Evaluating general-purpose multimodal large language models (MLLMs) for surgical scene understanding remains limited by scarce surgical data and fragmented evaluation protocols. We address these challenges through a two-stage evaluation framework for surgical scene understanding. In Stage I, we introduce SurgKnowBench, a diagnostic benchmark that harmonizes public surgical datasets across procedures and tasks and evaluates proprietary and open-weight MLLMs to map the boundary of pretrained surgical competence. SurgKnowBench reveals that current models retain partial visual priors but remain weak on procedural reasoning and workflow assessment. Building on this failure frontier, and motivated by the scaffolded nature of surgical training, we introduce SurgAgentGym, a controlled environment where general-purpose MLLM agents can use bounded knowledge search over SurgWiki and general-purpose visual grounding for surgical tasks. SurgAgentGym evaluates whether generalist agents can improve surgical understanding at inference time through tool-mediated evidence use, without additional surgical training. Our results show that agentic inference narrows the gap mainly for perception-heavy tasks, while fine-grained localization and expert-style assessment remain persistent bottlenecks. This opens a path toward future studies of agentic surgical understanding.

The rapid progress of Large Language Models has advanced agentic systems in decision-making, coordination, and task execution. Yet, existing agentic system generation frameworks lack full autonomy, missing from-scratch agent generation, self-optimizing agent functionality, and collaboration, limiting adaptability and scalability. We propose SwarmAgentic, the first framework that fully automates agentic system generation, optimization, and collaboration, constructing agents from scratch and jointly refining functionality and coordination via language-driven exploration. To enable efficient search over system-level structures, SwarmAgentic maintains a population of candidate systems and evolves them via feedback-guided updates, drawing inspiration from Particle Swarm Optimization (PSO). We evaluate our method on six real-world, open-ended, and exploratory tasks involving high-level planning, system-level coordination, and creative reasoning. Given only a task description and an objective function, SwarmAgentic outperforms all baselines, achieving a +261.8% relative improvement over ADAS on the TravelPlanner benchmark, highlighting the effectiveness of full automation in structurally unconstrained tasks. This framework marks a significant step toward scalable and autonomous agentic system design, bridging swarm intelligence with fully automated system multi-agent generation.