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OBJECTIVE: Transthoracic Chitwood clamp is widely used for aortic cross clamping for robotic cardiac procedures. It has one fixed jaw and one moving jaw installed through a curved long shaft. Routinely this device is positioned to clamp the ascending aorta as the moving jaw to be positioned upwards and the convex side to be rightwards. The rightwards convexity of the device may outstretch through superior vena cava. This effect may narrow the working area and increase the risk of collusion of the robotic arms with the clamp inside the thoracic cavity during the operation. This issue may clinically be important for procedures involving sinus venosus type atrial septal defect closure and for the patients with low body surface area at whom the distances between port sites are relatively short.
This report demonstrates a simple maneuver of inversely positioning the Chitwood clamp that may be helpful in robotic repair of sinus venosus type atrial septal defect closure and in patients with low body surface area that will undergo a robotic procedure..
METHODS: The entry point of the clamp in to the thoracic cavity was same as it was in routine cases. The positioning was performed inversely with a careful attention applied to the posterior aortic wall and pulmonary arteries. (Figure 1)
RESULTS: Between March 2010 and December 2014, inversely positioning of the clamp was applied in robotic procedures to patients with sinus venosus atrial septal defects or the ones with a low body surface area. Approximately a 3 cm wider working area was when compared to classical clamping technique (Figure 1). No aortic or pulmonary artery injury was observed.
CONCLUSIONS: Inversely positioning of this device with the convex side to be leftwards by an attentive maneuver provides a safe aortic clamping and a wide working area and prevents collusion of arms with the clamp inside the thoracic cavity.