[tool buzzes]
Yeah, man.
That's right.
That's exactly right.
Hi.
I'm Dr. Leonard Lee. I'm a cardiac surgeon,
and today I'll be showing you
some of our commonly used instruments for heart surgery.
For every operation,
we start with these accessories,
and the first are the surgical loupes, or telescopes.
These are a 3 1/2 times magnification,
and these allow us to see very small pieces of anatomy
in very clear manner.
In addition, this is the surgical headlamp,
which gives us a bright, very bright field of view,
so we can see every nuance of the anatomy.
Probably one of the most dramatic instruments that we use
is the sternal saw.
And this is the instrument that allows us
to go through the breastbone
in the middle of the chest to get to the heart.
It's very similar to a common jigsaw
that you would use for home improvement.
It has a safety mechanism, obviously,
'cause it can be very dangerous,
and we unclick the safety mechanism,
and like any other oscillating saw, it has a throttle,
which allows us to give very high power
or very low power.
And this is how we get through the breastbone.
Years of training.
This is the Morse sternal retractor,
and this is what we use to hold the breastbone open.
And it gets inserted something like this,
and then we can retract the sternum,
which then will give us access to the heart.
Then we use what's called the electrocautery Bovie.
This is one of the stars of the show,
as well as one of the
most commonly used instruments in all of surgery,
and this is what we use most often
during the course of any operation.
This instrument allows us to both cut through tissues
as well as cauterize small blood vessels,
so we can operate in a relatively bloodless field.
So, these tubes are called cannulas,
and these are what we insert directly into the heart
to divert blood away from the patient
to the heart-lung machine,
which will be life-sustaining
while we're operating on a still and nonworking heart.
All these holes allow for the blood to leave the body
and go to the heart-lung machine
in an uninterrupted fashion.
So, anytime we need to make a new cut
into a new part of a patient body, we use scalpels.
So, this is a 10 blade,
and this is the scalpel that we use
to make the initial incision at the beginning of surgery.
This is an 11 blade, which is very sharp and very pointed
and commonly used to make
small, stabbing types of incisions.
When we need to make smaller cuts
and more precise,
we then use a 15 blade,
which allows us to manipulate it much easier.
Producer: And are we moving on to ...
clamps? Are those clamps?
This is a clamp. Aortic cross-clamp.
So, there are vascular clamps
and nonvascular clamps.
The vascular clamps have very specific types of jaws,
which are called non-crushing.
So the importance of non-crushing
is that we don't want the cells
that make up that particular part of the organ
to be crushed or killed or devitalized
because you're closing the clamp on it.
The other clamps don't have that specialty,
and so we use these often to hold suture
or to hold areas that we are not as concerned
about maintaining the viability of the cells.
So, this is our aortic cross-clamp.
The aorta is the big blood vessel off the top of the heart
that feeds blood to the entire body.
It's about 3 centimeters across,
and this is used to occlude that blood vessel
at the time of surgery.
So if you imagine my fingers being the aorta,
the clamp would be placed completely across the aorta
and clamped so that there's no blood flow.
But again, non-crushing,
and you can see that I can put this across my fingers
without killing my fingers.
These are our other wide ranges of clamps,
going small as this, we refer to as mosquito,
which is a very small clamp
that can clamp very, very small blood vessels.
All these clamps are used to hold things,
whether it's tissue or sutures,
that allow us to proceed with the operation.
So, commonly used sutures
during the course of our operation,
we often use up to
50 or 60 different types of sutures,
but these are some of the more common ones that we use.
This is Prolene.
Prolene is what's referred to as a monofilament suture,
and this is permanent
and stays in the patient's body forever.
This is what we use to sew onto vessels, like the aorta,
to hold things in place.
Once it's time to sew the coronary arteries,
the bypasses onto the heart,
this is 7-0 Prolene,
and you can see how fine the needle is,
and you can see how fine the suture is.
The suture is as fine as a human hair.
And this is why we need to wear magnification
at the time of surgery.
We're often using this suture on blood vessels
that are as small as 2 millimeters in diameter
and very, very frail and paper-thin.
So we want to be as careful as possible,
make the smallest holes as possible,
so that we can minimize any sources of potential bleeding.
At the beginning of the operation,
we divided the breastbone.
So we need a means to put that breastbone back together.
And for that, we use stainless steel wires.
And it's an extremely sharp needle
and a very, very heavy needle driver.
And this goes through the bone
and is twisted and re-approximates the breastbone.
These wires are permanent as well.
People often wonder why our needles are curved.
And the reason needles are curved
is so that we can go through
and come out on the other side
without distorting the tissues.
These are the instruments that we use
for the coronary bypass part of the operation,
where we're sewing on the arteries
on the surface of the heart.
And you can see that they're all normal-size instruments,
but the tips are very, very fine.
These are called micro Potts scissors,
and these are the scissors we use
to open up the actual coronary artery.
These are called mammary pickups,
and these are the forceps that we use
to handle the coronary arteries as well.
And you can see how fine the tips are.
So, this is the robot room,
and this is the room that was specifically designed
to house the robot.
So, the use of the robot is to
allow us to get into different body parts
minimally invasively.
The other advantage is that we all have tremors.
The further we are away
and the longer instrument that we're using,
the greater the tremor that's transmitted
to the tip of the instrument.
So this takes all of that away.
So, this is the surgeon console of the robot,
and this allows for binocular vision,
you're using both eyes.
It also gives three-dimensional view,
so you have a sense of depth.
The only part that's missing
is the haptic feedback, or the touch sense,
but we have just about everything else.
It also magnifies, 9 times magnification,
and these casters allow for
opening and closing of an instrument
and rotation, just like your wrist,
and allow for very large motions of my hands
to translate into very fine motions
at the tips of the robot hands.
The pedals are used to help manipulate the left arm,
the right arm, to move the camera closer and further,
and allows you to manipulate in three-dimensional space.
So it's obviously a very complex instrument,
and the robot is obviously, has multiple arms
that we need to be able to manage all of them.
So we only have two hands, but we have four arms.
So we can switch from arm to arm
by utilizing the different pedals
that we have at our disposal here on the console.
That's about it for us.
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