Patent Description:
Minimally invasive surgical approaches are gaining increased interest in relation to coronary procedures. Coronary revascularization procedures such as the grafting of the internal thoracic artery (ITA) has shown superior long-term patency and improved patient outcome in coronary artery bypass graft (CABG) surgeries. While conventional approaches to ITA harvesting have included median sternotomy or multiple thoracoports, a minimally invasive approach is desirable. A minimally invasive procedure related to revascularization using either the left or right internal thoracic artery (ITA), or the left or right internal mammary artery (IMA) may utilize access to the IT As via sub-xiphoid access, where increased surgical space is gained by accessing the internal thoracic arteries via incision at the subxiphocostal region.

Upon harvesting either the left internal thoracic artery (LITA) or the right internal thoracic artery (RITA) anastomoses to the left anterior descending (LAD) coronary artery and to the right coronary artery (RCA), respectively, can be performed without cardiopulmonary bypass (CPB). A significant advantage of this approach is that a perfectly harvested ITA graft can be perfectly anastomosed to the usual site on the LAD artery, or onto the RCA artery. A minimally invasive ITA harvesting procedure involving sub-xiphoid access also results in superior cosmetic results, is reasonably painless, and the arterial grafting can be accomplished on the beating heart. Recent approaches of minimally invasive ITA harvesting surgical techniques have been shown to result in increased effective length of ITA bypasses, reduced operation times, and improved patient recovery.

While less invasive surgical approaches for ITA harvesting and CABG have shown promise, visualization, maintenance of insufflation, and distal suturing of a coronary anastomosis in totally endoscopic coronary artery bypass grafting on the beating heart is technically demanding. There is a need for larger working spaces to accommodate an increased range of motion during surgical procedures, as well as room for additional surgical tools, such as endoscopes, suturing tools, and the like. However, achieving an increased working space should ideally preserve chest wall integrity and avoid CPB. Likewise, a minimally invasive surgical approach should not compromise the reliability of a cardiac repair.

Therefore, there exists a need for minimally invasive surgical devices and methodology applicable to ITA harvesting and other surgical procedures such as epicardial lead placement and others that increase operable space for harvesting and anastomosis and other surgical procedures, reduce operating time, and improve patient outcome during minimally invasive cardiac procedures and other surgical procedures.

<CIT> disclose a hand held retractor for endoscopic use. The hand-held retractor comprises a longitudinally-extending blunt blade, a separating member, a handle, and a means for connecting the handle to the separating member.

<CIT> discloses a system for producing a substernal space accessed via a sub-xyphoid incision. The system includes an upper spreader portion including a main body member and a hook operatively configured to lift a sternum region of the patient.

<CIT> discloses a combination of complementary surgical instruments including a pair of retractors positioned at right angles to and overlaying one another during surgery. The retractor includes arms having a blade attached thereto including vertical faces used in retaining and holding back soft tissue during surgery.

It will be appreciated that for purposes of clarity and where deemed appropriate, reference numerals have been repeated in the figures to indicate corresponding features, and that the various elements in the drawings have not necessarily been drawn to scale in order to better show the features.

The presently claimed invention provides a sternal ascender apparatus according to claim <NUM>. Further developments of the herein claimed invention are described in the dependent claims. A sternal ascender apparatus for use during minimally invasive surgical procedure is disclosed. The apparatus also includes an indicator handle configured for gripping having a proximal end. The sternal ascender may include a panel configured to enable lifting a ribcage having an underside, a support beam traversing the underside of the panel, and a post for attachment to the sternal ascender apparatus. The post is coupled to a proximal end of the panel and is configured to be inserted and locked in the proximal end of the indicator handle. The apparatus includes further an actuator drive having a linear rack pivotably coupled to the indicator handle, and a housing movably coupled to the actuator drive along the linear rack. The housing further may include a cylindrical gear where the cylindrical gear is engaged with the linear rack.

Another sternal ascender apparatus is disclosed. The sternal ascender may include a panel having a plurality of textural features, a support beam traversing the panel, and a post coupled to a proximal end of the panel. The apparatus may also include an indicator handle removably coupled to the sternal ascender, an actuator drive pivotably coupled to the indicator handle having a linear rack, and a housing movably coupled to the actuator drive having a cylindrical gear and two instrument adapters.

<FIG> is a perspective view of one embodiment of a sternal ascender apparatus with a right sternal ascender attached. An embodiment of a sternal ascender apparatus <NUM> is shown in <FIG>, with a right sternal ascender <NUM> installed therein. The right sternal ascender <NUM> defines a panel <NUM>, the panel <NUM> having several textural features <NUM> configured to provide an atraumatic yet firm grip on the underside of a ribcage when the sternal ascender assembly <NUM> is in use in a minimally invasive surgical procedure. The panel <NUM> of the right sternal ascender <NUM> also defines a notch <NUM> and has a support beam <NUM> on the underside of the panel <NUM> The right sternal ascender <NUM> has a mounting post <NUM> on a proximal end 12P. The mounting post <NUM> is coupled to a proximal end 22P of an indicator handle <NUM> at the end of the mounting portion <NUM> of the indicator handle <NUM>. The right sternal ascender <NUM> is coupled by reversible means such that the right sternal ascender <NUM> may be easily removed and replaced with a left sternal ascender, which is not shown in this view. The term ascender may be used interchangeably with the term elevator or lifter, as they equivalently describe the intended function of the ascender and associated apparatus. This coupling means will be described in further detail later. One alternate example of a coupling method is using a set screw, although others may be known to those skilled in the arts. The indicator handle <NUM> further defines a grip <NUM> in the underside of the indicator handle <NUM>, which is configured for an ergonomic gripping feature for the comfort of use by a surgeon. At a distal end 22D of the indicator handle <NUM> is a connection end <NUM> and a pressable switch <NUM>. Towards the distal end 22D of the indicator handle <NUM> is a depth indication mark <NUM>, which is vertically aligned with the distal end 12D of the right sternal ascender <NUM>. The connection end <NUM> is a coupling point that accepts a corresponding connection end <NUM> on a linear rack or linear actuator gear <NUM> by way of mating with the connection end <NUM> and is pivotably attached by joining a pivot pin <NUM> or alternatively by other attachment means into a hole or other attachment means not shown in this view. The pressable switch <NUM> can be pressed or actuated to defeat a pawl that is located inside the indicator handle <NUM>, but not shown in this view. The pawl interfaces with a fixed indexing gear located inside the connection end <NUM> portion of the linear actuator gear <NUM>. This will be discussed later in more detail in regard to <FIG>. The pawl defines a spring or biasing element to bias, while at rest, one or more teeth defined by the pawl toward the fixed indexing gear, which is not shown in this view but is coupled to the connection end <NUM> of the linear actuator gear <NUM>. When the one or more teeth on the pawl intermesh with one or more corresponding teeth or other locking feature defined by the fixed indexing gear, this locks the angular position of the linear actuator gear <NUM> relative to the position of the indicator handle <NUM>. When switch <NUM> is pressed or actuated, the pawl is defeated and temporarily pushed away from the fixed indexing gear, allowing free angular movement of the linear actuator gear <NUM> relative to the indicator handle <NUM>. Releasing the switch <NUM>, re-engages the pawl and the fixed indexing gear to once again interface and lock the angular position of the linear actuator gear <NUM> relative to the indicator handle <NUM> that it was in when the switch <NUM> was released.

The linear actuator gear <NUM> further defines several teeth <NUM> and several recesses <NUM> that engage a cylinder gear <NUM>. The linear actuator gear <NUM> fits through an actuator slot <NUM> in a dual side instrument adapter <NUM>. The dual side instrument adapter <NUM> defines a first adapter channel <NUM> and a second adapter channel, not visible here, on the opposite side. The dual side instrument adapter <NUM> also defines several locking mechanisms <NUM>, <NUM> for locking the dual side instrument adapter <NUM> into a surgical equipment holder on each side. Once the dual side instrument adapter <NUM> is attached on each side to a surgical equipment holder, it can be positioned over a patient by bridging two surgical equipment holders across a surgical table. Other embodiments may only have a single adapter channel for mounting onto a single surgical equipment holder. Attached to the dual side instrument adapter <NUM> is a gear housing <NUM> which holds the cylinder gear <NUM>. A handle or swivel bar <NUM> is coupled to the cylinder gear <NUM>. Turning the handle <NUM> rotates the cylinder gear <NUM> and thereby moves the linear actuator gear <NUM> back and forth which forms an actuator drive. In this embodiment, the sternal ascender assembly <NUM> is inserted into an incision below the sub-xiphoid of a patient undergoing a minimally invasive surgical procedure, such as an ITA harvesting procedure or other surgical procedure in which increased access space below the sub-xyphoid process is advantageous. The panel <NUM> of the right sternal ascender <NUM> can be used to enable lifting the ribcage, thereby increasing space in the subxiphoid area. One feature of the sternal ascender assembly <NUM> is that the length of the distal end 22D of the indicator handle <NUM> is substantially the same as the length of the right sternal ascender <NUM> panel <NUM>, which provides the surgeon with a visible indication, along with the depth indication mark <NUM> of how far the right sternal ascender <NUM> or the right sternal ascender (if installed into the sternal ascender apparatus <NUM>) has been inserted into the subxiphoid cavity of the patient. The distal end 22D of the indicator handle <NUM> is substantially aligned with a distal end 12D of the sternal ascender <NUM>. The indicator handle <NUM> is also substantially parallel to the panel <NUM> of the right sternal ascender <NUM> or the panel of a right sternal ascender. Once the sternal ascender apparatus or assembly <NUM> is inserted into the subxiphoid cavity, the sternal ascender assembly <NUM> is attached to one or more surgical equipment holders, enabling stability of force throughout a minimally invasive surgical procedure. Further adjustments to the position of the sternal ascender assembly <NUM> may then be made by pivoting about the coupling joint of the indicator handle <NUM> and the linear actuator gear <NUM>. The sternal ascender assembly <NUM> can be further adjusted by rotating the swivel bar <NUM> and actuating the linear actuator gear <NUM> in a distal direction. This operation will be discussed in further detail later.

<FIG> is a series of exploded views illustrating the assembly of the sternal ascender apparatus of <FIG>. As illustrated in <FIG>, a first handle half 22A defines a recess or channel <NUM> having a mounting slot <NUM> and a seat <NUM>. The mounting slot <NUM> and seat <NUM> defined by the channel <NUM>, also referred to as a t-slot based on the general shape thereof, are configured to removably receive an alignment key on the post of either a left or right sternal ascender. A second handle half 22B also defines a corresponding recess, not shown in this view. The first handle half 22A also defines a second recess <NUM> at an opposite end and a gear recess <NUM> and hole <NUM>. The second handle half 22B also defines a corresponding recess, not shown in this view. The second recess <NUM> is configured to receive and hold a spring <NUM>, spring plunger <NUM>, and plunger housing <NUM>, which are first assembled together. A pawl gear <NUM> having gears <NUM> and an ungeared portion <NUM> and a fixed indexing gear or a pivot gear <NUM> having a gear keyway <NUM> are placed into hole <NUM> and held in gear recess <NUM>, respectively, on the first handle half 22A. The pawl gear <NUM> is held against the spring <NUM>, spring plunger <NUM>, and plunger housing <NUM> assembly such that the pawl gear <NUM> is biased against the pivot gear <NUM> until the pawl gear <NUM> is depressed to slide the pawl gear <NUM> so that the gears <NUM> are disengaged from the pivot gear <NUM> such that it interfaces with the ungeared portion <NUM> of the pawl gear <NUM>, thus allowing free rotation or pivoting of the pivot gear <NUM>. When the pawl gear <NUM> is released, the gears <NUM> relock with the pivot gear <NUM> preventing further pivoting or rotation of the pivot gear <NUM>. The second handle half 22B is then placed over the first handle half 22A and fastened using several rivets <NUM> which are placed and fixed into holes <NUM>, <NUM>, <NUM> on the second handle half 22B. While holes and rivets are used here to fixedly attach the handle halves 22A, 22B together, welding, adhesives or other means known to those skilled in the art may also be employed.

<FIG> illustrates the assembly of an instrument adapter assembly <NUM> portion of the sternal ascender apparatus <NUM>. A first adapter housing <NUM> having several holes <NUM> and side hole <NUM> is assembled by placing a first cam <NUM> having a flat 96F into hole <NUM>. A first lever lock <NUM> having a key <NUM> is placed into hole <NUM> and into the first cam <NUM> such that rotating the first lever lock <NUM> will also rotate the first cam <NUM> within hole <NUM>. The first lever lock <NUM> is pivotably attached to the first adapter housing <NUM> with the use of rivet <NUM> being placed into channel <NUM> on the first lever lock <NUM>. A second adapter housing <NUM> having several holes <NUM> and side hole, not visible here, is assembled by placing a second cam <NUM> having a flat 98F into hole <NUM>. A second lever lock <NUM> having a key <NUM> is placed into a hole on the second adapter housing <NUM> and into the second cam <NUM> such that rotating the second lever lock <NUM> will also rotate the second cam <NUM> within the hole in the second adapter housing <NUM>. The second lever lock <NUM> is pivotably attached to the second adapter housing <NUM> with the use of rivet <NUM> being placed into channel <NUM> on the second lever lock <NUM>.

<FIG> continues the assembly of the sternal ascender apparatus <NUM> focusing on the linear actuator gear <NUM>. The linear actuator gear <NUM>, having a connection end <NUM> which further defines a hole <NUM> and several teeth <NUM> with several recesses <NUM> positioned therebetween. A cylinder gear <NUM> defines two sides <NUM>, a side channel <NUM> on either side <NUM>, a slot <NUM>, and two posts <NUM>, one of which is visible here, is placed into the linear actuator gear <NUM> with the two posts <NUM> held in two adjacent recesses <NUM>. A drive bottom <NUM> is fixed with two rivets <NUM> onto the two posts <NUM> of the cylinder gear <NUM> on the opposite side of the linear actuator gear <NUM>. Once fully assembled, the cylinder gear <NUM> is rotated in a clockwise or counterclockwise direction this thereby moves the linear actuator gear back and forth forming an actuator drive. As the cylinder gear <NUM> is rotated, the first pinion or post <NUM> will rotate out of a recess <NUM> on the linear actuator gear <NUM> and outward while the second pin driver (not visible here) remains in a second recess <NUM> and rotates within the second recess <NUM>. The first post <NUM> will rotate into a third recess <NUM>, past the second recess <NUM> thus translating rotational motion into linear motion and moving the linear actuator gear <NUM> relative to the gear housing <NUM>. Performing this operation in the reverse will move the actuator gear <NUM> in the reverse direction. A upper rack housing <NUM> having a central opening <NUM> and several holes <NUM> is then placed over the linear actuator gear <NUM> and cylinder gear <NUM> so that the cylinder gear <NUM> protrudes from the central opening <NUM> of the upper rack housing <NUM> and the upper rack housing <NUM> is able to slide along the linear actuator gear <NUM> as the cylinder gear <NUM> is rotated. <FIG> illustrates the handle <NUM> being placed into the cylinder gear <NUM> between the two sides <NUM> and held in place by placing a rivet <NUM> through the side channels <NUM> on the cylinder gear <NUM> and through the hole <NUM> on the swivel bar <NUM>. A middle rack housing <NUM> having a central hole <NUM>, several holes <NUM>, and two housing inserts <NUM> is placed onto the bottom of the linear actuator gear <NUM> to align with the upper rack housing <NUM>. The holes <NUM> on the upper rack housing <NUM> are aligned with the holes <NUM> on the middle rack housing <NUM>. The two housing inserts <NUM> are configured to hold captive and allow free rotation of the drive bottom <NUM> of the cylinder gear <NUM>. The handle or swivel bar <NUM> is used to swivel and rotate the cylinder gear <NUM> during operation. The assembly of the sternal ascender apparatus <NUM> is completed in <FIG> by inserting the distal end 22D of the indicator handle <NUM> into the linear actuator gear <NUM>. The pivot pin <NUM> is inserted into hole <NUM> with the pivot pin post <NUM> interlocking into the gear keyway <NUM> of the pivot gear <NUM>, the function of which was illustrated in <FIG>. The instrument adapter assembly <NUM> shown and described in regard to <FIG> is placed onto the bottom of the middle rack housing <NUM> and holes <NUM> in the instrument adapter assembly <NUM> are aligned with the corresponding <NUM> holes in the upper rack housing <NUM>. Several rivets <NUM> are then placed into the holes <NUM> to fixedly join the instrument adapter assembly <NUM> to the middle rack housing <NUM> and upper rack housing <NUM>.

<FIG> is a perspective view of a left sternal ascender. This view illustrates the various features defined by the left sternal ascender <NUM>. The left sternal ascender <NUM> defines a panel <NUM> having several textural features <NUM>, a contralateral, or pertaining to the opposite side of targeted anatomical area, notch <NUM> at a proximal end 152P, a support beam <NUM> traversing the underside of the panel <NUM>, and a mounting post <NUM> for attachment to a sternal ascender apparatus. The panel <NUM> has a rounded shape with a slight edge at a distal end 152D of the panel <NUM> of the left sternal ascender <NUM>. Also defined by the post <NUM> are two opposing alignment and orientation features <NUM> configured to align, slide and lock the left sternal ascender <NUM> into the handle. These features <NUM> form a general t-shape, which are configured to fit into the aforementioned t-slot on the indicator handle <NUM>. The use of this feature will be described further in regard to <FIG>. The post <NUM> also defines an angular front alignment feature <NUM> which is used to help align and place the left sternal ascender in an anatomical notch defined between a rib and sternum. This can serve as a tactile assist in placing the sternal ascender in an appropriate place when in use as part of a sternal ascender apparatus. While the embodiment shown has these characteristics, alternate embodiments of a sternal ascender panel may have other shapes or radiuses, and may or may not be sharpened. Still other embodiments may have other features aside from the rectangular textural features <NUM> shown here, and may include other shaped features or none at all. Other embodiments of left sternal ascenders may be made of metal, plastic, composites, or mixtures or conbinations thereof or contain alternate alignment or locking methods and features. <FIG> are front, left side, right side, rear, top, and bottom elevational views, respectively, of the sternal ascender of <FIG>.

<FIG> is a perspective view of a right sternal ascender. This view illustrates the various features defined by the right sternal ascender <NUM>. The right sternal ascender <NUM> defines a panel <NUM> having several textural features <NUM>, a contralateral, or pertaining to the opposite side of targeted anatomical area, notch <NUM> at a proximal end 12P, a support beam, not shown here, traversing the underside of the panel <NUM>, and a mounting post <NUM> for attachment to a sternal ascender assembly. The panel <NUM> has a rounded shape with a slight edge at a distal end 12D of the panel <NUM> of the right sternal ascender <NUM>. Also defined by the post <NUM> are two opposing alignment and orientation features <NUM> configured to align, slide and lock the left sternal ascender <NUM> into the handle. These features <NUM> form a general t-shape, which are configured to fit into the aforementioned t-slot on the indicator handle <NUM>. The use of this feature will be described further in regard to <FIG>. The post <NUM> also defines an angular front alignment feature <NUM> which is used to help align and place the left sternal ascender in an anatomical notch defined between a rib and sternum. This can serve as a tactile assist in placing the sternal ascender in an appropriate place when in use as part of a sternal ascender apparatus. While the embodiment shown has these characteristics, alternate embodiments may have other shapes or radiuses, and may or may not be sharpened. Still other embodiments may have other attachment features aside from the rectangular textural features <NUM> shown here, and may include other shaped features or none at all. Other embodiments of right sternal ascenders may be made of metal, plastic, composites, or mixtures or conbinations thereof. <FIG> are front, left side, right side, rear, top, and bottom elevational views, respectively, of the right sternal ascender of <FIG>.

<FIG> are a series of perspective views illustrating operational steps showing the loading of the left sternal ascender of <FIG> into the sternal ascender apparatus of <FIG>. The appropriate sternal ascender, left or right, is selected depending on the area of interest for a minimally invasive surgical procedure requiring the sternum of a patient to be lifted upward. <FIG> shows the right sternal ascender <NUM> aligned with and in proximity to the t-slot <NUM> of the indicator handle <NUM> of the sternal elevator apparatus <NUM> with the orientation features <NUM> on the post <NUM> of the right sternal ascender <NUM> moved towards direction <NUM> and fully inserted into the slot <NUM> of the indicator handle <NUM>. Once inserted, as shown in <FIG>, the right sternal ascender <NUM> is pulled downward in direction <NUM> towards the seat <NUM> in the slot <NUM> of the indicator handle <NUM> to lock the right sternal ascender <NUM> into place. <FIG> shows the fully inserted and locked right sternal ascender <NUM> in the indicator handle <NUM>.

<FIG> is a perspective view of a surgical setting including the use of the sternal ascender apparatus of <FIG>. In the illustrated surgical setting, an operating table <NUM> having a rail <NUM> and a patient <NUM> on the table <NUM> prepared for a surgical procedure are shown. Positioned on the rail <NUM> is a first surgical equipment holder apparatus <NUM> having a first central surgical equipment holder <NUM> attached to the first surgical equipment holder apparatus <NUM>. The first surgical equipment holder apparatus <NUM> is attached to the sternal ascender apparatus <NUM> at the first adapter channel <NUM>. On an opposite side of the table, a second surgical equipment holder apparatus <NUM> is attached to an opposite rail, which is not visible here. The second surgical equipment holder apparatus <NUM> has a second central surgical equipment holder <NUM> attached thereto and is also attached to the corresponding second adapter channel on the sternal ascender apparatus <NUM> on its opposite side, not visible here. Each of the first central surgical equipment holder <NUM> and the second central surgical equipment holder <NUM> can be utilized to position and hold one or more pieces of surgical equipment or tools such as the sternal ascender apparatus <NUM> or alternatively scope holders, cannulas, or other surgical implements during a minimally invasive or other surgical procedure. In this configuration, the first central surgical equipment holder <NUM> and the second central surgical equipment holder <NUM> are shown bridging over the patient <NUM> in order to firmly position the sternal ascender apparatus <NUM> in an initial centralized location relative to the patient <NUM> on the table <NUM>.

<FIG> are a series of perspective views illustrating operational steps of the use of the sternal ascender apparatus in a surgical context. In <FIG>, portions of the patient <NUM> are shown in cross-section and portions of various instrumentation are removed from view for the purposes of clarity. The patient <NUM> is shown prepped for a surgical procedure, having an incision <NUM> made at just below the xiphoid process at the sternal notch, near the sternum <NUM>. The sternal elevator apparatus <NUM> is secured onto the first central surgical equipment holder <NUM> and the second central surgical equipment holder <NUM>, which are firmly mounted onto the operating table <NUM>. The upper rack housing <NUM>, or the arch keystone is at the top of the toothed linear rack and thus enables subsequent movement of the rack <NUM> upward. The angle of the indicator handle <NUM> and therefore the sternal ascender <NUM> has been adjusted by pressing the pivot button or pressable switch <NUM> on the indicator handle <NUM>, allowing movement of the indicator handle <NUM> relative to the linear actuator gear <NUM>. As shown in <FIG>, the distal end 12D of the sternal ascender <NUM> is inserted in direction <NUM> into the incision <NUM> until the sternal ascender <NUM> is in a desired location along the sternum <NUM>. The sternal ascender <NUM> is aligned with the anatomy of the sternum <NUM> by using the depth indicator <NUM> to gauge the location of the tip of the panel of the sternal ascender <NUM> within the chest. At this point, the first central surgical equipment holder <NUM> and the second central surgical equipment holder <NUM> are locked and secured into place after proper adjustment. <FIG> illustrates the swivel bar <NUM> being unlocked and moved counterclockwise <NUM> to raise the sternal ascender <NUM> and indicator handle <NUM> in direction <NUM>, which applies retraction to the sternum <NUM> and creates the subxiphoid space <NUM> for access. A final state of this described procedure is illustrated in <FIG>, at which time the swivel bar <NUM> can be moved to a full up or down position to lock the gear housing <NUM> in place to prevent any further movement of the sternal ascender <NUM>.

Claim 1:
A sternal ascender apparatus (<NUM>) for use during minimally invasive surgical procedure, comprising:
an indicator handle (<NUM>, <NUM>) configured for gripping, wherein the indicator handle (<NUM>, <NUM>) has a proximal end (22P, 152P);
a sternal ascender (<NUM>, <NUM>) comprising:
a panel (<NUM>, <NUM>) configured to enable lifting a ribcage, said panel having an underside,
characterized by:
a support beam (<NUM>, <NUM>) traversing the underside of the panel (<NUM>, <NUM>), and
a post (<NUM>, <NUM>) for attachment to the sternal ascender apparatus (<NUM>), wherein the indicator handle is coupled to the sternal ascender, and wherein the post (<NUM>, <NUM>) is coupled to a proximal end (12P, 152P) of the panel (<NUM>, <NUM>), and wherein the post (<NUM>, <NUM>) is configured to be inserted and locked in the proximal end (22P, 152P) of the indicator handle (<NUM>);
an actuator drive having a linear rack (<NUM>) pivotably coupled to the indicator handle (<NUM>); and
a housing (<NUM>) movably coupled to the actuator drive along the linear rack (<NUM>).