Indian Journal of Thoracic and Cardiovascular Surgery, 1982, 1 : 84-5

Gigli Saw Introducer for Median Sternotomy ~OLOMON VICTOR, K. M. SHYAMPRASAD, C.S. VIJAYASANKAR, A. D. JOSEPH, G. PRABItAKAR

Fig. I

Fig. 2

In developing countries, cost continues to be major considerat ion in open heart surgery, especially when many open heart procedures

From The Institute of Cardiology, Government General Hospital, Madras

Address for reprints: Dr. Solomon Victor, 15, East Street, Kitpauk Garden CoIony, Madras-600 010

are performed daily. Even in developed coun- tries cost of open heart surgery has caused concern., 12 Tomatis et aP were motivated by

sense of responsibility towards the society which entrusts the medical profession with its health

and expects efficient use o f its resources and succeeded in reducing the cost o f open heart

surgery by critically considering every step in

Sigli Saw Introducer 85

Fig. 3

open heart surgery from cost efficiency angle.

Sternal saws are expensive and need to be imported. Facilities for repairs and steriliza- tion by ethylene oxide gas sterilisation is not available in many centres. Gigli saw is cheap and indigenously made. Usually a long artery forceps is used to introduce the Gigli saw. Often it is not easy to open the jaws and feed the wire.

We have designed an introducer,* using the

* manufactured by South. India Surgical Company. Madras

principle of tendon tunnelling forceps, in which only the tip moves when the handle is opened. The instrument is passed with minimal dissec- tion in the epigastrium and suprasternal fossa, hugging the posterior surface of the s te rnum The tip presents above the sternum, guided by the finger. The posterior blade of the handle and the posterior jaw of the tip is stationary. When the anterior blade of the handle is moved forwards, the anterior jaw of the tip opens (Fig. 2). The eye of the Gigli wire is easily introduced. The tip is provided with one tooth in each jaw to prevent the wire from slipping (Fig. 3). We have used this instrument in more than 500 open heart procedures without complications. It is cheap. It has helped our centre to perform three to six open heart pro- cedures daily.

References

1. MUSTARD RA. Editorial. Major Cardiac Surgery. Are the benefits worth the cost? Ann Thorac Surg 1977; 24: 400-2.

2. MARTY AT, MATAR AF, DANIELSON R, O*REILLY R. The variation in hospital charges. A problem in deter- mining cost~benefit for cardiac szwgery. Ann Thorac Surg 1977; 24: 409-16.

3. TOMATIS LA, SCrlLOSSER R J, RIAm M, STOCKINGER US, KANTEN R. Cost containment via expense ratio- nalization in open heart surgery. J Thorac Cardio- vasc Surg 1979; 77: 448-51.