Ball and socket coronary stabilizer

An apparatus for stabilizing a predetermined area on a heart or other organ of a patient to enable a surgical procedure, the apparatus comprising a bifurcated member having two elongated prongs and an elongated handle segment pivotally and rotatably attached to the bifurcated member. The handle segment can be movably attached to a rib retractor or other surgical device so that a person is not required to hold the handle segment. The preferred embodiment of the apparatus of the present invention further comprises a device to lock or frictionally hold the bifurcated member in a desired position both on the organ and relative to the handle segment during the surgical procedure.

BACKGROUND OF THE INVENTION
 1. Field of the Invention
 This invention relates to an apparatus for stabilizing a predetermined area
 of the body during surgical intervention, which better enables a surgeon
 to perform a surgical procedure at the surgical site. In particular, the
 invention relates to an apparatus for stabilizing a predetermined area of
 the heart for performing minimally invasive coronary artery bypass
 grafting at the surgical site, in which the apparatus is adapted to be
 connected to a rib retractor, has a rotatable and pivotal joint between
 the handle and stabilizing device, and has a means for easily switching
 among different sized stabilizing devices.
 2. Background Art
 Atherosclerosis or coronary artery disease is among the most common and
 serious health problems confronting the medical profession. In the past,
 many different approaches at therapy have been utilized. Surgical
 correction of occluded or stenosed coronary arteries via bypass grafting
 through conventional approaches, such as the sternotomy, are probably
 still the most common procedure performed today, especially where multiple
 bypass grafts are needed.
 However, interventional techniques, such as percutaneous transluminal
 angioplasty (PTCA), have gained popularity as the method of choice for
 therapy of atherosclerotic occlusions for several reasons. The
 transluminal approach is a minimally invasive technique which subjects the
 patient to less trauma and less recovery time, especially when compared to
 bypass grafts which utilize homologous tissue, such as saphenous vein
 grafts. Often the patient suffers complications at the graft donor site
 which are worse than the sternotomy and anastomosis.
 Although PTCA procedures are often successful, complications such as
 restenosis or thrombosis and embolism can occur. Intravascular stents are
 sometimes deployed at the PTCA site to lessen the occurrence of
 restenosis. However, restenosed vessels often require surgical
 intervention for correction.
 Surgical correction of restenosis, as well as conventional bypass graft
 surgery, require that the heart be stopped and the patient placed on a
 heart/lung bypass machine during the procedure. This occurs at
 considerable expense and risk to the patient. In an effort to reduce the
 expense, risk and trauma to the patient, physicians have recently turned
 to minimally invasive surgical approaches to the heart, such as
 intercostal and endoscopic access to the surgical site. In addition,
 utilization of alternative graft vessels, such as the internal mammary
 artery (IMA), have also greatly reduced the trauma to the patient and
 increased the efficacy of surgical therapy.
 Prior to the present invention, however, attempts at performing minimally
 invasive bypass grafting on a beating heart were thought to be too
 tedious, dangerous and difficult because of the delicate nature of the
 surgical procedure, the lack of adequate access through a reduced surgical
 field, and the lack of a way to adequately stabilize and reduce movement
 at the graft site. Such a minimally invasive bypass grafting performed on
 the beating heart eliminates the expense and risk of stopping the heart
 and the necessity of the heart lung bypass machine and decreases patient
 recovery time. For single or double bypass procedures, especially where
 the IMA is utilized, patient trauma and recovery time is even further
 decreased.
 SUMMARY OF THE INVENTION
 The above problems of the prior art are overcome by the present invention,
 which provides an apparatus for stabilizing a predetermined area on a
 heart or other organ of a patient to enable a surgical procedure to be
 performed. The apparatus of the present invention comprises a bifurcated
 member having two prongs, an elongated handle segment, and a means for
 pivotally connecting the handle segment to the bifurcated member. Each
 prong of the bifurcated member, also known as a tine assembly, has a first
 section and a second section. The first section is adjacent the handle
 segment and terminates in the second section. The second section engages
 the heart or other organ on which the surgical procedure occurs.
 The present invention also encompasses a means for movably mounting the
 handle segment to a rib retractor or other surgical device. The mounting
 means, which is preferably a swivel head, holds the bifurcated member at
 the predetermined site, thus alleviating the requirement that a person
 hold the handle segment.
 A further aspect of the present invention is that it includes a means for
 rotatably and pivotally connecting the bifurcated member to the handle
 segment. In the preferred embodiment, a ball and socket design is used. In
 conjunction, the present invention comprises a means for locking the
 bifurcated member in a desired position relative to the handle segment
 when the bifurcated member is disposed on the heart of a patient. The
 surgeon can tighten the ball and socket to frictionally hold the assembly
 using a tightener located at the upper end of the handle segment, which is
 advantageous during a surgical procedure where space within the surgical
 site is limited.
 Since the second section of the bifurcated member engages the heart, it is
 desired that the second section further comprises a means for stabilizing
 it from sliding on the heart. Stabilizing the apparatus on the heart is an
 important consideration during the surgical procedure. The present
 invention can encompass many different stabilizing means, including, for
 example, a DeBakey serrated pattern, a textured portion on at least a
 portion of one second section, an insert disposed on the second section
 having a plurality of teeth, an insert having a plurality of flexible
 hooks, an insert having a plurality of bristles, or even a flexible
 covering disposed over at least a portion of the second section. The
 flexible covering can be a cloth, such as cotton, or a tubular member
 formed from a material such as silicon.
 As will be appreciated, the apparatus of the present invention can be used
 in surgical procedures other than heart surgery, including, for example,
 soft tissue procedures such as vascular thrombosis repair, intestinal
 resection and anastomosis and other intra-abdominal procedures, and the
 like.
 Thus, it is an object of the invention to provide an apparatus for
 stabilizing a predetermined area of the heart or other organ of a patient
 to enable a surgeon to perform a surgical procedure at the predetermined
 site.
 Another object of the invention is to provide an apparatus for
 stabilization of an area of the beating heart adjacent to a coronary
 artery for performing coronary artery bypass grafting.
 Yet another objective of the present invention is to provide an apparatus
 in which the bifurcated member can both rotate and pivot relative to the
 handle segment to ensure the maximum adaptability for work within the
 surgical site. An associated objective is to use an apparatus in which the
 bifurcated member can be easily exchanged with another bifurcated member
 of a different size when necessary.
 A further object of the invention is to provide an apparatus as above that
 is adapted for pivotal attachment to a device that provides access to the
 surgical site, such as a rib spreader or other retractor.
 The above recited objects of the invention are not intended to so limit the
 used of the invention. These and other objects of the invention will be
 apparent to the skilled artisan based upon the following disclosure.

DETAILED DESCRIPTION OF THE INVENTION
 The present invention is more particularly described in the following
 examples that are intended as illustrative only since numerous
 modifications and variations therein will be apparent to those skilled in
 the art. As used in the specification and in the claims, "a" can mean one
 or more, depending upon the context in which it is used.
 The present invention, as shown in FIGS. 1-8, encompasses an apparatus 10
 for stabilizing a predetermined area on a heart of a patient to enable a
 surgical procedure to be performed. The apparatus 10, or stabilizer,
 comprises a bifurcated member 30 that is pivotally connected to an
 elongated handle segment 50. The handle segment 50 is preferably movably
 mounted to a rib spreader 20 or other similar equipment that remains
 stationary positioned on or adjacent to the patient during a surgical
 procedure.
 The present invention is ideal for use in heart surgery, in either
 conventional open heart surgery or by minimally invasive surgery, e.g.,
 minimally invasive coronary artery bypass grafting. For minimally invasive
 surgery, access to the heart may be achieved through the ribs of the
 patient using a rib spreader 20, as shown in FIGS. 1 and 2. In the typical
 procedure, the surgeons will access the heart via the fourth intercostal
 space located between the third and fourth ribs, but this may be changed
 based on the individual patient's anatomy. Since, for the above reasons,
 this procedure is sometimes performed on a beating heart, it is
 advantageous to stabilize the heart in the area that the surgical
 procedure will occur.
 When the present invention engages the surface of the heart, the surgeon
 applies a slight compressive force on the heart with the apparatus 10 in
 the area that the surgical procedure will occur so that the heart's
 movement at that specific area is diminished and stabilized. Stabilizing
 the heart is particularly useful for a heart suturing technique in the
 area of the coronary arteries such as the anastomosis of a bypass graft.
 In particular, it is advantageous to place a traction suture around an
 artery using a needle and suture thread while the present invention is
 stabilizing the surface of the heart adjacent to the artery. One skilled
 in the art will appreciate that the present invention, although ideal for
 heart surgery, can be used at any location on or within the body where
 tissue stabilization or isolation of a predetermined area is desired,
 including but not limited to the liver, kidneys, bladder, stomach,
 intestines, and vascular and other soft tissue surgery.
 The bifurcated member 30 of the present invention has two elongated prongs
 32 in which each prong 32 has a proximal end 34 and an opposite distal end
 36 and each prong 32 forms a first section 38 and a second section 40. The
 prongs 32 are attached to each other adjacent their proximal ends 34. The
 first section 38 of each prong 32 is adjacent the proximal end 34 and
 terminates in the second section 40, and the second section 40 is adjacent
 the distal end 36. The second section 40 is adapted to engage a
 predetermined area on the heart or other organ of the patient.
 A third section 42, shown in FIG. 8, can be added to at least one of the
 prongs 32 at the end of the second section 40 that is opposite the first
 section 38. The third section 42 can be used as a tissue retractor or a
 retractor to pull a selected item, such as surgical thread, away from the
 area that the surgical procedure is being performed. In addition, the
 third section 42 can be advantageously positioned to secure surgical
 thread to a cleat (not shown) disposed on the handle segment 50.
 As best shown in FIG. 3, a connecting member 44 is disposed intermediate
 the proximal end 34 of each prong 32, instead of directly connecting the
 prongs 32 to each other. The connecting member 44 has opposed ends in
 which each end is attached to the proximal end 34 of a respective prong
 32. As one skilled in the art will appreciate, the length of the first
 section 38 can be very short so that the connecting member 44 would be
 either attached directly to or slightly separated from the second section
 40. However, this alternate embodiment is not desirable because a
 separation height of at least a quarter (1/4) of an inch is desired
 between the surface of the heart and the connecting member 44, to which
 the attached handle segment 50 is attached.
 The handle segment 50 is used to extend the bifurcated member 30 into the
 chest of the patient to reach the surface of the heart. The handle segment
 50 has a first end 52 and an opposite second end 54. The handle segment 50
 also has an outer surface or member and a longitudinal axis L and defining
 a bore 56 therethrough. The bore 56 is disposed adjacent the first end 52
 of the handle segment 50 and extends substantially perpendicular to its
 longitudinal axis L.
 Referring now to FIGS. 1-4, the stabilizer 10 of the present invention
 comprises a means for pivotally connecting the first end 52 of the handle
 segment 50 to the two prongs 32 of the bifurcated member 30 adjacent their
 proximal ends 34. The pivotal connecting means comprises a positioning
 member 60 and a rod 62 rotatably disposed through the bore 56 in the
 handle segment 50. The rod 62 has opposed ends and a length extending
 therebetween. One end of the rod 62 is fixedly attached to the positioning
 member 60 and the opposed end of the rod 62 is fixedly attached to the
 connecting member 44 so that the bifurcated member 30 is at least
 partially rotatable about an axis of rotation R, which is parallel to and
 disposed through the bore 56 of the handle segment 50. Preferably, the
 length of the rod 62 is of a size to allow rotation of the bifurcated
 member 30 but to prevent transverse, or lateral, movement of the
 bifurcated member 30 relative to the longitudinal axis L of the handle
 segment 50. That is, the bifurcated member 30 is rotatable but does not
 have undesirable lateral play.
 As shown in FIG. 1, the stabilizer 10 can use a pin 64 fixedly attached to
 a portion of the handle segment 50 intermediate its first and the second
 ends 52, 54. The pin 64 is disposed to block complete rotation of the
 bifurcated member 30 so that bifurcated member 30 is rotatable less than
 360.degree. about the bore 56 of the handle segment 50. This prevents the
 bifurcated member 30 flipping to an inverted position when the surgeon is
 placing the second section 40 of the prongs 32 on the heart of the
 patient.
 The advantage of the pivotal connecting means is that the second sections
 40 can be disposed at the predetermined location on the heart and the
 bifurcated member 30 disposed in the desired position relative to the
 handle segment 50, such as the handle segment 50 being oriented to a
 position that does not interfere with the surgeon performing the surgical
 procedure. That is, once the bifurcated member 30 is properly positioned,
 then the handle segment 50 is moveable to the desired position relative to
 the bifurcated member 30 and, optionally, locked at that position by a
 mechanical device, such as a swivel head, so that the handle segment 50
 does not interfere with the surgery.
 The connecting means can alternatively connect the handle segment 50 to the
 bifurcated member 30 so that the bifurcated member 30 is both rotatable
 and pivotal relative to the handle segment 50. The increased movement of a
 rotatable and pivotal connecting means is preferred compared with the
 pivotal connecting means shown in FIGS. 1-4.
 Referring now to FIG. 5, a first, preferred embodiment of the connecting
 means is shown in which the bifurcated member 30 is rotatably and
 pivotally movable relative to the handle segment 50. The connecting means
 uses a ball and socket for connecting the first end 52 of the handle
 segment 50 to the bifurcated member 30 so that the bifurcated member 30 is
 movable to the desired position.
 The connecting means comprises a longitudinally-extending bore 58 formed
 within at least a portion of the handle segment 50 and a ball 66 disposed
 within a portion of the bore 58. The ball 66 is placed adjacent the first
 end 52 of the handle segment 50 and a portion of the ball 66 is fixedly
 attached to the bifurcated member 30, preferably the connecting member 44.
 The ball 66 is movably secured within the bore 58, wherein the ball 66 and
 attached bifurcated member 30 are rotatably and pivotally movable relative
 to the handle segment 50 without separating therefrom.
 This preferred embodiment of the connecting means further comprises a means
 for locking the connecting means so that the bifurcated member 30 is held
 in the desired position. The locking means preferably comprises a shaft 80
 disposed, at least partially, within the bore 58, a socket 68 attached to
 the shaft 80, and a means for adjustably positioning the shaft 80 and
 attached socket 68 within the bore 58. The shaft 80 has an upper end 82
 and an opposite lower end 83, to which the socket 68 is attached. The
 socket 68 can be integrally formed into the lower end 83 of the shaft 80
 or, alternatively, a separate component attached to the shaft 80. The
 socket 68 has an interior surface of a size to complimentarily and
 detachably engage the ball 66. Preferably, the socket 68 forms a
 180.degree. arc in cross section to provide the maximum surface area to
 contact the ball 66.
 The adjustable positioning means moves the shaft 80 and attached socket 68
 within the bore 58 between an engaged position and a disengaged position.
 In the engaged position, the interior surface of the socket 68 detachably
 engages the ball 66 to frictionally hold the ball 66 in the desired
 position, which is preferably set after the bifurcated member 30 is
 disposed on the heart and the attached handle segment 50 oriented to the
 desired position. In the disengaged position, the interior surface of the
 socket 68 and the ball 66 are spaced apart so that the ball 66 and
 attached bifurcated member 30 are movable. Of course, the interior surface
 of the socket 68 and ball 66 do not need to be completely spaced apart to
 be in the disengaged position, but, instead, sufficiently separated to
 allow movement therebetween. That is, in the disengaged position, the
 socket 68 and ball 66 are adequately physically separated, or disengaged,
 so that the socket 68 does not frictionally hold or lock the ball 66 in a
 non-movable position.
 Preferably, the positioning means also comprises a portion of the bore 58
 complementarily engaging a portion of the shaft 80. The interface between
 the bore 58 and shaft 80 controls the relative movement therebetween as
 the shaft 80 is moved within the bore 58. It is preferred that the
 portions of the bore 58 and the shaft 80 that engage each other are
 complementarily threaded surfaces, although other embodiments may be used,
 such as a protrusion (not shown) on the shaft 80 that traverses along a
 channel (not shown) in the bore 58 to maintain the desired relative
 longitudinal position therebetween. As shown in FIG. 5, the bore 58 has a
 length extending between the first and second ends 52, 54 of the handle
 segment 50 and the length of the shaft 80 is about the same as the length
 of the bore 58. A tightener 69 is fixedly attached to the upper end 82 of
 the shaft 80 and disposed outside the bore 58. Rotation of the tightener
 69 causes the attached shaft 80 and socket 68 to move longitudinally
 between the engaged and disengaged positions because of the
 complementarily threaded surfaces of the shaft 80 and bore 58 engaging
 each other.
 FIG. 6 shows a second embodiment of the rotatable and pivotal connecting
 means, which also uses a ball and socket. This embodiment comprises the
 bore 58 longitudinally extending through the handle segment 50 and the
 shaft 80 being disposed within the bore 58. The ball 66 is fixedly
 attached to the lower end 83 of the shaft 80. The socket 68 has an
 interior surface, a top end, and an opposed bottom end, which is adapted
 to mount the bifurcated member 30 thereto. The interior surface of the
 socket 68 complementarily and detachably engages the ball 66. The socket
 68 also defines an opening therein adjacent its top end through which a
 portion of the shaft 80 extends. A bowl-shaped member 84 is fixedly
 attached to the first end 52 of the handle segment 50 for receiving a
 portion of the socket 68 therein.
 Similar to the first ball and socket embodiment, this embodiment of the
 connecting means also comprises a means for locking the connecting means
 so that the bifurcated member 30 is held in the desired position. In the
 engaged position, the interior surface of the socket 68 engages the ball
 66 and the bowl-shaped member 84 engages the opposite surface of the
 socket 68 so that the bowl-shaped member 84 and the ball 66 frictionally
 hold the socket 68 disposed therebetween in the desired position. In the
 disengaged position, the socket 68 and the bowl-shaped member 84 are
 spaced apart so that the socket 68 and attached bifurcated member 30 are
 movable. Similar to the first ball and socket embodiment discussed above,
 the components do not need to be completely spaced apart in the disengaged
 position, but sufficiently separated so that the ball 66 and bowl-shaped
 member 84 do not prevent the socket 68 and attached bifurcated member 30
 from moving.
 Also, similar to the first ball and socket embodiment, the positioning
 means preferably comprises a threaded portion of the bore 58
 complementarily engaging a threaded portion of the shaft 80. However,
 unlike the first ball and socket embodiment, the tightener 69 is rotatably
 attached to the second end 54 of the handle segment 50 instead of being
 fixedly attached to the shaft 80. The tightener 69 defines a threaded bore
 therethrough which complementarily engages a section of the threaded
 portion of the shaft 80 so that rotations of the tightener 69
 longitudinally moves the shaft 80 between the engaged and disengaged
 positions. When the surgeon tightens the tightener 69, the ball 66 is
 moved toward the handle segment 50, which correspondingly moves the socket
 68 into the bowl-shaped member 84. The surgeon continues to turn the
 tightener 69 until the socket 68 is securably seated in the bowl-shaped
 member 84 with the bifurcated member 30 at a desired orientation. As shown
 in FIG. 6, the socket 68 allows the shaft 80 to be pivoted thirty degrees
 (30.degree.) in all directions relative to its centerline, but can be
 designed pivot up to ninety degrees (90.degree.).
 FIG. 7 shows a third ball and socket embodiment of the connecting means
 which comprises a socket 68 disposed at the first end 52 of the handle
 segment 50 and a ball 66 joined to the bifurcated member 30. The ball 66
 is complementarily received within the socket 68. Preferably, the
 connecting means also comprises a means for locking the ball 66 in the
 desired position. Here, the socket 68 is formed of a plurality of
 individual segments 68a that can be pulled toward each other to lock, or
 frictionally hold, the ball 66 in the desired position. To pull the
 segments 68a together, the tightener 69 is rotated, which moves the shaft
 80 disposed through the bore 58. The shaft 80 interconnects the socket 68
 with the tightener 69 and when the shaft 80 pulls the socket 68 toward the
 tightener 69 and a portion of the socket 68 into the first end 52 of the
 handle segment 50, the handle segment 50 constricts the size of the socket
 68. Constriction of the socket 68 causes the segments 68a to be pulled
 together and securely hold the ball 66.
 Other connecting means are contemplated including, for example, a hinged
 connection (not shown) in which the handle segment 50 only pivots in a
 plane other than the plane shown in FIGS. 1-4. Another possible embodiment
 is a swivel mechanism (not shown), similar to a swivel used in fishing.
 However, as one skilled in the art will appreciate, it is preferred to use
 a connecting means that both rotatably and pivotally connects the
 bifurcated member 30 to the handle segment 50 and that can lock the
 bifurcated member 30 when disposed on the heart in a desired position
 relative to the handle segment 50.
 The connecting means can further comprise a means for removably, or
 interchangeably, mounting the bifurcated member 30 to the handle segment
 50. The bifurcated member 30 thus can be detachably secured to the handle
 segment 50 and is interchangeable with another bifurcated member 30, e.g.,
 a bifurcated member in which the prongs are a different size or have a
 different separation distance therebetween.
 For the preferred embodiment shown in FIGS. 5 and 5A-5D, the removable
 mounting means comprises a portion of the handle segment 50 defining an
 opening 59 therethrough. The opening 59 is of a size through which the
 ball 66 can traverse so that the ball 66 is movable between a occupied
 position and a withdrawn position. In the withdrawn position, the ball 66
 is removed from the bore 58, as shown in FIG. 5A. FIG. 5B shows the ball
 66 being placed into the bore 58 through the opening 59. In the occupied
 position, the ball 66 is disposed within the bore 58, which is shown in
 FIG. 5C. FIG. 5D show the shaft 80 moved toward the first end 52 of the
 handle segment 50 so that the socket 68 engages the ball 66.
 The opening 59 in the handle segment 50 is disposed intermediate the first
 and second ends 52, 54 of the handle segment 50. Once the ball 66
 traverses through the opening 59 and enters into the bore 58, as shown in
 FIG. 5B, the ball 66 is moved toward the first end 52 of the handle
 segment 50, as shown in FIGS. 5C and 5D, where it cannot be laterally
 moved and withdrawn through the opening 59. That is, the ball 66 must be
 moved upward toward the second end of the handle segment 50 to be
 realigned with the opening 59 to be removed from the bore 58. Thus, when
 the shaft 80 and attached socket 68 are in the engaged position, as shown
 in FIG. 5D, the ball 66 and attached bifurcated member 30 are prevented
 from moving to the withdrawn position.
 Referring again to FIG. 6, the removable mounting means of the second
 embodiment comprises a detent 90 formed in the interior side of the socket
 68 adjacent its bottom end. The connecting member 44 is attached to a
 plunger device 92 that has a shell 94 containing at least one circular
 member 96 and a means for biasing the circular member 96 away from the
 center of the shell 94. An example of the biasing means is a spring (not
 shown).
 The shell 94 has an outer periphery that is complementarily received within
 a portion of the interior surface of the socket 68 adjacent its bottom end
 when no portion of the circular member 96 extends outwardly from the shell
 94. The biasing means, however, biases a portion of the circular member 96
 to extend past the outer periphery of the shell 94. When the shell 94 is
 pushed into the socket 68, the normally outwardly-projecting circular
 member 96 is forced toward the center of the shell 94 against the opposing
 force of the biasing means. Once the shell 94 is pushed far enough into
 the socket 68 so that the circular member 96 aligns with the detent 90,
 the biasing means forces the circular member 96 into the detent 90, as
 shown in FIG. 6. The shell 94 remains detachably secured in this position
 until a force is applied to the shell 94, such as downwardly pulling on
 the bifurcated member 30, to overcome the force of the biasing means.
 Thus, the plunger device 92 is movable between an occupied position, in
 which a portion of the plunger device 92 is disposed within the socket 68,
 and a withdrawn position, in which the plunger device 92 is spaced apart
 from the socket 68. Thus, bifurcated members are interchangeable in the
 present invention, which is advantageous for different patients or changes
 in circumstances that arise during the surgical procedure.
 In an alternate embodiment, the removable mounting means comprises the
 interior surface of the socket having a threaded surface (not shown) and a
 portion of the shell having a complementarily threaded surface (not shown)
 that detachably connects to the socket. However, this alternate embodiment
 is less desirable because it could allow rotation of the bifurcated member
 to occur.
 The present invention preferably further comprises a means for movably
 mounting the handle segment 50 to a rib retractor 20. Referring back to
 FIGS. 1 and 2, it is preferred that the mounting means comprises a swivel
 head 70 having a first portion 72, a second portion 74, and a tightening
 portion 76. The first portion 72 defines a slot 73 therethrough which is
 of a size to slidably and adjustably receive a portion of the handle
 segment 50 therein. The handle segment 50, accordingly, is movable in the
 slot 73 longitudinally and rotationally relative to the first portion 72
 of the swivel head 70.
 The second portion 74 defines an opening 75 therethrough which is adapted
 to detachably and slidably engage a portion of the rib retractor 20,
 preferably, an elongated slide segment 22. That is, the second section 40
 allows movement of the handle segment 50 and attached bifurcated member 30
 in all directions relative to the slide segment 22. The second section 40
 is slidable along the slide segment 22 and is pivotal transversely
 relative to the slide segment 22. Furthermore, the handle segment 50 is
 rotatable so that its longitudinal axis L can form different angles
 relative to the length, or longitudinal axis, of the slide segment 22. The
 handle segment 50 thus is movable to any position except where the swivel
 head 70, handle segment 50, or bifurcated member 30 are blocked by an
 obstruction, such as a portion of the rib retractor 20. This freedom of
 movement, coupled with the movement that the pivotal connecting means and
 first portion 72 provides, allow the surgeon the greatest flexibility to
 dispose the second section 40 of each prong 32 on the heart while the
 handle segment 50 is movably connected to the rib retractor 20.
 An advantage of the present invention is that the handle segment 50 and
 bifurcated member 30 can be pre-aligned so that the bifurcated member 30
 is self-positioning on the patient's heart by lowering the handle segment
 50. Once the surgeon lowers the bifurcated member 30 to the desired
 position, the surgeon can then maintain the second sections 40 engaging
 the heart while re-orienting the handle segment 50, if required, to a
 position that allows the greatest access to the surgery site. When the
 handle segment 50 is at the desired orientation, the tightening portion 76
 of the swivel head 70 is tightened, preferably by a single turn of the
 tightening portion 76, to secure the handle segment 50 at a desired
 position.
 The tightening portion 76 operates by a screw member 78 disposed through a
 section of the swivel head 70 tightening the first and second portions 72,
 74 in place. Thus, the tightening portion 76 detachably secures the handle
 segment 50 at a desired orientation in the slot 73 of the first portion 72
 and the swivel head 70 at a desired position on the rib retractor 20 so
 that the surgeon is free to perform the surgical procedure. The tightened
 portion can be easily loosened, when desired, to allow the handle segment
 50 and the bifurcated member 30 to be moved.
 The handle segment 50 thus is held in the desired position by a connection
 with the rib retractor 20 that is necessary to preform the surgical
 procedure. As shown best in FIG. 2, the stabilizer 10 can be disposed to
 the side of the rib retractor 20 so that it allows a wide angle of access
 to the surgical site. An undesirable alternative is to have another
 surgeon or nurse hold the handle segment 50 during the surgical procedure,
 which creates problems with space constraints, fluctuations in the
 pressure of the second sections 40 on the heart, and increased costs for
 the extra person to hold the handle segment 50.
 As one skilled in the art will appreciate, there are numerous other options
 available to mount the handle segment 50 to the rib retractor 20 or other
 surgical equipment so that the second section 40 is maintained at a
 desired position without a person physically holding the apparatus 10. One
 example of such a mounting means is a ball and socket connection (not
 shown). However, it has been found that the swivel head is a more
 desirable mounting means because of the control and ease of locking the
 bifurcated member 30 and handle segment 50 at the desired position.
 Referring now to FIGS. 3 and 4, the second section 40 each of the two
 prongs 32 is preferably disposed substantially perpendicular to the
 longitudinal axis L of the handle segment 50, regardless of the direction
 that the bifurcated member 30 pivots. It is also preferred that the second
 sections 40 of each of the two prongs 32 are co-planar and that the
 juncture between the first section 38 and the second section 40 of the
 prongs 32 of the bifurcated member 30 form an approximately 90.degree., or
 right, angle .phi. therebetween, as shown in FIG. 8. A right, or even
 obtuse, angle .phi. is preferred so that the surgeon has better access to
 the area that the surgical procedure is performed. An acute angle could be
 used, but it is less desirable because it would likely interfere with the
 surgical procedure.
 For use in heart surgery, the apparatus 10 has certain size limitations.
 For example, the available area to a surgeon to perform a minimally
 invasive surgical procedure on the heart via an intercostal approach is
 approximately three (3) inches by one and a half (11/2) inches, which, of
 course, may vary between patients. Accordingly, it is desired that the
 width between the second sections 40 be in the range of one half (1/2) to
 one and a quarter (11/4) inches, more preferably in the range of three
 quarters (3/4) of an inch to one (1) inch. These widths are narrow enough
 to fit into the confined space, yet wide enough to bridge the area of
 interest, e.g., bridge an artery that is to be bypassed.
 In a preferred embodiment, the length of the second section 40 is in the
 range of one half (1/2) inch to one and a half (11/2) inches, more
 preferably in the range of two-thirds (2/3) of an inch to three quarters
 (3/4) of an inch. In the preferred embodiment, each second section 40 is
 one (1) inch long and separated by three quarters (3/4) of an inch to one
 (1) inch from the other second section 40.
 Since the second section 40 engages the heart, it is preferable that this
 section further comprise a means for stabilizing the second section 40
 from sliding on the heart when in contact therewith. That is, the
 stabilizing means resists sliding or slipping motion between the surface
 of the heart and the second section 40. The stabilizing means increases
 the coefficient of friction but should not have a texture that may
 potentially damage tissue of the heart or other vital organs.
 In one embodiment shown in FIG. 8, the stabilizing means comprises a
 textured surface 46 which is a knurled texture. Other embodiments are
 contemplated, such as a DeBakey serrated pattern (not shown) or a
 plurality of intersecting slits (not shown) that prevent the second
 section 40 from sliding when it engages the heart. As one skilled in the
 art will appreciate, other stabilizing means can be used so long as the
 stabilizing means atraumatically grips the tissue.
 Another contemplated embodiment of the stabilizing means includes a
 removable insert (not shown) having an attaching surface secured to the
 second section 40 of each prong 32 and an opposite stabilizing surface
 (not shown) which carries the stabilizing means. The stabilizing surface
 of the insert can comprise a plurality of tungsten carbide or stainless
 steel teeth forming the DeBakey or other pattern. Another embodiment is
 that the stabilizing surface comprises a plurality of flexible hooks (not
 shown). The preferred hooks are those of a hook and loop fastener,
 commonly referred to as VELCRO.RTM. fasteners. Still another embodiment
 comprises a plurality of bristles (not shown) in which the bristles are
 disposed at a plurality of different orientations, similar to that of a
 tube or glass cleaner. Because of the multiple orientations of the
 bristles, any direction that the second section 40 tends to slide is
 resisted by bristles oriented that direction that contact the surface of
 the heart to resist the motion.
 Yet another embodiment of the stabilizing means comprises a flexible
 covering disposed over at least a portion of the second section 40. The
 covering can be a cloth, such as cotton, braided cotton, linen or other
 coverings that resist motion when disposed on the surface of a heart.
 Similarly, the covering can be a tubular member selected from the group of
 silicon, rubber, or plastic as well as other materials that resist motion
 when disposed on the surface of a heart.
 Although the present invention has been described with reference to
 specific details of certain embodiments thereof, it is not intended that
 such details should be regarded as limitations upon the scope of the
 invention except as and to the extent that they are included in the
 accompanying claims.