Hands-free approach for the left atrial appendage in Cox maze IV.

Surgical excision of the left atrial appendage is an essential key in the Cox maze IV procedure. Management of very thin, friable, and delicate tissue in the base of the left atrial appendage can be difficult. We have designed a simple method to expose adequately without handling the base of the left atrial appendage. With this technique, the risk of bleeding due to excessive traction or manipulation of the heart is dramatically reduced.