Scaling Video Pretraining for Surgical Foundation Models

Abstract

Surgical video understanding is essential for computer-assisted interventions, yet existing surgical foundation models remain constrained by limited data scale, procedural diversity, and inconsistent evaluation, often lacking a reproducible training pipeline. We propose SurgRec, a scalable and reproducible pretraining recipe for surgical video understanding, instantiated with two variants: SurgRec-MAE and SurgRec-JEPA. We curate a large multi-source corpus of 10,535 videos and 214.5M frames spanning endoscopy, laparoscopy, cataract, and robotic surgery. Building on this corpus, we develop a unified pretraining pipeline with balanced sampling and standardize a reproducible benchmark across 16 downstream datasets and four clinical domains with consistent data splits. Across extensive comparisons against SSL baselines and vision-language models, SurgRec consistently achieves superior performance across downstream datasets. In contrast, VLMs prove unreliable for fine-grained temporal recognition, exhibiting both performance gaps and sensitivity to prompt phrasing. Our work provides a reproducible, scalable foundation for the community to build more general surgical video models. All code, models, and data will be publicly released.

Figures (3)

• Figure 1: Overview of the proposed medical video pretraining and evaluation framework.
• Figure 2: Distribution visualization of the pretraining corpus.
• Figure 3: Balanced data sampling. UMAP projection of embeddings extracted via DINOv3 (left: raw, right: sampled).