Abstract:
The present invention relates to surgical retractors and devices for stabilizing a predetermined area of the body during a surgical procedure, more particularly to surgical retractors and stabilizing devices used in connection with minimally invasive coronary artery bypass grafting surgical procedures, and more specifically to surgical retractors and stabilizing devices especially configured for use with each other for such surgical procedures wherein the retractor includes a plurality of recessed surfaces thereon for the mounting of a tower type of sled member thereon and wherein the sled member is readily attachable and removable from the retractor and is adjustable upon actuation of an adjustment knob which releasably controls the rotation of the connector with respect to the retractor and the movement of the stabilization arm segment with respect to the retractor upon actuation of a single knob or actuator.

Description:
“The present application is a continuation of U.S. Ser. No. 09/489,274 filed on Jan. 21, 2000, now abandoned, which is a continuation-in-part of U.S. Ser. No. 09/345,859 filed on Jul. 1, 1999 now U.S. Pat. No. 6,348,036, Provisional U.S. Ser. No. 60/117,333 filed on Jan. 24, 1999. 
    
    
     FIELD OF INVENTION 
     The present invention relates to surgical retractors and stabilization devices for engaging a predetermined area of the body during a surgical procedure, more particularly to surgical retractors and stabilizing devices used in connection with coronary artery bypass grafting surgical procedures, and more specifically to surgical retractors and stabilizing devices particularly configured for use with each other for such surgical procedures. 
     The present application is related to U.S. Ser. No. 60/117,333 filed on Jan. 24, 1999 and U.S. Ser. No. 09/345,859 filed on Jul. 1, 1999 the priority thereof is claimed hereby and the disclosures thereof are incorporated herein by reference. 
     BACKGROUND OF THE INVENTION 
     Diseases of the cardiovascular system affect millions of people each year and are a cause of death for large numbers of people in the United States and throughout the world. A particularly prevalent form of cardiovascular disease involves a reduction in the blood supply to the heart caused by atherosclerosis (coronary artery disease) or other conditions that create a restriction in blood flow at a critical point in the cardiovascular system leading to the heart. 
     One technique for treating such a blockage or restriction is a surgical procedure known as a coronary artery bypass graft procedure, which is more commonly known as “a heart bypass” operation. The surgical correction of occluded or stenosed coronary arteries by means of bypass grafting are probably still the most common procedures performed today, especially when multiple grafts are needed. 
     In the coronary artery bypass graft procedure, the surgeon may remove a portion of a vein from another part of the body for grafting or detaches one end of a local artery and connects that end past the obstruction while leaving the other end attached to the existing arterial supply. When using a vein from another part of the body, the surgeon installs this portion at points that bypass the obstruction. In both cases, the objective is to restore normal blood flow to the heart. 
     In addition, when using this technique, the surgeon makes a long incision down the middle of the chest, saws through the sternum, spreads the two halves of the sternum apart. In the past, the surgeon then performed several procedures necessary to connect the surgical patient to a cardiopulmonary bypass machine to continue the circulation of oxygenated blood to the rest of the body while the heart is stopped and the graft is being sewn in place. Although such a procedure is one common technique, the procedure is lengthy, traumatic and can damage the heart, the central nervous system and the blood supply of the patient. 
     Interventional techniques, such as percutaneous transluminal angioplasty (PTCA) have gained popularity as the method of choice for therapy of atherosclerosis occlusions for several reasons. The transluminal approach is a less invasive technique that subjects the patient to fewer traumas and a shorter recovery time, especially when compared to bypass grafts, which utilize homologous tissue, such as saphenous vein grafts. Also, the patient often suffers complications at the donor site of the graft that may be worse than the sternotomy and anastomosis. 
     Although PTCA procedures are often successful, complications such as restenosis or thrombosis and embolism can occur. Restenosed vessels may often require surgical intervention for correction. The surgical correction of restenosis, like the conventional coronary bypass surgical procedure, oftentimes required the heart to be stopped and the patient placed on a heart/lung bypass machine during the procedure. 
     In recent years, and in an effort to reduce expense, risk and trauma to the patient, physicians have turned to alternate approaches to heart surgery, including less invasive procedures such as intercostal and endoscopic access to the surgical site. Additionally, beating heart surgery has begun to replace cardiopulmonary bypass surgery using a pump. With such procedures, the heart is beating during the surgical procedure. Thus, there is no need for any form of cardiopulmonary bypass and there is no need to perform the extensive surgical procedures necessary to connect the patient to such a bypass machine. 
     Over the years, there have been many attempts at performing minimally or less invasive bypass grafting on a beating heart. Until recently, these techniques have been thought of as being 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 tissue movement at the graft site. These procedures are performed while the heart muscle is continuing to beat so that the heart continues to move in a three dimensional movement and the blood continues to flow while the surgeon attempts to evaluate the vessel and then sew the graft in place. Also, the surgical procedure to install the graft requires placing a series of sutures through the wall of an extremely small vessel and onto the artery and heart tissue while the heart continuously moves during the procedure. It is necessary that these sutures be fully and securely placed so the graft is firmly in position and does not leak. 
     There is disclosed in U.S. Pat. No. 5,730,757, an access platform for the dissection of an internal mammary artery. The described access platform has first and second blades interconnected to a spreader member that laterally drives the blades apart together and support pads interconnected to the first blade. A torsional member is operably interconnected to the first blade and the spreader member and is used to vertically displace the first blade in either direction. Thus, increasing the surgeon&#39;s working space and visual access for the dissection of the internal mammary artery. A tissue retractor interconnected to the blades is used to draw the soft tissue around the incision away from the surgeon&#39;s work area. It is further provided that the access platform can include a port that can be used to mount a heart stabilizer instrument. 
     There also is described in U.S. Pat. No. 5,875,782 granted to Ferrari et al. and U.S. Pat. No. 5,894,843 granted to Benetti et al. an apparatus for stabilizing the predetermined area on a heart or other organ of a patient to enable a surgical procedure on a beating heart. The apparatus includes a bifurcated member having two elongated prongs and an elongated handle. The handle segment can be movably attached to a rib retractor so that a person is not required to hold the handle segment. In one disclosed embodiment, the apparatus further includes a device to hold the bifurcated member in a desired position against the surface of the heart so that a stabilizing force is applied against the heart. 
     There also is described in U.S. Pat. No. 5,836,311 granted to Borst et al. an apparatus for stabilizing the predetermined area on a heart or other organ of a patient to enable a surgical procedure on a beating heart. The apparatus includes a single legged or bifurcated member having a plurality of suction members thereon which are attached to the surface of the heart using suction pressure. The arm portion of this device can be movably attached to a rib retractor or other surgical device so a person is not required to hold the handle segment and the suction device may be locked into position against the surface of the heart. 
     It is therefore desirable to provide a new system and devices related thereto for stabilizing a predetermined area of the body, such as the heart and methods related thereto. It is particularly desirable to provide such a system and devices thereto that are less complex and more user friendly in comparison to prior art devices. Such systems and devices thereto preferably are simple in construction, versatile and are preferably low profile to minimize obstruction of the view of the surgeon or nurse to the surgical field. 
     SUMMARY OF THE INVENTION 
     The present invention features a system for retracting, stabilizing or manipulating a predetermined area of a body. The system includes a surgical retractor, a stabilization arm or apparatus and a tissue support or stabilization device, and methods of use related thereto. Also featured is a system that also supports any of a number of surgical implements, for example a diaphragm retractor, a valve retractor, a light or a suction device for use during a surgical procedure. The stabilization system and related devices and apparatuses thereto that are featured herein are particularly advantageous for use in performing off-pump coronary artery bypass grafting procedures in which the heart remains beating during the surgical procedure. One advantage of the present invention relates to the use of the stabilization arm to provide a low profile stabilization system so that obstruction of the physician&#39;s view of the surgical site is minimized. Another advantage of the present invention relates to the use of the sled member on the arms of the retractor and even more preferably on the rack segment of the retractor. Additionally, the sled member of the present invention allows for a full range of motion that is controlled by a single knob that is easily manipulated by the surgeon. 
     The stabilization device preferably includes a device of the type commonly known as the Cohn Cardiac Stabilizer marketed by the Genzyme Corporation of Cambridge Mass., although horseshoe or suction type devices may also be used. The preferred form of the stabilization device is a generally square or rectangularly shaped member having a planar surface with centrally located opening therein. This opening is the area through which the surgeon performs the anastomosis or other procedure on the tissue of the beating heart. The stabilization device is preferably a two piece member so that once the anastomosis is completed, the pieces may be separated to remove the device from around the anastomosis. As described more fully below, flexible tapes are sutured through the tissue and then threaded through the stabilizing device. Once the stabilization device is positioned in the desired orientation and location, the flexible tapes are then pulled snug through the opening of the stabilization device to provide a system which captures the tissue and minimizes the overall movement of the predetermined area of the tissue. 
     The stabilization arm of the present invention preferably includes an elongated handle having a first or distal end portion and a connector thereon for releasably connecting the stabilization device to the elongated handle first end. This connection allows the stabilization device to be pivotally and slidably moved to a desired position into contact with the predetermined area of the tissue of the patient while minimizing the interference of the stabilization device and stabilization arm with the field of view in the surgical field. The stabilization arm also includes a mounting mechanism or sled member through which the stabilization arm is preferably slidable. The stabilization arm may also be positioned on either side of the vertical pivot point of the sled member to further increase the versatility of the stabilization system to allow the stabilization device to be positioned in the desired location of the surgical site. Alternately, one form of the sled member may also be oriented at an angle relative to the retractor to further increase the versatility of the present invention. Additionally, the stabilization arm may be straight or curved to provide the surgeon with yet another choice to obtain the best access to the desired surgical site. 
     According to one aspect of the present invention, the arms and rack surface of the retractor are configured with a plurality of mounting surfaces thereon. The mounting surfaces are preferably equally spaced along substantially the entire length thereof. The mounting surface is preferably spaced apart a predetermined and consistent distance from the front edge and is also preferably located on the interconnecting or rack segment of the retractor. Also, the stabilization arm preferably includes a sled member that is configured to removably engage the mounting surface at a desired location on one or more of the arms or the rack segment of the retractor. The sled member includes a lever or knob member for selectively engaging a mounting surface on the arm or rack segment of the retractor so the sled member is removably and adjustably secured to the arms or the rack segment of the retractor. 
     Each of the features described herein enable the user to determine the optimum position for the stabilization arm and stabilization device while ensuring that the surgeon&#39;s view of the surgical site is not unnecessarily obstructed. Additionally, these features allow the present invention to be used in many different medical procedures because of the versatility of system set up and orientation of the components of this invention. 
     Other aspects and embodiments of the invention are more fully discussed below. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     For a fuller understanding of the nature and desired objects of the present invention, reference is made to the following detailed description taken in conjunction with the accompanying drawing figures wherein like reference numbers denote corresponding parts throughout the several views and wherein: 
     FIGS. 1 A-C illustrate various perspective views of a stabilization system according to the present invention for stabilizing a predetermined area of a body such as a predetermined area of a heart or other organ of a patient to enable the conduct of a surgical operation or procedure; 
     FIG. 2 is a cross-sectional view of the retractor through a mounting surface and having the blade slots removed for clarity; 
     FIGS. 3 A-C are various perspective views of a portion of the stabilization system of the present invention illustrating the sled member, stabilization arm and stabilization device of the present invention; 
     FIGS. 4 A-C are side and elevational views of a further embodiment of the sled member of the present invention; 
     FIG. 5 is a cross sectional view of the sled member shown in FIGS. 4 A-C taken generally along lines  5 — 5  of FIG. 4A; and 
     FIG. 6 is a cross sectional view of a further embodiment of a sled member of the present invention taken generally along the same lines as lines  5 — 5  of FIG.  4 A. 
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     Referring now to the various figures of the drawings wherein like reference numbers refer to like elements, there is shown a stabilization system  100  according to the present invention for stabilizing a predetermined area of the body of a human patient such as a predetermined area of a heart or other organ to assist the surgeon in performing the surgical procedure. For the sake of brevity, common components between the various embodiments are described only once and are not necessarily repeated as they relate to each separate embodiment discussed below. The stabilization system of the present invention is particularly useful in connection with single or multiple vessel off-pump coronary artery bypass surgery on a beating heart surgery through a sternotomy or mini-sternotomy. 
     A surgeon may use the stabilization system  100  to apply a slight contacting or compressive force on the heart in the area where the surgical procedure will be performed so the movement of the local tissue at the surgical site is diminished. In a preferred form of this invention, the stabilization system  100  is used in combination with flexible tapes or sutures or other mechanical means so that the tissue adjacent to the surface of the heart is stabilized or captured using a combination of restraining and stabilizing forces. In certain procedures, it may also be advantageous to place a traction suture around an artery using a needle and suture thread to occlude the blood vessel. These sutures may then be attached to the stabilizing device so that the flow of blood through the blood vessel is selectively restricted. 
     Systems for stabilizing the heart of a patient are particularly useful for various suturing techniques or procedures. One example of this type of procedure is the performance of an anastomosis for a bypass graft. In this type of procedure, the physician is attempting to suture the circumference of a blood vessel that may be about 1 mm to a moving blood vessel on the surface of the heart. Another area of use of the present invention may be in brain surgery, heart valve surgery or other types of blood vessel surgery where stability is critically important to avoid disastrous consequences or where it is desirable to have a precisely defined surgical field. One skilled in the art will appreciate that the present invention, although advantageously suited 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. This includes, but is not limited to, the liver, kidneys, bladder, stomach, intestines, brain and vascular and other soft tissue surgery. Additionally, one skilled in the art will appreciate, as hereinafter described, that the supporting components of the system can be adapted so that any surgical instrument or device can be self-supported during a surgical procedure. 
     As shown in the drawings, the stabilization system  100  according to the present invention includes a retractor  102 , a stabilization sub-system or stabilization arm  104  and a stabilization device  106 . The retractor  102  is specifically configured so the stabilization arm  104  can be secured thereto. The retractor  102  preferably includes a rigid L-shaped member  110  having an arm segment  112  and a rack segment  114 . The retractor  102  also preferably includes a movable second arm segment  116  having a handle  118  thereon which is movably associated with the L-shaped member  110 . 
     The stabilization arm or sub-system  104  preferably includes an elongate handle or stabilization arm segment  180  and sled member  140  that preferably interconnect the retractor  102  and the stabilization device  106 . The stabilization arm segment  180  preferably includes a first end having a distal connector  181  thereon to pivotally and removably retain the stabilization device  106  thereon. The stabilization arm segment  180  is attachable to the retractor  102  by a connector such as a mounting mechanism or sled member  140 . The proximal or second end  182  of the stabilization arm segment  180  preferably includes a knob  184  thereon that may be rotatable with respect to the stabilization arm segment  180  to allow the movement of the stabilization device  106  to be pivotal and/or fixed with respect to the stabilization arm segment  180  by manipulating the knob  184  on the proximal end of the stabilization arm segment  180 . This arrangement also allows the stabilization device  106  to be mountable on and removable from the distal connector  181 . 
     The preferred form of the stabilization device  106  is generally a rectangular shape having an opening or window area  190  therein. The stabilization device  106  preferably includes a first surface  192  that is generally planar and may include a textured surface thereon to facilitate the engagement between the stabilization device and the tissue of the predetermined area or the heart of the patient. The second surface  194  of the stabilization device  106  preferably includes a post member  196  extending therefrom. The distal connector  181  on the first end of the stabilization arm segment  180  preferably releasably and rotatably engages the post member  196 . 
     As described briefly above, the retractor  102  preferably includes a handle  118  located on the second arm segment  116  and the handle  118  is rotatable for displacing the two arm segments  112 ,  116  with respect to each other. In the preferred form of this invention, rotation of the handle  118  causes a pair of posts or pinions to sequentially engage the teeth located on the outer edge of the rack segment  114  to increase or decrease the distance between the first and second arms  112  and  116 . In a specific illustrative embodiment, the rack segment  114  is configured with a finochetti type of rack as is known to those skilled in the art. In conjunction with the handle  118 , the rack segment  114  and movable second arm  116  form a rack and pinion type of means for displacing the arm segments  112 ,  116  with respect to each other. As shown, this type of rack segment  114  includes a plurality of laterally extending teeth that engage the posts or similar tooth engaging members located in operative contact with the handle  118  of the second arm segment  116 . It is anticipated that a variety of mechanisms may be used to move the second arm segment  116  along the rack segment  114 . For example, a gear mechanism, a slide and locking mechanism or similar arrangement may be used to accomplish the separation and fixation of the second arm  116  with respect to the first arm  112 . It is within the scope of the present invention, however, for the retractor  102  to be configured or designed with any of a number of means known to those skilled in the art for selectively displacing the respective arm segments,  112  and  116  either towards or away from each other in a parallel, obtuse or acute angled manner. 
     As indicated above, in a specific illustrative embodiment, the rack segment  114  is configured with a finochetti type of rack as is known to those skilled in the art. The retractor  102  also includes a plurality of blades  128  at least one blade extending outwardly from a surface, the bottom surface, of each arm segment  112 ,  116 . At least one arm segment and preferably both arm segments  112 ,  116  and/or the rack segment  114  are configured so as to provide at least one mounting point or mounting surface  120  to which a sled member  140  is secured. Preferably, the arm segment and/or the rack segment are configured so as to provide a plurality of such mounting surfaces  120 . More particularly, the arm segments,  112  and  116  and/or rack segment  114  are configured with a depressed and generally concave surface  122  in the top surface of the arm/rack segment and a corresponding arcuate or convex surface  124  on the bottom surface thereof to form each mounting surface  120  as shown in FIG.  2 . Although convex and concave surfaces are illustrated, it is within the scope of the present invention for these surfaces to have nearly any shape, including a generally arcuate shape. For example, the convex surface on the backside of the art could be a concave or other surface. 
     Slots  126  are preferably formed in a portion of each mounting surface  120 . Preferably, the slots  126  form a generally X-shaped pattern in the concave surface  122  with a through hole centered in the bottom of the depressed surface. However, other slot patterns such as an Y-shaped pattern or a star shaped pattern are within the scope of the present invention. Preferably, a portion of the slots also is arranged so as to extend through the front edge  119  of the arm/rack segment so a portion of the shaft  142  of the sled member  140  can pass therethrough to the centrally located through hole. 
     As shown in FIGS. 1A-C, the stabilization arm segment  104  includes the stabilization arm segment  180  and the sled member  140 . The sled member  140  is configured so the surgeon can position the stabilization arm segment  180  along the retractor  102  to stabilize the predetermined area of the patient. The sled member  140  is also configured so the surgeon, after positioning the stabilization device  106 , can secure the stabilization device  106  and the stabilization arm segment  180  to the retractor  102  so the stabilization device  106  remains fixed in this position without further input or action by the surgeon. 
     Referring also to FIGS. 3A-C, the sled member  140  includes a washer member  144 , a shaft  142 , a clamp mount housing  146 , and an adjustment knob  148 . The lower surface  150  of the clamp mount housing  146  is configured and arranged so as to complement the shape or configuration of the concave surface  122  of each mounting surface  120 . This is done so the surgeon can translate or rotate the sled member  140  while the lower surface  150  is disposed within the depression of the mounting surface  120 . The upper surface  152  of the washer member  144  also is configured and arranged so as to complement the shape or configuration the convex surface  124  forming each mounting surface  120 . 
     The shaft  142  is rotatably mounted within the adjustment knob  148  and a distal end thereof is rotatably secured to the washer member  144  so rotation of the knob in one direction causes the washer member to be drawn to the lower surface  150  of the clamp mount housing  146 . Correspondingly, if the knob is rotated in the opposite direction, the washer member  144  is urged away from the lower surface  150  of the clamp mount housing  146 . The shaft  142  is also rotatably disposed within the clamp mount housing  146  so it generally extends along a long axis of the clamp mount housing. 
     When the sled member  140  is disposed at a mounting surface  120  and the adjustment knob  148  is rotated so the washer member  144  is drawn towards the lower surface  150  of the clamp mount housing  146 , the upper surface  152  of the washer member  144  comes into contact with and engages the convex surface  124  on the backside of the retractor arm/rack. Correspondingly, the lower surface  150  of the clamp mount housing  146  is drawn towards the concave surface  122  of the mounting surface  120  with such a rotation of the adjustment knob  148 . When the housing lower surface  150  and the washer member upper surface  152  are in contact with and engage the concave and convex,  122  and  124 , respectively, the continued rotation of the adjustment knob  148  compresses the clamp mount  154  so as to secure the stabilization arm segment  180  to the clamp mount housing  146 . 
     Accordingly, the inner diameter of the clamp mount  154  is established so the stabilization arm segment  180  is secured therein when the adjustment knob  148  is turned a specified number of revolutions. The inner diameter is also established such that for a lesser number of revolutions, the stabilization arm segment  180  remains slidably disposed within the clamp mount  154  so the surgeon can appropriately position the stabilization device  106  in the surgical site. 
     The stabilization arm segment or sub-system  104  preferably includes a curved and elongate stabilization arm segment  180  that is preferably formed of a tubular member  188 . The stabilization arm segment  180  preferably includes a first end having a distal connector  181  thereon to pivotally and removably retain the stabilization device  106  thereon. The stabilization arm segment  180  is attachable to the retractor  102  by a connector such as the mounting mechanism or sled member  140 . The proximal end of the stabilization arm segment  180  preferably includes a movable knob  184  thereon that is rotatable with respect to the stabilization arm segment  180  to allow the movement of the stabilization device  106 . The movable knob  184  allows the stabilization device  106  to be fixed, removable and/or pivotal with respect to the stabilization arm segment  180  by manipulating the movable knob  184  on the proximal end of the stabilization arm segment  180 . This arrangement also allows the stabilization device  106  to be mountable on and removable from the distal connector  181  such that the stabilization device  106  may be disposable while the stabilization arm segment may be reusable. 
     A fixed knob  186  is fixed distally of the movable knob  184  on the tubular member  188  of this embodiment to allow the user to rotate the stabilization device  106  and stabilization arm segment  180  by manipulating the fixed knob  186 . The movable knob  184  is preferably threadable into the proximal end of the fixed knob  186 . Clockwise movement of the movable knob causes an elongate rod member to move distally within the stabilization arm segment  180  to press a pin member in the distal connector  181  against the post member  196  of the stabilization device  106  in a slot  187  in the distal connector  181 . Counterclockwise movement of the movable knob allows the elongate rod member to move proximally within the stabilization arm segment  180  to release the pin member and allow the post member to pivot or be removed from the slot  187 . 
     The stabilization device  106  of the stabilization system  100  may be any number of devices that are available for use to contact and engage a predetermined area of the body as well as providing a window or access through which is presented the area targeted by the surgical or, medical procedure to be performed. Such devices include, but are not limited to a Cohn Cardiac stabilizer supplied by Genzyme Surgical Products of Fall River Mass., USA or a bifurcated design provided by numerous companies. 
     There are shown in FIGS. 4 A-D various views of an alternative embodiment for a sled member  140  for use in the stabilization system  100  according to a further form of the present invention wherein like numbers are used for like elements. The sled member  140  includes a washer member  144 , a shaft  142 , and a clamp mount housing  146 , a first adjustment knob  248  and a second adjustment knob  250 . The washer member  144  preferably includes an upper surface  152  thereon. The upper surface preferably has a shape that is complementary to the bottom surface of the mounting surface on the retractor. The clamp mount housing  146  preferably includes a lower surface  150  shaped to generally conform to the upper surface of the mounting surface on the retractor. As shown, the clamp mount housing  146  also preferably includes the clamp mount  154  therein. The clamp mount  154  is sized to receive the stabilization arm segment  180  therein and is compressible to engage the stabilization arm segment therein as the knobs  248  and  250  are rotated. Reference should be made to the foregoing discussion for the related components. 
     In the embodiment, shown in FIGS. 4A-C and  5 , the first and second adjustment knobs  248  and  250  act separately on the shaft  142 . The first adjustment knob  248  is configured to draw the shaft upwardly when it is rotated in one direction so as to draw the washer member  144  towards the housing lower surface  150 . The first adjustment knob  248  is configured, however, so the washer member upper surface  152  and the housing lower surface  150  cannot be placed in firm engagement with the concave and convex surfaces  122 ,  124  at the mounting surface when the first adjustment knob  248  has been rotated its maximum extent. Rather, the maximum extent of rotation for the first adjustment knob  248  is set so the sled member  140  cannot be withdrawn from the mounting surface but can be translated within the depressed region at the mounting surface  120  by the surgeon for purposes of positioning the stabilization device  106 . 
     The second adjustment knob  250  of this embodiment is configured so it draws the shaft  142  of the sled member  140  upwardly when it is rotated in one direction so the housing lower surface  150  and the washer member  144  of the sled member  140  engage the concave and convex surfaces  122 ,  124  of the mounting surface  120  thereby securing the sled member to the retractor arm or rack segment  112 ,  114 . Such rotation also causes the clamp mount  154  to be compressed thereby clamping the stabilization arm segment  180  therein. In this way, the stabilization device  106  can remain in contact with and engage the predetermined area without further action or input by the surgeon (i.e., self-supporting). 
     In an alternate embodiment, as shown in FIG. 6, the first and second adjustment knobs  278  and  280  act separately on the shaft  142  and washer member  144 . For the sake of brevity, like numbers are used to designate like elements referred above. The first adjustment knob  278  is configured to apply pressure against a ball member  282 , which extends upwardly from the washer member  144 . The ball member  282  is captured in a housing  284  and enables the user to adjust the orientation of the clamp mount housing  146  relative to the washer member  144  such that the clamp mount housing  146  and the stabilization arm segment  180  may be tilted or oriented at an angle relative to the washer member  144  and therefore at an angle relative to the retractor  102 . The second adjustment knob  280  is configured to draw the shaft upwardly when it is rotated in one direction so as to draw the washer member  144  towards the housing lower surface  150  and also apply a compressive force against the stabilization arm segment  180  to securely retain the stabilization arm segment in the desired position. The first adjustment knob  278  is configured so the washer member upper surface  252  and the housing lower surface  150  may be oriented at various angles relative to each other prior to the placement of the clamp mounting housing  146  in firm engagement with the concave and convex surfaces  122 ,  124  of the mounting surface  120 . Rather, the rotation for the first adjustment knob  278  is set so the shaft engages the ball member  282  to prevent further rotation of the washer member  144  relative to the clamp mount housing  146  when the first adjustment knob  278  is tightened. 
     The second adjustment knob  280  of this embodiment is configured so it draws the shaft  142  of the sled member  140  upwardly when it is rotated in one direction so the housing lower surface  150  and the washer member  144  securely engage the concave and convex surfaces  122 ,  124  of the mounting surface  120  thereby securing the sled member  140  to the retractor arm or rack segment. Such rotation also causes the clamp mount  154  to be compressed thereby clamping the stabilization arm segment  180  therein. In this way, the stabilization device  106  can remain in contact with and engage the predetermined area without further action or input by the surgeon (i.e., self-supporting). 
     The stabilizing systems according to the further embodiments of the present invention are used in a similar manner as the stabilizing system  100  of the first aspect of the invention. The principle difference being the manner in which the stabilization arm segment  104  is mounted to the retractor  102  and the manner in which the surgeon would adjust the stabilization device  106  such that it is contact with and engaging the predetermined area. As such the following describes the mounting of the sled member and adjustment of the stabilization device  106 , with reference to each of the Figures. 
     After the surgeon has retracted the tissue and the sternum, by outwardly disposing the retractor arm segments  112 ,  116 , the surgeon mounts the stabilization arm segment  104  to one of the mounting surfaces  120  on an arm segment  112 ,  116  or rack segment  114 . To accomplish this the surgeon first slides the portion of the shaft located between the housing lower surface and the washer member upper surface through the portion of the slot  126  that extends to the front edge of the retractor arm,  112  or  116 , or rack segment  114  for a mounting surface  120 . This is done until the housing lower surface is generally opposite to the concave surface  122  of the mounting surface  120 . In one of the embodiments described above, the surgeon may adjust the relative orientation of the clamp mount housing and the washer member to adjust the angle of approach by the stabilization arm segment to the surgical site. 
     The surgeon may then rotates the adjustment knob or knobs a number of turns to reduce the spacing between the housing lower surface and the washer member upper surface so the sled member cannot slide back out the slot  126 . For one or more embodiments of the alternate embodiments of the sled member described above, the surgeon may rotate the first adjustment knob to its maximum extent so as to accomplish the same effect. 
     To securely and finally position the stabilizer device  106 , the surgeon then may do any one or more of the following (1) translate the sled member within the depressed region of the mounting surface  120 , including using the other slots formed in the concave surface  122 , (2) rotate the sled member about the shaft, (3) slide the stabilization arm segment  180  within the clamp mount of the clamp mount housing, (4) pivot the stabilization device  106  about the distal connector  181  of the stabilization arm segment  180  or (5) adjust the angle of the clamp mount housing relative to the retractor. After the stabilization device  106  has been positioned at the desired area, the surgeon rotates the movable knob  184  on the stabilization arm segment so as to prevent further movement of the stabilization device  106  with respect to the distal connector  181  of the stabilization arm segment  180 . The surgeon also rotates the appropriate adjustment knob of the sled member so the housing lower surface and the washer member upper surface firmly engage the concave and convex surfaces  122 ,  124  of the mounting surface  120  thereby securing the sled member at the desired mounting surface  120 . Additionally, such rotation also compresses the clamp mount to securely clamp the stabilization arm segment  180  therein. For the alternative embodiments of the sled members, the surgeon rotates the first and/or second adjustment knobs so as to accomplish the same securing and clamping effect. 
     As indicated above, it is within the scope of the present invention for the stabilization device  106  to be replaced with any of a number of stabilization devices known to those skilled in the art, for example a Cohn Cardiac Stabilizer manufactured by Genzyme Surgical Products Corporation of Cambridge, Mass., U.S.A. Additionally, although the stabilization arm segment  180  is illustrated as being a curved member, the stabilization arm segment can include an arcuate section, be sinuous or straight. 
     In the foregoing discussion, the sled member of any of the embodiments of the invention is described in terms of clamping and supporting a stabilizer. It is within the scope of the present invention, however, for the support to be configured to removably secure any of a number of surgical instrumentalities to the retractor such as for example valve or diaphragm retractors. Additionally, although one support is described as being in use at a time, it is within the scope of the present invention for plurality or a multiplicity of supports to be secured to the retractor. For example, one sled member could be provided to support a diaphragm retractor and another sled member to support a stabilizer. 
     Although various preferred embodiments of the present invention have been described using specific terms, such description is for illustrative purposes only, and it is to be understood that changes and variations may be made without departing from the spirit or scope of the following claims.