Hernia Treatment. To the Future Together. Hernia Repair

Transcription

1 Hernia Treatment To the Future Together Hernia Repair

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3 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

4 Inguinal Hernia Description: 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. Treatment: 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: Inguinal hernias Umbilical hernias Incisional hernias Femoral hernias There are two kinds of operation of the inguinal hernias: Open repair Without mesh: Bassini, Shouldice Tension free method with mesh: Lichtenstein Endoscopic repair with meshes TAPP, TEP 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. 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. 4

5 Hernia Preparation Open Hernia Repair Skin incision. Splitting of the Externusaponeurose. Protection of the nerves. 4 5 Preparation of the Musculus cremaster. Preparation of the herina sac. The preparation of the hernia is an important step and the following techniques are based on the approach explanation of this page. 5

6 Bassini Technique Open Reparation of Inguinal Hernias The inguinal canal after ligation and resection of the hernial sac. Starting the suture near the pubic crest. Loose stitches comprising the inguinal ligament, transversalis fascia, transverses abdominis muscle and internal oblique muscle. 4 5 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. 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 6

7 Shouldice Technique Open Reparation of Inguinal Hernias First line of suture Second line of suture Opening the transversalis fascia at the level of the inguinal canal. 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. 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. 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. Advantages: The operation can be performed under local anesthesia Double layer low-tension suture 7

8 Lichtenstein Technique Open Tension Free Method Mesh fixation to the inguinal ligament. Mesh fixation to the inguinal ligament. Mesh fixation to the internal oblique muscle. Spermatic cord is placed between the two tails of the mesh. 5 6 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. 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. Advantages: Tension free The operation can be performed under local anesthesia 8

9 Plug Technique Tension Free Method (Rutkow Robbins) Placing the plug at the deep inguinal ring. Inserting and fixing the plug in the deep inguinal ring. 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. 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

10 TAPP Technique (TransAbdominal PrePeritoneal) Laparoscopic Inguinal Hernia Repair Creating the peritoneal flap. Dissecting the hernia sac. Inserting and fixating the mesh. 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. 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. Advantages: Minimal invasive Attendance of bilateral hernias at the same time through one incision For large and recurrent hernias 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 10

11 TEP Technique (Totally ExtraPeritoneal Technique) Laparoscopic Inguinal Hernia Repair 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. Dilatation under visual monitoring to create working space between the abdominal wall and the peri - toneum (HERLOON ballon). Insert the visualization trocar with cone. 4 5 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. 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. The posterior wall of inguinal canal is strengthened with an endoscopically placed polypropylene mesh between the musculature of the abdominal wall and the peritoneum. Advantages: Minimal invasive Attendance of bilateral hernias at the same time through one incision Peritoneum won t be incised Avoid bowel ingury 11

12 Incisional and Umbilical Hernia Description: The other significant hernia types are the incisional and the umbilical hernias. Treatment: 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. Onlay Sublay IPOM (IntraPeritoneal Onlay Mesh) On the following page the description of these techniques can be found. 12

13 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 trans - abdominal approach. 13

14 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: Monofilament Polypropylene Construction: Knitted Weight: 60g/m 2 Pore size: 1.5 mm Universal-light mesh 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 Size Content / Box Cat. No. Shape 5 x 10 cm 5 pieces x 15 cm 5 pieces x 15 cm 5 pieces x 36 cm 5 pieces x 15 cm 5 pieces x 30 cm 5 pieces x 10 cm 5 pieces x 14 cm 5 pieces

15 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: Monofilament Polypropylene Construction: Knitted Weight: 36g/m 2 Pore size: 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. Shape 5 x 10 cm 5 pieces x 15 cm 5 pieces x 15 cm 5 pieces x 20 cm 5 pieces x 15 cm 5 pieces x 10 cm 5 pieces x 14 cm 5 pieces For more information: 15

16 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: Monofilament Polypropylene Construction: Knitted Weight: 48g/m 2 Pore size: 3.6 x 2.8 mm 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. 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. Shape 30 x 30 cm 5 pieces x 15 cm 5 pieces x 30 cm 5 pieces x 15 cm 5 pieces x 15 cm 5 pieces For more information: 16

17 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. Characteristic: Composition: Structure: cptfe Micromachined condensed Polytetrafluoroethylene Monolayer Density: 0.9 g/cm 2 Pore size: 2.4 mm (Star shape) Advantages 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. Shape Porous Shape 26 x 36 cm 1 piece x 30 cm 1 piece x 22 cm 1 piece x 15 cm 1 piece x 14 cm 1 piece x 15 cm 1 piece x 15 cm 1 piece x 15 cm 1 piece x 11 cm 1 piece

18 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: Monofilament Polypropylene Construction: Knitted Weight: 82g/m 2 Pore size: 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. Shape 3 x 10 cm 5 pieces x 10 cm 5 pieces x 15 cm 5 pieces x 15 cm 5 pieces x 30 cm 5 pieces x 36 cm 5 pieces Indication Inguinal Hernia Incisional Hernia Reconstruction of chest wall 7.5 x 7.5 cm 5 pieces x 15 cm 5 pieces x 30 cm 5 pieces x 9.5 cm 5 pieces x 12.5 cm 5 pieces x 10 cm 5 pieces x 14 cm 5 pieces x 10 cm 5 pieces x 14 cm 5 pieces For more information:

19 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. Material: Monofilament Polypropylene Construction: Knitted Weight: 82g/m 2 Pore size: 0.8 mm Advantages Most anatomic 3-D shape 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 Contents Article No. Plug Plug Onlay flat shaped Premilene Mesh Plug Plug Depth cm Small Onlay - 5 x 10 cm 5/Box with small onlay Premilene Mesh Plug Plug Depth cm Medium Onlay - 5 x 10 cm 5/Box with small onlay Premilene Mesh Plug Plug Depth cm Large Onlay - 5 x 10 cm 5/Box with small onlay Premilene Mesh Plug Plug Depth cm Extra Large Onlay - 5 x 10 cm 5/Box with small onlay 19

20 Absorbable Sutures Safil Monosyn Mid-term absorbable Mid-term absorbable Chemical Composition: Polyglycolic acid Structure: Braided Monofilament Colour: violet or undyed Sizes: braided: USP8-0 - USP2 monofilament: USP USP9-0 Absorption Time: 1. day 100 % 18. day 50 % 21. day 40 % Complete Absorption: from 60 to 90 days Indication: Gastrointestinal surgery Gynaecology / obstetrics Ophthalmic surgery Orthopaedics Urology Skin closure (intra, sub, skin) Neurosurgery Ligatures Advantages: High tensile strength Excellent knotting ability Smooth passage through tissue Easy handling Chemical Composition: Glyconate Structure: Monofilament Colour: violet or undyed Sizes: USP7-0 - USP1 Absorption Time: 1. day 100 % 14. day 50 % 21. day 20 % Complete Absorption: from 60 to 90 days Indication: Gastrointestinal surgery Gynaecology / obstetrics Urology Plastic and reconstructive surgery Skin closure (intra, sub, skin) Ligatures Advantages: Superior initial knot tensile strength Ideal degradation profile for soft tissues Smooth tissue passage Excellent knot security Quick mass absorption 20

21 MonoPlus MonoMax Long-term absorbable Long-term absorbable Chemical Composition: Polydioxanone Structure: Monofilament Chemical Composition: Poly-4 Hydroxybutyrate Structure: Monofilament Colour: violet Sizes: USP7-0 - USP2 Absorption Time: 1. day 100 % 14. day 90 % days 50 % Complete Absorption: from 180 to 210 days Indication: Abdominal wall closure Orthopaedics Paediatric cardiovascular surgery Colour: violet Sizes: USP 1(metric 4), USP 0 (metric 3.5) and USP 2/0 (metric 3) Absorption Time: 1. day 100 % 90 days 50 % Complete Absorption: after 180 days 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

22 Non-Absorbable Sutures Premilene Dafilon Non-absorbable Non-absorbable Chemical Composition: Polypropylene Structure: Monofilament Chemical Composition: Polyamide 6 and 6.6 Structure: Monofilament Colour: blue Sizes: braided: USP USP1 Colour: blue / undyed / black Sizes: braided: USP USP1 Indication: Vascular surgery Cardiac surgery Plastic and reconstructive surgery Skin closure (intra, sub, skin) Neurosurgery Microsurgery Gastrointestinal surgery Advantages: Smooth passage through tissue Excellent knot run down and security Minimal acute inflammatory reaction in tissues Unsurpassed strength Optimal elasticity and elongation properties Indication: Skin closure (intra, sub, skin) Plastic and reconstructive surgery Microsurgery Ophthalmic surgery Neurosurgery Advantages: High tensile strength Excellent knotting ability Smooth passage through tissue Easy handling 22

23 Skin Stapler and Tissue Adhesive Manipler AZ Histoacryl Staple Information: Type: Wide No: 35 Chemical composition: Enbucrilate Colour: blue, translucent Staple Dimension: Crown: 6.9 mm Leg.: 3.6 mm Indication: Thoracic surgery Cardiac- and vascular surgery General surgery Gynaecology / Urology Orthopaedics Sizes: 0.5 ml 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

24 Recommended materials Absorbable Sutures Name Sizes Needle length Cat. No. Indication Safil USP 2-0 HR17 C for Peritoneum suture Safil USP 2-0 HR22 C for Peritoneum suture Safil USP 2-0 HR37s C for Closure of External aponeurosis Safil USP 3-0 HR26 C for Subcutaneous suture Safil USP 2-0 JRC30 C for Fascia suture in the TAPP technique Safil USP 0 JRC30 C for Fascia suture in the TAPP technique Monosyn USP 4-0 DSMP19 C for Skin closure Monosyn USP 3-0 DSMP24 C for Skin closure MonoPlus USP 4-0 HR26 C for Peritoneum suture in TAPP technique MonoPlus USP 4-0 GR19 C for Peritoneum suture in TAPP technique MonoPlus USP 1 HRT48 loop C for Abdominal Wall Closure MonoMax USP 1 HRT48 loop B for Abdominal Wall Closure MonoMax USP 0 HRT48 loop B for Abdominal Wall Closure Non-Absorbable Sutures Name Sizes Needle length Cat. No. Indication Premilene USP 4-0 DSMP19 C for Skin closure Premilene USP 3-0 DSMP24 C for Skin closure Premilene USP 2-0 HR26 C for Mesh fixating Premilene USP 2-0 HR26s C for Multilayer interrupted suture in Bassini technique, for transversalis duplication in Shouldice technique, for fixation the muscles to inguinal ligament in Shouldice technique Premilene USP 0 HR26s C for transversalis duplication in Shouldice technique Premilene USP 0 HR37s C for transversalis duplication in Shouldice technique Dafilon USP 4-0 DSMP19 C for skin closure Dafilon USP 3-0 DSMP24 C for skin closure Skin Stapler, Tissue Adhesive Name Sizes Information Cat. No. Indication Manipler AZ 6.9 / 3.6 mm W for skin closure Histoacryl 0.5 ml 10 ampoules for skin closure (blue) Histoacryl 0.5 ml 10 ampoules for skin closure (translucent) 24

25 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 BB084R Scalpel Handle #3, fitting no. 3 for blades 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

26 Endoscopy Basic Set *only for the TEP technique For more information: Name Cat. No. No. Metzenbaum Scissors, serrated PO004R 1 or 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 PO107R 1 with reservoir in the jaw Durogrip Needle Holder, straight PL407R 1 or Durogrip Needle Holder, left curved PL408R 1 26

27 Name Cat. No. No. HERLOON System The Herloon hernia sytem has two components 1 Component 1: 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 EJ871R EJ870P Trocar for Mini-Laparotomy 1 10/110 mm, w. stopcock Consisting of EK024R, EK086P, EK098R, EK064R Trocar Sleeve EK015R 1 5/110 mm, smooth, w/o stopcock Sealing unit EK080P 1 5 mm Conical Sharp Trocar Pin EK046R 1 5/110 mm Trocar Sleeve EK024R 2 10/110 mm, smooth, w. stopcock Sealing unit EK083P mm, with 5 mm flap converter Conical Sharp Trocar Pin EK056R 1 10/110 mm Reduction Sleeve EK090R 2 10 to 5 mm Full HD Laparoscope PE889A 1 10 mm / 0 or Full HD Laparoscope PE909A 1 10 mm / 30 27

28 B. Braun Surgical SA Carretera de Terrassa, Rubí Spain Phone Fax Aesculap AG Am Aesculap-Platz Tuttlingen Germany Phone +49 (0) Fax +49 (0) 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. B /1/1