# Bootstrapping Vision-Language Model for Hysteroscopic Surgical Scene Segmentation

arXiv: https://arxiv.org/abs/2608.09302 · HTML: https://mlsanity.com/paper/2608.09302/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Medical vision-language models, one of 16 directions in Multimodal LLMs / vision-language models.
- Builds on 16 of its 33 references that are in the map.
- First posted on arXiv 10 Aug 2026.

## Placed in

- Multimodal LLMs / vision-language models / [Medical vision-language models](https://mlsanity.com/mllm/medical-vision-language-models/)

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

- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [Visual Instruction Tuning](https://mlsanity.com/paper/2304.08485/) (2023)
- [BLIP-2: Bootstrapping Language-Image Pre-training with Frozen Image Encoders and Large Language Models](https://mlsanity.com/paper/2301.12597/) (2023)
- [BLIP: Bootstrapping Language-Image Pre-training for Unified Vision-Language Understanding and Generation](https://mlsanity.com/paper/2201.12086/) (2022)
- [Masked-attention Mask Transformer for Universal Image Segmentation](https://mlsanity.com/paper/2112.01527/) (2021)
- [MedCLIP: Contrastive Learning from Unpaired Medical Images and Text](https://mlsanity.com/paper/2210.10163/) (2022)
- [Segment Everything Everywhere All at Once](https://mlsanity.com/paper/2304.06718/) (2023)
- [Segment Anything in Medical Images](https://mlsanity.com/paper/2304.12306/) (2023)
- [Surgical Data Science -- from Concepts toward Clinical Translation](https://mlsanity.com/paper/2011.02284/) (2020)
- [SurgicalSAM: Efficient Class Promptable Surgical Instrument Segmentation](https://mlsanity.com/paper/2308.08746/) (2023)
- [Segment Anything Model for Medical Image Segmentation: Current Applications and Future Directions](https://mlsanity.com/paper/2401.03495/) (2024)
- [RULE: Reliable Multimodal RAG for Factuality in Medical Vision Language Models](https://mlsanity.com/paper/2407.05131/) (2024)
- [Towards Unified Surgical Skill Assessment](https://mlsanity.com/paper/2106.01035/) (2021)
- [Text Promptable Surgical Instrument Segmentation with Vision-Language Models](https://mlsanity.com/paper/2306.09244/) (2023)
- [Exploring Intra- and Inter-Video Relation for Surgical Semantic Scene Segmentation](https://mlsanity.com/paper/2203.15251/) (2022)
- [Pseudo-label Guided Cross-video Pixel Contrast for Robotic Surgical Scene Segmentation with Limited Annotations](https://mlsanity.com/paper/2207.09664/) (2022)

## Abstract (arXiv)

Hysteroscopic surgical scene segmentation plays a pivotal role in understanding the hysteroscopic intraoperative environment as well as computer-assisted intervention. However, this task presents unique challenges due to the high morphological similarity among different lesions and the presence of artifacts such as specular reflections, motion blur, and fluid occlusions in surgical videos. In this work, we propose the first vision-language model (VLM)-based hysteroscopic surgical scene segmentation method, which performs pixel-wise localization for fifteen representative categories in hysteroscopic surgical scenes. Our VLM-hyster has a segmentation backbone that utilizes the pretrained image encoder for robust visual feature extraction, coupled with a transformer-based decoder for dense prediction. Moreover, we design category-specific text prompts and incorporate a masked distillation branch to filter out visual features with low correlation to the text prompts, enabling the model to focus more effectively on category-specific image regions and thereby enhancing segmentation performance. We collect a large multicentric hysteroscopic surgical scene dataset, containing 4,020 high-resolution images with detailed mask annotations, for model training and evaluation. Experimental results demonstrate that VLM-hyster substantially outperforms state-of-the-art AI models. Furthermore, extensive assessments by gynecologists, as well as multicentre and prospective validations, demonstrate VLM-hyster's robustness and generalizability. The results suggest that VLM-hyster earns considerable potential in enabling AI-assisted localization of surgical instruments and lesions in hysteroscopic surgeries. Code is available at https://github.com/viscom-tongji/VLM-hyster.