Physically valid surgical simulators: linear versus nonlinear tissue models.

Realistic modeling of the interaction between surgical instruments and organs has been recognized as a key requirement in the development of high-fidelity surgical simulators. For a nonlinear model, the well-known Poynting effect developed during shearing of the tissue results in normal forces not seen in a linear elastic model. It is demonstrated that the difference in force magnitude for myocardial tissue is larger than the just noticeable difference for contact force discrimination thresholds published in the psychophysics literature. This work also proposes the validation of simulators by careful examination of relevant simulator design parameters that relate to final simulator behaviors affecting clinical outcomes.