Memory-Augmented Multimodal LLMs for Surgical VQA via Self-Contained Inquiry

Abstract

Comprehensively understanding surgical scenes in Surgical Visual Question Answering (Surgical VQA) requires reasoning over multiple objects. Previous approaches address this task using cross-modal fusion strategies to enhance reasoning ability. However, these methods often struggle with limited scene understanding and question comprehension, and some rely on external resources (e.g., pre-extracted object features), which can introduce errors and generalize poorly across diverse surgical environments. To address these challenges, we propose SCAN, a simple yet effective memory-augmented framework that leverages Multimodal LLMs to improve surgical context comprehension via Self-Contained Inquiry. SCAN operates autonomously, generating two types of memory for context augmentation: Direct Memory (DM), which provides multiple candidates (or hints) to the final answer, and Indirect Memory (IM), which consists of self-contained question-hint pairs to capture broader scene context. DM directly assists in answering the question, while IM enhances understanding of the surgical scene beyond the immediate query. Reasoning over these object-aware memories enables the model to accurately interpret images and respond to questions. Extensive experiments on three publicly available Surgical VQA datasets demonstrate that SCAN achieves state-of-the-art performance, offering improved accuracy and robustness across various surgical scenarios.