title: A versatile tool for exposure in minimally invasive surgery.
abstract: BACKGROUND
  Endoscopic surgery in a major cavity in the body requires space for manipulation and presentation of the target organ or site. For coronary artery grafting on the working heart, additional local cardiac wall immobilization is indispensible.
  
  
  METHODS
  A passive hydraulic arm was developed to be mounted on the operating table rail. The development focused on the arm's versatility, durability, flexibility in manipulation, and extreme stiffness when in position.
  
  
  RESULTS
  The arm was flexible and easy to manipulate. The tip did not move during tightening, and the arm was stiff once tightened. The arm was successfully used in small and full access beating heart coronary bypass grafting, through the latter(i.e., sternotomy) for multivessel revascularization. Immobilization and presentation were achieved by suction fixation, allowing accurate anastomosis suturing.
  
  
  CONCLUSIONS
  The arm enabled effective target site presentation and stabilization on the working heart. According to these observations, it may be useful as a basic tool for endoscopic surgery.
authors.affiliation: Department of Cardiothoracic Surgery of Utrecht Medical Center, Utrecht University, The Netherlands. E.Jansen@HLI.AZU.NL
authors.forename: E W
authors.initials: EW
authors.lastname: Jansen
authors.forename: E
authors.initials: E
authors.lastname: Duiveman
authors.forename: A P
authors.initials: AP
authors.lastname: Ansems
authors.forename: C M
authors.initials: CM
authors.lastname: Ligtvoet
mesh_terms: D004724:Endoscopy; D004867:Equipment Design; D007103:Immobilization; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D012149:Restraint, Physical / Q000295:instrumentation*