A METHOD FOR IMMOBILIZING TISSUE DURING CARDIAC SURGERY

摘要

Surgical methods and instruments are disclosed for performing port-access orclosed-chest coronary artery bypass (CABG) surgery in multivessel coronaryartery disease.In contrast to standard open-chest CABG surgery, which requires a medianstemotomy orother gross thoracotomy to expose the patient's heart, post-access CABGsurgery is performedthrough small incisions or access ports made through the intercostal spacesbetween thepatient's ribs, resulting in greatly reduced pain and morbidity to thepatient. In situ arterialbypass grafts, such as the internal mammary arteries and/or the rightgastroepiploic artery, areprepared for grafting by thoracoscopic or laparoscopic takedown techniques.Free grafts,such as a saphenous vein graft or a free arterial graft, can be used toaugment the in situarterial grafts. The graft vessels are anastomosed to the coronary arteriesunder directvisualization through a cardioscopic microscope inserted through anintercostal access port.Retraction instruments are provided to manipulate the heart within the closedchest of thepatient to expose each of the coronary arteries for visualization andanastomosis. Disclosedare a tunneler and an articulated tunneling grasper for rerouting the graftvessels, and a finger-like retractor, a suction cup retractor, a snare retractor and a loopretractor for manipulatingthe heart. Also disclosed is a port-access topical cooling device forimproving myocardialprotection during the port-access CABG procedure. An alternate surgicalapproach using ananterior mediastinotomy is also described.