# SurgNarrator: A Generative Retrieval Framework for Surgical Video Understanding

arXiv: https://arxiv.org/abs/2608.04676 · HTML: https://mlsanity.com/paper/2608.04676/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 43 of its 45 references that are in the map.
- First posted on arXiv 5 Aug 2026.

## Builds on (most cited first, 30 of 43)

- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [The Llama 3 Herd of Models](https://mlsanity.com/paper/2407.21783/) (2024)
- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [Sentence-BERT: Sentence Embeddings using Siamese BERT-Networks](https://mlsanity.com/paper/1908.10084/) (2019)
- [Qwen3 Technical Report](https://mlsanity.com/paper/2505.09388/) (2025)
- [Representation Learning with Contrastive Predictive Coding](https://mlsanity.com/paper/1807.03748/) (2018)
- [Qwen3-VL Technical Report](https://mlsanity.com/paper/2511.21631/) (2025)
- [CIDEr: Consensus-based Image Description Evaluation](https://mlsanity.com/paper/1411.5726/) (2014)
- [Video-LLaMA: An Instruction-tuned Audio-Visual Language Model for Video Understanding](https://mlsanity.com/paper/2306.02858/) (2023)
- [Video-ChatGPT: Towards Detailed Video Understanding via Large Vision and Language Models](https://mlsanity.com/paper/2306.05424/) (2023)
- [CLIP4Clip: An Empirical Study of CLIP for End to End Video Clip Retrieval](https://mlsanity.com/paper/2104.08860/) (2021)
- [VideoCLIP: Contrastive Pre-training for Zero-shot Video-Text Understanding](https://mlsanity.com/paper/2109.14084/) (2021)
- [MedGemma Technical Report](https://mlsanity.com/paper/2507.05201/) (2025)
- [EndoNet: A Deep Architecture for Recognition Tasks on Laparoscopic Videos](https://mlsanity.com/paper/1602.03012/) (2016)
- [Qwen3-VL-Embedding and Qwen3-VL-Reranker: A Unified Framework for State-of-the-Art Multimodal Retrieval and Ranking](https://mlsanity.com/paper/2601.04720/) (2026)
- [TeCNO: Surgical Phase Recognition with Multi-Stage Temporal Convolutional Networks](https://mlsanity.com/paper/2003.10751/) (2020)
- [Rendezvous: Attention Mechanisms for the Recognition of Surgical Action Triplets in Endoscopic Videos](https://mlsanity.com/paper/2109.03223/) (2021)
- [Surgical Data Science: Enabling Next-Generation Surgery](https://mlsanity.com/paper/1701.06482/) (2017)
- [AutoLaparo: A New Dataset of Integrated Multi-tasks for Image-guided Surgical Automation in Laparoscopic Hysterectomy](https://mlsanity.com/paper/2208.02049/) (2022)
- [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)
- [Video-based surgical skill assessment using 3D convolutional neural networks](https://mlsanity.com/paper/1903.02306/) (2019)
- [SAR-RARP50: Segmentation of surgical instrumentation and Action Recognition on Robot-Assisted Radical Prostatectomy Challenge](https://mlsanity.com/paper/2401.00496/) (2023)
- [SurgicalGPT: End-to-End Language-Vision GPT for Visual Question Answering in Surgery](https://mlsanity.com/paper/2304.09974/) (2023)
- [Pixel-Wise Recognition for Holistic Surgical Scene Understanding](https://mlsanity.com/paper/2401.11174/) (2024)
- [CholecTriplet2021: A benchmark challenge for surgical action triplet recognition](https://mlsanity.com/paper/2204.04746/) (2022)
- [HecVL: Hierarchical Video-Language Pretraining for Zero-shot Surgical Phase Recognition](https://mlsanity.com/paper/2405.10075/) (2024)
- [Challenges in Multi-centric Generalization: Phase and Step Recognition in Roux-en-Y Gastric Bypass Surgery](https://mlsanity.com/paper/2312.11250/) (2023)
- [Surgical-LVLM: Learning to Adapt Large Vision-Language Model for Grounded Visual Question Answering in Robotic Surgery](https://mlsanity.com/paper/2405.10948/) (2024)
- [Procedure-Aware Surgical Video-language Pretraining with Hierarchical Knowledge Augmentation](https://mlsanity.com/paper/2410.00263/) (2024)

## Abstract (arXiv)

Surgical procedures unfold as structured and recurring clinical events, whose real-time understanding via intraoperative surgical videos is critical for intraoperative decision-making and support. However, existing video understanding methods force a trade-off: autoregressive video-language models support comprehensive reasoning but are not practical for time-sensitive clinical applications, whereas contrastive models offer low latency but struggle with complex scene understanding. Recently, generative retrieval has been explored for general-domain video understanding, but transferring it to surgery is not trivial because near-identical visual appearances may indicate semantically distinct events, and the terminology involved is highly surgery-specific. To this end, we propose SurgNarrator, a new generative retrieval framework tailored for surgical video understanding. We construct a well-curated surgery-centric vocabulary from surgical captions to define a clinically meaningful retrieval space. We then adapt the pre-trained Qwen3-VL-Embedding-8B to learn discriminative clinical representations with a temporally-aware contrastive objective. During inference, a hierarchical, procedure-aware retrieval strategy narrows the search space to the relevant procedure type, delivering fast and effective responses. Our method is comprehensively evaluated on twelve benchmarks in a zero-shot setting and achieves consistent performance gains over state-of-the-art baselines, while reducing output-stage latency by more than two orders of magnitude compared with the generative baseline.