BiliVLA: Scene-Aware Vision-Language-Action Model with Reinforcement Learning for Autonomous Biliary Endoscopic Navigation

Endoscopic retrograde cholangiopancreatography (ERCP) demands precise endoscopic navigation and stable biliary cannulation within a narrow monocular field characterized by specular reflections, partial occlusions, and frequent tissue contact. Although recent robotic systems and vision-based assistance techniques improve operator ergonomics and provide perceptual cues, their performance degrades under pronounced anatomical variability and safety-critical visual artifacts, which hinders reliable autonomy in cannulation-grade procedures. Here, we present BiliVLA, a scene-aware Vision-Language-Action (VLA) framework that formulates biliary endoscopic navigation as an instruction-conditioned visuomotor learning problem. Given an endoscopic observation and a stage-specific language instruction, BiliVLA jointly predicts the target category, a grounded bounding box, and a discrete three-degree-of-freedom (3-DoF) motor command for a continuum endoscope. The proposed framework incorporates scene-aware supervision to improve semantic target consistency and safety-aware recovery supervision to induce conservative retreat behaviors under luminal wall contact. A key component of BiliVLA is a two-stage training paradigm that combines grounding-enhanced supervised fine-tuning (SFT) with Group Relative Policy Optimization (GRPO), thereby improving action reliability and decision consistency during closed-loop navigation. Across three ERCP subtasks, BiliVLA achieves the best overall performance in physical phantom experiments, with a total mIoU of 0.9625, an overall action precision of 91.96%, and an overall success rate (SR) of 84.85%. These results indicate that integrating semantic grounding, scene-aware learning, and reward-guided optimization strengthens perception--action alignment and enables more robust autonomous biliary endoscopic navigation.