Percutaneous Sub-xiphoid Lifting Device for Minimally Invasive Cardiac Surgery
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Solution Overview
Problem
Minimally invasive surgical procedures for internal thoracic artery harvesting and epicardial lead placement face challenges in achieving sufficient working space without compromising chest wall integrity or requiring cardiopulmonary bypass, while maintaining effective visualization and reducing operating time.
Innovation Solution
A percutaneous sub-xiphoid lifting device with a handle, lifter block, and pivotably coupled beams is used to create increased space by lifting the sternum, allowing for enhanced surgical access and accommodating additional tools, such as endoscopes and suturing instruments, while preserving chest wall integrity.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Productivity
If a minimally invasive surgical approach is used for internal thoracic artery harvesting, then patient recovery is improved and cosmetic results are superior, but sufficient working space for surgical tools and endoscopes is limited
Solution Approach 1:
The rib cage lifting device introduces a vertical dimension to the surgical approach by lifting the rib cage upward, creating additional working space in the thoracic cavity without requiring larger incisions. This dimensional change allows standard surgical tools and endoscopes to operate effectively while maintaining minimally invasive access points.
Solution Approach 2:
The lifter block acts as an intermediary mechanical element that translates the lifting force from the beams into upward movement of the rib cage. This intermediary mechanism enables controlled elevation of the rib cage to create necessary working space while preserving the integrity of the minimally invasive approach.
2Ease of operation
If the rib cage is lifted to increase working space, then surgical access is improved, but chest wall integrity may be compromised
Solution Approach 1:
The lifting system employs dynamic, adjustable beams that can be positioned and tensioned to provide controlled lifting force. The system allows for real-time adjustment of lifting magnitude, enabling surgeons to create sufficient working space while stopping before compromising chest wall integrity. The dynamic nature of the system permits precise control over the degree of rib cage elevation.
Solution Approach 2:
The device enables controlled changes in the spatial parameters of the thoracic cavity by adjusting beam tension and position. By modifying these parameters, the system creates optimal working space while maintaining the structural integrity threshold of the chest wall, allowing surgeons to operate within safe mechanical limits.
3Area of stationary object
If conventional sternotomy or multiple thoracoports are used, then sufficient working space is achieved, but invasiveness increases and patient recovery is prolonged
Solution Approach 1:
The lifting device segments the function of creating working space from the incision size. Instead of requiring large incisions (multiple thoracoports or sternotomy) to gain access, the system uses small incisions to insert beams that mechanically lift the rib cage, thereby segmenting the access function from the working space creation function.
Solution Approach 2:
The lifting device performs multiple functions: it creates working space, maintains minimally invasive access, stabilizes the rib cage position during surgery, and can be adjusted throughout the procedure. This multi-functionality replaces the need for multiple separate instruments or larger incisions required in conventional approaches.
4Reliability
If minimally invasive techniques are used for coronary anastomosis on the beating heart, then cardiopulmonary bypass is avoided, but visualization and distal suturing become technically demanding
Solution Approach 1:
By lifting the rib cage vertically, the device creates additional depth and working room in the thoracic cavity, allowing endoscopes and suturing tools to reach distal coronary sites with improved visualization angles. This dimensional change provides the necessary space for precise visual inspection and delicate suturing operations on the beating heart.
Solution Approach 2:
The lifting device serves as a mechanical intermediary that creates and maintains an optimized surgical environment, enabling the use of endoscopic visualization tools and fine suturing instruments to function effectively in the constrained minimally invasive access configuration.
Data Source
AI summary
A percutaneous sub-xiphoid lifting device is disclosed. Also disclosed is a percutaneous sub-xiphoid lifting device including a beam assembly and a lifting assembly. The percutaneous sub-xiphoid lifting device includes a pair of beams, pivotably coupled at a distal end and configured to be releasably attached to the lifter block coupled to a handle. The percutaneous sub-xiphoid lifting device may further include a light source used for improved visualization. A method of using the percutaneous sub-xiphoid lifting device for increasing space beneath the sternum during a minimally invasive surgical procedure is also disclosed.