Title: Enhancing Surgical Instrument Handling and Assembly Through a Marker-Free Multi-Camera AR Guidance System: An Analysis of Efficiency and Cognitive Load

Abstract

The assembly and manipulation of surgical tools place significant cognitive burdens on scrub nurses, a challenge that intensifies when working with unfamiliar equipment. This paper introduces a novel guidance system designed to support surgical instrumentation by integrating multi-camera 6D pose estimation with augmented reality (AR) visualization on a head-mounted display. Notably, this system operates without the need for external tracking markers. By leveraging known objects for pose estimation and continuous camera calibration, the approach ensures robust performance. The underlying 6D pose estimation network was trained exclusively on synthetic data to enhance generalizability and real-world applicability.

During intraoperative use, the AR interface provides tooltip localization cues and step-by-step assembly animations. Users can navigate between assembly stages using a combination of gaze-based selection and a foot pedal. Technical assessments indicate that the proposed method surpasses current state-of-the-art 6D pose estimation techniques.

To evaluate clinical utility, a user study involving 29 scrub nurses was conducted using a simulated knee arthroplasty scenario. The study compared the AR guidance system against traditional paper manuals. Results demonstrated that AR guidance significantly lowered perceived workload. Objectively, the system decreased task completion time by 21.3%, equating to a reduction of 4.76 minutes. Notably, scrub nurses with limited experience using the specific instrument set derived the most benefit from the system. Error rates remained consistent across both conditions. Qualitative responses pointed to enhanced process clarity, diminished information overload, and a greater sense of autonomy. In conclusion, this marker-free, multi-camera AR guidance system offers both subjective and objective improvements in intraoperative instrumentation performance, particularly aiding less experienced scrub nurses.

Source: arXiv Generated at: 2026-06-04 00:00:00 UTC