Hernia Treatment To the Future Together Hernia Repair 2 Hernia Repair is the most frequent procedure in general surgery of the abdominal area. The treatment of hernias is therefore for every surgeon and hospital of utmost medical and economical importance. Through the history of hernia treatment there have been many new techniques and innovations, but there is still space for further developments and improvements. It is a must to develop always better materials to improve the convenience of the patient and to further lower the recurrence rates. Many studies show that the use of new mesh implants can reduce the rate of recurrency in hernia treatment. The future lies in the well-tested and established hernia methods with the new implants and materials. The usable sutures and implants in hernia surgery has to meet special quality requirements. To keep this quality it’s necessary to have commitment in a new research and development. B. Braun plays a leading role in innovations due to the research and development in all fields of medical surgery. Innovation is the only way to the future and that’s why the contact with the surgeons is really important to us. Only with the help of them we can act to the new needs. Our secret of success is a philosophy of Sharing Expertise. B. Braun offers a dialogue to go to the future together! 3 Inguinal Hernia Description: Treatment: A hernia occurs when the inside layers of the abdominal wall weaken then bulge or tear. The inner lining of the abdomen pushes through the weakened area to form a sac. Nowadays the treatment method for the inguinal hernia is a small operation, which is one of the most common operations performed by surgeons. There are several types of hernia, but the most important are: Umbilical hernias Open repair – Without mesh: Bassini, Shouldice – Tension free method with mesh: Lichtenstein Incisional hernias Endoscopic repair with meshes Femoral hernias TAPP, TEP Inguinal hernias The most common hernia type is the inguinal hernia, which has two types: Indirect - a protrusion through the internal inguinal ring passes along the inguinal canal through the abdominal wall. This is the more common form accounting for 80 %. Direct - hernia protrudes directly through the abdominal wall into inguinal canal. 4 There are two kinds of operation of the inguinal hernias: Experience shows that the use of the mesh reduces the recurrence rate. According to the new researches the ideal pore size guarantees, that the mesh won’t cause discomfort for the patients. All of Aesculap products fit to these new needs. Our main aim is to give a short description about these techniques, and what kind of tools, sutures and implants are recommended for the techniques. Hernia Preparation Open Hernia Repair 1 Skin incision. 4 2 Splitting of the Externusaponeurose. 3 Protection of the nerves. 5 The preparation of the hernia is an important step and the following techniques are based on the approach explanation of this page. Preparation of the Musculus cremaster. Preparation of the herina sac. 5 Bassini Technique Open Reparation of Inguinal Hernias 1 The inguinal canal after ligation and resection of the hernial sac. 4 2 Starting the suture near the pubic crest. 5 3 Loose stitches comprising the inguinal ligament, transversalis fascia, transverses abdominis muscle and internal oblique muscle. A series of suture lines is used to reinforce the posterior wall of the inguinal canal and narrow the internal inguinal ring by the “triple layer” (transversalis fascia, transverses abdominis muscle and internal oblique muscle) is sutured to the inguinal ligament. Advantages: Finished repair. 6 Closure of external oblique aponeurosis. The operation can be performed under local anesthesia Can be performed in growing patients, pregnant women and women who may become pregnant Shouldice Technique Open Reparation of Inguinal Hernias 1 Opening the transversalis fascia at the level of the inguinal canal. 2 3 First line of suture Second line of suture Pubic crest – deep inguinal ring – pubic crest. This running suture approximates the iliopubic tract to the aponeurosis of the transverses abdominis muscle, including the transversalis fascia. Unlike Bassini’s all layer interrupted suture, the Shouldice approach to repairing the posterior wall of the inguinal canal begins at the level of the transversalis fascia. The transversalis fascia is divided parallel to the inguinal ligament, and a double layer of transversalis fascia is sutured to the inguinal ligament, using continuous suture lines. This is reinforced by an additional continuous double layer of low-tension suture which is placed between the internal oblique muscle and the lower part of the inguinal ligament. 4 Deep inguinal ring – pubic crest – deep inguinal ring. This running suture approximates the internal oblique muscle to the inguinal ligament. Closure of external oblique aponeurosis. Advantages: The operation can be performed under local anesthesia Double layer low-tension suture 7 Lichtenstein Technique Open Tension Free Method 2 1 Mesh fixation to the inguinal ligament. Mesh fixation to the inguinal ligament. 6 5 The lower edges of the two tails are sutured to the inguinal ligament to create a new initernal ring comprised of mesh. Closure of external oblique aponeurosis. In this procedure, which uses a conventional anterior approach, a polypropylene mesh is implanted between the external aponeurosis and the internal oblique muscle to form a strong posterior wall of the inguinal canal. Advantages: Tension free The operation can be performed under local anesthesia 8 3 4 Mesh fixation to the internal oblique muscle. Spermatic cord is placed between the two tails of the mesh. Technique: The medial end of the mesh is cut to the shape of the medial corner of the inguinal canal (Optilene® Pre-shaped Mesh can also be used). The rounded corner is sutured, with a nonabsorbable monofilamented suture material, to the anterior rectus sheath above the pubic bone and overlapping the rectus sheath by 1 to 1.5 cm. This suture is continued to attach the lower edge of the mesh to the inguinal ligament up to a point just lateral to the internal ring. A slit is made at the lateral end of the mesh, creating two tails. The upper edge of the mesh is sutured in place with two interrupted absorbable sutures, one to the rectus sheth and the other to the internal oblique aponeurosis just lateral to the internal ring. Using a single nonabsorbable monofilamented suture the lower edges of each of the completion knot of the lower running suture. This creates a new internal ring made of mesh. Plug Technique Tension Free Method (Rutkow – Robbins) 1 2 3 Placement of a reinforcement mesh in the inguinal canal that through an aperture allows passage of the spermatic cord. This opening in the mesh is sutured. The rest of the mesh is left unfixed. Placing the plug at the deep inguinal ring. Inserting and fixing the plug in the deep inguinal ring. In this open tension free treatment the hernia sac is pushed back to abdominal cavity with a Premilene® Mesh Plug and the defect is filled perfectly. Due to the unique technique, the use of the plug is simple. The plug is applied following the PIS technique (Position, Insert, Stabilize). Advantage: The operation can be performed under local anesthesia 9 TAPP Technique (TransAbdominal PrePeritoneal) Laparoscopic Inguinal Hernia Repair 1 Creating the peritoneal flap. 2 Dissecting the hernia sac. During this hernia treatment, the posterior wall of inguinal canal will be strengthened with an endoscopically placed polypropylene mesh between the musculature of the abdominal wall and the peritoneum through a transabdominal entrance. The operation process takes place in the abdominal cavity. 3 Inserting and fixating the mesh. Advantages: Minimal invasive Attendance of bilateral hernias at the same time through one incision For large and recurrent hernias TAPP is a tension free method, strengthening the posterior wall of the inguinal canal and all potential hernia sites in the groin with a laparoscopically placed polypropylene mesh into the preperitoneal space. The access is transabdominal, through abdominal cavity. 10 Reinforcement of the abdominal wall and closure of the hernia opening from the proper side (where the pressure comes from), thus enabling immediate postoperative physical work load TEP Technique (Totally ExtraPeritoneal Technique) Laparoscopic Inguinal Hernia Repair 1 A incision of 2 cm is made on the anterior rectus sheath, off the midline (on the affected side). Using a finger and blunt dissection, a tunnel is created and the HERLOON single use ballon is inserted. 4 2 3 Dilatation under visual monitoring to create working space between the abdominal wall and the peritoneum (HERLOON ballon). Insert the visualization trocar with cone. In this reparation method, a whole operation takes places outside the abdominal cavity. A balloon trocar (e.g. Herloon system) is used to create a working space between the abdominal wall and the peritoneum. 5 The posterior wall of inguinal canal is strengthened with an endoscopically placed polypropylene mesh between the musculature of the abdominal wall and the peritoneum. The balloon trocar is then replaced by a trocar with a special sealing cone (mini-laparotomy trocar). The polypropylene mesh (e.g.: Optilene® Mesh LP) is inserted. Advantages: Minimal invasive Attendance of bilateral hernias at the same time through one incision Peritoneum won’t be incised Avoid bowel ingury 11 Incisional and Umbilical Hernia Description: Treatment: The other significant hernia types are the incisional and the umbilical hernias. There are three kinds of incisional and umbilical hernia treatment with meshes: Incisional hernias are caused by thinning or stretching of scar tissue that forms after surgery. This weakened scar tissue then creates a weakness in the abdominal wall. Because of this weakness, the hernia can occur during abdominal strain. Umbilical hernias develop in and around the area of the umbilicus. 12 Onlay Sublay IPOM (IntraPeritoneal Onlay Mesh) On the following page the description of these techniques can be found. Onlay Technique The mesh is placed on the Rectus sheath (abdominis) with open technique. Sublay Technique In this open or laparoscopic technique, the mesh will be placed intraperitoneal. IPOM (IntraPeritoneal Onlay Mesh) In this endoscopic hernia attendance, the mesh will be placed intra-peritoneal onlay with transabdominal approach. 13 Optilene® Mesh Universal-light mesh for inguinal and incisional hernia repair Optilene® Mesh is a universal-light mesh, which combines a lightweight concept with an excellent handling. It is a soft, large pore and elastic mesh – at the same time it is a strong mesh with excellent spread characteristics. The blue guidelines allow for a well directed placement. The mesh can be used for inguinal and incisional hernia repair. It provides optimal handlich for open and laparoscopic application. Optilene® Mesh is suitable for all hernia repairs. Advantages Material: Construction: Weight: Pore size: ■ Universal-light mesh Monofilament Polypropylene Knitted 60g/m2 1.5 mm ■ Large pores ■ Blue guidelines ■ Filament-reinforced ■ Soft, convenient and strong ■ Fully transparent ■ Homogenous elasticity ■ Open and laparoscopic procedures Indication ■ Inguinal Hernia ■ Incisional Hernia ■ Reconstruction of chest wall Content / Box Cat. No. 5 x 10 cm 5 pieces 1065020 7.5 x 15 cm 5 pieces 1065030 Size 14 10 x 15 cm 5 pieces 1065040 26 x 36 cm 5 pieces 1065060 15 x 15 cm 5 pieces 1065080 30 x 30 cm 5 pieces 1065090 4.5 x 10 cm 5 pieces 1065140 6 x 14 cm 5 pieces 1065150 Shape Optilene® Mesh LP Super-light and fully transparent Optilene® Mesh LP is a super-light polypropylene mesh which offers an excellent biocompatibility. The foreign body reaction is reduced considerably. Optilene® Mesh LP is the alternative super-light mesh for all open hernia repair procedures. It perfectly conforms to anatomical structures. Due to its excellent flexibility Optilene® Mesh LP adapts to the movements of the patient resulting from body motion. Optilene® Mesh LP offers extreme dimensional stability as well as full transparency so that the tissue underneath is visible during surgery. Material: Construction: Weight: Pore size: Monofilament Polypropylene Knitted 36g/m2 1 mm Advantages ■ Super-light Polypropylene ■ Large pores ■ Soft and pliable ■ Fully transparent ■ Thin and comformable ■ Flexible, strong and secure ■ Ideal for inguinal hernia repair ■ Easy placement Indication ■ Inguinal Hernia ■ Incisional Hernia ■ Reconstruction of chest wall Size Content / Box Cat. No. 5 x 10 cm 5 pieces 1064735 7.5 x 15 cm 5 pieces 1064715 10 x 15 cm 5 pieces 1064725 15 x 20 cm 5 pieces 1064855 15 x 15 cm 5 pieces 1064705 4.5 x 10 cm 5 pieces 1064765 6 x 14 cm 5 pieces 1064775 Shape For more information: www.optilene.com 15 Optilene® Mesh Elastic Elastic Lightweight and Large Pore Mesh Optilene® Mesh Elastic is a lightweight and large pore polypropylene mesh. Due to the multidirectional elasticity the mesh is able to adapt to all movements taking place in the abdominal wall. The new honeycomb like structure with the large pores enables for ideal healing and formation of an elastic scar. Material: Construction: Weight: Pore size: The mesh is ideal for incisional hernia repair and can also be used to repair inguinal hernias. Optilene® Mesh Elastic helps for maintaining an excellent abdominal wall physiology and results in highest patient convenience. Monofilament Polypropylene Knitted 48g/m2 3.6 x 2.8 mm Advantages ■ High patient convenience ■ Ideal for incisional hernia repair ■ Multidirectional elasticity ■ Lightweight mesh ■ Large pores ■ Monofilament structure ■ Excellent handling Indication ■ Inguinal Hernia ■ Incisional Hernia ■ Reconstruction of chest wall Size Content / Box Cat. No. 30 x 30 cm 5 pieces 1064900 15 x 15 cm 5 pieces 1064910 20 x 30 cm 5 pieces 1064940 10 x 15 cm 5 pieces 1064920 7.5 x 15 cm 5 pieces 1064930 Shape For more information: www.optilene.com 16 Omyra® Mesh Prevention means Comfort. Reducing adhesions, Impairing Bacterial Growth. Omyra® Mesh is the first bacterial resistant antiadhesive mesh. Omyra® Mesh brings a new concept for hernia repair. It is made of light-weight condensed Polytetrafluoroethylene (cPTFE) and a Star-Macroporous structure improves the adhesion prevention features of the traditional expanded PTFE and enhances the tissue integration achieved with Polypropylene meshes. The CondensTech, transparent monolayer Omyra® Mesh provides the best handling, specially in laparoscopic procedures. Advantages Characteristic: cPTFE Composition: Micromachined condensed Polytetrafluoroethylene Structure: Monolayer Density: 0.9 g/cm2 Pore size: 2.4 mm (Star shape) ■ Impairment of Bacterial Growth ■ Reduction of Adhesion Formation ■ Avoidance of Seroma ■ Highly Biocompatible ■ Optimal handling features Indication ■ Incisional Hernia ■ Inguinal Hernia Size Content / Box Cat. No. 26 x 36 cm 1 piece 1062636 20 x 30 cm 1 piece 1062030 15 x 22 cm 1 piece 1061520 11 x 15 cm 1 piece 1061115 14 x 14 cm 1 piece 1061414 15 x 15 cm 1 piece 1061515 10 x 15 cm 1 piece 1061015 7.5 x 15 cm 1 piece 1060715 6 x 11 cm 1 piece 1060611 Shape Porous Shape 17 Premilene® Mesh Polypropylene Mesh for Hernia Repair Premilene® Mesh, made from monofilament polypropylene, is used for hernia repair or for reconstruction of the chest wall. The monofilaments are knitted into an elastic, durable, large pore mesh. Premilene® Mesh is characterized by the extreme dimensional stability of its thin mesh wall. It adapts optimally to movements of the patient. The technically advanced mesh structure is retained after cutting and does not fray. Premilene® Mesh is a highly transparent so that tissue underneath is visible during surgery. Material: Construction: Weight: Pore size: Monofilament Polypropylene Knitted 82g/m2 0.8 mm Advantages ■ Rapid healing and tissue penetration ■ Ideal Pore size ■ Thinmesh structure ■ Excellent transparency ■ Good handling ■ Well tolerated ■ Good stability Size Content / Box Cat. No. 3 x 10 cm 5 pieces 1064305 ■ Inguinal Hernia 5 x 10 cm 5 pieces 1064315 ■ Incisional Hernia 7.5 x 15 cm 5 pieces 1064425 10 x 15 cm 5 pieces 1064495 5 x 30 cm 5 pieces 1064445 26 x 36 cm 5 pieces 1064465 7.5 x 7.5 cm 5 pieces 1064415 15 x 15 cm 5 pieces 1064435 30 x 30 cm 5 pieces 1064455 4.5 x 9.5 cm 5 pieces 1064325 5 pieces 1064335 4.5 x 10 cm 5 pieces 1064345 6 x 14 cm 5 pieces 1064365 4.5 x 10 cm 5 pieces 1064385 6 x 14 cm 5 pieces 1064375 6 x 12.5 cm Shape For more information: www.bbraunmeshes.com 18 Indication ■ Reconstruction of chest wall Premilene® Mesh Plug Polypropylene mesh for plug technique Premilene® Mesh Plug is designed for the repair of recurrent hernias and can also be used for primary inguinal hernias. The smooth self-expanding plug fills the defect perfectly. The Plug adapts optimally to the shape of the defect and the natural anatomy. Premilene® Mesh Plug is a pre-shaped mesh with excellent properties: Rapid healing and tissue penetration, high biocompatibility and stability. It is able to conform to the movements of the patient. Advantages Material: Construction: Weight: Pore size: ■ Most anatomic 3-D shape Monofilament Polypropylene Knitted 82g/m2 0.8 mm ■ Smooth plug design ■ Blunt tip ■ Exclusive blue center grip ■ Full range of plug depths ■ Pre-shaped mesh onlay Indication ■ Inguinal Hernia Repair ■ Incisional Hernia Repair Description Dimensions Form Plug flat Contents Article No. Plug Onlay shaped Premilene® Mesh Plug Plug Depth - 2.5 cm Small Onlay - 5 x 10 cm with small onlay 5/Box 1064605 Premilene® Mesh Plug Plug Depth - 3.25 cm Medium Onlay - 5 x 10 cm with small onlay 5/Box 1064615 Premilene® Mesh Plug Plug Depth - 3.75 cm Large Onlay - 5 x 10 cm with small onlay 5/Box 1064625 Premilene® Mesh Plug Plug Depth - 4.5 cm Extra Large Onlay - 5 x 10 cm with small onlay 5/Box 1064635 19 Absorbable Sutures Safil® ■ 20 Mid-term absorbable Monosyn® ■ Mid-term absorbable Chemical Composition: Polyglycolic acid Chemical Composition: Glyconate Structure: Braided Monofilament Structure: Monofilament Colour: violet or undyed Colour: violet or undyed Sizes: braided: USP8-0 - USP2 monofilament: USP10-0 - USP9-0 Sizes: USP7-0 - USP1 Absorption Time: 1. day 100 % 18. day 50 % 21. day 40 % Absorption Time: 1. day 100 % 14. day 50 % 21. day 20 % Complete Absorption: from 60 to 90 days Complete Absorption: from 60 to 90 days Indication: ■ Gastrointestinal surgery ■ Gynaecology / obstetrics ■ Ophthalmic surgery ■ Orthopaedics ■ Urology ■ Skin closure (intra, sub, skin) ■ Neurosurgery ■ Ligatures Indication: ■ Gastrointestinal surgery ■ Gynaecology / obstetrics ■ Urology ■ Plastic and reconstructive surgery ■ Skin closure (intra, sub, skin) ■ Ligatures Advantages: ■ High tensile strength ■ Excellent knotting ability ■ Smooth passage through tissue ■ Easy handling Advantages: ■ Superior initial knot tensile strength ■ Ideal degradation profile for soft tissues ■ Smooth tissue passage ■ Excellent knot security ■ Quick mass absorption MonoPlus® ■ Long-term absorbable MonoMax® ■ Long-term absorbable Chemical Composition: Polydioxanone Chemical Composition: Poly-4 Hydroxybutyrate Structure: Monofilament Structure: Monofilament Colour: violet Colour: violet Sizes: USP7-0 - USP2 Sizes: USP 1(metric 4), USP 0 (metric 3.5) and USP 2/0 (metric 3) Absorption Time: 1. day 100 % 14. day 90 % 28 - 35 days 50 % Absorption Time: 1. day 100 % 90 days 50 % Complete Absorption: from 180 to 210 days Complete Absorption: after 180 days Indication: ■ Abdominal wall closure ■ Orthopaedics ■ Paediatric cardiovascular surgery Indication: ■ Abdominal wall closure Advantages: ■ High knot tensile strength ■ Outstanding strength retention for extended wound support ■ Very flexible ■ Pliable and easy to knot ■ Conveniently elongable ■ Smooth passage through tissue Advantages: ■ High knot tensile strength ■ Outstanding strength retention for extended wound support ■ Very flexible ■ Pliable and easy to knot ■ Conveniently elongable ■ Smooth passage through tissue 21 Non-Absorbable Sutures Premilene® ■ 22 Non-absorbable Dafilon® ■ Non-absorbable Chemical Composition: Polypropylene Chemical Composition: Polyamide 6 and 6.6 Structure: Monofilament Structure: Monofilament Colour: blue Colour: blue / undyed / black Sizes: braided: USP10-0 - USP1 Sizes: braided: USP11-0 - USP1 Indication: ■ Vascular surgery ■ Cardiac surgery ■ Plastic and reconstructive surgery ■ Skin closure (intra, sub, skin) ■ Neurosurgery ■ Microsurgery ■ Gastrointestinal surgery Indication: ■ Skin closure (intra, sub, skin) ■ Plastic and reconstructive surgery ■ Microsurgery ■ Ophthalmic surgery ■ Neurosurgery Advantages: ■ Smooth passage through tissue ■ Excellent knot run down and security ■ Minimal acute inflammatory reaction in tissues ■ Unsurpassed strength ■ Optimal elasticity and elongation properties Advantages: ■ High tensile strength ■ Excellent knotting ability ■ Smooth passage through tissue ■ Easy handling Skin Stapler and Tissue Adhesive Manipler® AZ Histoacryl® Chemical composition: Enbucrilate Staple Information: Type: Wide No: 35 Colour: blue, translucent Staple Dimension: Crown: 6.9 mm Leg.: 3.6 mm Sizes: ■ 0.5 ml Indication: ■ Thoracic surgery ■ Cardiac- and vascular surgery ■ General surgery ■ Gynaecology / Urology ■ Orthopaedics Indication: ■ Closure of minor skin wounds without suturing ■ Sclerosation Therapy Advantages: ■ Grip designed for best angle ■ Automatic clip ejection ■ Box-style staple ■ Ease of use Advantages: ■ Excellent cosmetic results ■ High mechanical strength ■ Short duration of treatment ■ Low medical fees ■ Local anaesthetic is not required ■ Avoids additional trauma (suture hole stitches) ■ No removal of sutures required ■ Effective protection against bacteria infection (adhesive film) ■ Over 30 years of clinical experience ■ Storage at room temperature 23 Recommended materials Absorbable Sutures Name Sizes Needle length Cat. No. Indication Safil USP 2-0 HR17 C1048015 for Peritoneum suture ® Safil USP 2-0 HR22 C1048031 for Peritoneum suture Safil® USP 2-0 HR37s C1048095 for Closure of External aponeurosis Safil® USP 3-0 HR26 C1048041 for Subcutaneous suture Safil® USP 2-0 JRC30 C1048483 for Fascia suture in the TAPP technique Safil® USP 0 JRC30 C1048482 for Fascia suture in the TAPP technique Monosyn® USP 4-0 DSMP19 C0023624 for Skin closure Monosyn USP 3-0 DSMP24 C0023633 for Skin closure MonoPlus® USP 4-0 HR26 C0024024 for Peritoneum suture in TAPP technique MonoPlus® USP 4-0 GR19 C0024984 for Peritoneum suture in TAPP technique MonoPlus® USP 1 HRT48 loop C0024394 for Abdominal Wall Closure MonoMax® USP 1 HRT48 loop B0041241 for Abdominal Wall Closure MonoMax® USP 0 HRT48 loop B0041240 for Abdominal Wall Closure Sizes Needle length Cat. No. Indication Premilene® USP 4-0 DSMP19 C0090676 for Skin closure Premilene ® USP 3-0 DSMP24 C0090656 for Skin closure Premilene® USP 2-0 HR26 C0090042 for Mesh fixating Premilene® USP 2-0 HR26s C0095442 for Multilayer interrupted suture in ® ® Non-Absorbable Sutures Name Bassini technique, for transversalis duplication in Shouldice technique, for fixation the muscles to inguinal ligament in Shouldice technique Premilene® USP 0 HR26s C0095443 for transversalis duplication in Premilene® USP 0 HR37s C0090152 for transversalis duplication in Dafilon® USP 4-0 DSMP19 C0936235 for skin closure Dafilon USP 3-0 DSMP24 C0936316 for skin closure Sizes Information Cat. No. Indication Manipler®AZ 6.9 / 3.6 mm W35 783100 for skin closure ® Histoacryl 0.5 ml 10 ampoules 1050044 for skin closure (blue) Histoacryl® 0.5 ml 10 ampoules 1050071 for skin closure (translucent) Shouldice technique Shouldice technique ® Skin Stapler, Tissue Adhesive Name 24 General Surgery Basic Instrument Set For Open Hernia Treatments Name No. Cat. No. Maier Sponge Forceps, curved, 265 mm 2 BF059R Backha Towel Clamp, 110 mm 4 BF432R Towel Clamp for Paper Cloths 115 mm 2 BF465R Scalpel Handle, fitting no. 4 for blades 18 - 37 2 BB084R Scalpel Handle #3, fitting no. 3 for blades 10 - 15 and 40, 42 1 BB073R Metzenbaum Durotip® Dissecting Scissors, curved, 180 mm 1 BC271R Durotip Ligature Scissors, serrated, curved, 180 mm 1 BC295W Mayo-Lexer Durotip® Dissecting Scissors, curved, 165 mm 1 BC284R Surgical scissors, straight, blunt / sharp, 145 mm 1 BC324R Dissecting Forceps, medium, 145 mm 1 BD027R Tissue Forceps, 1 X 2 teeth, medium,145 mm 2 BD537R ® De Bakey Atraumata Dissecting Forceps, 2,0 mm wide, 150 mm 2 FB400R Kocher Haemastatic Forceps, 1 X 2 teeth, straight, 140 mm 6 BH614R Pean Haemastatic Forceps, straight, 140 mm 6 BH424R Halsted – Mosquito Haemastatic Forceps, curved, 125 mm 6 BH111R Kocher – Ochser Haemastatic Forceps, straight, 200 mm 2 BH646R ® Maier Sponge Forceps, straight, 265 mm 2 BF058R Mikulicz Peritoneum Forceps, 205 mm 4 BJ314R Overholt Dissecting Forceps, fine pattern, figure 1, 210 mm 2 BJ081R Overholt Dissecting Forceps, fine pattern, figure 2, 220 mm 2 BJ082R Deschamps Ligature Needle, curved to left, 215 mm 1 BM810R Koenig Guiding Probe, 5 mm, 195 mm 1 BM901R Crile-Wood Durogrip® 1 BM016R Hergar – Mayo Durogrip® needleholder, 205 mm 2 BM067R De Bakey Durogrip needleholder, 180 mm 1 BM035R Roux Retractor, double ended, set of 3, 165 mm 1 BT030R ® Langenbeck Retractor, 33 X 14 mm, 210 mm 2 BT322R Interior Box, for BL 930, round 1 BL931R Laboratory dish 0.16 l 1 JG522R Laboratory dish 0.4 l 1 JG523R Kidney tray stainless steel 250 mm 1 JG506R Redon Spike Ch. 12 Slig. CVD. triang. tip 1 BN944R Redon Spike Ch. 14 Slig. CVD. triang. tip 1 BN945R 25 Endoscopy Basic Set *only for the TEP technique For more information: www.endoscopy-catalog.com Name Cat. No. No. Metzenbaum Scissors, serrated PO004R 1 Hook Scissors, blunt PO001R 1 Maryland Fixation / Dissection Forceps PO102R 1 Atraumatic Fixation / Dissection Forceps PO101R 1 Delicate Dissecting Forceps PO151R 1 Pike-Mouth Forceps with reservoir in the jaw PO107R 1 Durogrip Needle Holder, straight or PL407R 1 Durogrip Needle Holder, left curved PL408R 1 or 26 Name Cat. No. HERLOON System The Herloon hernia sytem has two components No. 1 Component 1: EJ871R Reusable Trocar Body* Trocar body for EJ870P with blunt obturator 10/300 mm Component 2: Single Use Balloon Shaft with Hand Pump* 10 pieces, individual sterile packaging EJ870P Trocar for Mini-Laparotomy 10/110 mm, w. stopcock Consisting of EK024R, EK086P, EK098R, EK064R 1 Trocar Sleeve 5/110 mm, smooth, w/o stopcock EK015R 1 Sealing unit 5 mm EK080P 1 Conical Sharp Trocar Pin 5/110 mm EK046R 1 Trocar Sleeve 10/110 mm, smooth, w. stopcock EK024R 2 Sealing unit 10 - 12 mm, with 5 mm flap converter EK083P 2 Conical Sharp Trocar Pin 10/110 mm EK056R 1 Reduction Sleeve 10 to 5 mm EK090R 2 Full HD Laparoscope 10 mm / 0° or PE889A 1 Full HD Laparoscope 10 mm / 30° PE909A 1 27 B. Braun Surgical SA | Carretera de Terrassa, 121 | 08191 Rubí | Spain Phone +34 93 5 86 62 00 | Fax +34 93 6 99 73 03 | www.bbraun.es Aesculap AG | Am Aesculap-Platz | 78532 Tuttlingen | Germany Phone +49 (0) 74 61 95-0 | Fax +49 (0) 74 61 95-26 00 | www.aesculap.com Aesculap – a B. Braun company All rights reserved. Technical alterations are possible. This leaflet may be used for no other purposes than offering, buying and selling of our products. No part may be copied or reproduced in any form. In the case of misuse we retain the rights to recall our catalogues and pricelists and to take legal actions. Brochure No. B47102 1109/1/1
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