Accuracy evaluation of a mitral valve surgery assistance system based on optical tracking

Purpose Mitral valve reconstruction is a widespread surgical method to repair incompetent mitral valves, which usually includes implantation of a ring prosthesis. To date, intraoperative analysis of the mitral valve is merely based on visual assessment using simple surgical tools, which might not allow for accurate assessment of the complex anatomy. Methods We propose a novel intraoperative computer-based assistance system, which combines passive optical tracking technology with tailored measurement strategies applicable during different phases of the intraoperative workflow. Based on the assessment of the valvular apparatus by customized tracked instruments, the system (1) generates an enhanced three-dimensional visualization, which (2) incorporates accurate quantifications and (3) provides assistance, e.g., in terms of virtual prosthesis selection. Results Phantom experiments in a realistic environment revealed a high system accuracy (mean precision 0.12 ± 0.09 mm and mean trueness 0.77 ± 0.39 mm) and a low user error (mean precision 0.18 ± 0.10 mm and mean trueness 0.81 ± 0.36 mm). The assistance system was successfully applied five times during open and minimally invasive reconstructive surgery in patients having mitral valve insufficiency. The measurement steps integrate well into the traditional workflow, enhancing the surgeon’s three-dimensional perception and generating a suggestion for an appropriate prosthesis. Conclusion The proposed assistance system provides a novel, accurate, and reproducible method for assessing the valvular geometry intraoperatively.