Sternal ascender device

Abstract

A sternum elevator device is disclosed. The sternum elevator includes a panel, a support beam spanning the panel, and a post coupled to a proximal end of the panel. The device also includes an indicator handle coupled to the sternum elevator, an actuator drive pivotally coupled to the indicator handle, and a housing movably coupled to the actuator drive. The sternum elevator device may have an actuator drive incorporating a linear rack. The housing may further include a cylindrical gear. The cylindrical gear engages with the linear rack.

Description

[Technical Field]

[0001] The present invention relates to minimally invasive surgical devices, and more particularly to surgical devices used to increase the operable space during minimally invasive surgery. [Background technology]

[0002] Minimally invasive surgical approaches have gained increasing interest in relation to coronary artery surgery. Coronary revascularization procedures, such as internal thoracic artery (ITA) transplantation, have shown excellent long-term patency and patient improvement in coronary artery bypass graft (CABG) surgery.

[0003] While traditional approaches to ITA harvesting include a median sternotomy or multiple median sternotomies, a minimally invasive approach is desirable. Minimally invasive procedures involving revascularization using either the left or right internal thoracic artery (ITA) or the left or right mammary artery (IMA) can utilize subxiphoid access to the ITA. Accessing the ITA through a subxiphoid incision provides a large surgical space.

[0004] Harvesting either the left internal thoracic artery (LITA) or the right internal thoracic artery (RITA) allows anastomosis to the left anterior descending (LAD) coronary artery and right coronary artery (RCA) without cardiopulmonary bypass (CPB). A key advantage of this approach is that the graft vessel of the harvested ITA is perfectly anastomosed to the normal site of the LAD or RCA artery. Minimally invasive ITA harvest procedures with subxiphoid access provide excellent cosmetic results, minimal pain, and allow arterial grafting to be performed on the beating heart. Recent approaches to minimally invasive ITA harvest surgical techniques have resulted in increased effective ITA bypass length, reduced operative time, and improved patient recovery.

[0005] Although minimally invasive surgical approaches for ITA harvesting and CABG are promising, the visualization, insufflation, and distal suturing of coronary anastomoses during fully endoscopic coronary artery bypass grafting on a beating heart are technically demanding. A large working space is required for a wide range of motion during surgery, as well as space for additional surgical instruments such as endoscopes and suturing devices. However, increased working space ideally requires maintaining the integrity of the chest wall and avoiding cardiopulmonary bypass (CPB). Likewise, minimally invasive surgical approaches should not compromise the reliability of cardiac repair.

[0006] Therefore, there is a need for minimally invasive surgical devices and methods applicable to ITA harvesting and other procedures (e.g., epicardial lead placement) that increase the maneuverable space for harvesting, anastomosis, and other procedures, reduce surgical time, and improve patient outcomes during minimally invasive cardiac and other procedures. Summary of the Invention

[0007] A sternal ascender device is disclosed. The sternal ascender includes a panel, a support beam spanning the panel, and a post coupled to a proximal end of the panel. The device further includes an indicator handle coupled to the sternal ascender, an actuator drive pivotally coupled to the indicator handle, and a housing movably coupled to the actuator drive. The sternal ascender device may include an actuator drive incorporating a linear rack. The housing may include a cylindrical gear that engages the linear rack.

[0008] Another sternal ascender device is disclosed. The sternal ascender includes a panel having a plurality of textured features, a support beam spanning the panel, and a post coupled to a proximal end of the panel. The device further includes an indicator handle removably coupled to the sternal ascender, an actuator drive pivotally coupled to the indicator handle and having a linear rack, and a housing movably coupled to the actuator drive and having a cylindrical gear and two instrument adapters. [Brief explanation of the drawings]

[0009] [Figure 1] FIG. 1 illustrates an upper right perspective view of one embodiment of a sternal ascender device with a right sternal ascender attached.

[0010] [Figure 2A] 2 is an exploded view showing the assembly process of the sternal ascender device of FIG. 1. [Figure 2B] 10A to 10C are exploded views showing the assembly process of the sternal ascender device. [Figure 2C] 10A to 10C are exploded views showing the assembly process of the sternal ascender device. [Figure 2D] 10A to 10C are exploded views showing the assembly process of the sternal ascender device. [Figure 2E] 10A to 10C are exploded views showing the assembly process of the sternal ascender device.

[0011] [Figure 3] FIG. 1 is a perspective view of the left sternal ascender.

[0012] [Figure 4A] FIG. 4 is a front view of the sternal ascender of FIG. [Figure 4B] FIG. 2 is a left side view of the sternal ascender. [Figure 4C] FIG. 2 is a right side view of the sternal ascender. [Figure 4D] FIG. 2 is a rear view of the sternal ascender. [Figure 4E] FIG. 2 is a top view of the sternal ascender. [Figure 4F] FIG. 2 is a bottom view of the sternal ascender.

[0013] [Figure 5] FIG. 1 is a perspective view of the right sternal ascender.

[0014] [Figure 6A] FIG. 6 is a front view of the right sternal ascender of FIG. [Figure 6B] FIG. [Figure 6C] FIG. [Figure 6D] FIG. [Figure 6E] FIG. [Figure 6F] FIG.

[0015] [Figure 7A] 6A-6C are perspective views illustrating a procedure for loading the right sternal ascender of FIG. 5 into the sternal ascender device of FIG. 1. [Figure 7B] FIG. [Figure 7C] FIG.

[0016] [Figure 8] FIG. 2 is a perspective view of a surgical set including the use of the sternal ascender device of FIG. 1.

[0017] [Figure 9A] 10A-10C are perspective views illustrating the steps of using the sternal ascender device in surgery. [Figure 9B] FIG. [Figure 9C] FIG. [Figure 9D] FIG.

[0018] It will be understood that for purposes of clarity, and where considered appropriate, reference numerals have been repeated in the figures to indicate corresponding features, and that in order to better illustrate the features, the various elements of the drawings have not necessarily been drawn to scale.

[0019] FIG. 1 is a perspective view of one embodiment of a sternal ascender device with a right sternal ascender attached. The sternal ascender device 10 shown in FIG. 1 includes a right sternal ascender 12. The right sternal ascender 12 defines a panel 14 having several textured features 15. The textured features 15 are configured to provide a firm grip on the underside of the rib cage without traumatizing human tissue when the sternal ascender assembly 10 is used in minimally invasive surgical procedures. The panel 14 of the right sternal ascender 12 also defines a notch 16 and has a support beam 18 below the panel 14. The right sternal ascender 12 includes a mounting post 20 at a proximal end 12P. The mounting post 20 is coupled to the proximal end 22P of the indicator handle 22 at the end of the mounting portion 24 of the indicator handle 22. The right sternal ascender 12 is attached by reversible means, allowing it to be easily removed and replaced with a left sternal ascender (not shown). The term "ascender" is interchangeable with the terms elevator or lifter, which equally describe the intended function of the ascender and associated devices. The attachment means are described in more detail below. An alternative attachment method is the use of a locking screw, although others may be known to those skilled in the art. The indicator handle 22 defines a grip 26 on its underside. The grip 26 is configured to provide an ergonomic grip for ease of use by the surgeon. The distal end 22D of the indicator handle 22 includes a connecting end 28 and a depressible switch 30. The distal end 22D of the indicator handle 22 includes a depth indicator mark 27 that is vertically aligned with the distal end 12D of the right sternal ascender 12. Link end 28 is a connection point that matingly receives a corresponding link end 32 of a linear rack (linear actuator gear) 34. Link end 28 is rotatably attached to link end 32 by connecting a pivot pin 40 or other attachment means to a hole or other attachment means (not shown in this view).Depressible switch 30 can be depressed (activated) to defeat a pawl member (not shown) located within indicator handle 22. The pawl member engages a fixed indexing gear located within connecting end 32 of linear actuator gear 34, as described in more detail below with reference to FIGS. 2A-2E. The pawl member defines a spring (biasing element) that, when at rest, biases one or more teeth defined by the pawl member toward the fixed indexing gear. This fixed indexing gear (not shown) is coupled to connecting end 32 of linear actuator gear 34. When one or more teeth of the pawl member engage one or more corresponding teeth (or other locking feature) defined by the fixed indexing gear, the angular position of linear actuator gear 34 is locked relative to the position of indicator handle 22. When switch 30 is depressed (activated), the pawl member is defeated and temporarily displaced from the fixed indexing gear, allowing free angular movement of linear actuator gear 34 relative to indicator handle 22. Releasing the switch 30 re-engages the pawl member and fixed indexing gear, thereby re-locking the angular position of the linear actuator gear 34 relative to the indicator handle 22 (the angular position it was in when the switch 30 was released).

[0020] The linear actuator gear 34 further defines several teeth 36 and several recesses 38 that engage with a cylinder gear 122. The linear actuator gear 34 mates with a dual-sided instrument adapter 44 via an actuator slot 42. The dual-sided instrument adapter 44 defines a first adapter channel 46 and an opposing second adapter channel (not visible in this view). The dual-sided instrument adapter 44 also defines several locking mechanisms 100, 102 for locking the dual-sided instrument adapter 44 to a surgical instrument holder on each side. Once the dual-sided instrument adapter 44 is attached to surgical instrument holders on both sides, the instrument adapter 44 can be positioned on a patient by connecting the two surgical instrument holders across the operating table. Other embodiments may have only a single adapter channel for attachment to a single surgical instrument holder. Attached to the dual-sided instrument adapter 44 is a gear housing 48 that holds the cylinder gear 122. A handle (pivot bar) 50 is coupled to the cylinder gear 122. Turning the handle 50 rotates the cylinder gear 122, which moves the linear actuator gear 34 back and forth, creating the actuator drive. In this embodiment, the sternal ascender assembly 10 is inserted into a patient's subxiphoid incision during a minimally invasive procedure (ITA harvest procedure or other surgery) in which increased subxiphoid access space is desired. The panel 14 of the right sternal ascender 12 can be used to elevate the rib cage, thereby increasing space in the subxiphoid region. One feature of the sternal ascender assembly 10 is that the length of the tip 22D of the indicator handle 22 is substantially the same as the length of the panel 14 of the right sternal ascender 12. This, along with the depth indicator markings 27, provides the surgeon with a visual indication of how far the right sternal ascender 12 or left sternal ascender (the sternal ascender mounted on the sternal ascender device 10) has been inserted into the patient's subxiphoid cavity. The tip 22D of the indicator handle 22 is substantially aligned with the tip 12D of the sternal ascender 12.The indicator handle 22 is also substantially parallel to the panel 14 of the right sternal ascender 12 or the panel 14 of the left sternal ascender. Once the sternal ascender device (assembly) 10 is inserted into the subxiphoid cavity, the sternal ascender assembly 10 is attached to one or more surgical instrument holders, which provides force stabilization throughout the minimally invasive procedure. Additionally, the position of the sternal ascender assembly 10 can be adjusted by pivoting the indicator handle 22 about the coupling joint with the linear actuator gear 34. The sternal ascender assembly 10 can be further adjusted by rotating the pivot bar 50 to actuate the linear actuator gear 34 distally, as will be described in more detail below.

[0021] 2A-2E are exploded views illustrating the assembly sequence of the sternal ascender device of FIG. 1. As shown in FIG. 2A, the first handle half 22A defines a channel 52 having a mounting slot 54 and a seat 56. The mounting slot 54 and seat 56 defined by the channel 52, also referred to as a T-slot based on their shape, are configured to removably receive an alignment key for either the left or right sternal ascender post. The second handle half 22B also defines a corresponding recess (not shown in this view). The first handle half 22A also defines a second recess 72, a gear recess 74, and a hole 76 at the opposite end. The second handle half 22B also defines a corresponding recess (not shown in this view). The second recess 72 is configured to receive and retain the spring 58, spring plunger 60, and plunger housing 62, which are first assembled together. A pawl gear 64 having a gear portion 66 and a non-gear portion 65 is positioned within a bore 76 in the first handle half 22A. A fixed indexing gear (pivot gear) 68 having a keyway 70 is retained in the gear recess 74 in the first handle half 22A. The pawl gear 64 is retained against the assembly of the spring 58, spring plunger 60, and plunger housing 62, which biases the pawl gear 64 toward the pivot gear 68 until the pawl gear 64 is pushed and slides. When the pawl gear 64 slides, the gear portion 66 disengages from the pivot gear 68, which then engages the non-gear portion 65 of the pawl gear 64. This allows the pivot gear 68 to rotate freely. When pawl gear 64 is released, gear portion 66 relocks pivot gear 68, preventing further pivoting (rotation) of pivot gear 68. Second handle half 22B is placed over first handle half 22A and secured using several rivets 90 that are placed and secured within holes 84, 86, 88 in second handle half 22B. In this embodiment, holes and rivets are used to secure and attach handle halves 22A, 22B together, although welding, adhesives, or other means known to those skilled in the art could also be used.

[0022] 2B illustrates the assembly process for the instrument adapter assembly 116 portion of the sternal ascender device 10. A first adapter housing 92, having several holes 95 and a side hole 97, is assembled by placing a first cam 96, having a flat 96F, into the hole 97. A first lever lock 100, having a key 104, is placed into the hole 97 and the first cam 96, such that rotating the first lever lock 100 also rotates the first cam 96 within the hole 97. The first lever lock 100 is pivotally attached to the first adapter housing 92 using a rivet 108, which is placed in a channel 106 of the first lever lock 100. A second adapter housing 94, having several holes 95 and a side hole (not visible in this view), is assembled by placing a second cam 98, having a flat 98F, into the hole 97. A second lever lock 102 having a key 110 is disposed within the hole in the second adapter housing 94 and 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 disposed within a channel 112 in the second lever lock 102.

[0023] FIG. 2C illustrates the assembly process for the sternal ascender device 10, focusing on the linear actuator gear 34. The linear actuator gear 34 has a connecting end 32 and further defines a hole 136, several teeth 36, and recesses 38 disposed between the teeth. The cylinder gear 122 defines two side portions 130, a side channel 128 in the side portion 130, a slot 124, and two posts 126 (one of which is visible in this view). The cylinder gear 122 is positioned on the linear actuator gear 34, with the two posts 126 held in two adjacent recesses 38. A drive bottom 134 is secured to the two posts 126 of the cylinder gear 122 by two rivets 132 on the opposite side of the linear actuator gear 34. When fully assembled, the cylinder gear 122 is rotated clockwise or counterclockwise, which moves the linear actuator gear back and forth, forming the actuator drive. As the cylinder gear 122 rotates, the first pinion (post) 126 rotates out of the recess 38 of the linear actuator gear 34, while the second pin driver (not visible in this view) rotates within the second recess 38. The first post 126 rotates through the second recess 38 and into the third recess 38. In this way, the rotational motion is converted into linear motion, moving the linear actuator gear 34 relative to the gear housing 48. Reversing this motion causes the actuator gear 34 to move in the opposite direction. Next, an upper rack housing 48, which has a central opening 120 and several holes 118, is placed over the linear actuator gear 34 and cylinder gear 122, with the cylinder gear 122 protruding from the central opening 120 of the upper rack housing 48. This allows the upper rack housing 48 to slide along the linear actuator gear 34 as the cylinder gear 122 rotates. FIG. 2D shows the handle 50. The handle 50 is placed on the cylinder gear 122 between the two side portions 130 and is held in place by passing a rivet 119 through a side channel 128 in the cylinder gear 122 and through a hole 138 in the pivot bar 50.A middle rack housing 140 is positioned at the bottom of the linear actuator gear 34 and is aligned with the upper rack housing 48. The middle rack housing 140 has a central hole 142, several holes 144, and two housing inserts 146. The hole 118 in the upper rack housing 48 is aligned with the hole 144 in the middle rack housing 140. The two housing inserts 146 are configured to restrain the drive bottom 344 of the cylinder gear 122 while allowing free rotation. A handle (pivot bar) 50 is used to rotate the cylinder gear 122 during surgery. As shown in FIG. 2E, assembly of the sternal ascender device 10 is completed by inserting the tip 22D of the indicator handle 22 into the linear actuator gear 34. The pivot pin 40 is inserted into the hole 136 with the post 148 of the pivot pin engaging the gear keyway 70 of the pivot gear 68. Its function is illustrated in FIG. 2A. 2B is placed at the bottom of the mid-rack housing 140, with the holes 95 in the instrument adapter assembly 116 aligned with the corresponding holes 118 in the upper rack housing 48. Several rivets 150 are then placed in the holes 118 to securely couple the instrument adapter assembly 116 to the mid-rack housing 140 and the upper rack housing 48.

[0024] FIG. 3 is a perspective view of the left sternal ascender. This view illustrates various features defined by the left sternal ascender 152. The left sternal ascender 152 includes a panel 154, a notch 162 at its proximal end 152P, a support beam 160 across the underside of the panel 154, and a mounting post 158 ​​for attachment to a sternal ascender device. The panel 154 includes several textured features 156 on the side opposite the anatomical region being operated on. The panel 154 of the left sternal ascender 152 has a rounded shape with slight edges at its distal end 152D. The post 158 ​​also defines two opposing alignment and orientation features 164. These features 164 are configured to align, slide, and lock the left sternal ascender 152 relative to the handle. These features 164 are generally T-shaped and are configured to fit into the aforementioned T-slots of the indicator handle 22. The use of this feature is further described with reference to Figures 7A-7C. The post 158 ​​also defines an angled anterior alignment feature 166. This feature 166 helps align and position the left sternal ascender in the anatomical notch defined between the ribs and the sternum. This serves as a tactile aid for proper placement when the sternal ascender is used as part of a sternal ascender device. While the illustrated embodiment has these features, alternative embodiments of the sternal ascender panels may have other shapes or radii, and may be sharp or non-sharp. Still other embodiments may have other features besides the rectangular textured feature 156 shown here, may include features of other shapes, or may not include a textured feature at all. Other embodiments of the left sternal ascender may be formed from metal, plastic, composite materials, or combinations thereof, and may include alternative alignment and locking methods and features. 4A, 4B, 4C, 4D, 4E, and 4F are front, left, right, back, top, and bottom views, respectively, of the sternal ascender of FIG. 3.

[0025] FIG. 5 is a perspective view of the right sternal ascender. This view illustrates various features defined by the right sternal ascender 12. The right sternal ascender 12 includes a panel 14, a notch 16 at the proximal end 12P, a support beam (not shown) across the underside of the panel 14, and a mounting post 20 for attachment to a sternal ascender device. The panel 14 includes several textured features 15 on the side opposite the anatomical region to be operated on. The panel 14 of the right sternal ascender 12 has a rounded shape with slight edges at the distal end 12D. The post 20 also defines two opposing alignment and orientation features 168. These features 168 are configured to align, slide, and lock the right sternal ascender 12 relative to the handle. These features 168 are generally T-shaped and are configured to fit into the aforementioned T-slots of the indicator handle 22. The use of this feature is further described with reference to Figures 7A-7C. The post 20 also defines an angled anterior alignment feature 170. This feature 170 helps align and position the right sternal ascender in the anatomical notch defined between the ribs and the sternum. This serves as a tactile aid for proper placement when using the sternal ascender as part of a sternal ascender device. While the illustrated embodiment has these features, alternative embodiments may have other shapes or radii, and may be sharp or non-sharp. Still other embodiments may have other attachment features other than the rectangular textured feature 15 shown here, may include features of other shapes, or may not include a textured feature at all. Other embodiments of the right sternal ascender may be formed from metal, plastic, composite material, or a combination thereof. 6A, 6B, 6C, 6D, 6E, and 6F are front, left, right, back, top, and bottom views, respectively, of the sternal ascender of FIG.

[0026] Figures 7A-7C are perspective views illustrating the sequence of steps for loading the right sternal ascender of Figure 5 into the sternal ascender device of Figure 1. The appropriate sternal ascender (left or right) is selected depending on the area of ​​minimally invasive surgery requiring elevation of the patient's sternum. Figure 7A shows the right sternal ascender 12 aligned with and positioned near the T-slot 54 of the indicator handle 22 of the sternal elevator device 10. The orientation feature 168 of the post 20 of the right sternal ascender 12 moves in direction 169 until it is fully inserted into the slot 54 of the indicator handle 22. Once inserted as shown in Figure 7B, the right sternal ascender 12 is pulled downward in direction 171 toward the seat 56 of the slot 54 of the indicator handle 22, thereby locking the right sternal ascender 12 into place. Figure 7C shows the right sternal ascender 12 fully inserted and locked into the indicator handle 22.

[0027] Figure 8 is a perspective view of a surgical set that includes the use of the sternal ascender device of Figure 1. The surgical set shown includes an operating table 174 having rails 176 and a patient 172 on the operating table 174 awaiting surgery. Attached to the rails 176 is a first surgical instrument holder device 178 having a first central surgical instrument holder 182. The first surgical instrument holder device 178 is attached to the sternal ascender device 10 in the first adapter channel 46. On the opposite side of the operating table, a second surgical instrument holder device 180 is attached to the opposite rail (not visible in this view). The second surgical instrument holder device 180 has a second central surgical instrument holder 184 and is attached to a second adapter channel (not visible in this view) on the opposite side of the sternal ascender device 10. During minimally invasive or other procedures, the first central surgical instrument holder 182 and the second central surgical instrument holder 184 can each be utilized to position and hold one or more of the sternal ascender device 10, a scope holder, a cannula, or other surgical instruments and tools. In this configuration, the first central surgical instrument holder 182 and the second central outer surgical instrument holder 184 extend beyond the patient 172, thereby securely positioning the sternal ascender device 10 in an initial, central position relative to the patient 172 on the operating table 174.

[0028] Figures 9A-9D are perspective views illustrating a sequence of steps for using the sternal ascender device in surgery. In Figures 9A-9D, a patient 172 is shown partially in cross section, with various instruments omitted for clarity. The patient 172 is shown prepared for surgery. An incision 186 has been made in the patient just below the xiphoid process (in the sternal notch near the sternum 188). The sternal elevator device 10 is secured to a first central surgical instrument holder 182 and a second central surgical instrument holder 184, which are securely attached to the operating table 174. The upper rack housing 48 (keystone of the arch) rests atop the toothed linear rack, allowing subsequent upward movement of the rack 34. The angle of the indicator handle 22, and therefore the angle of the sternal ascender 12, can be adjusted by depressing the pivot button 30 on the indicator handle 22 to move the indicator handle 22 relative to the linear actuator gear 34. As shown in FIG. 9B, the tip 12D of the sternal ascender 12 is inserted into the incision 186 in a direction 190 until the sternal ascender 12 is in the desired position along the sternum 188. The sternal ascender 12 is aligned with the anatomical structure of the sternum 188. This alignment is achieved using the depth indicator 27 to determine the position of the tip of the sternal ascender 12 panel within the chest. At this point, the first central surgical instrument holder 182 and the second central surgical instrument holder 184 are properly adjusted and locked into place. FIG. 9C shows the swivel bar 50 unlocked and rotated counterclockwise 192, thereby raising the sternal ascender 12 and indicator handle 22 in a direction 194. This retracts the sternum 188, creating a subxiphoid space 198 for access. The end state of the described procedure is shown in FIG. 9D. At this point, the pivot bar 50 can be moved to the fully up or down position to lock the gear housing 48 in place and prevent further movement of the sternal ascender 12.

[0029] Various advantages of the sternal ascender device have been discussed. The embodiments discussed herein are described by way of example. Those skilled in the art will appreciate that the foregoing detailed disclosure is intended to be presented by way of example only, and not by way of limitation. By way of example, while the end effectors discussed have often focused on the use of a scope, the system can be used to position other types of surgical instruments. Although not expressly described herein, various changes, improvements, and modifications will occur to those skilled in the art. Although not expressly described herein, various changes, improvements, and modifications will occur to those skilled in the art. These changes, improvements, and modifications are intended to be suggested herein and are within the spirit and scope of the claimed invention. The drawings are not necessarily to scale. Furthermore, the described order of processing or sequence of elements, or numerical, letter, or other designations, therefore, are not intended to limit the claims to any order, unless otherwise specified in the claims. The present invention is therefore limited only by the following claims and equivalents thereof.

Claims

1. a sternal ascender including a panel extending from a proximal end to a distal end, a support beam as part of the panel, the support beam crossing an underside of the panel and supporting the panel, and a post protruding from the proximal end of the panel; an elongated indicator handle extending from a proximal end to a distal end; an elongated linear actuator gear extending from a proximal end to a distal end; a housing coupled to a portion of the linear actuator gear; Equipped with the linear actuator gear is coupled to the housing so as to be displaceable relative to the housing, and the distal end of the indicator handle is rotatably coupled to the proximal end of the linear actuator gear; a sternal ascender device, wherein the post of the sternal ascender is removably coupled directly to a portion of the base end of the indicator handle, and wherein a depth indication mark on the tip of the indicator handle is aligned with the tip of the panel of the sternal ascender.

2. The sternal ascender device of claim 1 , wherein the panel further comprises a plurality of texture features.

3. 2. The sternal ascender device of claim 1, wherein the portion of the proximal end of the indicator handle includes a slot configured to removably receive an alignment key formed in the post.

4. 2. The sternal ascender device of claim 1, wherein the indicator handle extends from the proximal end to the distal end along a handle axis, the panel extends from the proximal end to the distal end along a panel axis, and the handle axis is parallel to the panel axis of the panel of the sternal ascender.

5. 2. The sternal ascender device of claim 1, wherein the housing further includes a cylindrical gear, a portion of the cylindrical gear engaging the portion of the linear actuator gear to displace the linear actuator gear relative to the housing.

6. a pawl member disposed within the indicator handle; and a fixed index gear coupled to the proximal end of the linear actuator gear; when the pawl member is in a first fixed position relative to the fixed indexing gear, a portion of the pawl member selectively engages a portion of the fixed indexing gear to prevent the proximal end of the linear actuator gear from rotating relative to the distal end of the indicator handle; 2. The sternal ascender device of claim 1, wherein when the pawl member is in a second unlocked position relative to the fixed indexing gear, the portion of the pawl member disengages from the portion of the fixed indexing gear to allow the proximal end of the linear actuator gear to rotate relative to the distal end of the indicator handle.

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