Suturing map for endoscopic mitral valve repair developed on high-fidelity endoscopic simulator

Minimally invasive mitral valve surgery demands a different mind-set from surgeons due to its high complexity and steep learning curve, especially in a fully endoscopic approach. Smaller incisions, working with long-shafted instruments, and a relatively fixed camera position in a limited working space necessitate the development of new surgical routines.  We used a high-fidelity mitral valve simulator to develop a suturing map for placement of the annuloplasty ring with minimal tissue manipulation and maximal visual exposure. The suturing map could be helpful for less experienced surgeons who are starting to learn the techniques of minimally invasive mitral valve surgery.