The handling and assembly of instruments during surgery imposes high cognitive demands on scrub nurses, particularly when instruments are unfamiliar. We present a supporting guidance system for surgical instrumentation that combines multi-camera 6D pose estimation with augmented reality in-situ visualization on a head-mounted display without the requirement for additional markers. Pose estimation and consecutive camera calibration are achieved through known objects. The 6D pose estimation network is trained purely on synthetic data, aiming for better generalizability and real-world applicability. The AR guidance displays tooltip localization cues and step-wise assembly animations. Via gaze-based selection and a foot pedal, users can switch between assembly steps in intraoperative use. In a technical evaluation, our approach outperforms state-of-art 6D pose estimation. A user study with 29 scrub nurses was conducted in a surgical simulation of knee arthroplasty, comparing the system against a paper manual. AR guidance significantly reduced the perceived workload compared. Objectively, AR guidance reduced task completion time by 21.3\% (4.76 minutes). Specifically, scrub nurses less experienced with the instrument set benefited when using the system. Error frequencies were comparable between conditions. Qualitative feedback highlighted improved process clarity, reduced information overload, and perceived independence. To summarize, our marker-free multi-camera AR guidance approach for surgical instruments can, subjectively and objectively, improve intraoperative instrumentation performance, particularly for untrained scrub nurses.

翻译：手术过程中器械的处理与装配对洗手护士提出了较高的认知负荷需求，尤其当器械不熟悉时更为显著。本文提出一种无需额外标记物的手术器械辅助引导系统，该系统将多摄像头6D位姿估计与头戴式显示器上的增强现实原位可视化技术相结合。位姿估计及后续相机标定通过已知物体实现。6D位姿估计网络完全基于合成数据进行训练，旨在提升泛化能力与实际应用效果。增强现实引导系统可显示器械尖端定位提示及分步装配动画。通过基于注视点的选择与脚踏开关，用户可在术中操作时切换装配步骤。技术评估表明，本方法优于现有6D位姿估计技术。在膝关节置换术模拟场景下，对29名洗手护士开展用户研究，将本系统与纸质手册进行对比。结果显示，增强现实引导显著降低了感知工作负荷。客观指标上，增强现实引导使任务完成时间缩短21.3%（4.76分钟）。尤其对不熟悉该器械组的洗手护士，使用本系统获益更明显。两组间错误频率无显著差异。定性反馈显示，增强现实引导提升了流程清晰度，减少了信息过载，并增强了操作自主性。综上所述，本研究所提出的无标记多摄像头增强现实器械引导系统，可在主观与客观层面改善术中器械操作表现，尤其适用于未受过培训的洗手护士。