# NVIDIA Cosmos-H-Dreams: Real-Time Generative Physics Simulation for Surgical Robotics

arXiv: https://arxiv.org/abs/2608.24199 · HTML: https://mlsanity.com/paper/2608.24199/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Placed in Medical and surgical world models, one of 11 directions in World models.
- Builds on 18 of its 40 references that are in the map.
- First posted on arXiv 25 Aug 2026.

## Placed in

- World models / [Medical and surgical world models](https://mlsanity.com/wm/medical-and-surgical-world-models/)

## Builds on (most cited first, 18 of 18)

- [Flow Straight and Fast: Learning to Generate and Transfer Data with Rectified Flow](https://mlsanity.com/paper/2209.03003/) (2022)
- [Wan: Open and Advanced Large-Scale Video Generative Models](https://mlsanity.com/paper/2503.20314/) (2025)
- [π0: A Vision-Language-Action Flow Model for General Robot Control](https://mlsanity.com/paper/2410.24164/) (2024)
- [World Models](https://mlsanity.com/paper/1803.10122/) (2018)
- [Cosmos World Foundation Model Platform for Physical AI](https://mlsanity.com/paper/2501.03575/) (2025)
- [V-JEPA 2: Self-Supervised Video Models Enable Understanding, Prediction and Planning](https://mlsanity.com/paper/2506.09985/) (2025)
- [Self Forcing: Bridging the Train-Test Gap in Autoregressive Video Diffusion](https://mlsanity.com/paper/2506.08009/) (2025)
- [World Action Models are Zero-shot Policies](https://mlsanity.com/paper/2602.15922/) (2026)
- [Learning Interactive Real-World Simulators](https://mlsanity.com/paper/2310.06114/) (2023)
- [World Simulation with Video Foundation Models for Physical AI](https://mlsanity.com/paper/2511.00062/) (2025)
- [Cosmos 3: Omnimodal World Models for Physical AI](https://mlsanity.com/paper/2606.02800/) (2026)
- [Advancing Open-source World Models](https://mlsanity.com/paper/2601.20540/) (2026)
- [Cosmos-Transfer1: Conditional World Generation with Adaptive Multimodal Control](https://mlsanity.com/paper/2503.14492/) (2025)
- [Error Analyses of Auto-Regressive Video Diffusion Models: A Unified Framework](https://mlsanity.com/paper/2503.10704/) (2025)
- [NVIDIA OmniDreams: Real-Time Generative World Model for Closed-Loop Autonomous Vehicle Simulation](https://mlsanity.com/paper/2606.03159/) (2026)
- [Open-H-Embodiment: A Large-Scale Dataset for Enabling Foundation Models in Medical Robotics](https://mlsanity.com/paper/2604.21017/) (2026)
- [Deformable Models for Surgical Simulation: A Survey](https://mlsanity.com/paper/1909.03363/) (2019)
- [Cosmos-Surg-dVRK: World Foundation Model-based Automated Online Evaluation of Surgical Robot Policy Learning](https://mlsanity.com/paper/2510.16240/) (2025)

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

- [SurgCast: Action-Conditioned Future Skeletons for Controllable Surgical World Models](https://mlsanity.com/paper/2610.15645/) (2026)

## Abstract (arXiv)

Generative simulation for surgical robotics still lacks real-time interaction. Physical-robot experiments, often involving animal or cadaver labs, are time-consuming, costly, and difficult to reproduce, while classical simulators struggle to capture photorealistic appearance and deformable-tissue dynamics. We address this gap with Cosmos-H-Dreams, an integrated real-time surgical world-model system combining an action-conditioned generative model, a teacher-to-student distillation recipe, and a deployment stack built on the NVIDIA FlashDreams streaming-inference library. Starting from Cosmos-H-Surgical-Simulator, a multi-embodiment action-conditioned surgical video world model fine-tuned on the large-scale Open-H-Embodiment corpus, we post-train this checkpoint on embodiment- and procedure-specific data. By distilling the resulting bidirectional teacher into a causal, few-step student with Self Forcing, we turn a passive video generator into a controllable surgical simulator that streams at ~160 inference FPS on a single NVIDIA RTX PRO 6000 Blackwell workstation GPU. Crucially, Cosmos-H-Dreams is controller-agnostic: any interface that emits a stream of robot kinematics can drive it. We demonstrate live control through a browser keyboard over WebRTC, a Meta Quest headset over WebXR, a commercial surgical robot console such as CMR Surgical's Versius, and learned policies operating in closed loop. To our knowledge, this is the first interactive surgical world model supporting live human and policy control. Human operators and policies alike can act inside the synthesized world and observe the consequences in real time. We release Cosmos-H-Dreams as an open surgical simulation system, providing a common foundation for surgical education, scalable synthetic data generation, and future intraoperative decision support.