# Structured Reasoning Agentic Framework for Interpretable Critical View of Safety Assessment

arXiv: https://arxiv.org/abs/2609.31524 · HTML: https://mlsanity.com/paper/2609.31524/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 16 of its 26 references that are in the map.
- First posted on arXiv 25 Sep 2026.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)

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

- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [Qwen3 Technical Report](https://mlsanity.com/paper/2505.09388/) (2025)
- [SAM 3: Segment Anything with Concepts](https://mlsanity.com/paper/2511.16719/) (2025)
- [EndoNet: A Deep Architecture for Recognition Tasks on Laparoscopic Videos](https://mlsanity.com/paper/1602.03012/) (2016)
- [Videos as Space-Time Region Graphs](https://mlsanity.com/paper/1806.01810/) (2018)
- [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)
- [Surgical Data Science -- from Concepts toward Clinical Translation](https://mlsanity.com/paper/2011.02284/) (2020)
- [Learning Multi-modal Representations by Watching Hundreds of Surgical Video Lectures](https://mlsanity.com/paper/2307.15220/) (2023)
- [4D-OR: Semantic Scene Graphs for OR Domain Modeling](https://mlsanity.com/paper/2203.11937/) (2022)
- [HecVL: Hierarchical Video-Language Pretraining for Zero-shot Surgical Phase Recognition](https://mlsanity.com/paper/2405.10075/) (2024)
- [Procedure-Aware Surgical Video-language Pretraining with Hierarchical Knowledge Augmentation](https://mlsanity.com/paper/2410.00263/) (2024)
- [Latent Graph Representations for Critical View of Safety Assessment](https://mlsanity.com/paper/2212.04155/) (2022)
- [The Endoscapes Dataset for Surgical Scene Segmentation, Object Detection, and Critical View of Safety Assessment: Official Splits and Benchmark](https://mlsanity.com/paper/2312.12429/) (2023)
- [Encoding Surgical Videos as Latent Spatiotemporal Graphs for Object and Anatomy-Driven Reasoning](https://mlsanity.com/paper/2312.06829/) (2023)
- [Multi-modal Representations for Fine-grained Multi-label Critical View of Safety Recognition](https://mlsanity.com/paper/2507.05007/) (2025)

## Abstract (arXiv)

Surgical scene understanding is critical for computer-assisted intervention, yet laparoscopic cholecystectomy remains challenged by the complex anatomy of the hepatocystic triangle and the risk of bile duct injury. Existing methods for Critical View of Safety (CVS) assessment typically treat it as a holistic prediction task, mapping visual features directly to criterion-level labels. This black-box paradigm lacks explicit reasoning about anatomical relationships, limiting both interpretability and compositional generalization. To address this, we propose ReasonCVS, a structured reasoning agentic framework empowered by Vision-Language Models (VLMs) that decomposes CVS assessment into explicit, fine-grained anatomical verification. Specifically, we devise an Anatomical Scene Graph Abstraction (ASGA) that organizes anatomical entities and their spatial relationships into a structured representation. To operationalize this, we introduce a Rationale-Aware Reasoning Agent, powered by a Large Language Model (LLM) fine-tuned via rationale distillation. Functioning as a strict central decision-maker, it invokes VLM-driven Sub-criterion Verifier as a specialized perceptual tool to parse the graph and independently evaluate individual sub-criteria. Through calibrated soft reasoning, this agent synthesizes the tool-gathered distributed observations, yielding a final verdict alongside a traceable clinical rationale. Extensive experiments on the Endoscapes-CVS201 benchmark demonstrate that ReasonCVS achieves superior performance (68.1% mAP) over state-of-the-art while providing interpretable, criterion-level explanations for reliable surgical assessment.