# UniSurgSAM: A Unified Promptable Model for Reliable Surgical Video Segmentation

arXiv: https://arxiv.org/abs/2604.03645 · HTML: https://mlsanity.com/paper/2604.03645/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 16 of its 34 references that are in the map.
- First posted on arXiv 4 Apr 2026.

## Builds on (most cited first, 16 of 16)

- [Robust Speech Recognition via Large-Scale Weak Supervision](https://mlsanity.com/paper/2212.04356/) (2022)
- [SAM 3: Segment Anything with Concepts](https://mlsanity.com/paper/2511.16719/) (2025)
- [XMem: Long-Term Video Object Segmentation with an Atkinson-Shiffrin Memory Model](https://mlsanity.com/paper/2207.07115/) (2022)
- [Video Object Segmentation using Space-Time Memory Networks](https://mlsanity.com/paper/1904.00607/) (2019)
- [2017 Robotic Instrument Segmentation Challenge](https://mlsanity.com/paper/1902.06426/) (2019)
- [2018 Robotic Scene Segmentation Challenge](https://mlsanity.com/paper/2001.11190/) (2020)
- [SAM2Long: Enhancing SAM 2 for Long Video Segmentation with a Training-Free Memory Tree](https://mlsanity.com/paper/2410.16268/) (2024)
- [A Distractor-Aware Memory for Visual Object Tracking with SAM2](https://mlsanity.com/paper/2411.17576/) (2024)
- [SAR-RARP50: Segmentation of surgical instrumentation and Action Recognition on Robot-Assisted Radical Prostatectomy Challenge](https://mlsanity.com/paper/2401.00496/) (2023)
- [Towards Robust Referring Video Object Segmentation with Cyclic Relational Consensus](https://mlsanity.com/paper/2207.01203/) (2022)
- [Surgical SAM 2: Real-time Segment Anything in Surgical Video by Efficient Frame Pruning](https://mlsanity.com/paper/2408.07931/) (2024)
- [SAMWISE: Infusing Wisdom in SAM2 for Text-Driven Video Segmentation](https://mlsanity.com/paper/2411.17646/) (2024)
- [MATIS: Masked-Attention Transformers for Surgical Instrument Segmentation](https://mlsanity.com/paper/2303.09514/) (2023)
- [ReSurgSAM2: Referring Segment Anything in Surgical Video via Credible Long-term Tracking](https://mlsanity.com/paper/2505.08581/) (2025)
- [Synergistic Bleeding Region and Point Detection in Laparoscopic Surgical Videos](https://mlsanity.com/paper/2503.22174/) (2025)
- [Where It Moves, It Matters: Referring Surgical Instrument Segmentation via Motion](https://mlsanity.com/paper/2601.12224/) (2026)

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

- [LD-RSVIS: A Large-Scale and Diverse Benchmark for Referring Surgical Video Instrument Segmentation](https://mlsanity.com/paper/2609.23067/) (2026)

## Abstract (arXiv)

Surgical video segmentation is fundamental to computer-assisted surgery. In practice, surgeons need to dynamically specify targets throughout extended procedures, using heterogeneous cues such as visual selections, textual expressions, or audio instructions. However, existing Promptable Video Object Segmentation (PVOS) methods are typically restricted to a single prompt modality and rely on coupled frameworks that cause optimization interference between target initialization and tracking. Moreover, these methods produce hallucinated predictions when the target is absent and suffer from accumulated mask drift without failure recovery. To address these challenges, we present UniSurgSAM, a unified PVOS model enabling reliable surgical video segmentation through visual, textual, or audio prompts. Specifically, UniSurgSAM employs a decoupled two-stage framework that independently optimizes initialization and tracking to resolve the optimization interference. Within this framework, we introduce three key designs for reliability: presence-aware decoding that models target absence to suppress hallucinations; boundary-aware long-term tracking that prevents mask drift over extended sequences; and adaptive state transition that closes the loop between stages for failure recovery. Furthermore, we establish a multi-modal and multi-granular benchmark from four public surgical datasets with precise instance-level masklets. Extensive experiments demonstrate that UniSurgSAM achieves state-of-the-art performance in real time across all prompt modalities and granularities, providing a practical foundation for computer-assisted surgery. Code and datasets will be available at https://jinlab-imvr.github.io/UniSurgSAM.