Sternal Ascender Rack Gear Subxiphoid Space

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Solution Overview

Problem

Minimally invasive surgical procedures for coronary revascularization, such as ITA harvesting, face challenges in achieving sufficient operable space without compromising chest wall integrity or requiring cardiopulmonary bypass, while maintaining the reliability of cardiac repair and improving patient outcomes.

Innovation Solution

A sternal ascender apparatus that includes a panel with textural features, a support beam, and a post, coupled with an actuator drive incorporating a linear rack and cylindrical gear, allowing for adjustable lifting of the ribcage to increase subxiphoid space during surgical procedures, enabling better visualization and tool access without cardiopulmonary bypass.

Engineering Contradictions & Design Principles

VSEngineering Contradiction Analysis

1Productivity

If minimally invasive surgical approach is used for ITA harvesting, then patient recovery is improved and cosmetic results are superior, but operable space is reduced and surgical complexity increases

Engineering Contradiction:

Improvepatient recoveryVSAvoidoperable space

Core Design Contradiction:

ProductivityVSArea of stationary object

Solution Approach 1:

The sternal ascender apparatus introduces a vertical dimension to create working space. By lifting the sternum upward along the vertical axis, the device creates subxiphoid access space without requiring lateral chest wall retraction or traditional sternotomy, thus maintaining minimally invasive benefits while providing adequate surgical workspace.

Inventive Principle:

Principle #17Another dimension (Dimensionality change)

Solution Approach 2:

The sternal ascender acts as an intermediary mechanical device between the surgeon and the surgical field. It provides a controlled mechanism for creating and maintaining working space, allowing surgical tools and endoscopes to access the internal thoracic arteries through the subxiphoid region without direct manual manipulation of the chest wall.

Inventive Principle:

Principle #24Intermediary (Mediator)

2Area of stationary object

If larger working space is achieved through traditional sternotomy, then operable space is increased, but chest wall integrity is compromised and invasiveness increases

Engineering Contradiction:

Improveworking spaceVSAvoidchest wall integrity

Core Design Contradiction:

Area of stationary objectVSObject-affected harmful factors

Solution Approach 1:

The sternal ascender apparatus segments the function of creating surgical space from the chest wall structure itself. Instead of compromising the entire chest wall through sternotomy, the device provides localized, temporary elevation of the sternum only in the subxiphoid region, preserving the integrity of the rest of the chest wall.

Inventive Principle:

Principle #1Segmentation

Solution Approach 2:

The apparatus uses a flexible panel with textural features that can conform to and gently lift the sternum without causing structural damage. This flexible interface allows for controlled space creation while maintaining the natural integrity and continuity of the chest wall structures.

Inventive Principle:

Principle #30Flexible shells and thin films

3Productivity

If subxiphoid access is used for ITA harvesting, then operable space is increased without CPB, but visualization and distal suturing become technically demanding

Engineering Contradiction:

Improveoperating timeVSAvoidvisualization and suturing

Core Design Contradiction:

ProductivityVSEase of operation

Solution Approach 1:

The sternal ascender serves as an intermediary that stabilizes and maintains the surgical field in an optimal position. By providing consistent upward lift, it creates a stable working environment that facilitates endoscopic visualization and allows suturing tools to reach distal coronary anastomosis sites more effectively.

Inventive Principle:

Principle #24Intermediary (Mediator)

Solution Approach 2:

The apparatus provides dynamic, adjustable lifting capability that can be modified during the surgical procedure. The actuator drive mechanism allows the surgeon to adjust the degree of sternal elevation to optimize visualization and tool access for different surgical steps, including distal suturing.

Inventive Principle:

Principle #15Dynamics

Applied Scientific Principles

This section explains which scientific principles are used to turn an abstract innovation direction into a practical engineering solution.

Function Achieved in This Case

The sternal ascender apparatus effectively increases operable space during minimally invasive cardiac procedures, reducing operating time, and improving patient recovery by providing a stable and adjustable platform for surgical tools, thus enhancing the reliability of cardiac repairs without compromising chest wall integrity.

Implementation Method 1

an actuator drive incorporating a linear rack. The housing further may include a cylindrical gear where the cylindrical gear is engaged with the linear rack

Methodology Applied

Scientific EffectMechanical Advantage: Mechanical Advantage

Data Source

PatentUS20230190254A1Sternal ascender apparatus

Publication Date: 2023.06.22 LSI SOLUTIONS INC

AI summary

A sternal elevator apparatus is disclosed. The sternal elevator may include a panel, a support beam traversing the panel, and a post coupled to a proximal end of the panel. The apparatus may also include an indicator handle coupled to the sternal elevator, an actuator drive pivotably coupled to the indicator handle, and a housing movably coupled to the actuator drive. The sternal elevator apparatus may have an actuator drive incorporating a linear rack. The housing further may include a cylindrical gear where the cylindrical gear is engaged with the linear rack.