Accurate foreground masks can still form an incorrect surgical-instrument instance set: duplicate, fragmented, merged, missed, or empty-frame predictions may preserve favorable pixel overlap while violating object identity and count. Final query selection is therefore a relational, variable-cardinality problem rather than a collection of independent candidate decisions. We evaluate topology-aware query selection, which represents the nonempty candidates of a fixed Mask2Former as a complete graph, learns relational candidate and pair representations, predicts set cardinality, and solves an exact structured subset problem. The formal comparison is the complete relational path versus a node-feature-matched path; it evaluates the combined effect of pairwise geometry, message passing, and the additional relational-path capacity, not an isolated component. On the sealed 22-case source test, all three discovery seeds supported instance-set performance improvement with segmentation fidelity and predefined technical-safety preservation: instance F1 increased by 0.0504--0.0612 and positive-frame set-failure rate decreased by 0.0848--0.1060. Direct ROBUST-MIPS transfer reproduced the complete result in all three seeds. Endoscapes supported only one of three seeds and therefore did not establish stable direct transfer. Taken together, the results support a bounded conclusion: the evaluated complete path improved coherent instance-set construction from fixed Mask2Former candidates in specified native-instance contracts, while stable cross-domain transfer and component-specific effects remain unestablished.
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.