensive spatial annotations. This study investigates how text can be harnessed as a powerful tool for both training and inference in multi-modal surgical foundation models to automate CVS recognition. Unlike many existing multi-modal models, which are primarily adapted for multi-class classification, CVS recognition requires a multi-label framework. Zero-shot evaluation of existing multi-modal surgical models shows a significant performance gap for this task. To address this, we propose CVS-AdaptNet, a multi-label adaptation strategy that enhances fine-grained, binary classification across multiple labels by aligning image embeddings with textual descriptions of each CVS criterion using positive and negative prompts. By adapting PeskaVLP, a state-of-the-art surgical foundation model, on the Endoscapes-CVS201 dataset, CVS-AdaptNet achieves 57.6 mAP, improving over the ResNet50 image-only baseline (51.5 mAP) by 6 points. Our results show that CVS-AdaptNet's multi-label, multi-modal framework, enhanced by textual prompts, boosts CVS recognition over image-only methods. We also propose text-specific inference methods, that helps in analysing the image-text alignment. While further work is needed to match state-of-the-art spatial annotation-based methods, this approach highlights the potential of adapting generalist models to specialized surgical tasks. Code: https://github.com/CAMMA-public/CVS-AdaptNet