Daily Papers

Endoscopic Submucosal Dissection (ESD) is a minimally invasive procedure initially developed for early gastric cancer treatment and has expanded to address diverse gastrointestinal lesions. While computer-assisted surgery (CAS) systems enhance ESD precision and safety, their efficacy hinges on accurate real-time surgical phase recognition, a task complicated by ESD's inherent complexity, including heterogeneous lesion characteristics and dynamic tissue interactions. Existing video-based phase recognition algorithms, constrained by inefficient temporal context modeling, exhibit limited performance in capturing fine-grained phase transitions and long-range dependencies. To overcome these limitations, we propose SPRMamba, a novel framework integrating a Mamba-based architecture with a Scaled Residual TranMamba (SRTM) block to synergize long-term temporal modeling and localized detail extraction. SPRMamba further introduces the Hierarchical Sampling Strategy to optimize computational efficiency, enabling real-time processing critical for clinical deployment. Evaluated on the ESD385 dataset and the cholecystectomy benchmark Cholec80, SPRMamba achieves state-of-the-art performance (87.64% accuracy on ESD385, +1.0% over prior methods), demonstrating robust generalizability across surgical workflows. This advancement bridges the gap between computational efficiency and temporal sensitivity, offering a transformative tool for intraoperative guidance and skill assessment in ESD surgery. The code is accessible at https://github.com/Zxnyyyyy/SPRMamba.

Intraoperative bleeding during Endoscopic Submucosal Dissection (ESD) poses significant risks, demanding precise, real-time localization and continuous monitoring of the bleeding source for effective hemostatic intervention. In particular, endoscopists have to repeatedly flush to clear blood, allowing only milliseconds to identify bleeding sources, an inefficient process that prolongs operations and elevates patient risks. However, current Artificial Intelligence (AI) methods primarily focus on bleeding region segmentation, overlooking the critical need for accurate bleeding source detection and temporal tracking in the challenging ESD environment, which is marked by frequent visual obstructions and dynamic scene changes. This gap is widened by the lack of specialized datasets, hindering the development of robust AI-assisted guidance systems. To address these challenges, we introduce BleedOrigin-Bench, the first comprehensive ESD bleeding source dataset, featuring 1,771 expert-annotated bleeding sources across 106,222 frames from 44 procedures, supplemented with 39,755 pseudo-labeled frames. This benchmark covers 8 anatomical sites and 6 challenging clinical scenarios. We also present BleedOrigin-Net, a novel dual-stage detection-tracking framework for the bleeding source localization in ESD procedures, addressing the complete workflow from bleeding onset detection to continuous spatial tracking. We compare with widely-used object detection models (YOLOv11/v12), multimodal large language models, and point tracking methods. Extensive evaluation demonstrates state-of-the-art performance, achieving 96.85% frame-level accuracy (pmleq8 frames) for bleeding onset detection, 70.24% pixel-level accuracy (leq100 px) for initial source detection, and 96.11% pixel-level accuracy (leq100 px) for point tracking.

Gastrointestinal malignancies constitute a leading cause of cancer-related mortality worldwide, with advanced-stage prognosis remaining particularly dismal. Originating as a groundbreaking technique for early gastric cancer treatment, Endoscopic Submucosal Dissection has evolved into a versatile intervention for diverse gastrointestinal lesions. While computer-assisted systems significantly enhance procedural precision and safety in ESD, their clinical adoption faces a critical bottleneck: reliable surgical phase recognition within complex endoscopic workflows. Current state-of-the-art approaches predominantly rely on multi-stage refinement architectures that iteratively optimize temporal predictions. In this paper, we present Clinical Prior Knowledge-Constrained Diffusion (CPKD), a novel generative framework that reimagines phase recognition through denoising diffusion principles while preserving the core iterative refinement philosophy. This architecture progressively reconstructs phase sequences starting from random noise and conditioned on visual-temporal features. To better capture three domain-specific characteristics, including positional priors, boundary ambiguity, and relation dependency, we design a conditional masking strategy. Furthermore, we incorporate clinical prior knowledge into the model training to improve its ability to correct phase logical errors. Comprehensive evaluations on ESD820, Cholec80, and external multi-center demonstrate that our proposed CPKD achieves superior or comparable performance to state-of-the-art approaches, validating the effectiveness of diffusion-based generative paradigms for surgical phase recognition.