Development of a high-fidelity minimally invasive mitral valve surgery simulator

Peyman Sardari Nia*, Jean H. T. Daemen, Jos G. Maessen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objectives: The aim of this study was to develop a high-fidelity minimally invasive mitral valve surgery (MIMVS) simulator.

Methods: The process of industrial serial design was applied based on pre-set requirements, acquired by interviewing experienced mitral surgeons. A thoracic torso with endoscopic and robotic access and disposable silicone mitral valve apparatus with a feedback system was developed. The feedback system was based on 4 cameras around the silicone valve and an edge detection algorithm to calculate suture depth and width. Validity of simulator measurements was assessed by comparing simulator-generated values with measurements done manually on 3dimensional reconstructed micro-computed tomography scan of the same sutures. Independent surgeons tested the simulator between 2014 and 2018, whereupon an evaluation was done through a questionnaire.

Results: The feedback system was able to provide width and depth measurements, which were subsequently scored by comparison to pre-set target values. Depth did not significantly differ between simulator and micro-computed tomography scan measurements (P =.139). Width differed significantly (P =.001), whereupon a significant regression equation was found (P

Conclusions: We successfully developed a high-fidelity MIMVS simulator for endoscopic and robotic approaches. The simulator provides a platform to train skills in an objective and reproducible manner. Future studies are needed to provide evidence for its application in training surgeons.

Original languageEnglish
Pages (from-to)1567-1574
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Issue number4
Publication statusPublished - Apr 2019


  • minimally invasive mitral valve surgery
  • high-fidelity
  • simulator
  • endoscopic
  • robotic

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