The 3rd hand--a simple but useful tool for beating heart total endoscopic coronary bypass grafting (BH-TECAB)

The transition to totally endoscopic arterial bypass grafting (TECAB) by computer enhanced instrumentation systems brings the loss of an assisting hand for grasping the pedicle of the internal thoracic artery (ITA) and holding the threads, since only two robotic arms are positioned in the thoracic cavity. That is why exact planning of every step during surgery is mandatory. Especially the positioning of the IMA pedicle during beating heart procedures is imperative for friction-free workflow during the anastomosis. Stay sutures may partially overcome this problem. However, the pedicle hanging on stay sutures still tends to sway around, repositioning is limited. To aid in better workflow, we developed an easy-to-use and cheap holder for the IMA pedicle without the need of any additional port. By inserting a steel wire through the stabilizing system, the pedicle can be easily fixed onto it thus positioned and repositioned wherever it is needed during sewing the anastomosis.