# SUREON: A Benchmark and Vision-Language-Model for Surgical Reasoning

arXiv: https://arxiv.org/abs/2603.06570 · HTML: https://mlsanity.com/paper/2603.06570/

## Key facts

- Cited by 7 papers in the map (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 32 of its 37 references that are in the map.
- First posted on arXiv 6 Mar 2026.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)

## Builds on (most cited first, 30 of 32)

- [DeepSeekMath: Pushing the Limits of Mathematical Reasoning in Open Language Models](https://mlsanity.com/paper/2402.03300/) (2024)
- [Qwen3-VL Technical Report](https://mlsanity.com/paper/2511.21631/) (2025)
- [Video-ChatGPT: Towards Detailed Video Understanding via Large Vision and Language Models](https://mlsanity.com/paper/2306.05424/) (2023)
- [Video-R1: Reinforcing Video Reasoning in MLLMs](https://mlsanity.com/paper/2503.21776/) (2025)
- [EndoNet: A Deep Architecture for Recognition Tasks on Laparoscopic Videos](https://mlsanity.com/paper/1602.03012/) (2016)
- [MedVLM-R1: Incentivizing Medical Reasoning Capability of Vision-Language Models (VLMs) via Reinforcement Learning](https://mlsanity.com/paper/2502.19634/) (2025)
- [2017 Robotic Instrument Segmentation Challenge](https://mlsanity.com/paper/1902.06426/) (2019)
- [Med-R1: Reinforcement Learning for Generalizable Medical Reasoning in Vision-Language Models](https://mlsanity.com/paper/2503.13939/) (2025)
- [Rendezvous: Attention Mechanisms for the Recognition of Surgical Action Triplets in Endoscopic Videos](https://mlsanity.com/paper/2109.03223/) (2021)
- [2018 Robotic Scene Segmentation Challenge](https://mlsanity.com/paper/2001.11190/) (2020)
- [CholecSeg8k: A Semantic Segmentation Dataset for Laparoscopic Cholecystectomy Based on Cholec80](https://mlsanity.com/paper/2012.12453/) (2020)
- [Apollo: An Exploration of Video Understanding in Large Multimodal Models](https://mlsanity.com/paper/2412.10360/) (2024)
- [Learning Multi-modal Representations by Watching Hundreds of Surgical Video Lectures](https://mlsanity.com/paper/2307.15220/) (2023)
- [Comparative Validation of Machine Learning Algorithms for Surgical Workflow and Skill Analysis with the HeiChole Benchmark](https://mlsanity.com/paper/2109.14956/) (2021)
- [SAR-RARP50: Segmentation of surgical instrumentation and Action Recognition on Robot-Assisted Radical Prostatectomy Challenge](https://mlsanity.com/paper/2401.00496/) (2023)
- [Pixel-Wise Recognition for Holistic Surgical Scene Understanding](https://mlsanity.com/paper/2401.11174/) (2024)
- [Heidelberg Colorectal Data Set for Surgical Data Science in the Sensor Operating Room](https://mlsanity.com/paper/2005.03501/) (2020)
- [Challenges in Multi-centric Generalization: Phase and Step Recognition in Roux-en-Y Gastric Bypass Surgery](https://mlsanity.com/paper/2312.11250/) (2023)
- [Latent Graph Representations for Critical View of Safety Assessment](https://mlsanity.com/paper/2212.04155/) (2022)
- [EndoChat: Grounded Multimodal Large Language Model for Endoscopic Surgery](https://mlsanity.com/paper/2501.11347/) (2025)
- [SurgVLM: A Large Vision-Language Model and Systematic Evaluation Benchmark for Surgical Intelligence](https://mlsanity.com/paper/2506.02555/) (2025)
- [Distilling Vision-Language Models on Millions of Videos](https://mlsanity.com/paper/2401.06129/) (2024)
- [LEMON: A Large Endoscopic MONocular Dataset and Foundation Model for Perception in Surgical Settings](https://mlsanity.com/paper/2503.19740/) (2025)
- [CholecInstanceSeg: A Tool Instance Segmentation Dataset for Laparoscopic Surgery](https://mlsanity.com/paper/2406.16039/) (2024)
- [SurgLaVi: Large-Scale Hierarchical Dataset for Surgical Vision-Language Representation Learning](https://mlsanity.com/paper/2509.10555/) (2025)
- [EgoThinker: Unveiling Egocentric Reasoning with Spatio-Temporal CoT](https://mlsanity.com/paper/2510.23569/) (2025)
- [SurgRAW: Multi-Agent Workflow with Chain of Thought Reasoning for Robotic Surgical Video Analysis](https://mlsanity.com/paper/2503.10265/) (2025)
- [Video Dataset for Surgical Phase, Keypoint, and Instrument Recognition in Laparoscopic Surgery (PhaKIR)](https://mlsanity.com/paper/2511.06549/) (2025)
- [GynSurg: A Comprehensive Gynecology Laparoscopic Surgery Dataset](https://mlsanity.com/paper/2506.11356/) (2025)
- [Domain Adaptation of VLM for Soccer Video Understanding](https://mlsanity.com/paper/2505.13860/) (2025)

## Built on by (most cited first, 7 of 7)

- [MedHorizon: Towards Long-context Medical Video Understanding in the Wild](https://mlsanity.com/paper/2605.06537/) (2026)
- [Surg-R1: A Hierarchical Reasoning Foundation Model for Scalable and Interpretable Surgical Decision Support with Multi-Center Clinical Validation](https://mlsanity.com/paper/2603.12430/) (2026)
- [SurgSigma: A Spectrum of Large-Scale Multimodal Data and Foundation Models for Surgical Intelligence](https://mlsanity.com/paper/2603.16822/) (2026)
- [SurgAtlas: A Large-Scale Surgical Video-Language Dataset with 2,391 Hours of Open and Minimally Invasive Surgery](https://mlsanity.com/paper/2606.25905/) (2026)
- [A Comparative Study in Surgical AI: Potential and Limitations of Data, Compute, and Scaling](https://mlsanity.com/paper/2603.27341/) (2026)
- [SurgNarrator: A Generative Retrieval Framework for Surgical Video Understanding](https://mlsanity.com/paper/2608.04676/) (2026)
- [DART: Depth-as-Target Pretraining for Surgical Vision Foundation Models](https://mlsanity.com/paper/2609.04555/) (2026)

## Abstract (arXiv)

Surgeons don't just see -- they interpret. When an expert observes a surgical scene, they understand not only what instrument is being used, but why it was chosen, what risk it poses, and what comes next. Current surgical AI cannot answer such questions, largely because training data that explicitly encodes surgical reasoning is immensely difficult to annotate at scale. Yet surgical video lectures already contain exactly this -- explanations of intent, rationale, and anticipation, narrated by experts for the purpose of teaching. Though inherently noisy and unstructured, these narrations encode the reasoning that surgical AI currently lacks. We introduce SUREON, a large-scale video QA dataset that systematically harvests this training signal from surgical academic videos. SUREON defines 12 question categories covering safety assessment, decision rationale, and forecasting, and uses a multi-agent pipeline to extract and structure supervision at scale. Across 134.7K clips and 170 procedure types, SUREON yields 206.8k QA pairs and an expert-validated benchmark of 354 examples. To evaluate the extent to which this supervision translates to surgical reasoning ability, we introduce two models: SureonVLM, a vision-language model adapted through supervised fine-tuning, and SureonVLM-R1, a reasoning model trained with Group Relative Policy Optimization. Both models can answer complex questions about surgery and substantially outperform larger general-domain models, exceeding 84% accuracy on the SUREON benchmark while outperforming general-domain models on standard surgical perception tasks. Qualitative analysis of SureonVLM-R1 reveals explicit reasoning behavior, such as inferring operative intent from visual context.