With the sternum split this clamp/spreader device can be inserted in the chest cavity. Crank/Crank/Crank/Crank. A lot like a bumper jack.
With the spreader in place, they can really get to work. I think the "vacum-cleaner hose" goes to the heart/lung machine, but I don't know that..
It's now about 10:30 am; these guys have only split the chest about 45 minutes ago.