Heart valve surgery. Special tools being used to carry out keyhole heart surgery to replace a defective heart valve. The hole in the patient's chest (between two ribs) is held open by soft- tissue retractors to allow access to the heart. A set of metal retractors, not normally used in keyhole surgery, are also being used because this patient has an unusually deep chest. This is near the end of the operation and one of the blood suction tubes (red) has been withdrawn. The wire is an electrical pacer wire, and is left in place to restart the heart if needed. Keyhole heart surgery is less traumatic than open heart surgery (where the rib cage is opened).