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

  • Sandy EngelhardtEmail author
  • Raffaele De Simone
  • Sameer Al-Maisary
  • Silvio Kolb
  • Matthias Karck
  • Hans-Peter Meinzer
  • Ivo Wolf
Original Article



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.


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.


Phantom experiments in a realistic environment revealed a high system accuracy (mean precision \(0.12 \pm 0.09\) mm and mean trueness \(0.77 \pm 0.39\) mm) and a low user error (mean precision \(0.18 \pm 0.10 \) mm and mean trueness \(0.81 \pm 0.36\) 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.


The proposed assistance system provides a novel, accurate, and reproducible method for assessing the valvular geometry intraoperatively.


Mitral valve geometry Intraoperative computer-assisted measurements Optical tracking 



This work was carried out with support of the German Research Foundation (DFG) as part of project B01, SFB/TRR 125 Cognition-Guided Surgery. We thank the Division of fine mechanics for manufacturing the instruments and Jörg Rodrian for his technical support.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or National Research Committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© CARS 2016

Authors and Affiliations

  • Sandy Engelhardt
    • 1
    Email author
  • Raffaele De Simone
    • 2
  • Sameer Al-Maisary
    • 2
  • Silvio Kolb
    • 1
  • Matthias Karck
    • 2
  • Hans-Peter Meinzer
    • 1
  • Ivo Wolf
    • 1
    • 3
  1. 1.Medical and Biological InformaticsGerman Cancer Research Center (DKFZ)HeidelbergGermany
  2. 2.Department of Cardiac SurgeryUniversity Hospital HeidelbergHeidelbergGermany
  3. 3.Department of Computer ScienceMannheim University of Applied ScienceMannheimGermany

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