1. Toward a Definitive, Totally Thoracoscopic Procedure for Atrial Fibrillation 
John Sirak, MD, Danielle Jones, RN, Benjamin Sun, MD, Chittoor Sai-Sudhakar, MD, Juan Crestanello, MD, Michael Firstenberg, MD 
The Annals of Thoracic Surgery 
Volume 86, Issue 6, Pages (December 2008)
DOI: /j.athoracsur
Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
An endoscopic Kittner retracts the superior vena cava anteromedially, exposing the transverse sinus from the right superior pulmonary vein to the left atrial appendage. In the left panel, the right atrial appendage is retracted laterally, thereby exposing the noncoronary root of the aorta.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
Access to the noncoronary root of the aorta is facilitated by lateral retraction of the right atrial appendage. A vertical line of ablations was performed extending from the anterior trigone of the mitral valve to the connecting ablations across the dome of the left atrium. (IVC = inferior vena cava; RIPV = right inferior pulmonary vein; RSPV = right superior pulmonary vein; SVC = superior vena cava.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

4. Fig 3
Ablation of the anterior mitral trigone is verified by demonstration on transesophageal echocardiography of compression of the noncoronary sinus of aorta.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

5. Fig 4
Meticulous division of the ligament of Marshall is essential for reasons of both complete autonomic denervation and optimizing exposure for the left-sided ablations. (LIPV = left inferior pulmonary vein; LSPV = left superior pulmonary vein.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions