Sternum riser device

Abstract

A sternum lift device is disclosed. The sternum lift device may include a panel, a support beam extending across the panel, and a post coupled to a proximal end of the panel. The device may also include an indicator handle coupled to the sternum lift device, an actuator transmission pivotally coupled to the indicator handle, and a housing movably coupled to the actuator transmission. The sternum lift device may include an actuator transmission including a linear rack. The housing may further include a cylindrical gear, wherein the cylindrical gear meshes with the linear rack.

Description

[0001] Citation of Related Applications

[0002] This international application claims priority to U.S. Provisional Patent Application No. 62 / 889,690, filed on August 21, 2019, and entitled “STERNAL ELEVATOR ASSEMBLY.” This international application also claims priority to U.S. Provisional Patent Application No. 62 / 916,591, filed on October 17, 2019, and entitled “STERNAL ELEVATOR ASSEMBLY.” This international application also claims priority to U.S. Provisional Patent Application No. 62 / 989,044, filed on March 13, 2020, and entitled “STERNAL ELEVATOR ASSEMBLY.” All of Applications 62 / 889,690, 62 / 916,591, and 62 / 989,044 are hereby incorporated by reference in their entirety. Technical Field

[0003] The claimed invention relates to minimally invasive surgical devices, and more particularly, to a surgical device for increasing the workable space during minimally invasive surgical procedures. Background Art

[0004] With respect to coronary artery surgery, minimally invasive surgical approaches are receiving increasing attention. Coronary revascularization procedures such as internal thoracic artery (ITA) grafting have demonstrated superior long-term patency and improved patient outcomes in coronary artery bypass graft (CABG) surgery. While conventional approaches to ITA harvesting include a median sternotomy or multiple thoracotomies, minimally invasive approaches are desirable. Minimally invasive procedures associated with revascularization using the left or right internal thoracic artery (ITA) or the left or right internal mammary artery (IMA) can utilize access to the ITA via a subxiphoid approach, wherein increased surgical space is obtained by accessing the internal thoracic artery via an incision at the subxiphoid region.

[0005] When the left internal thoracic artery (LITA) or right internal thoracic artery (RITA) is harvested, anastomosis to the left anterior descending (LAD) coronary artery and to the right coronary artery (RCA), respectively, can be performed without cardiopulmonary bypass (CPB). A significant advantage of this approach is that a perfectly harvested ITA graft can be perfectly anastomosed to the common site on the LAD artery or to the RCA artery. Minimally invasive ITA harvesting procedures involving a subxiphoid approach also produce excellent cosmetic results, are fairly painless, and allow the arterial graft to be performed on a beating heart. Recent approaches to minimally invasive ITA harvesting surgical techniques have been shown to increase the effective length of the ITA bypass, reduce operative time, and improve patient recovery.

[0006] While less invasive surgical approaches for ITA harvesting and CABG have shown promise, visualization, insufflation maintenance, and distal suturing of the coronary anastomosis are technically demanding when performing fully endoscopic coronary artery bypass grafting on a beating heart. A larger working space is required to accommodate the increased range of motion during surgery, as well as space for additional surgical tools such as endoscopes and suturing tools. However, achieving increased working space should ideally maintain chest wall integrity and avoid CPB. Similarly, a minimally invasive surgical approach should not compromise the reliability of the cardiac repair.

[0007] Therefore, there is a need for minimally invasive surgical devices and methods suitable for ITA harvesting and other surgical procedures (such as epicardial lead placement and others), which increase the operating space for harvesting and anastomosis and other surgical procedures during minimally invasive cardiac surgery and other surgical procedures, reduce operating time, and improve patient outcomes. Summary of the Invention

[0008] A sternum riser device is disclosed. The sternum riser may include a panel, a support beam extending across the panel, and a column coupled to a proximal end of the panel. The device may also include an indicator handle coupled to the sternum riser, an actuator transmission pivotally coupled to the indicator handle, and a housing movably coupled to the actuator transmission. The sternum riser device may include an actuator transmission including a linear rack. The housing may further include a cylindrical gear, wherein the cylindrical gear meshes with the linear rack.

[0009] Another sternal riser device is disclosed. The sternal riser may include a panel having a plurality of textured features, a support beam extending across the panel, and a post coupled to a proximal end of the panel. The device may also include an indicator handle removably coupled to the sternal riser, an actuator transmission pivotally coupled to the indicator handle and having a linear rack, and a housing movably coupled to the actuator transmission and having a cylindrical gear and two instrument adapters. BRIEF DESCRIPTION OF THE DRAWINGS

[0010] Figure 1 is an upper right top perspective view of one embodiment of a sternum riser device with a right sternum riser attached.

[0011] Figures 2A to 2E It is an example Figure 1 A series of exploded views of the apparatus of the sternum riser device.

[0012] Figure 3 It is a perspective view of the left sternal ascender.

[0013] Figure 4A 、 Figure 4B 、 Figure 4C 、 Figure 4D 、 Figure 4E and Figure 4F They are Figure 3 Front elevation, left elevation, right elevation, rear elevation, top elevation and bottom elevation of the sternal ascender.

[0014] Figure 5 is a perspective view of the right sternal ascender.

[0015] Figure 6A 、 Figure 6B 、 Figure 6C 、 Figure 6D 、 Figure 6E and Figure 6F They are Figure 5 Front elevation, left elevation, right elevation, rear elevation, top elevation and bottom elevation of the right sternal ascender.

[0016] 7A to 7C This is an example showing Figure 5 The left sternum riser is loaded onto Figure 1 A series of perspective views of the operating steps of the sternum riser device.

[0017] Figure 8 This includes the use of Figure 1 Perspective view of the surgical environment with the sternal riser device.

[0018] 9A to 9D is a series of perspective views illustrating the operational steps of using the sternum riser device in a surgical setting.

[0019] It will be appreciated that for purposes of clarity and where considered appropriate, reference numerals have been repeated among the figures to indicate corresponding features, and that the various elements in the figures are not necessarily drawn to scale in order to better illustrate the features. DETAILED DESCRIPTION

[0020] Figure 1 is a perspective view of one embodiment of a sternum riser device with a right sternum riser attached. Figure 1, an embodiment of the sternal riser assembly 10 is shown in FIG. The right sternal riser 12 defines a panel 14 having a plurality of textural features 15 configured to provide a non-invasive and secure grip on the underside of the thorax when the sternal riser assembly 10 is used in minimally invasive surgery. The panel 14 of the right sternal riser 12 also defines a recess 16 and has a support beam 18 on the underside of the panel 14. The right sternal riser 12 has a mounting post 20 at a proximal end 12P. The mounting post 20 is coupled to a proximal end 22P of the indicator handle 22 at the end of the mounting portion 24 of the indicator handle 22. The right sternal riser 12 is coupled by reversible means, allowing the right sternal riser 82 to be easily removed and replaced with a left sternal riser (not shown in this view). The term riser may be used interchangeably with the terms lifter or elevator, as they both equivalently describe the intended function of the riser and associated apparatus. This coupling means will be described in further detail later. An alternative example of a coupling method is to use a set screw, but other coupling methods will be apparent to those skilled in the art. The indicator handle 22 further defines a grip 26 in the underside of the indicator handle 22, which is configured as an ergonomic grip feature for comfortable use by the surgeon. At the distal end 22D of the indicator handle 22 is a connecting end 28 and a depressible switch 30. Toward the distal end 22D of the indicator handle 22 is a depth indicator mark 27 that is vertically aligned with the distal end 12D of the right sternum riser 12. The connecting end 28 is a coupling point that receives a corresponding connecting end 32 on a linear rack or linear actuator gear 34 by mating with the connecting end 28 and is pivotally attached to a hole or other attachment member not shown in this view by engaging a pivot pin 40 or, alternatively, by other attachment members. The depressible switch 30 can be pressed or actuated to disable a pawl located inside the indicator handle 22 and not shown in this view. The pawl interfaces with a fixed indexing gear located inside the connecting end 32 portion of the linear actuator gear 34. This will be discussed later with respect to Figures 2A to 2E30 . The pawl defines a spring or biasing element that, when at rest, biases one or more teeth defined by the pawl toward a fixed indexing gear, which is not shown in this view but is coupled to the connecting end 32 of the linear actuator gear 34. When the one or more teeth on the pawl intermesh with one or more corresponding teeth or other locking features defined by the fixed indexing gear, this locks the angular position of the linear actuator gear 34 relative to the position of the indicator handle 22. When the switch 30 is pressed or actuated, the pawl is deactivated and temporarily urged away from the fixed indexing gear, thereby allowing free angular movement of the linear actuator gear 34 relative to the indicator handle 22. Releasing the switch 30 causes the pawl to re-engage with the fixed indexing gear to once again engage and lock the angular position of the linear actuator gear 34 relative to the indicator handle 22, which is the position that the linear actuator gear 34 assumes when the switch 30 is released.

[0021] The linear actuator gear 34 further defines a plurality of recesses 38 and a plurality of teeth 36 that mesh with the cylindrical gear 122. The linear actuator gear 34 fits through the actuator slot 42 in the bilateral instrument adapter 44. The bilateral instrument adapter 44 defines a first adapter channel 46 and an opposing second adapter channel (not visible here). The bilateral instrument adapter 44 also defines a plurality of locking mechanisms 100, 102 for locking the bilateral instrument adapter 44 into the surgical device holder on each side. Once the bilateral instrument adapter 44 is attached to the surgical device holder on each side, it can be positioned above the patient by bridging the two surgical device holders across the operating table. Other embodiments may have only a single adapter channel for mounting to a single surgical device holder. Attached to the bilateral instrument adapter 44 is a gear housing 48 that holds the cylindrical gear 122. A handle or lever 50 is coupled to the cylindrical gear 122. Turning the handle 50 rotates the cylindrical gear 122 and, thereby, moves the linear actuator gear 34 back and forth, forming an actuator transmission. In this embodiment, the sternal riser assembly 10 is inserted into an incision below the xiphoid process of a patient undergoing a minimally invasive surgical procedure (such as an ITA harvesting procedure or other surgical procedure) where increased access space below the xiphoid process is beneficial. The faceplate 14 of the right sternal riser 12 can be used to lift the thoracic cavity, thereby increasing the space in the subxiphoid region. A feature of the sternal riser assembly 10 is that the distal end 22D of the indicator handle 22 is substantially the same length as the faceplate 14 of the right sternal riser 12. This, along with depth indicator markings 27 indicating how far the right sternal riser 12, or the right sternal riser if incorporated into the sternal riser device 10, has been inserted into the patient's subxiphoid space, provides a visual indication to the surgeon. The distal end 22D of the indicator handle 22 is substantially aligned with the distal end 12D of the sternal riser 12. The indicator handle 22 is also substantially parallel to the faceplate 14 of the right sternal riser 12, or the faceplate of the right sternal riser. Once the sternum riser device or assembly 10 is inserted into the subxiphoid space, the sternum riser assembly 10 is attached to one or more surgical equipment supports to achieve force stability throughout the minimally invasive surgical procedure. The position of the sternum riser assembly 10 can then be further adjusted by pivoting around the coupling joint of the indicator handle 22 and the linear actuator gear 34. The sternum riser assembly 10 can be further adjusted by rotating the rotating rod 50 and actuating the linear actuator gear 34 in the distal direction. This operation will be described in further detail later.

[0022] Figures 2A to 2E It is an example Figure 1 A series of exploded views of the assembly of the sternum riser device. Figure 2AAs illustrated in FIG, first handle half 22A defines a recess or channel 52 having a mounting slot 54 and a seat 56. The mounting slot 54 and seat 56 defined by channel 52 (also referred to as a T-slot due to its general shape) are configured to removably receive an alignment key on the column of the left or right sternum riser. Second handle half 22B also defines a corresponding recess, not shown in this view. First handle half 22A also defines a second recess 72 at the opposite end, as well as a gear recess 74 and a hole 76. Second handle half 22B also defines a corresponding recess, not shown in this view. Second recess 72 is configured to receive and retain the spring 58, spring plunger 60, and plunger housing 62, which are first assembled together. The pawl gear 64 having a gear 66 and a gearless portion 65, and the fixed indexing gear or pivot gear 68 having a gear keyway 70 are placed into holes 76 and retained in the gear recess 74 on first handle half 22A, respectively. Pawl gear 64 is held against the spring 58, spring plunger 60, and plunger housing 62 assembly, biasing pawl gear 64 against pivot gear 68 until pawl gear 64 is depressed, causing it to slide, disengaging gear 66 from pivot gear 68. This disengages the pivot gear 68, allowing the pivot gear 68 to engage the gearless portion 65 of pawl gear 64, thereby allowing free rotation or pivoting of pivot gear 68. When pawl gear 64 is released, gear 66 relocks with pivot gear 68, preventing further pivoting or rotation of pivot gear 68. The second handle half 22B is then placed over the first handle half 22A and secured using a plurality of rivets 90, which are placed and secured in holes 84, 86, and 88 in the second handle half 22B. While holes and rivets are used here to securely attach the handle halves 22A and 22B together, welding, adhesives, or other means known to those skilled in the art may also be employed.

[0023] Figure 2BThe assembly of the instrument adapter assembly 116 portion of the sternum riser device 10 is illustrated. The first adapter housing 92, having a plurality of holes 95 and a side hole 97, is assembled by placing a first cam 96 having a flat portion 96F into hole 97. A first lever lock 100 having a key 104 is placed into hole 97 and into the first cam 96, such that rotating the first lever lock 100 also rotates the first cam 96 within hole 97. The first lever lock 100 is pivotally attached to the first adapter housing 92 using a rivet 108 placed into a channel 106 on the first lever lock 100. The second adapter housing 94, having a plurality of holes 95 and a side hole (not visible here), is assembled by placing a second cam 98 having a flat portion 98F into hole 97. A second lever lock 102 having a key 110 is placed into a hole on the second adapter housing 94 and into the second cam 98, such that rotating the second lever lock 102 also rotates the second cam 98 within the hole in the second adapter housing 94. The second lever lock 102 is pivotally attached to the second adapter housing 94 using a rivet 114 placed into a channel 112 on the second lever lock 102 .

[0024] Figure 2CContinuing with the assembly of the sternum riser device 10, focus is placed on the linear actuator gear 34. The linear actuator gear 34 has a connecting end 32 that further defines a hole 136 and a plurality of teeth 36 with a plurality of recesses 38 positioned therebetween. The cylindrical gear 122 defines two sides 130, a side channel 128 on each side 130, a slot 124, and two posts 126 (one of which is not visible here). The cylindrical gear is placed into the linear actuator gear 34 with the two posts 126 retained in two adjacent recesses 38. The transmission base 134 is secured to the two posts 126 of the cylindrical gear 122 on opposite sides of the linear actuator gear 34 using two rivets 132. Once fully assembled, the cylindrical gear 122 is rotated in a clockwise or counterclockwise direction, which in turn causes the linear actuator gear to move forward and backward, thereby forming an actuator transmission. As the cylindrical gear 122 rotates, the first pinion or post 126 rotates out of the recess 38 on the linear actuator gear 34 and outward, while the second pin driver (not visible here) remains in the second recess 38 and rotates within it. The first post 126 rotates past the second recess 38 and into the third recess 38, thereby converting the rotary motion into linear motion and moving the linear actuator gear 34 relative to the gear housing 48. Doing this in reverse moves the actuator gear 34 in the opposite direction. The upper rack housing 48, having a central opening 120 and a plurality of holes 118, is then placed over the linear actuator gear 34 and the cylindrical gear 122, such that the cylindrical gear 122 protrudes from the central opening 120 of the upper rack housing 48 and is able to slide along the linear actuator gear 34 as the cylindrical gear 122 rotates. Figure 2D The handle 50 is illustrated as being placed into the cylindrical gear 122 between the two sides 130 and held in place by placing a rivet 119 through the side channel 128 on the cylindrical gear 122 and through the hole 138 on the turning rod 50. An intermediate rack housing 140 having a central hole 142, a plurality of holes 144 and two housing inserts 146 is placed onto the bottom of the linear actuator gear 34 to align with the upper rack housing 48. The holes 118 on the upper rack housing 48 align with the holes 144 on the intermediate rack housing 140. The two housing inserts 146 are configured to hold a captive and allow free rotation of the transmission bottom 134 of the cylindrical gear 122. The handle or turning rod 50 is used to swivel and rotate the cylindrical gear 122 during operation. In Figure 2E The assembly of the sternum riser device 10 is completed by inserting the distal end 22D of the indicator handle 22 into the linear actuator gear 34. The pivot pin 40 is inserted into the hole 136, wherein the pivot pin 148 interlocks with the gear keyway 70 of the pivot gear 68. Figure 2A As shown in the example. Figure 2BThe instrument adapter assembly 116 shown and described is placed onto the bottom of the intermediate rack housing 140, and the holes 95 in the instrument adapter assembly 116 are aligned with the corresponding holes 118 in the upper rack housing 48. A plurality of rivets 150 are then placed into the holes 118 to fixedly join the instrument adapter assembly 116 to the intermediate rack housing 140 and the upper rack housing 48.

[0025] Figure 3 is a perspective view of the left sternal riser 152. This view illustrates the various features defined by the left sternal riser 152. The left sternal riser 152 defines a panel 154 having a plurality of textural features 156 on the opposite side of or belonging to the target anatomical region, a notch 162 at the proximal end 152P, a support beam 160 across the bottom side of the panel 154, and a mounting post 158 ​​for attachment to the sternal riser device. The panel 154 has a circular shape with a thin edge at the distal end 152D of the panel 154 of the left sternal riser 152. The post 158 ​​also defines two opposing alignment and orientation features 164 that are configured to align, slide, and lock the left sternal riser 152 into the handle. These features 164 form a generally T-shape that is configured to fit into the aforementioned T-slot on the indicator handle 22. 7A to 7C The use of this feature is further described. The post 158 ​​also defines an angular front alignment feature 166, which is used to help align and place the left sternal riser in the anatomical notch defined between the ribs and the sternum. When used as part of a sternal riser device, this can be used as a tactile aid to place the sternal riser in the appropriate position. Although the embodiment shown has these characteristics, alternative embodiments of the sternal riser panel may have other shapes or radii and may or may not be sharp. Other embodiments may have other features in addition to the rectangular texture feature 156 shown here, and may include features of other shapes or may not include features of other shapes at all. Other embodiments of the left sternal riser may be made of metal, plastic, composite materials, or mixtures or combinations thereof, or contain alternative alignment or locking methods and features. Figure 4A 、 Figure 4B 、 Figure 4C 、 Figure 4D 、 Figure 4E and Figure 4F They are Figure 3 Front elevation, left elevation, right elevation, rear elevation, top elevation and bottom elevation of the sternal ascender.

[0026] Figure 5is a perspective view of the right sternal riser. This view illustrates the various features defined by the right sternal riser 12. The right sternal riser 12 defines a panel 14 having a plurality of textural features 15 on the opposite side of or belonging to the target anatomical region, a notch 16 at the proximal end 12P, a support beam across the bottom side of the panel 14, not shown here, and a mounting post 20 for attachment to the sternal riser assembly. The panel 14 has a circular shape with a thin edge at the distal end 12D of the panel 14 of the right sternal riser 12. The post 20 also defines two opposing alignment and orientation features 168 that are configured to align, slide, and lock the left sternal riser 12 into the handle. These features 168 form a generally T-shape that is configured to fit into the aforementioned T-slot on the indicator handle 22. 7A to 7C The use of this feature is further described. The post 20 also defines an angular front alignment feature 170 that is used to help align and place the left sternal riser in the anatomical notch defined between the ribs and the sternum. When used as part of a sternal riser device, this can be used as a tactile aid to place the sternal riser in the appropriate position. Although the embodiment shown has these characteristics, alternative embodiments may have other shapes or radii and may or may not be sharp. Other embodiments may have other features in addition to the rectangular texture features 15 shown here and may include features of other shapes or may not include features of other shapes at all. Other embodiments of the right sternal riser may be made of metal, plastic, composite materials, or mixtures or combinations thereof. Figure 6A 、 Figure 6B 、 Figure 6C 、 Figure 6D 、 Figure 6E and Figure 6F They are Figure 5 Front elevation, left elevation, right elevation, rear elevation, top elevation and bottom elevation of the right sternal ascender.

[0027] 7A to 7C This is an example showing Figure 5 The left sternum riser is loaded onto Figure 1 A series of perspective views of the steps in the operation of the sternum lift device. The appropriate left sternum lift or right sternum lift is selected depending on the area of ​​interest for the minimally invasive surgical procedure that requires lifting the patient's sternum upward. Figure 7A The right sternum riser 12 is shown aligned with and proximate to the t-slot 54 of the indicator handle 22 of the sternum lift device 10, wherein the orientation feature 168 on the post 20 of the right sternum riser 12 is moved toward direction 169 and fully inserted into the slot 54 of the indicator handle 22. Once inserted, as shown Figure 7B, the right sternum riser 12 is pulled downwardly in direction 171 toward the seat 56 in the slot 54 of the indicator handle 22 to lock the right sternum riser 12 into place. Figure 7C The right sternum riser 12 is shown fully inserted and locked into the indicator handle 22 .

[0028] Figure 8 This includes the use of Figure 1 1 . A perspective view of a surgical environment in which a sternum riser device is provided. In the illustrated surgical environment, an operating table 174 having rails 176 and a patient 172 prepared for surgery on the operating table 174 are shown. Positioned on the rails 176 is a first surgical instrument support assembly 178 having a first central surgical instrument support 182 attached thereto. The first surgical instrument support assembly 178 is attached to the sternum riser device 10 at the first adapter channel 46. On the opposite side of the operating table, a second surgical instrument support assembly 180 is attached to an opposite rail, which is not visible here. The second surgical instrument support assembly 180 has a second central surgical instrument support 184 attached thereto and is also attached to a corresponding second adapter channel (not visible here) on the opposite side of the sternum riser device 10. Each of the first and second central surgical equipment supports 182, 184 can be utilized to position and hold one or more surgical equipment or tools, such as the sternum riser device 10 or alternatively, an observation instrument holder, cannula, or other surgical implements, during minimally invasive or other surgical procedures. In this configuration, the first and second central surgical equipment supports 182, 184 are shown bridged over the patient 172 to securely position the sternum riser device 10 in an initial, centralized position relative to the patient 172 on the operating table 174.

[0029] 9A to 9D is a series of perspective views illustrating the steps of using the sternum riser device in a surgical setting. 9A to 9D, portions of the patient 172 are shown in cross-section and portions of various instruments have been removed from view for purposes of clarity. The patient 172 is shown prepared for surgery with an incision 186 made adjacent the sternum 188 just below the xiphoid process at the sternal notch. The sternal elevator apparatus 10 is secured to a first central surgical equipment support 182 and a second central surgical equipment support 184 which are securely mounted to the operating table 174. The upper rack housing 48 or dome trapezoidal member is on top of the toothed linear rack and thereby enables the rack 34 to subsequently be moved upwardly. The angle of the indicator handle 22 and therefore the angle of the sternal elevator 12 has been adjusted by pressing a pivot button or depressible switch 30 on the indicator handle 22, thereby allowing the indicator handle 22 to move relative to the linear actuator gear 34. As Figure 9B , the distal end 12D of the sternal riser 12 is inserted into the incision 186 in the direction 190 until the sternal riser 12 is in the desired position along the sternum 188. The sternal riser 12 is aligned with the anatomy of the sternum 188 by measuring the position of the tips of the panels of the sternal riser 12 within the thoracic cavity using the depth indicator 27. At this point, the first and second central surgical instrument supports 182, 184 are locked and secured in place after proper adjustment. Figure 9C The lever 50 is illustrated unlocked and moved counterclockwise 192 to raise the sternum riser 12 and indicator handle 22 in direction 194, which applies retraction to the sternum 188 and creates a subxiphoid space 198 for entry. Figure 9D The final state of this described procedure is illustrated in , where the rotation lever 50 can be moved to the full up or down position to lock the gear housing 48 in place, thereby preventing any further movement of the sternum riser 12 .

[0030] The various advantages of the sternum riser assembly have been discussed above. The embodiments discussed herein have been described by way of example in this specification. It will be understood by those skilled in the art that the foregoing detailed disclosure is intended to be presented by way of example only and is not restrictive. As an example only, although the end effectors in the examples discussed generally focus on the use of observation instruments, such systems can be used to position other types of surgical equipment. Various changes, improvements and modifications will occur to and are contemplated by those skilled in the art, but are not expressly described herein. Such changes, improvements and modifications are intended to be suggested thereby and are within the spirit and scope of the claimed invention. The drawings included herein are not necessarily drawn to scale. In addition, the recited order of processing elements or sequences or the use of numbers, letters or other names therefor is not intended to limit the claims to any order, except as may be specified in the claims. Therefore, the present invention is limited only by the appended claims and their equivalents.

Claims

1. A sternum riser device for use during minimally invasive surgery, comprising: an indicator handle configured for grasping, wherein the indicator handle has a proximal end and a distal end; Sternum riser, including: a panel configured to elevate the thorax, the panel having a bottom side; a support beam across the underside of the panel; and a post for attachment to the sternal riser device, wherein the post is coupled to a proximal end of the panel, wherein the post is configured to be inserted into and locked into the proximal end of the indicator handle; an actuator transmission having a linear rack pivotally coupled to the distal end of the indicator handle; and A housing is movably coupled to the actuator transmission along the linear rack.

2. The sternum riser device according to claim 1, wherein: The sternum riser is removably coupled to the indicator handle.

3. The sternum riser device according to claim 1, wherein: The post further includes an alignment key.

4. The sternum riser device according to claim 1, wherein: The panel further includes angled alignment features on the distal ends of the posts.

5. The sternum riser device according to claim 1, wherein: The panel further includes a plurality of textural features.

6. The sternum riser device according to claim 1, wherein: The panel further includes a notch at a proximal end of the panel.

7. The sternum riser device according to claim 1, wherein: The indicator handle further includes a mounting slot and a recess.

8. The sternum riser device according to claim 7, wherein: The mounting slot is configured to removably receive an alignment key on the post.

9. The sternum riser device according to claim 8, wherein: The recess is configured to removably receive the alignment key on the post.

10. The sternum riser device according to claim 1, wherein: The indicator handle is parallel to the face plate of the sternum riser.

11. The sternum riser device according to claim 1, wherein: The distal end of the indicator handle is aligned with the distal end of the panel of the sternum riser.

12. The sternum riser device according to claim 1, wherein: The housing further includes a spur gear.

13. The sternum riser device according to claim 12, wherein: The cylindrical gear is meshed with the linear rack.

14. The sternum riser device according to claim 1, wherein: The housing further includes an instrument adapter.

15. The sternum riser device according to claim 1, wherein The housing further includes two instrument adapters.

16. The sternum riser device of claim 1, wherein: The indicator handle further includes a pawl; and The actuator transmission further includes a fixed indexing gear.

17. The sternum riser device according to claim 16, wherein: The fixed indexing gear is configured to interface with the pawl on the indicator handle.

18. The sternum riser device according to claim 17, wherein: The indicator handle further includes a switch configured to disable the pawl to disengage, thereby allowing the fixed indexing gear to freely rotate relative to the indicator handle.

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