arXiv:2611.13971v1 Announce Type: cross Abstract: Intraoperative scene perception in ophthalmic microsurgery is limited by instrument occlusion: when a tool enters the high-magnification field, it conceals tissue from both the surgeon and the perception components of robot-assisted systems that process the video. Generative inpainting can remove the occluder but replaces the missing image content with synthesis, which is unsuitable when visual provenance matters. Many video inpainters also depend on future frames and cannot operate online. We present TransGHOST, a causal reference-guided reconstruction pipeline whose non-generative safe mode operates in real time. Every restored value is obtained by resampling a recorded frame using geometric transforms fitted only to visible regions. The system provides per-pixel confidence and provenance and marks unsupported pixels as abstentions. We evaluate TransGHOST on a new veterinary clinical corpus of canine cataract surgery with pixel-level instrument and anatomy labels. Only the occluded region is scored, and each scoring target is verified to differ from the reference supplied to the system. Safe mode reaches 31.89 dB masked PSNR and 0.915 masked SSIM at 51.7 ms median and 85.5 ms 95th-percentile latency. On a pre-declared held-out cohort using instrument cutouts excluded from segmentation training, it reaches 29.83 dB masked PSNR, while matched-mask evaluation on validation shows a 3.45 dB advantage over LaMa. Region-aware reference selection improves masked PSNR by 3.60 dB over recency when candidate references can themselves be occluded. Reference-age analysis further defines the operating interval for the brief, repeated occlusions targeted by TransGHOST.