NVIDIA Cosmos3-H-Dreams: Bringing Clinical Surgery to Life Through Generative Simulation

Picture moving the Cadiere grasper, grasping the gallbladder, and lifting it, all within a generated surgical scene that responds in real time. Today, we take the next step and introduce Cosmos3-H-Dreams, bringing interactive generative simulation to the visual and procedural complexity of clinical surgery with our most convincing in-body imagery to date.

Our first Cosmos-H-Dreams release, built on Cosmos-Predict2.5, brought interactive generative simulation to dVRK tabletop suturing, a foundational proving ground for surgical robotics. As world foundation model (WFM), Cosmos-H-Dreams demonstrated an alternative to numerical simulation: rather than explicitly modeling scene geometry, tissue deformation, and physical interactions, it learned visual dynamics directly from synchronized video and robot kinematics, yielding interactive tabletop task simulation with high realism.

Today, Cosmos3-H-Dreams advances this capability by learning from video and robot kinematics recording during clinical procedures on the CMR Surgical Versius platform. To our knowledge, this is the first real-time generative surgical simulator trained on clinical cholecystectomy recordings to support live kinematic control. Powered by Cosmos 3 and accelerated with FlashDreams, NVIDIA’s accelerated streaming-inference library, Cosmos3-H-Dreams runs interactively on a single NVIDIA RTX PRO 6000 GPU.

1. From Tabletop Tasks to Clinical Scenes

Visual realism is therefore a starting point for validation, not proof of biomechanical accuracy. The generated scene must also follow the controls: translation, rotation, and gripper commands should produce coherent anatomical consequences. A plausible-looking rollout that ignores those commands cannot serve as an interactive environment.