# SCISSR: Scribble-Conditioned Interactive Surgical Segmentation and Refinement

arXiv: https://arxiv.org/abs/2603.18544 · HTML: https://mlsanity.com/paper/2603.18544/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 27 of its 31 references that are in the map.
- First posted on arXiv 19 Mar 2026.

## Builds on (most cited first, 27 of 27)

- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [Segment Anything](https://mlsanity.com/paper/2304.02643/) (2023)
- [SegFormer: Simple and Efficient Design for Semantic Segmentation with Transformers](https://mlsanity.com/paper/2105.15203/) (2021)
- [SAM 2: Segment Anything in Images and Videos](https://mlsanity.com/paper/2408.00714/) (2024)
- [Deep High-Resolution Representation Learning for Visual Recognition](https://mlsanity.com/paper/1908.07919/) (2019)
- [Unified Perceptual Parsing for Scene Understanding](https://mlsanity.com/paper/1807.10221/) (2018)
- [SAM 3: Segment Anything with Concepts](https://mlsanity.com/paper/2511.16719/) (2025)
- [ScribbleSup: Scribble-Supervised Convolutional Networks for Semantic Segmentation](https://mlsanity.com/paper/1604.05144/) (2016)
- [SegNeXt: Rethinking Convolutional Attention Design for Semantic Segmentation](https://mlsanity.com/paper/2209.08575/) (2022)
- [Reviving Iterative Training with Mask Guidance for Interactive Segmentation](https://mlsanity.com/paper/2102.06583/) (2021)
- [Deep Interactive Object Selection](https://mlsanity.com/paper/1603.04042/) (2016)
- [2018 Robotic Scene Segmentation Challenge](https://mlsanity.com/paper/2001.11190/) (2020)
- [SAM-Med2D](https://mlsanity.com/paper/2308.16184/) (2023)
- [On Regularized Losses for Weakly-supervised CNN Segmentation](https://mlsanity.com/paper/1803.09569/) (2018)
- [f-BRS: Rethinking Backpropagating Refinement for Interactive Segmentation](https://mlsanity.com/paper/2001.10331/) (2020)
- [SimpleClick: Interactive Image Segmentation with Simple Vision Transformers](https://mlsanity.com/paper/2210.11006/) (2022)
- [DeepIGeoS: A Deep Interactive Geodesic Framework for Medical Image Segmentation](https://mlsanity.com/paper/1707.00652/) (2017)
- [CholecSeg8k: A Semantic Segmentation Dataset for Laparoscopic Cholecystectomy Based on Cholec80](https://mlsanity.com/paper/2012.12453/) (2020)
- [SurgicalSAM: Efficient Class Promptable Surgical Instrument Segmentation](https://mlsanity.com/paper/2308.08746/) (2023)
- [MedSAM2: Segment Anything in 3D Medical Images and Videos](https://mlsanity.com/paper/2504.03600/) (2025)
- [CycleMix: A Holistic Strategy for Medical Image Segmentation from Scribble Supervision](https://mlsanity.com/paper/2203.01475/) (2022)
- [ScribblePrompt: Fast and Flexible Interactive Segmentation for Any Biomedical Image](https://mlsanity.com/paper/2312.07381/) (2023)
- [MIDeepSeg: Minimally Interactive Segmentation of Unseen Objects from Medical Images Using Deep Learning](https://mlsanity.com/paper/2104.12166/) (2021)
- [Exploring Intra- and Inter-Video Relation for Surgical Semantic Scene Segmentation](https://mlsanity.com/paper/2203.15251/) (2022)
- [Systematic Evaluation and Guidelines for Segment Anything Model in Surgical Video Analysis](https://mlsanity.com/paper/2501.00525/) (2024)
- [Surgical Scene Segmentation by Transformer With Asymmetric Feature Enhancement](https://mlsanity.com/paper/2410.17642/) (2024)

## Abstract (arXiv)

Accurate segmentation of tissues and instruments in surgical scenes is annotation-intensive due to irregular shapes, thin structures, specularities, and frequent occlusions. While SAM models support point, box, and mask prompts, points are often too sparse and boxes too coarse to localize such challenging targets. We present SCISSR, a scribble-promptable framework for interactive surgical scene segmentation. It introduces a lightweight Scribble Encoder that converts freehand scribbles into dense prompt embeddings compatible with the mask decoder, enabling iterative refinement for a target object by drawing corrective strokes on error regions. Because all added modules (the Scribble Encoder, Spatial Gated Fusion, and LoRA adapters) interact with the backbone only through its standard embedding interfaces, the framework is not tied to a single model: we build on SAM 2 in this work, yet the same components transfer to other prompt-driven segmentation architectures such as SAM 3 without structural modification. To preserve pre-trained capabilities, we train only these lightweight additions while keeping the remaining backbone frozen. Experiments on EndoVis 2018 demonstrate strong in-domain performance, while evaluation on the out-of-distribution CholecSeg8k further confirms robustness across surgical domains. SCISSR achieves 95.41% Dice on EndoVis 2018 with five interaction rounds and 96.30% Dice on CholecSeg8k with three interaction rounds, outperforming iterative point prompting on both benchmarks.