High-fidelity surgical video generation is increasingly important for surgical education, simulation, and downstream AI training, as conventional simulation pipelines are limited by cost, realism, and scenario diversity. Adapting generic text-to-video diffusion models to surgical procedures remains difficult, however, due to complex anatomical structures, intricate tool-tissue interactions, the inherently hierarchical nature of surgical workflows, and the scarcity of curated training data outside a few well-studied procedures. We propose a surgical video generation framework that combines hierarchical procedural annotation with curriculum transfer learning. Surgical procedures are decomposed into three levels (phase, task, and action) and a pretrained text-to-video diffusion model is progressively adapted from coarse to fine-grained surgical context, supported by a dynamic sampling strategy that handles variable-resolution and variable-length surgical clips. We instantiate the framework on Bilateral Axillo-Breast Approach robotic thyroidectomy, a procedure for which no curated benchmark currently exists. Relative to the preceding task-level model, the final action-level model reduces FVD by 20.1% and FID by 15.7%, and a matched-budget ablation indicates that these gains arise from the curriculum design rather than from additional training. A user study with six clinicians rates visual realism highly while highlighting remaining gaps in anatomical accuracy and clinical reliability. The proposed framework offers a step toward AI-driven surgical simulation in procedures where curated data are scarce.

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