Once the beating heart surgery started getting popular, we started propagating the technique. We then noticed that the stabilizers are the only ones that needs to be discarded. But that too could be sterilized and reused, using ethylene oxide. In spite of the sterilization
technique, we still had to discard these plastic stabilizers after using it for about 20 times, as it became sloppy. Hence we noticed that in our unit we had to procure two stabilizers every month. And so 24 stabilizers a year had to be discarded. This was again costing a thousand USD a piece. Hence we ventured on to develop a reusable, metallic stabilizer where in the only piece that needed to be replaced for every surgery were the pods (Figure 1).These pods would cost only about 10 USD a piece. Once this stabilizer was developed, we have now started using them as normal metallic surgical instruments and have been routinely sterilizing them. Over the last two years we have used the same instrument sets for over six hundred coronary surgeries. This set is in fact made of a sternal spreader with a railing on both sides over which a vertical two inch metallic rod could be fixed with a screw and the position could be moved according to the coronary artery which needed to be bypassed. Over this metal rod, we have the stabilizer rod that is fixed at its base with another clamp, which in turn could be moved over the metal rod to which ever position we need. The stabilizer rod is in fact a curved metallic tube which houses another curved metal rod inside. The curved out tube has a distal metal end that holds a housing in which the pod head could play around. This housing has three slots which allows the pod to move in them when positioned. The proximal end of the outer tube has a screw which when screwed would tighten the inner rod. The inner rod at its distal end is convex and this moves on the concave end of the interlocking rod in front of it. The interlocking rod is the crux of the stabilizer. This is a half a centimetre piece of metal which is concave on both ends. The proximal concave end allows the metal rod to push it forward or distally, and the distal concave bit allows the head of head of the pod to rest on it. Hence when the pod is placed parallel to the coronary artery, we first tighten the rod in the intended positionand the pod is tightened by tightening the screw at the proximal end this screw in turn pushed the inner rod forward and the rod pushes the interlocking rod which in turn tighten the head of the pod in the desired position. This once positioned is so stable that it does not move at all. The pod has suckers like in the conventional stabilizers, which could be attached to the suction apparatus and used as suction stabilizer as well. Over time, once we get used to the stabilizer we can avoid suction if not absolutely needed