DuoRotate/InLine Instruments Instruction Manual

Important general notes and instructions Make sure that this product is used only as intended and described in this instruction manual, by adequately trained and qualified medical personnel, Maintenance and repair must be carried out by authorized experts. Use the product only in the combinations and with the accessories and spare parts specified in this instruction manual. Use other combinations, accessories and replacement parts only if they are expressly intended for the planned appli­ cation and if the performance characteristics and safety requirements are met. The product must not be altered in any way. Reprocess the product in accordance with the manual before every use and before return shipment to protect the pa­ tient, user and third parties. This manual is an integral part of the product and must be stored in such a way that it is accessible at any time during its entire life cycle. This manual must be passed on to any subsequent owner or user. Immediately on receipt, check the product and its accessories for completeness and possible damage. Should the shipment give rise to complaints, please inform the manufacturer or supplier immediately. Subject to technical changes! Due to ongoing developments the illustrations and technical data may deviate slightly.

Safety instructions and levels of danger Symbol

Level of danger

WARNING!

Failure to observe can result in death or serious injury.

CAUTION!

Failure to observe can result in slight injury or damage to the product.

IMPORTANT!

Failure to observe can result in damage to the product or surroundings.

NOTE!

User tips for optimum device use and other useful information.

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GERMANY RICHARD WOLF GmbH 75438 Knittlingen Pforzheimerstr. 32 Telephone: +49 70 43 35-0 Telefax: +49 70 43 35-4300 MANUFACTURER [email protected] www.richard-wolf.com

USA RICHARD WOLF Medical Instruments Corporation 353 Corporate Woods Parkway Vernon Hills, Illinois 60061 Toll Free: 001 (800) 323 - 9653 Phone: 001 (847) 913 - 1113 Fax: 001 (847) 913 - 1488 [email protected] www.richardwolfusa.com

UK RICHARD WOLF UK Ltd. Waterside Way Wimbledon SW17 0HB Telephone: + 44 20 89 44 74 47 Telefax: + 44 20 89 44 13 11 [email protected] www.richardwolf.uk.com

BELGIUM / NETHERLANDS N.V. Endoscopie RICHARD WOLF Belgium S.A. Industriezone Drongen Landegemstraat 6 9031 Gent Drongen Telephone: +32 92 80 81 00 Telefax: +32 92 82 92 16 [email protected] www.richard-wolf.be

FRANCE RICHARD WOLF France S.A.R.L. Rue Daniel Berger Z.A.C. La Neuvillette F-51100 Reims Telephone: +33 3 26 87 02 89 Telefax: +33 3 26 87 60 33

AUSTRIA RICHARD WOLF Austria Ges.m.b.H. Wilhelminenstraße 93 a A-1160 Vienna Telephone: +43 14 05 51 51 Telefax: +43 14 05 51 51 45

[email protected]

[email protected] www.richard-wolf.com

Marketing Office U.A.E RICHARD WOLF Middle East P.O. Box 500283 AL Thuraya Tower 1 9th Floor, Room 904, Dubai Telephone: + 9 71 43 68 19 20 Telefax: + 9 71 43 68 61 12 [email protected] www.richard-wolf.com

INDIA RICHARD WOLF India Private Ltd. JMD Pacific Square No. 211 A, Second Floor Behind 32nd Milestone Gurgaon - 122 001 National Capitol Region Telephone: + 91 12 44 31 57 00 Telefax: + 91 12 44 31 57 05 [email protected] www.richard-wolf.com

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Contents 1

Technical description...

1

2

Intended use...

1

3

Indications and field of use...

1

4 4.1 4.2

Contraindications and side effects... Contraindications... Side effects...

1 1 1

5

Combinations...

2

6 6.1 6.1.1 6.2 6.2.1 6.3

Illustration... DuoRotate / InLine forceps and scissors... Legend and identification... DuoRotate / InLine hook electrodes... Legend and identification... Identification...

3 3 3 4 4 4

7 7.1 7.2 7.2.1 7.2.2 7.3

Use... Preparation... Additional notes and instructions for use... DuoRotate handle... InLine forceps / Inline electrodes... HF applications...

5 5 5 5 5 6

8 8.1 8.2

Checks... Visual check... Function check...

8 8 8

9 9.1 9.1.1 9.1.2 9.2 9.2.1 9.2.2 9.3

Reprocessing and maintenance... Disassembly before cleaning... Disassembly of DuoRotate/InLine forceps and scissors... Disassembly of DuoRotate/InLine hook electrode... Assembly before sterilization... Assembly of DuoRotate/InLine forceps and scissors... Assembly of DuoRotate/InLine hook electrode... Reprocessing procedure...

9 9 9 10 11 11 12 13

10 10.1 10.2 10.3

Technical data and order data... DuoRotate forceps and scissors... InLine forceps and scissors... DuoRotate / InLine hook electrodes...

17 17 18 19

11

Spare parts and accessories... 19

12 12.1

Operating, storage, transport and shipping conditions... 20 Disposal of product, packaging material and accessories... 20

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I

1

Technical description

2

Intended use

The DuoRotate/InLine instruments comprise the following components: Jaw insert Sheath/scissor tube Handle The forceps and scissors are used for endoscopically controlled grasping and cutting, as well as the dissection of soft tissue / organs. Minor hemorrhages can be coagulated by means of high frequency current using instruments with HF con­ nector. Monopolar HF electrodes are used for tissue / vessel coagulation (hemostasis) and for dissecting and cutting by means of high frequency current under endo­ scopic view. These products are exclusively intended for use by specialized medical personnel and may only be applied by medically qualified and adequately instructed per­ sons.

3

Indications and field of use

4

Contraindications and side effects

4.1

Contraindications.

Examination, diagnosis and therapy in conjunction with endoscopic accessories. These instruments are used in the medical disciplines of: Surgery Urology Gynecology

CJD - Creutzfeldt Jakob Disease or a vCJD - Variant of the Creutzfeldt-Jakob Disease BSE - Bovine Spongiform Encephalopathy; so-called mad cow disease (e.g. Creutzfeldt-Jakob Disease) TSE - Transmissible Spongiform Encephalopathy On the basis of the patient's general condition the doctor in charge must decide whether the planned use is possible or not. Comply with the laws and regulations valid in your country. For further notes and instructions please refer to the latest medical literature. Contraindications directly related to the product are presently unknown.

4.2

Side effects

1

No side effects are to be expected if the system is used as intended.

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5

Combinations

DuoRotate/InLine instruments are used in conjunction with endoscopes and en­ doscopic accessories (e.g. KeyPort system, flexible trocar sleeves). The electrode handle 8399303 is only intended for use in conjunction with the 45° and 90° hook electrodes.

CAUTION! Do not combine products incorrectly! Injuries of the patient, user or others as well as damage to the product are possi­ ble. The different products can only be used together if their intended uses and rele­ vant technical data (such as working length, diameter, peak voltage, etc.) are the same. Follow the instruction manuals of the products used in combination with this prod­ uct. Follow the "Notes and instructions on HF applications", order no.: GA-S 002 as well as the HF device manufacturer's instructions.

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6

Illustration

6.1

DuoRotate / InLine forceps and scissors 3.6

2.2

2

3.1

3A

DuoRotate

2.1 3.7

3.5

3.3 2.2

3.4

InLine

3.6

3.2

3.1

3B

2.1

2 1.1

1

Fig. 1 6.1.1

3.3 3.2

1.2

Legend and identification

3

Item

Designation

Item

Designation

1

Jaw/scissor insert

3.1

HF connector

1.1

Jaw section / scissors

3.2

Movable grip

1.2

Screw sleeve

3.3

Lock

2

Sheath tube

3.4

Locking lever

2.1

Thread

3.5

Trigger

2.2

Locking element

3.6

Star wheel

3

Handle

3.7

Selector lever

3A

DuoRotate handle

3B

InLine handle

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6.2

DuoRotate / InLine hook electrodes 2.2

2

3.6

DuoRotate

2.1 InLine

3C 3.1 2.2

2.1

2 4.1

4.2

4 Fig. 2 6.2.1

6.3

Legend and identification Item

Designation

Item

Designation

2

Sheath tube

4

DuoRotate/InLine hook electrode

2.1

Thread

4.1

Hooks 45° / 90°

2.2

Locking element

4.2

Screw sleeve

3C

DuoRotate/InLine electrode handle

3.1

HF connector

3.6

Star wheel

Identification Symbol

Designation Observe the manual

REF

Order number

LOT

Lot identification number

SN

Serial no. Identification in conformity with Medical Product Directive 93/42/EEC, only valid if the product and/or the packaging is marked with this identification. Products of category IIa and above, as well as sterile products or products with measuring function of category I, are additionally marked with the code no. of the notified body (0124).

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7

Use CAUTION! The products have only limited strength! Excessive force will cause damage, impair the function and therefore endanger the patient. Immediately before and after each use, check the products for damage, loose parts and completeness. Do not use the products if they are damaged or incomplete or have loose parts.

7.1

Preparation

7.2

Additional notes and instructions for use

Check assembly: see section 9.2 Run through the checks: see section 8 Connect HF products to the HF generator via the HF connection cable (see accessories).

NOTE! Encrusted and soiled jaws / electrodes during the intervention impair the HF per­ formance! Dissolve encrusted or soiled coagulation surfaces with 3% hydrogen perox­ ide solution (H2 O2 solution) and clean with a compress. Then rinse with sterile water. 7.2.1

DuoRotate handle Function of selector lever (3.7) and star wheel (3.6):

2

3.7 3.6

II

I III Fig. 3

7.2.2

Fig. 3: Depending on the position of the selector lever (3.7) the star wheel (3.6) serves to either rotate the jaw section (1.1) or the complete sheath (2) of the forceps. Lever in position I (front) The jaw section can be rotated Lever in position II (rear) The sheath tube can be rotated Lever in position III (center) The star wheel is locked

InLine forceps / Inline electrodes Fig. 4: The sheath tube (2) can be mounted in the handle (3) in different positions.

2

3.6

3

Fig. 4

5

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Fig. 5: Via the star wheel (3.6), the jaw section (1.1) or the hook (4.1), respectively, can be rotated.

3.6 1.1

4.1

3.6

Fig. 5 7.3

HF applications

Follow the "Notes and instructions on HF applications", order no.: GA-S 002 as well as the HF device manufacturer's instructions.

WARNING! Danger of injury ! The HF product is not visible through the scope! Inadvertent tissue injuries as well as damage to parts of the product are possible. Activate HF products only after the part conducting HF current is fully visible through the scope and contact is made with the intended application area. CAUTION! Thermal tissue damage due to excessively high HF voltage! Exceeding the maximum recurring peak voltage of an HF product in conjunction with an HF surgical device and/or a wrong selection of the mode of operation can destroy the insulation and cause leakage currents. Thermal tissue damage to the patient, user and third parties is possible. Use HF products in conjunction with an HF surgical device only with no more than the specified recurring peak voltage: Instruments with 1 kV DuoRotate handle. Instruments with InLine handle and 2 kV DuoRotate/InLine electrode handle. The HF products are only suitable for short coagulations of minor hemorrhages. A use with forced coagulation or spray coagulation above the specified value is not possible. CAUTION! Thermal tissue damage due to damaged insulation! On HF products that have been reprocessed many times or are worn the insula­ tion can be damaged. A damaged insulation causes leakage currents, leading to thermal tissue injuries to the patient, user or third parties. Check the insulation of the HF products for damage before use. Do not use HF products with damaged insulation. WARNING! HF arcing! Danger of injury if there is an insufficient distance between the live part of the HF product carrying HF current and other conductive parts. When the HF current is activated, the live parts of HF products carrying HF cur­ rent must have a safety distance of at least 10 mm from other conductive parts.

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CAUTION! Selection of wrong irrigation fluid! Do not use high conductivity irrigation fluid for monopolar HF applications! Increased risk of patient leakage currents No function of HF product. The user must choose the irrigation fluid as required by the application and the irrigation fluid must have a low electrical conductivity. Do not use NaCl solution (saline). CAUTION! Do not select HF output power incorrectly! Injuries of the patient as well as damage to the product are possible. The power should be set on the basis of the surgeon's experience and training in view of the corresponding indication. WARNING! Inadvertent tissue damage if flammable / explosive liquids, vapors or gases catch fire. When HF current is supplied, sparks are generated at the active electrodes / jaw sections, which may ignite flammable or explosive liquids, vapors or gases. Do not activate the HF current if the electrodes or jaw sections are in an explo­ sive environment.

7

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8

Checks CAUTION! Be careful if products are damaged or incomplete! Injuries of the patient, user and others are possible. Run through the checks before and after each use. Do not use the products if they are damaged, incomplete or have loose parts. Return damaged products together with any loose parts for repair. Do not attempt to do any repairs yourself.

8.1

Visual check

Check the products and the accessories for: damage surface changes (e. g. corrosion) sharp edges not suitable for the application loose or missing parts rough surfaces. Any inscriptions or identification necessary for the safe intended use must be legi­ ble. To prevent wrong handling or reprocessing, any illegible lettering, labeling or identification must be reinstated. Check the insulation of the HF cable for damage. Replace the HF cable if the insulation is damaged. Fig. 6

2

Check the insulation of the sheath tube (2) for mechanical damage and dielec­ tric breakdown (punctures). Do not use sheath tubes with damaged insulation.

Fig. 6

CAUTION! Damaged surface in the joint area of the forceps ! The joint pin may loosen. Check for surface changes, such as fissures, at the joint pin (fig. 7)

Fig. 7

8.2

Function check Check proper opening and closing of the jaw section / scissors. The jaw section / scissors must open and close easily when actuating the handle. Check rotation of jaw section / scissors and hooks. Check for easy assembly and proper functioning of the locking mechanisms of the individual products. Replace the products if the connection although locked is not secure. cannot be locked or is difficult to lock. Check lock and locking mechanism of handle.

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9

Reprocessing and maintenance WARNING! Creutzfeldt-Jakob Disease! If the patient is suspected of having Creutzfeldt-Jakob Disease (CJD) or a variant of the Creutzfeldt-Jakob Disease (vCJD) or the latter have been diagnosed, ade­ quate measures must be taken to prevent possible transmission to other patients, users and third parties. For this purpose, apply the country-specific reprocessing guidelines and regula­ tions.

9.1

Disassembly before cleaning Remove the HF cable.

9.1.1

Disassembly of DuoRotate/InLine forceps and scissors The disassembly of the DuoRotate/InLine forceps and scissors is illustrated by example of the DuoRotate forceps. The InLine forceps and scissors are disas­ sembled in the same way.

NOTE! Do not hold the movable grip (3.2) during disassembly, the grip must move freely! We recommend holding the forceps as shown in figure 8. Fig. 8: Deactivate the lock (3.3) on the handle, for this: Set the locking lever (3.4) to position I . Pull the locking element (2.2) on the sheath tube (2) in direction of arrow. The sheath tube (2) disengages from the handle (3). The movable grip (3.2) moves upward automatically.

3.2 3.4

2

2.2 3.3

Fig. 8 Fig. 9: Unscrew the screw sleeve (1.2) in direction of arrow and pull the jaw insert (1) out of the sheath tube (2).

1.2

1

2

Fig. 9

9

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9.1.2

Disassembly of DuoRotate/InLine hook electrode Fig. 10: Pull the locking element (2.2) by the sheath tube (2) in direction of arrow. The sheath tube (2) disengages from the electrode handle (3C).

2.2 2

3C

Fig. 10 Fig. 11: Loosen the screw sleeve (4.2) in direction of arrow and pull the hook electrode (4) out of the sheath tube (2).

4.2

4

2

Fig. 11

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9.2

Assembly before sterilization

9.2.1

Assembly of DuoRotate/InLine forceps and scissors The assembly of the DuoRotate/InLine forceps and scissors is explained by ex­ ample of a DuoRotate forceps. The InLine forceps and scissors are assembled in the same way. Fig. 12: Insert the jaw insert (1) into the sheath tube (2) as far as it will go. Then screw on the screw sleeve (1.2).

1.2

1

2

IMPORTANT! During assembly do not screw on the screw sleeve (1.2) too tight! Do not continue turning the sleeve once the stop is reached, as this may cause damage.

Fig. 12 NOTE! During assembly do not hold the movable grip (3.2) in place, it must move freely! We recommend holding the forceps as shown in figure 13. Fig. 13: Deactivate the lock (3.3) on the handle, for this purpose: Set the locking lever (3.4) to position I .

NOTE! Do not hold the sheath tube (2) by the locking element (2.2). Insert the sheath tube (2) with the jaw insert (1) in place into the handle (3). The sheath tube (2) clicks into place automatically. This will cause the movable grip (3.2) to move downward.

3 2 3.4 3.2 2.2

Fig. 13

11

3.3

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9.2.2

Assembly of DuoRotate/InLine hook electrode Fig. 14: Insert the hook electrode (4) into the sheath tube (2) as far as it will go. Then screw on the screw sleeve (4.2).

4.2

4

IMPORTANT! During assembly do not overtighten the screw sleeve (4.2)! Do not continue turning the sleeve once the stop is reached, as this may cause damage.

2

Fig. 14

NOTE! Do not hold the sheath tube (2) by the locking element (2.2). Insert the sheath tube (2) with the hook electrode (4) in place into the electrode handle (3C). The sheath tube (2) clicks into place automatically .

2

3C

2.2 Fig. 15

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9.3

Reprocessing procedure

The following table describes the reprocessing procedure used by Richard Wolf GmbH for validation.

IMPORTANT! If used as intended and following the manufacturer's instruction manual, it is not necessary to limit the number of possible reprocessing cycles. Careful and gentle handling of medical products during the entire reprocessing process has an essential influence on the service life of the products. Before returning defective products for repair, they must have been subjected to the entire reprocessing cycle. The user must ensure that the reprocessing process including the resources, materials and personnel are suitable to achieve the required results. The national and international requirements regarding the validation of the user's reprocessing process must be followed. IMPORTANT! Further notes and instructions on reprocessing are described in manual GA-J020 “Reprocessing of RICHARD WOLF Heat-stable Instruments“ and must be followed. IMPORTANT! Do not sterilize the products in hot-air sterilizers.

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Reprocessing guide: DuoRotate / InLine forceps and scissors Preparation at the point of use:

Directly after use, remove any coarse soiling from the instruments. If there are more than 6 hours between use and reprocessing, rinse out the hollow spaces of the instrument with a 5 ml syringe filled with water. Do not use any fixing or setting agents or hot water (>40°C) as this will bake the residues to the surfaces and may have a negative impact on cleaning.

Transport:

Safe storage and transport of the instruments to the reprocessing room in a closed container to avoid any damage to the instruments or contamination of the environment.

Pre-cleaning:

The illustrations show the DuoRotate handle (3A) and the electrode handle (3C) as well as the DuoRotate/Inline jaw insert and the DuoRotate sheath tube by way of example. 1. For disassembly of handle (3) / electrode handle (3C) see section 9.2. The jaw insert (1) / hook electrode (4) and sheath tube (2) remain in assembled condition. 2. Immerse the instruments for at least 5 minutes in cold water. 3. Brush the instruments by applying at least 15 brush strokes (back and forth) on each side. If necessary, keep brushing until all visible soiling has been removed.

Fig. 16 4. Rinse out the handle (3) / electrode handle (3C) with a cleaning gun by applying at least 15 pressure surges (2.5 - 4 bar).

3

3C

Fig. 17 5. Plug the rinsing adapter (X) proximally onto the sheath tube (2) as shown in Fig. 18. 6. Slightly loosen the jaw insert (1) / hook electrode (4) distally (approx. 2 rotations). 7. For rinsing out the products, use the "sheaths and inserts" attachment on the cleaning gun. 8. Rinse out with at least 30 pressure surges (2.5 - 4 bar). Then rinse the jaw section (1.1) / hook (4.1) separately with 15 pressure surges. 9. Disassemble the jaw insert (1) / hook electrode (4), see sections 9.1.1 and 9.1.2 Leave the rinsing adapter (X) on the sheath tube (2)!

1.1

2x

Fig. 18 Ultrasonic cleaning

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2

Rinsing adapter (x)

X

The rinsing adapter (x) may stay connected to the sheath tube (2)! Immerse the instruments in a cleaning and disinfecting solution approved for use in ultrasonic baths. Before, the chan­ nels of the instruments must be filled with this solution. Exposure time: 5 min Frequency: 35 kHz Temperature max.: 40°C After ultrasonic cleaning: Rinse out the sheath tube (2) for 20 seconds or in pulsed mode with 5 pressure surges (2.5- 4 bar) using a clean­ ing gun. Dry outside of instruments using a sterile lint-free disposable cloth or swab, dry hollow spaces with filtered compressed air (pulsed mode with 5 pressure surges, 2.5 - 4 bar).

14

Cleaning:

Manual cleaning

Machine cleaning

1.Precleaning 2.Remove the rinsing adapter (x) from the sheath tube (2). 3.Immerse instruments in a cleaning solution for at least 5 minutes. 4.Brush the handle (3), jaw section (1.1) / hook (4.1), joints and sheath tube (2) with a soft brush for at least 5 sec­ onds to remove any residues. 5.Rinse out the sheath tube (2) with a 5 ml syringe filled with cleaning solution. 6.Then rinse out the instruments for 20 seconds or in pulsed mode with 5 pressure surges (2.5 - 4 bar) using a cleaning gun.

1.Pre-clean the instruments manually before automatic machine cleaning. (see section on "precleaning"). 2.Secure the jaw insert (1) in horizontal position. 3.Attach the sheath tube (2) to a rinsing connector using rinsing adapter (X) and secure in place. 4.Plug the handle (3) onto a rinsing nozzle. Vario-TD program (without disinfection cycle) 4 min of pre-cleaning using cold water. Empty Wash with a cleaning agent for 6 min at 55° C Empty Neutralize with cold tap water for 3 min Empty 2 min of intermediate rinsing with cold tap water Empty

Disinfection:

1.Immerse instruments in an approved disinfectant solu­ tion, for the immersion time refer to the manufacturer's instructions. Carry out thermal machine disinfection following the na­ Fill the instrument channels with this solution before. tional requirements with regard to the A0 value (see DIN 2.At the end, carefully rinse out the instruments for at least EN ISO 15883). 15 seconds with fully demineralized water using a clean­ ing gun.

Drying:

Manual drying: Dry outside of instruments using a sterile lint-free dispos­ able cloth or swab, dry any hollow spaces with filtered compressed air.

Care:

After manual / machine disinfection: Sparingly oil the joint of the jaw section (1.1) with 1 drop of instrument oil. To improve the operation of the pull rod locking mechanism a drop of oil may be applied to the proximal end of the pull rod. The other surfaces must be oil-free. - Remove any excess oil.

Dry instruments in the drying cycle of the washer-disinfec­ tor. If necessary, additional manual drying can be achieved using a sterile lint-free disposable cloth or swab. Dry hol­ low spaces with filtered compressed air. Remove the rinsing adapter (x) from the sheath tube (2) after automatic cleaning in the washer/disinfector.

Fig. 19 Function check, maintenance:

Check visually for cleanliness. If necessary, repeat the reprocessing procedure until the instrument appears vis­ ually clean. Carry out a visual check: see section 8.1

Packaging:

Wrap instruments for sterilization as required by the standard.

Assembly before sterilization

See sections 9.2.1 and 9.2.2 Install the jaw insert (1) / hook electrode (4) in the sheath tube (2). To avoid stress cracks, loosen the screw sleeve (1.2) half a turn and retighten after sterilization. Install the handle (3) after sterilization.

Sterilization:

Sterilization with the fractional prevacuum cycle (ISO13060/ISO17665) complying with the relevant national statutory regulations. Temperature exposure time: 4 min at 134°C +4°C (273°F +7°F) 132°C +4°C (270°F +7°F) Drying time: 10 - 20 min Maximum sterilization temperature: 138°C

Positioning:

Store the sterilized instruments in a dry, clean and dust-free environment at moderate temperatures of 5°C to 40°C.

15

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Validation:

The following test instructions, materials and machines were used for validation: Machine cleaning agent: alkaline cleaning agent 0.5% neodisher FA (Dr. Weigert) Manual cleaning agent: enzymatic cleaning agent 0.5% neodisher MediClean (Dr. Weigert) Manual disinfectant: Cidex (Advanced Sterilization Products) Automatic washer-disinfector: G 7735 CD Miele Washer-disinfector rack: MIC rack cart

Additional instructions:

The user is obliged to validate his process in accordance with DIN EN ISO 17664.

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10

Technical data and order data

10.1

DuoRotate forceps and scissors DuoRotate Jaw insert

Type

DuoRotate

SHEATH TUBE INSULATED Ø 5.8MM SL 380MM

HANDLE PISTOL SHAPED MONO

8399310

8399301

Instrument, cpl., consisting of: •Jaw insert + sheath tube + handle + IRRIGATION ADAPTER 8399300

Type Designation

8399410 MIXTER DISSECTOR INSERT Ø 5.8MM DuoRotate/InLine

83993010 DuoRotate MIXTER DISSECT.FORCEPS MONO Ø 5.8MM BNDL

8399414 GRASP. FORCEPS INSERT Ø 5.8MM DuoRotate/InLine

83993011 DuoRotate GRASPING FORCEPS MONO Ø 5.8MM BNDL

8399412 MARYLAND DISSECTOR-INSERT Ø 5.8MM DuoRotate/InLine

83993012 DuoRotate MARYLAND DISS. FORCEPS MONO Ø 5.8MM BNDL

8399413 METZENBAUM SCISSORS INSERT Ø 5.8MM DuoRotate/InLine

83993013 DuoRotate METZENBAUM SCISSORS MONO Ø 5.8MM BNDL

8399415 INTESTINE GRASP. FORCEPS INSERT Ø 5.8MM DuoRotate/InLine

17

83993015 DuoRotate INTEST. GRASP. FORCEPS MONO Ø 5.8MM BNDL

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