Chapter 11. Arthroscopes 11 ARTHROSCOPY & LAPAROSCOPY. Introduction. Standard Arthroscope, 4.0mm with Arthroscopic Sheath

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1 Chapter 11 Introduction Using fibre optics the arthroscope is able to deliver light and obtain an image from within the joint thus obviating the need for an extensive surgical approach and keeping surgical trauma to soft tissues at a minimum. However, arthroscopy is not a risk free procedure as it involves placing sharp metal objects into the joint space. Standard Arthroscope, 4.0mm with Arthroscopic Sheath Although arthroscopy may be considered expensive in terms of both the dedicated instrumentation required and the time and money involved in training, it is recommended that sufficient resources are allocated to purchase good quality equipment at the outset. (Equipment failures being very frustrating and ultimately very expensive.) Arthroscopes An arthroscope is a rigid endoscope consisting of a system of lenses, which collects and transmits an image from the tip of the instrument along the shaft to an eyepiece or camera. A light post close to the eyepiece allows light to be passed into the shaft and down optic fibres surrounding the lens system to illuminate the subject area at the tip. The diameter refers to the outside diameter of the unsheathed shaft of the telescope. Two sizes are commonly used in equinel arthoscopy:4.0mm and 2.7mm. 4.0mm is the standard, with 2.7 being useful for small joints like the coffin joint. The viewing angle is the angle between the lens face and a line drawn at right angles to the long axis of the arthroscope. A 0 scope views straight ahead from the front of the lens, while a 90 scope sees an image at right angles to the long axis of the scope. Most veterinary arthroscopes have a viewing angle of 30, which is a compromise between field of view and distortion. The user needs to be aware which way the lens is pointing. The light post is used as a reference point and is positioned opposite the angle of view. Rotating the scope along its long axis will allow the surgeon to view a large area within the joint with minimal repositioning. An oblique viewing angle does offer the surgeon a limited ability to see around corners. 115 degree field of vision special coated front lense system elongated working lengths non rotating stopcock, robust and durable T Wide angle telescope, 30, OD:4 mm, WL:18 cm, 115 field of vision, standard light cable connectors, autoclavable S Sheath for arthroscopy, OD: 5.5 mm, WL:16 cm compatible with T , stopcock, including blunt & sharp trochar Needle Arthroscope, 2.7mm with Arthroscopic Sheath Each arthroscope will require a dedicated sheath, which protects the arthroscope as well as delivering fluid to the tip. Sheaths offering a high rate of flow are preferable. The sheath reduces the effective working length of the 4.0mm scope to approx 16.0cm. Conversely, the sheath will increase the working diameter of the arthroscope. 4.0mm becomes 5.5mm. All scopes are now available in autoclaveable versions. Autoclaving, especially for fine scopes, will significantly reduce the working life of the instrument. Autoclavable scopes can be soaked & we recommend this method of sterilisation to preserve your scope. If your scope is not marked autoclavable, it can only be soaked. T Wide angle telescope, 30, OD: 2.7 mm, WL:14 cm, large image technology, standard light cable connectors, autoclavable S Sheath for arthroscopy, OD: 3.8 mm, WL:12 cm, compatible with T , stopcock, including blunt & sharp trochar Accessories for sterilising and storing DE Sterilizing & storing tray, 290x80x52mm, perforated, stainless steel with silicon specially designed for rigid telescopes DE As above but 460x80x52mm

2 ARTHROSCOPY & LAPAROSCOPY 11 Hand Instruments TR Puncture needle, ID:3mm, WL:20cm, incl. sharp trocar I Hook probe for arthroscopy, 3 mm,12 cm, strong version, heavy handles I Special egress curette, straight, strong version, oval cup: 5.5mm, 3 mm opening and LL(f) suction connector, WL:11cm I Special knife for arthroscopy, 3 mm break safe special cut, heavy handles I Curette, straight, strong version, Cup oval, size: 6x4 mm I Curette, 35 oblique left, strong version, cup oval, size: 6x4 mm I Elevator, extra strong, curved, 6 mm I Curette, 35 oblique right, strong version, cup oval, size: 6x4 mm I Osteotome, curved, 6 mm I Special elevator for the coffin joint, acc to Dr. Zöttl, 12 cm, strong version I Chisel, straight, 4 mm I Special elevator for sesamoide fractures acc. to Dr. Foerner, 4 mm curved, long I Egress cannula, with sharp trocar, stopcock, ID: 3 mm, WL: 7 cm I Egress cannula, with sharp trocar, stopcock, ID: 4 mm, WL: 7 cm I Hook scissors for arthroscopy, straight, single action jaws, OD: 4 mm, WL: 15 cm

3 Rongeurs Standard Line Instruments High quality instruments with long life span specifically designed for arthroscopy. Standard Handle type, small jaws, extremely durable Light Sources & Cables Halogen light sources are inexpensive but not as good as the xenon based systems, which are, unfortunately, significantly more expensive to purchase and maintain. Xenon light sources have a higher intensity and are essential if the unit is to be used for laparoscopic work. Thus xenon is preferable but halogen can be used successfully in most joint investigations. Both xenon and halogen bulbs have a limited life (xenon typically 500 hours, halogen typically 2000 hours) and bulb failure is at best embarrassing so always carry a spare. The light cable carries light from the source to the arthroscope by fibre optics. Each cable has dedicated connectors to couple with the light source and the arthroscope. Connections on both light source and arthroscope vary from manufacturer to manufacturer. Converters are available for both light source and arthroscope but it is wise, if possible, to purchase the appropriate cable for the system. H Halogen Light Source 150W I I I Rongeur "standard line", cup size: 4x8 mm, oval, straight, fenestrated, WL: 11 cm Rongeur "standard line", cup size: 4x8 mm, oval, straight, fenestrated, ratchet, WL: 11 cm Rongeur "standard line", cup size: 4x8 mm, oval, angled upwards, fenestrated, L: 11 cm Ergonomic Line Instruments High quality instruments with long life span specifically designed for arthroscopy. Ergonomic Handle type, small jaws, extremely durable. H Halogen light source 150W 1, Xenon Light Source I Rongeur, cup size: 4 x 8 mm, fenestrated straight, WL: 12 cm, ergonomic handles I Rongeur/hook grasper "Chip-catcher", for large fragments, rachet, WL: 13.5 cm LK-FX-100 Xenon light source 3, Power Line Instruments High quality instruments with long life span specifically designed for arthroscopy. Heavy Handle type, small jaws, extremely durable. I I Rongeur "power line", cup size: 5x10 mm, straight, oval cup, WL: 15 cm, heavy handles, extremely durable Rongeur "power line", cup size: 5x10 mm fenestrated, straight, small tip, WL: 15 cm, heavy handles, extremely durable KW KS Fibre light cable, 4.8mm, 2.3M, both sides compatible to Wolf, autoclavable Fibre light cable, 4.8mm, 2.3M, unit side comp. to Storz, endoscope side comp. to Wolf, autoclavable KS Fibre light cable, 4.8mm, 2.3M, Olympus/Wolf KS Fibre light cable, 4.8mm, 3.0M, Storz/Storz All cable combinations available. 74

4 ARTHROSCOPY & LAPAROSCOPY 11 Cameras & Monitors Direct viewing of the joint through the eyepiece is possible. However, practicality and the issue of contamination dictate that a camera system is an essential part of the equipment. Arthroscopic cameras work in a very similar fashion to video cameras in common usage. The image at the eyepiece of the arthroscope is focussed on a light responsive electronic chip(s). The signal created is transferred to a camera controller, which processes the image into a signal recognised by the monitor and/or recording system. Most veterinary cameras have a single chip, which is sufficient for most users. The connection of the camera head to the eyepiece of the arthroscope is also variable. To maximise the choice and longevity of the instrumentation it is advised that a clip on camera head compatible with DIN standard eyepieces be selected. The camera heads are fully immersible. Top quality equipment from a major human arthroscopic company but at a discount price. It is important to obtain the best possible image. Arthroscopy is difficult enough without working with poor quality images. Buy the best scope and camera you can afford. The Eagle Eye camera is human quality as is the matching light source. ARTHREX EAGLE EYE CAMAERAS AND LIGHTS AR-5970SP Eagle Eye Single Chip Camera 4, AR-3595SP Eagle Eye 300watt Xenon light Source 3, AR-3041 Light Cable EAGLE OFFER Eagle Eye Single Chip Camera + Xenon Light Source & Cable Save 3, , Monitor Flat Screeen Professional Monitor Professional monitors offer a better image than domestic screens as they have a better resolution. Some pre-owned units are always available. Ring for details. Image Capture Good practice dictates that a record is made of any arthroscopic procedure. Subsequent investigations can be compared to earlier ones and images can be shared and compared with colleagues or tutors as part of a training programme. Domestic video recorders will create a permanent record of a procedure. However the data is relatively crude and difficult to manipulate. Still video printers capture an image from a video stream which can then be printed onto photographic paper. Digital video and data storage technology now allows the surgeon to record and store very large amounts of data in a digital format. The digital information can subsequently be manipulated by appropriate computer software to create both still and moving images in a variety of formats for storage or display. If clinical presentations are anticipated then a digital system is very desirable. Domestic DVD or combined DVD/Hard drive recorders offer huge storage capacities at reasonable prices. The data is stored as Digital Video (DV) which can be converted into many other formats. The major arthroscopy companies offer sophisticated data storage systems which are able to capture and store still and movie files via sterile touch screens or camera finger controls. Permanent records are maintained on DVD discs or computer hard drives. We usually have some pre-owned Sony video printers in stock. Ring for details. USB Based Image Capture System Pre-owned cathode ray tube type monitor Camera Covers DE CAMPT CAMET Camera covers, disposable, (30) polyethylene, 13x50cm Camera cover with perforated tip 250cm x 12.5cm (60 sterile) Camera cover with elasticised tip 250cm x 12.5cm (60 sterile) DE-10-25/Single Single camera cover (disposable) 13x50cm 5.50 DE Camera cover, reusable, waterproof, washable, autoclavable, 12x200cm, 1 pc The latest version the image capture device captures both still images and mpegs directly onto a USB stick ready for transfer to permanent storage. Capture is activated by pressing a button on the front panel or if the surgeon prefers to keep control there is an optional foot control. 46-USB-200 USB Image Capture Jpeg and Mpeg 2, USB-15-1 Footswitch for USB Capture System

5 Fluid Infusion and Outflow Infusion of fluids or gas into the joint is essential to create an environment in which the arthroscope can view joint structures. The joint must be expanded and debris removed to maintain a clear field of view. To maintain an appropriate intra-articular pressure (between 40 and 100mm of mercury) (0.053 and BAR) fluid inflow and outflow must be carefully regulated. Fluid under pressure may be obtained by either gravity feed systems or a pump. Gravity may be sufficient provided the fluid bags can be lifted high enough but greater, more controllable pressure may be obtained by use of a fluid compression bag. The bag of fluid to be infused is placed into a pressure bag, which is inflated using a hand or machine pump. Without careful monitoring hand inflation systems offer erratic pressure levels and use of a regulated pump offers much better control. A carbon dioxide powered pump may be used to pressurize a compression bag or infuse carbon dioxide directly into the joint. Dedicated roller type pumps are able to maintain a constant line pressure over extended periods but they may require dedicated tubing, are expensive to purchase and are more prone to breakdown. To create fluid flow through the joint, appropriate fluid outflow or egress must be maintained. In the smaller joints (elbow, hock and hip), a large bore hypodermic needle may be sufficient. In the larger joints (shoulder, stifle) where greater volumes of fluid are involved, dedicated multi fenestrated egress cannulae may be necessary, the waste fluid may be collected by either bag systems or suction devices. Use of direct CO2 infusion is indicated in some inflamed joints where inflammatory synovial villae obstruct the visual field, the villae being flattened under gas pressure rather than floating free in infused fluid. In addition, use of CO2 increases the field of view and image clarity of the arthroscope. CO2 is usually used intermittently with fluid to allow for flushing. Arthroscopy Infusion Pump Hand Pressure Infusion Cuffs AR AR AR AR Pressure infusion cuff for ml complete with pressure gauge and hand pump, reusable Pressure infusion cuff for ml complete with pressure gauge and hand pump, reusable Pressure infusion cuff for ml without pressure gauge, Luer Lock (fem), reusable Silicon tube, 7x2mm, 3m, autoclavable, Luer-Lock (m), needle (f), sterile bags/bottles X Spare silicon tube, 1 metre, size: 7x2mm, colour: natural LLM-1258 AR-10-9 Spare Luer-Lock connector, male, comp. to silicon tubes 7x2mm Spare needle for infusion bottles/bags, ID:5.5mm, comp. to silicon tubes (7x2mm) X Silicon tube, ID:5mm, 180cm, LLm both ends, autoclavable X LLM-1250 Spare silicon tube, 1m, autoclavable, size: 5x1,5mm, colour: nature 9.50 Spare Luer-Lock connector (m), comp. to silicon tubes (5x1.5mm) Pressure Pump Infusor Features: automatic control pressure continously adjustable max. 300mm Hg pressure easy handling no mechanical parts for fluid and CO 2 supply AR Pneumatic pressure infusor, for infusion cuffs, for veterinary arthroscopy, complete 4mm tube to central pressure supply, DIN tube connection, front side Luer-Lock (f), universal table fixator, easy pressure setting, automatic regulation (0-300mmHg) 1, Pressure Infusion Cuff with fluid bag Provided the surgeon is prepared to commit to the purchase of 100 patient infusion sets per year Arthrex is prepared to offer its Continuous Wave Arthroscopy Pump (AR-6450) (value 3,750) on free loan. This pump has been in use in the human sector for some 15 years and is very reliable. Line pressure and flow rate are user defined. This means that the fluid pressure does not have to be continually monitored and adjusted by nursing staff. In addition, if the tube pressure is correct, any problems with fluid flow can be immediately localised to the arthroscope. This is not the case with inflated cuffs where only the pressure within the bag is known. If you are performing 3 or more procedures per day it is cheaper to buy the separate Machine (one per day) and Patient Tube Sets. AR-6450 Arthroscopy Pump 3, AR-6415 Combination Machine and Patient Tube (10) AR-6410 Machine Tube Set (10) AR-6325 Patient Only Tube Set (20) AR Connection to fluid bag Patient Fluid Supply Infusor Hand pump or Luer-Lock (fem) for infusor Direct CO 2 supply (only in connection with CO 2 infusor Three way stopcock CO 2 Infusor, for large/small animal arthroscopy, DIN connector tube to pressure reducer (DIN type) pressure setting 0-300mm Hg tube connection Luer-Lock(f) 1, AR Reduction valve for CO 2-bottles, UK fitting AR Sterile filter system for CO 2 infusor, disposable, box with 50 pcs

6 ARTHROSCOPY & LAPAROSCOPY 11 Shaver Systems Virtually the only powered instrument in use in Veterinary arthroscopy is the shaver. The shaver is essentially a motorized bur. It may be used to debride cartilage, bone or soft tissues. A range of tips of different designs and sizes are available to manage the different tissues. Tips designed for soft tissues are typically larger and more aggressively toothed. Suction may be applied to the cutting tip via the hand piece to remove debris. The hand piece is driven by a control box operated by finger or foot controls. The speed and direction of cut are selectable. The tips are usually designed to be disposable, however with careful use, cleaning and re-sterilisation they may be re-used. Very expensive to buy new, Veterinary Instrumentation maintains a stock of high quality ex-hospital units for sale. Phone for details. Linvatec Shaver The Linvatec Shaver System is very interesting from a veterinary arthroscopy point of view as it is able to use 2.0mm micro burs. Other major brands have a minumum blade diameter of 2.8mm which may not seem a very big difference but is almost half as big again. Electrocautery Arthroscopic electrocautery or radiofrequency devices focally create heat within the tissues to create haemostasis, debridement or to shrink the joint capsule in selected cases of instability. Long, fine insulated probes are available which may be powered by standard surgical electrocautery units. The tips are bathed in fluid at all times but essentially the same processes occur at the tissue level as in surgical electrosurgery. Radiofrequency devices create heat by inter-molecular friction. Tips are available in both monopolar and bipolar formats and may be used to debride structures such as damaged meniscus or fat pad. Capsular shrinkage by radiofrequency may be used to tighten joint capsules following arthroscopy or injury. Radiofrequency ablation dissolves intra-articular tissues at a relatively low temperature. The resulting debris is removed by suction. The technique is therefore an alternative to the shaver for removing soft tissues. At least one manufacturer supplies combined shaver blades and ablator wands which offer both options on the same intra-articular device. Arthroscopic Procedure Electrosurgical System (OPES) The Universal Drive Console is a Microprocessor-controlled power unit that drives and controls current Linvatec handpieces. C9820, C9824, C9828, & Micro C9840. The latter is the most useful but most difficult to find. A wide range of current blades are available. CONSOLE FUNCTIONS INCLUDE: Audio response feedback. The unit tells you which direction the bur is moving. Normal (on-off) and variable (accelerator) footswitch speed controls. Footswitch sensitivity controls. Handpiece aspirate mode. Handpiece reverse/forward/oscillate cutting modes. Speed and direction of rotation are displayed. HANDPIECES Balance, sealed and lightweight. Sealed motor assembly. Up to 6000rpm in forward or reverse. Up to 1500rpm in oscillate Suction control valve. Cutting modes are controlled by footswitch or from the drive console. Supplied as kit including console, footcontrol (exact model may vary) and micro C9840 handpiece which take the micro series of blades going down to 2mm with 6 month warranty LINSHAV Linvatec Shaver System Complete 2, SBC9960 2mm Linvatec Micro Gator Shaver Blade SBC9950 2mm Linvatec Micro Cuda Shaver Blade SBC9911 2mm Linvatec Micro Spherical Shaver Blade SBC mm Linvatec Micro Gator Shaver Blade SBC mm Linvatec Micro Gator Shaver Blade SBC mm Linvatec Gator Shaver Blade SBC mm Linvatec Cuda Shaver Blade SBC mm Linvatec Spherical Shaver Blade Ablation wands A comprehensive orthopaedic electrosurgical system combining arthroscopic ablation, arthroscopic coagulation, open surgery monopolar and bipolar surgery from one fully digital generator. With 3 in 1 system flexibility, the OPES Electrical Generator is also capable of controlling a host of different instruments, including disposable monopolar arthroscopic electrodes, reusable and disposable monopolar open procedure pencils and tips, and reuseable bipolar forceps. The need for separate and costly systems is eliminated. Provided the surgeon is prepared to agree to an annual purchase commitment Arthrex is prepared to offer its OPES Console (AR-9600) (Value 5,500) on FREE loan. info@vetinst.com or phone John to discuss the purchase commitment. AR-9600 OPES Console 5, AR-9600FB Bipolar foot pedal AR-9611SFR Bipolar forceps AR-961CR Bipolar forceps cable AR-9610 Monopolar handpiece (disposable) (Box of 5) VAR Ground pad VAR Cable Ablation wands and electrodes from BROPES Opes Literature FOC 77

7 Laparoscopes for Minimally Invasive Surgery Laparoscopes Safety trocar Tissue pressure exposes the sharp tip T Good optics are a pre-requisite for successful laparoscopy. The more you see the easier it becomes. Fritz scopes have a patented large image optical system taking in a wide field of vision producing a full screen, very high definition image. All the laparoscopes are autoclavable and have standard eyepiece and light cable connectors. LAPAROSCOPES T Wide angle telescope, 0, OD:10mm, WL:50cm, large image optical system, stand. light connectors, autoclavable for equine and large animal practice T Wide angle telescope, 30, OD:10mm, WL:50cm, large image optical system, stand. light connectors, autoclavable for equine and large animal practice T Wide angle telescope, 30, OD:10mm, WL:30cm, SIRIUS system, autoclavable, standard light cable connectors Trochars and Cannulae Trochar cannulas are designed with different types of valves to reduce or to avoid CO 2 loss when changing instruments and telescope during laparoscopy and thoracoscopy. Our reusable and patented magnetic valve trocar system has several advantages compared to other valve types. They are lightweight and because of the valve construction, the insertion of instruments and scopes will pass smoothly through without scratching or touching the front lens like in a so called automatic valve system. In addition there is nearly no gas loss even when changing instruments. There are no mechanical parts to clean inside except the magnetic flap itself which is a great help to your staff. Trochar Cannulas with magnetic valving 5.5mm Inner Diameter T MM INNER DIAMETER TROCHARS & CANNULAE FOR 10MM SCOPES Cannula only, magnetic valve, ID:10 mm, WL:20 cm, inflation stopcock Safety trochar only compatible to cannulas ID:10 mm, WL: 20 cm, fully dismantable with cork screw handles MM INNER DIAMETER FOR STAPLER AND TISSUE EXTRACTION OR BIOPSIES Cannula only, magnetic valve, ID:16 mm, WL:15 cm Trinox, without stopcock Trochar only with sharp tip for trochars ID: 16 mm, WL: 15 cm Accessories ACCESSORIES Reducer adapter for trochar cannulas with ID:10 to 5.5mm Reducer adapter for trochar cannulas with ID:13 to 5.5mm Sealing caps, for trochar cannula 5.5mm p. of 10 pcs Sealing caps for trochars and reducer adapters Magnetic valve flap 5.5mm, p. of 2 pcs Magnetic valve flap 8/10mm, p. of 2 pcs Spleen/Kidney Trocar 5.5MM INNER DIAMETER CANNULAE FOR 5MM SCOPES Cannula only, magnetic valve, ID:5,5 mm, WL:20 cm, inflation stopcock Safety trochar only, compatible to cannulas ID:5,5 mm, WL: 20 cm, fully dismantable with cork screw handles Trochar only, with pyramidal tip for trochar with ID: 5.5 mm, WL:20 cm Designed by Dr Marien for closing of the spleen/kidney space. SPLEEN/KIDNEY TROCAR TR Working trocar acc. to Dr.Marien,ID:23 mm, 17 cm, including cannula (TR-250) sharp trochar (TR-23)

8 ARTHROSCOPY & LAPAROSCOPY 11 Palpation, Dissection and Puncture Instruments Laparoscopy First Puncture Needle. Veress Hand Instruments Fritz hand instruments have a modular construction. The handles, the connecting tubes and the working jaw tips are interchangeable. Easily stripped down for cleaning, compatible to 5mm and 10mm trochar cannulas. All handles have a High Frequency connector. Handles LAPAROSCOPY NEEDLE VERESS L Veress Needle 2mm x 150mm Luer Lock Thoracoscopy First Puncture Needle, long version THORACOSCOPY NEEDLE TR Thoracoscopy Needle 3mm x 200mm includes sharp trochar H11 /H12 H01 /H05 The instruments may have plastic coated or stainless handles. They may or may not have a ratchet. The ratchet may be external or enclosed. See individual instruments for exact construction. Tubular sheaths 5mm diameter, 470mm long protected interchangeable needle with outer tube. Consists of: L-47 Inside tube Luer lock Connector L-47-2 Outside tube/probe L-210 Needle 1x28mm PALPATION PROBE & PUNCTURE CANNULA L Palpation Probe/Cannula L-210 Injection Cannula 1 x 28mm compatible to L-33/47 2pcs L-218 Injection Cannula 1.9 x 26mm compatible to L-33/47 2pcs L-218R Injection Cannula 2 x 40mm blunt compatible to L-33/47 2pcs Knot tier and cutter Makes it easy to thread and tighten sutures. Integrated cutting device. 5mm diameter 400mm long. KNOT TIER AND CUTTER L Knot Tier Long Version Adjustable Fan Retractor 5mm or 10mm diameter options. Different working lengths which may be rotated through 360 degrees. Insulated or stainless steel. 5mm Instruments Complete Scissors SCISSORS H05V Metzenbaum Scissors (33cm) H05V Metzenbaum Scissors (43cm) Biopsy Forceps Metzenbaum Scissors H05V 5 mm, 33 cm, curved left, insulated, rotatable, dismantable,consisting of: jaws insert (53M01), sheath (53R1) handle (H 05), color code: white Metzenbaum Scissors H05V As above except 43cm Biopsy Forceps H01V H01V Biopsy forceps, double action jaws, with spikes, 5 mm,33 cm, rotatable, dismantable,consisting of: jaws insert (53 M 61), sheath (53 R 1) handle (H 01), color code: black BIOPSY FORCEPS H01V Biopsy Forceps Double Action Jaw (33cm) H01V Biopsy Forceps Double Action Jaw (43cm) Dissecting Forceps The spread of the five blades can be adjusted externally. O/D 10mm WL:340mm Luer lock irrigation connector. FAN RETRACTOR L Fan Retractor Dissecting Forceps (Maryland) H01V 5 mm, 33 cm, turned, insulated, rotatable, dismantable, consisting of: jaws insert (53 M 40), sheath (53 R 1) handle (H 01), color code: black DISSECTING FORCEPS H01V Dissecting Forceps (Maryland) (33cm) H01V Dissecting Forceps (Maryland) (43cm)

9 Grasping Forceps Grasping forceps H11V 5 mm, 33 cm, universal, insulated, rotatable, dismantable, consisting of: jaws insert (53 M 22), sheath (53 R 1) handle (H 11), color code: black GRASPING FORCEPS H11V Grasping Forceps (33cm) H11V Grasping Forceps (43cm) Claw Grasping Forceps Claw Grasping Forceps H12V 5 mm, 33 cm, straight, metal, rigid, dismantable, consisting of: jaws insert (53 M 30), sheath (53 R 6) handle (H 12) CLAW GRASPING FORCEPS H12V Claw Grasping Forceps (33cm) H12V Claw Grasping Forceps (43cm) mm Instruments Complete Scissors Mayo scissors, H05V, 10 mm, 37 cm,insulated, rotatable, dismantable, consisting of: jaws insert (13 M 11), sheath (13 R 1) handle (H 05) color code: white Atraumatic Grasping Forceps Atraumatic grasping forceps, H11V 10mm, 37 cm, insulated, rotatable, dismantable, consisting of: jaws insert (13 M 49), sheath (13 R 1) handle (H 11) color code: black ATRAUMATIC GRASPING FORCEPS H11V Atraumatic Grasping Forceps Claw Grasping Forceps Claw grasping forceps, H11V 10 mm, 37 cm, metal, double action jaws, rotatable, dismantable, consisting of: jaws insert (13 M 32), sheath (13 R 6) handle (H 11) CLAW GRASPING FORCEPS H11V Claw Grasping Forceps Needle Holders NEEDLE HOLDERS L L Suction/Irrigation Instrument TC jaw, straight, ID: 5 mm, long version, WL: 37 cm, axial handle, LL cleaning connector TC jaw, angled upward, ID: 5 mm, long version, WL: 37 cm, axial handle, LL cleaning connector SCISSORS H05V Mayo Scissors (37cm) Dissecting Forceps (Overholt) Dissecting forceps, (OVERHOLT), H11V turned, 10 mm, 37 cm, insulated, rotatable, dismantable,consisting of: jaws insert (13 M 48), sheath (13 R 1) handle (H11) color code: black DISSECTING FORCEPS (OVERHOLT) H11V Dissecting Forceps (Overholt) Babcock Grasping Forceps Babcock grasping forceps, H11V 10mm, 37 cm, insulated, rotatable, dismantable, consisting of: jaws insert (13 M 26), sheath (13 R 1) handle (H 11) color code: black Available in both 5mm and 10mm diameters. 5mm has single channel whilst 10mm has 2 channels to seperate suction and irrigation. Component and replacement parts available. Visit for details. SUCTION/IRRIGATION INSTRUMENT SM1-54RH98 SK1-54RH98 S9-14T2RH98 S9-14T4RH98 Special devices Suction/Irrigation Instrument ID:5mm, WL37cm metal tube Suction/Irrigation Instrument ID:5mm, WL37cm isolated tube Suction/Irrigation Instrument ID:10mm, WL37cm Olive tip Suction/Irrigation Instrument ID:10mm, WL37cm Perforated tip BABCOCK GRASPING FORCEPS H11V Babcock Grasping Forceps Universal Grasping Forceps Universal grasping forceps, H11V 10 mm, 37 cm, insulated, double action jaws, rotatable, dismantable, consisting of: jaws insert (13 M 25), sheath (13 R 1) handle (H 1) color code: black UNIVERSAL GRASPING FORCEP H11V Universal Grasping Forcep Please contact us for technical details / specifications. SPECIAL DEVICES H140-3S Suction and irrigation pump. Complete with 2 one litre bottles. Designed specifically for gastro enterology. 1, H160-AB Suction pump with 1 Litre bottle V CO2 Inflator DIN gas connection type For further information about Light sources, Cameras and monitors please see Page in the Arthroscopy section.