Chapter 2 - Veterinary Instrumentation

2 ARTHROSCOPY & LAPAROSCOPYChapter 2Arthroscopic stifle surgery indogsPat Ridge BVSc Cert VR Cert SAS MRCVS,Ridge Referrals, South Devon.The first report of stifle arthroscopy in dogs was back in 1978 (1) and inthe UK in 1981 (2). Since then stifle arthroscopy has struggled to beaccepted or practiced widely in the UK although in the USA it is morecommonly employed in private referral and academic practice. Withoutdoubt the learning curve is steep and the equipment neededconsiderable but the benefits in accuracy of joint examination andreduced morbidity have been demonstrated (3, 4).Positioning is critical to success and we use a moulding vacuum tablebag (Olympic Vac Pac) and a custom stifle brace (VeterinaryInstrumentation) with the patient in dorsal recumbency and the tabletilted 30 degrees from horizontal. Portals are created medial and lateralto the straight patella tendon with an egress cannula placed in themedial suprapatella pouch (5). A complete examination of thefemoropatella and then femorotibial joint can then be performed and thiscan include examination of the caudal femorotibial joint wherenecessary. Arthroscope size varies according to patient size but weusually use a 2.4mm ‘scope although we regularly perform jointexaminations in patients as small as cats (6) using a 1.9mm ‘scope andfor patients in excess of 60kg we use a 4mm ‘scope.The fat pad in dogs is considerably larger than that in humans and inorder to create a viewing window a motorized shaver (Adapteur PowerSystem, Arthrex) should be used to remove the inflamed fat pad,synovium and torn fibres of cranial cruciate ligament (CCL). The majorityof dogs will require a 3mm aggressive style shaver blade (DissectorRange, Arthrex) and this is attached to suction so that the debridedtissue is removed from the viewing area. In order that the joint isdistended a fluid ingress system is required and we use a fluid pumpthat automatically maintains the pressure as suction is used (ContinuousWave II Pump, Arthrex), which is available on free loan with an annualpurchase commitment.Meniscal injury occurs in around 40% of dogs with CCL damage (7, 8)and isolated medial (9) and lateral (10) meniscal injury have also beenreported in the dog. Examination of both menisci can be extremelychallenging via an arthrotomy whilst the CCL is intact and recently Hulseand others (11) have suggested that the remaining functional CCL inpartial tears may be “saved” by performing a tibial plateau levelingosteotomy. During arthroscopy both menisci may be completelyexamined, including careful palpation of the caudal horn, with the CCLintact. This is made easier with the use of a stifle distractor (VeterinaryInstrumentation) applied via insertion of 2mm Ellis pins into the medialfemoral condyle and proximal tibia. The use of this particular instrumentdoes not “crowd” the joint space with instruments so reduces the risk forarticular cartilage damage and leaves plenty of space for instruments tobe inserted to palpate structures or remove torn portions of meniscus,whilst at the same time allowing stifle flexion and extension.Meniscal TearMeniscal resection is without doubt one of the most challengingarthroscopic procedures but with practice can be accomplished in amatter of minutes. These may be the common “bucket handle” tears,complex horizontal cleavage tears or “parrot beak” tears. We routinelyperform meniscal resection with a combination of hook knives (Dr Fritz),fine angled punches(Slender Punch, Arthrex)and shavers (2mm to3.5mm Dissector, Arthrex).Indeed some studies haveshown that this may be allthat is required in somepatients with CCL tearsand concurrent medialmeniscal injury (12) and inselected patients this hasbecome our approach tomanagement incombination withrehabilitation (unpublishedwork).Arthroscopic Distractor (AR-17-01)Before DistractionAfter DistractionFor those who are interested both the ESVOT Arthroscopy WorkingGroup and the Arthrex VA3 group have regular meetings providing aninvaluable forum for discussion and practical experience in small animalarthroscopy.1. Seimering, G. H. (1978) Arthroscopy of dogs. Journal of American VeterinaryMedical Association March, 575- 5772. Kivumbi, C. W. and Bennett, D. (1981) Arthroscopy of the canine stifle joint.The Veterinary Record 109, 241- 2493. Hoelzler, M. G., Millis, D. L., Francis, D. A. and Weigel, J. P. (2004) Results ofarthroscopic versus open arthrotomy for surgical management of cranialcruciate ligament deficiency in dogs. Veterinary Surgery 33, 146- 1534. Pozzi, A., Hildreth, B. E. And Rajala- Schult, P. J. (2008) Comparison ofarthroscopy and arthrotomy for diagnosis of medial meniscal pathology: an exvivo study. Veterinary Surgery 37, 749- 7555. Beale, B., Hulse, D., Schulz, K. and Whitney, W. (2003) Arthroscopicallyassisted surgery of the stifle joint. In: Small Animal Arthroscopy, Saunders,Philadelphia. Pp 117- 1586. Ridge, P. A. (2010) Femoral condyle lesions similar to osteochondritisdissecans: Call for opinions or similar cases. Letters to the Editor: Veterinaryand Comparative Orthopaedics and Tramatology 23, 377- 3787. Ralphs, S. C. and Whitney, W. O. (2002) Arthroscopic evaluation of menisci indogs with cranial cruciate ligament injuries: 100 cases (1999- 2000). Journal ofAmerican Veterinary Medical Association 11, 1601-16048. Hays, G. M., Langley Hobbs, S. J. and Jeffery, N. D. (2010) Risk factors formedial meniscal injury in association with cranial cruciate ligament rupture.Journal of Small Animal Practice 51, 630- 6349. Ridge P. A. (2006) Isolated medial meniscal tear in a Border Collie. Veterinaryand Comparative Orthopaedics and Traumatology 19, 110- 11210. Williams, R. A. (2010) Isolated lateral meniscus tear in a Boxer. VeterinaryRecord 11, 419- 42011. Hulse, D., Beale, B. And Kerwin, S. (2010) Second look arthroscopic findingsafter tibial pleateaux levelling osteotomy. Veterinary Surgery 39, 350- 35412. Tivers, M. S., Comerford E. J. and Owen, M. R. (2009) Does a fabella-tibialsuture alter the outcome for dogs with cranial cruciate ligament insufficiencyundergoing arthrotomy and caudal pole medial meniscectomy? Veterinary andComparative Orthopaedics and Tramatology 4, 283- 28870

www.vetinst.comARTHROSCOPY & LAPAROSCOPY 2ArthroscopesAn arthroscope is a rigid endoscope consisting of a system of lenses,which collects and transmits an image from the tip of the instrument alongthe shaft to an eyepiece or camera. A light post close to the eyepieceallows light to be passed into the shaft and down optic fibres surroundingthe lens system to illuminate the subject area at the tip.The diameter refers to the outside diameter of the unsheathed shaft of thetelescope. Three sizes are commonly used in small animal arthoscopy:2.7mm, 2.4mm and 1.9mm. Arthroscope technology has improved somuch that optically the new 2.4mm arthroscope is as good as the older2.7mm version. The 2.4mm arthroscope is fine for most procedures butcan prove a little large in small elbows. As the diameter of the arthroscopebecomes smaller, there is less space for optical fibres, which hasimplications for light transmission and image size. Recent improvements inconstruction such as the use of rod lens systems as opposed to opticfibres has improved the performance of the smaller arthroscopes.Additionally the smaller arthroscopes are fragile and care must thereforebe exercised to avoid damage in use, cleaning and storage.The viewing angle is the angle between the lens face and a line drawn atright angles to the long axis of the arthroscope (see above right).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. Mostveterinary arthroscopes have a viewing angle of 30˚, which is acompromise between field of view and distortion. The user needs to beaware which way the lens is pointing. The light post is used as a referencepoint and is positioned opposite the angle of view. Rotating the scopealong its long axis will allow the surgeon to view a large area within thejoint with minimal repositioning. An oblique viewing angle does offer thesurgeon a limited ability to see ‘around corners’.Each arthroscope will require a dedicated sheath, which protects thearthroscope as well as delivering fluid to the tip. The sheath reduces theeffective working length and increases the working diameter of thearthroscope.Schematic of the tip ofa typical arthroscopeAll arthroscopes are now available in autoclavable versions. Autoclaving,especially of fine arthroscopes, will significantly reduce the working life ofthe instrument. Autoclavable arthroscopes may be soaked and werecommend this method of sterilisation to preserve your arthroscope. Ifyour arthroscope is not marked autoclavable, it may only be soaked.Arthrex ArthroscopesArthrex are leaders in the field of arthroscopy with a deserved reputationfor innovation and quality. We are pleased to offer their top of the rangearthroscopes and sheaths at a very competitive price. 2.7, 2.4 and 1.9arthroscopes are offered here but 4.0 are also available.Please e-mail or call our Vet Tech team for a quotation.+44 114 2588530 info@vetinst.com2.4 Arthroscope x 10cm, 30˚2.4 Sheath with Single Stopcock 3.2mm x 85cmObturator, BluntARTHREX ARTHROSCOPES AND SHEATHESIR-1030 2.7 Arthroscope x 18.0cm, 30 ˚ £1,550.00IR-1070 2.7 Arthroscope x 18.0cm, 70˚ £1,550.00IR-1100IR-1101Arthroscopy Sheath 4mm x 12.5cm, with TelescopeSnap-in Locking Mechanism, 2 Stopcocks £395.00Arthroscopy Sheath 4mm x 12.5cm, with TelescopeSnap-in Locking Mechanism, 1 Stopcock £395.00IR-1200 Obturator Semi Sharp £75.00IR-2030 2.7 Arthroscope x 11.0cm, 30˚ £1,325.00IR-2100Arthroscopy Sheath 4mm x 7.5cm, with TelescopeSnap-in Locking Mechanism, 2 Stopcocks £395.00IR-3030 2.4 Arthroscope x 10.0cm, 30˚ £1,350.00IR-3100IR-31022.4 Sheath 3.2mm dia x 8.5cm working length.1 Stopcock £425.002.4 Sheath 3.5mm dia x 6.5cm working length.2 Stopcock Rotating Option £425.00IR-3201 2.4 Obturator Blunt £85.00IR-4030 1.9 Arthroscope £1,325.00IR-4100 1.9 Sheath £425.00IR-4200 1.9 Obturator Blunt £95.00IR-4201 1.9 Obturator Sharp £95.00BXS2506050 Arthroscope Sterilisation/ Storage Box 250x60x50mm £95.002Arthroscopy RepairsMost damaged or broken arthroscopes can be repaired. Although nevercheap the repair is normally a full refurbishment to new standard andmay be considerably cheaper than a new arthroscope. The sameapplies to hand instruments which by their nature are delicate andvulnerable. Send your repair to our Vet Tech team for a quotation.71

2 ARTHROSCOPY & LAPAROSCOPYArthroscopic InstrumentationIrrigation and Working Cannulae,Trochar Changing System designed by VAN BREECannulae and portals: In order to fully examine the joint underinvestigation it may be necessary to manipulate some intra-articularstructures. The instruments used must be small and be introduced eitherdirectly through the peri-articular soft tissues or via a dedicated cannula.Where serial insertions and withdrawals or a range of instruments arerequired, particularly through multiple layers of soft tissue, a cannula ispreferable to minimize trauma, (trying to re-find a portal can befrustrating). Sets of cannulae dedicated to the most common joints arenow available. Initially a small diameter cannula is inserted using atrochar, the portal may then be enlarged by the use of a ‘switching stick’.The stick is inserted into the joint through the small cannula which isthen withdrawn. Larger cannulae may be slid down the changing stickand introduced into the joint. Exchanging a small cannula for a largerone can be surprisingly difficult without such an aid. The system iscolour coded for ease of use.Cannula SetsArthroscopy Starter KitInstrument choice is determined by personal choice and patientselection. However a Starter Kit is a useful starting point and offers adiscounted approach to setting up.The Arthroscopy Kit described is discounted by 10% compared to buyingthe individual components.In addition to arthroscopic hand instrumentation a suitable camera andlight source will be required. Several options, including pre-owned units,are available. Please telephone or e-mail to discuss options.CodeIR-3030I-18-518I-17-755S140-2438FAR-17-09SDescription2.4 Arthroscope x 10.0cm, 30˚Egress Cannula, Sharp Trocar, StopcockIØ 3mm, WL 7cmWorking Cannula Set "shoulder & elbow"Designed by van Bree, D: 2.3/2.9/3.5mm;WL: 3.5-5cmTarget Instrument designed Dr.Lehmannfor canine arthroscopy; comp.with S110-1932Hook Probe, 2.2mm, silicon handlecomp. autoclavable, colour code: redAR-17-06SCurrette, small 2.7mm, silicon handleyellow, autoclavable, colour code: redI-17-755I-17-500I-17-700Working Cannula Set "shoulder and elbow" designed byVAN BREE, D:2.3 / 2.9 / 3.5mm; WL:3.5-5cm and 7-8 cm,includes Sharp Trochar and Changing Rod £575.00Working Cannula Set "elbow" designed by VAN BREE,consist of 3 Cannulas D:2.3 / 2.9 / 3.5mm; WL:3.5-5cm.includes 1 Sharp Trochar and 1 Changing Rod (2.3mm) £375.00Working Cannula Set "shoulder" designed by VAN BREE,consist of 2 Cannulas D:2.9 / 3.5mm, WL:7-8cm.includes 1 Sharp Trochar and 1 Changing Rod (2.8mm) £250.00AR-17-07SAR-17-19SAR-17-11SAR-17-05SAR-17-03SRing Currette, 2.7mm, silicon handlered, autoclavable, colour code: blackHook Knife, 2.7mm, silicon handleorange, autoclavable, colour code: blueSmilie Knife, 2.7mm, silicon handleyellow, autoclavable, colour code: redBanana Knife, 2.7mm, silicone handleautoclavable, colour code: greenBayonett Knife 2.7mm, silicon handleyellow, autoclavable, colour code: blackAR-17-12SMicro Picking Knife, designed by Brian Beale2.7mm, silicon handle, colour code: yellowI-18-518Egress Cannula, with Sharp Trochar Stopcock,ID:3mm, WL:7mm £165.00AR-17-13Special Elevator, 2.7mm, with handlecolour code: metalI-17-822Milling Drill for arthroscopyAS-17-561Mini Grasping Forceps D: 2.0mm WL: 11cm, highqualityAS-17-662Alligator Grasping Forcepswith Ratchet OD: 2.7mm; WL: 12cm, high qualityAS-17-762Universal Rongeur and Grasping ForcepsOD: 3.4mm, WL: 12cm without RatchetAS-17-531Mini Rongeur and Biopsy ForcepsOD: 2mm, WL: 11cmAS-17-632Universal Rongeur and Grasping ForcepsFenestrated, OD: 2.7mm; WL: 12cmAR-08-100Pressure Infusion Cuff for 500-1000mlcomplete with Manometer and Hand PumpDE-5-17Cleaning Brush, small, 17cmDE-10-425Soak Basin for Chemical Solution DisinfectionDE-10-25 Camera Covers Disposable (30)Thanks to Noel Fitzpatrick for the photographFor further information about the Arthroscopic StifleLever see Page 55ARTHROSCOPY STARTER KITARTHROKIT Arthroscopy Starter Kit £7,450.0072

www.vetinst.comARTHROSCOPY & LAPAROSCOPY 2Hand InstrumentsHand instruments for investigation are designed to move or retractintra-articular structures and usually take the form of blunt probes orgrasping forceps. Where intra-articular surgery or sampling is involvedadditional cutting instruments will be required.Arthroscopy Hand Instrument SetA useful set of three arthroscopy instruments forexamination and intra-articular surgery. The two hand heldknives can deal with most meniscal tears, whilst the blackshaft of the hook probe minimises reflection.AR-17-09S Hook Probe 2.2mm, with silicon handle £185.00AR-17-13 Elevator, heavy, 2.7mm, with metal handle £185.00AR-17-03S Bayonet Knife 2.7mm, with silicon handle £185.00AR-17-05S Banana Knife 2.7mm, with silicon handle £185.00ARTHROSCOPY HAND INSTRUMENT SETAR-17-19X Pull Knife £85.00AR-17-11X Push Knife £85.00AR-17-10 Hook Probe 2.2mm, with stainless handle, black shaft £65.00AR-17-SET Arthroscopy Hand Instrument Set £175.00Gordon Coronoid OsteotomeAR-17-06S Curette 2.7mm, curved, with silicon handle £185.00AR-17-07S Ring Curette 2.7mm, small, with silicon handle £185.00Hold tear with clamp and push knifeagainst ‘handle’ to detach from bodyof meniscus.AR-17-11S Meniscus Knife, Smillie, 2.7mm, with silicon handle £185.00Designed and developed by Ian Holsworth, this narrow osteotome is usedfor arthroscopic sub-total coronoidectomies.GORDON CORONOID OSTEOTOMEAR-17-30 Gordon Coronoid Osteotome (4mm) £59.50AR-17-29 Gordon Coronoid Osteotome (2mm) £59.50AR-17-12SUse to pick area to encourageregeneration.Micro Picking Knife, acc to Dr Brian Beale 2.7mm,with silicon handle £185.00Use to hook under meniscal tears anddetach handle from body of meniscus.Suture Passing WireAR-17-19S Hook Knife 2.7mm, with silicon handle £185.00Inserts for interchangeable hand instrument (AR-17-00) are available.Please call for details.Passing soft suture material through bone tunnels of soft tissues withoutcausing additional trauma can be a challenge to the surgeon. The ArthrexSuture Passing Wire consists of a Nitinol loop attached to a flexible yet stiffwire. The wire may be pushed through bone tunnels of soft tissues and asthe tip emerges the Nitinol loop naturally springs open to receive the suturewhich may then be pulled back through.SUTURE PASSING WIREAR-1255-18 Suture Passing Wire 600mm £75.00001049a Arthroscopic Hohman 4mm £59.50Milling Drill designed by VAN RYSSEN & VAN BREECrystal CannulaClear cannulahas a lip at thetip to minimise‘fall out’.This hand driven bur allows curretage of both cartilage and bone throughthe smallest working cannula. Much cheaper and easier than shaversystems.I-17-822Milling Drill for arthroscopy completeOD: 2.2mm, WL: 12cm £375.00I-17-821 Replacement Bur and Shaft £130.00CRYSTAL CANNULAAR-6560 Crystal Cannula 5.75mm x 700mm (5 Pack) £115.0073

2 ARTHROSCOPY & LAPAROSCOPYArthroscopic Punches,Biopsy Forceps, Rongeurs andGrasping ForcepsArthroscopic forceps and rongeurs should be selected according to patientand portal size. A very small pair of grasping or cutting forceps will fit anyportal but will be easily damaged if used on large fragments. Various designsare available for grasping cutting, or nibbling intra-articular structures.AS-17-621 Arthroscopic Hook Scissors, OD: 2.7mm £695.003.4mm Instruments2.0mm Instruments• made for veterinary use• overstraining protectedAS-17-762Universal Rongeur and Grasping Forceps,Fenestrated without Ratchet, OD: 3.4mm workinglength 12cm with overstraining protection £795.002.0mm Instruments, working length 11cmArthrex Hand InstrumentsUseful Additions to the VAR-3000S Arthroscopy SetAngled Slender Meniscus PunchesAS-17-561 Mini Grasping Forceps, OD: 2.0mm £575.00AS-17-531 Mini Rongeur and Biopsy Forceps, OD: 2.0mm £575.00AS-17-551 Mini Punch for arthroscopy, OD: 2.0mm £575.00AS-17-521 Mini Scissor for arthroscopy, OD: 2.0mm £575.002.7mm Instruments2.7mm Instruments, working length 12cmIn the human knee management of meniscal tears is by arthroscopypunches. Most human arthroscopy punches are too large for the caninestifle even with appropriate distraction. Our External Stifle Distractor(AR-17-01, page 76) offers the best possible access. The Arthex slenderpunches are small enough and the best available. The straight one isincluded in VAR-3000S. If you can afford them the punches angled left andright work best of all.Slender Pointed Grasping ForcepsAS-17-662Alligator Grasping Forceps with Rachet, OD: 2.7mmwith overstraining protection £775.00AS-17-632Universal Rongeur and Grasping Forceps FenestratedOD: 2.7mm with overstraining protection £695.00Pointed grasping forceps may be used for gentle dissection and graspingof small intra-articular objects.Small ProbeAS-17-641AS-17-672Biopsy and SpoonOD: 2.7mm with overstraining protection £695.00Arthroscopic Punch,OD: 2.7mm with overstraining protection £795.00ARTHREX ADDITIONAL HAND INSTRUMENTSAR-11000 Slender Punch, Straight £1,025.00AR-11420 Slender Punch, Angled Left £1,050.00AR-11430 Slender Punch, Angled Right £1,050.00VAR-11700NR Slender Pointed Graspers, Straight £1,050.00AR-30000 Small Probe £215.0074

www.vetinst.comARTHROSCOPY & LAPAROSCOPY 2Canine Arthroscopy Set (VAR-3000S)Forceps TrayWorking with leading canine arthroscopic surgeons the Arthrex setcomprises a comprehensive range of instruments as three modules withina custom autoclave case.All the instruments are available separately but when bought as the boxedset there is a saving of 10%.Main Instrument TrayVAR-11600SR Grasper, Alligator Hook TipVAR-11100 Punch, Slender Straight TipThe forceps tray secures a Series I Grasper and Slender Punch in anupright position for easy accessibility. The tray has space for two furtherforceps.VAR-3008 Small Cup Curette, 2.5 mm diameterVAR-3009 Banana Knife, 2.5 mm diameterAR-5021 Graduated Black Probe, 1.5 mm TipAR-5007 Graduated Black Probe, 2.5 mm TipAR-10020 Probe, Stainless SteelAR-3033 Obturator, BluntCanine Cannula Set (VAR-3002S)photo Mark OwenGrasper-Alligator,Diameter 2.75mm withHooked Tip, Self ReleaseGrasping and maintaining a grip on fragments can be very challenging forboth surgeon and instrument. Once locked on, the surgeon isunderstandably reluctant to let go, sometimes taking an instrument beyondits working limits.The VAR-11600SR Alligator forcep is toothed for maximum grip and has aself releasing handle.The Alligator grasper is one of a range of canine arthroscopy instrumentsavailable as a set from Arthrex Vet Systems through VeterinaryInstrumentation. Call or e-mail for a full brochure.VAR-3002 Cannulas (2.9, 3.7 & 4.3 mm)VAR-3003 Cannulated ObturatorVAR-3004-2.9 Switching Stick, 2.9 mmVAR-3004-3.7 Switching Stick, 3.7 mmVAR-3005 Dilation Needles, qty. 5VAR-3006 Stifle Outflow Cannula with StopcockVAR-3007 Stifle Outflow ObturatorThe Cannula Set is available separately. The stand alone Cannula Setdoes not include the Outflow Cannula and Obturator.The Canine Arthroscopy Set combined with an Arthrex Camera and Lightsource would comprise a start up set for arthroscopy of the canine stifle,elbow, shoulder and hock.ARTHREX HAND INSTRUMENTSVAR-3000S Canine Arthroscopy Set Boxed £5,195.00VAR-11100 Punch, Slender Tip £1,015.00VAR-11600SR Grasper-Alligator, Ø 2.75mm, with Hook Tip £1,015.00VAR-3002S Canine Cannula Set £1,995.00VAR-3006 Outflow Cannula with Stopcock £450.00VAR-3007 Outflow Cannula Obturator £225.00VAR-3009 Banana Knife £395.00BRCANARTH Canine Arthroscopy Literature £FOC75

2 ARTHROSCOPY & LAPAROSCOPYShoulder Aiming DeviceDeveloped and tested at the Veterinary Facultyof Vienna, Austria by Dr Lehman.Due to the dense musclemass in shoulder joints,creating a puncture for aworking cannula is oftenquite difficult. If a cleanpuncture allowing accessdirectly to the joint is notachieved the first time, therisk of a subsynovialoedema increases greatly.Light Sources & CablesHalogen light sources are inexpensive but not as good as the Xenon basedsystems, which are, unfortunately, significantly more expensive to purchaseand maintain. Xenon light sources have a higher intensity and are essentialif the unit is to be used for laparoscopic work. Thus Xenon is preferable buthalogen can be used successfully in most joint investigations. Both Xenonand Halogen bulbs have a limited life (Xenon typically 500 hours, Halogentypically 2000 hours) and bulb failure is at best embarrassing so alwayscarry a spare. The light cable carries light from the source to thearthroscope by fibre optics. Each cable has dedicated connectors to couplewith the light source and the arthroscope. Connections on both light sourceand arthroscope vary from manufacturer to manufacturer. Convertors areavailable for both light source and arthroscope but it is wise, if possible, topurchase the appropriate cable for the system.The shoulder puncture system has been specifically designed to helpeliminate this risk. The system allows you to align your arthroscopeaccurately in the joint space. Simply attach the puncture system to thearthroscopic sheaths and maintain your arthroscopic vision in a paralleldirection to the shoulder joint rim. At this point you will find the workingtriangulation portal in an ideal position. After a puncture is created with thedesired trochar, simply replace the trochar with a working cannula andstart working with your instruments. Useful for both cranial and caudalapproaches. View at www.vetinst.com/videosXenon Light SourceSee VCOT 2004; 17:1-56 for reviewS140-2438FS140-1938FAiming Device by Dr Lehman for the canineshoulder for 2.4 Scope T140-2432 andChanging Rod I-17-028 £395.00Aiming Device by Dr Lehman for the canineshoulder for 1.9 Scope T110-1930 andChanging Puncture Rod I-17-028 £395.00I-17-028 Changing & Puncture Rod £95.00DVDLEHMAN DVD on use of Aiming Device. £FOC48-XE-300 Xenon Light Source £3,650.00Joint DistractionArthroscopic Joint DistractorOsteoarthritic stifles can be very ‘tight’ makingexamination and treatment of intra-articular lesionsdifficult. Distraction of the articular surfaces usingintra-articular instruments is difficult and cluttersthe operative field. Extra-articular distraction isvery effective and leaves potential instrumentportals available for more appropriateinstrumentation.AR-17-01 Arthroscopic Distractor £185.00AR-17-01/TPLO Arthroscopic Distractor. 1/8” (3.2mm) Pins £185.00Arthroscopic Stifle Lever VSTLKW-48-231KS-48-231Fibre Light Cable, 4.8mm, 2.3M,both sides compatible to Wolf, autoclavable £475.00Fibre Light Cable, 4.8mm, 2.3M, unit side comp.to Storz, endoscope side comp.to Wolf, autoclavable £425.00KS-48-230 Fibre Light Cable, 4.8mm, 2.3M, Olympus/ Wolf £450.00KS-48-300 Fibre Light Cable, 4.8mm, 3.0M, Storz/ Storz £450.00All cable combinations available.For further information including a detailed product descriptionsee page 55.AR-17-02 Arthroscopic Stifle Lever VSTL 280mm £135.0076

www.vetinst.comARTHROSCOPY & LAPAROSCOPY 2Cameras & MonitorsDirect viewing of the joint through the eyepiece is possible. However,practicality and the issue of contamination dictate that a camera system isan essential part of the equipment. Arthroscopic cameras work in a verysimilar fashion to video cameras in common usage. The image at theeyepiece of the arthroscope is focussed on a light responsive electronicchip(s). The signal created is transferred to a camera controller, whichprocesses the image into a signal recognized by the monitor and/orrecording system.Most veterinary cameras have a single chip, which is sufficient for mostusers.The connection of the camera head to the eyepiece of the arthroscope isalso variable. To maximise the choice and longevity of the instrumentationit is advised that a clip on camera head compatible with DIN standardeyepieces be selected. The camera heads are fully immersible.Arthrex Eagle Eye Cameras and Light SourcesTop quality equipment from a major human arthroscopic company but ata 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 EyeCamera is human quality as is the matching light source.ARTHREX EAGLE EYE CAMAERAS AND LIGHTSAR-5970SP Eagle Eye Single Chip Camera £4,375.00AR-3595SP Eagle Eye 300watt Xenon Light Source £4,095.00AR-3041 Light Cable £525.00EAGLE OFFEREagle Eye Single Chip Camera+ Xenon Light Source & Cable Save £3,495.00 £5,500.00MonitorFlat Screeen Professional MonitorProfessional monitors offer a better image than domestic screens as theyhave a better resolution. Some pre-owned units are always available. Ringfor details.Image CaptureGood practice dictates that a record is made of any arthroscopicprocedure. Subsequent investigations can be compared to earlier onesand images can be shared and compared with colleagues or tutors as partof a training programme. Domestic video recorders will create a permanentrecord of a procedure. However the data is relatively crude and difficult tomanipulate. Still video printers capture an image from a video streamwhich can then be printed onto photographic paper.Digital video and data storage technology now allows the surgeon torecord and store very large amounts of data in a digital format. The digitalinformation can subsequently be manipulated by appropriate computersoftware to create both still and moving images in a variety of formats forstorage or display. If clinical presentations are anticipated then a digitalsystem is very desirable. Domestic DVD or combined DVD/Hard driverecorders offer huge storage capacities at reasonable prices.The data is stored as Digital Video (DV) which can be converted into manyother formats. The major arthroscopy companies offer sophisticated datastorage systems which are able to capture and store still and movie filesvia sterile touch screens or camera finger controls. Permanent records aremaintained 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 SystemPre-owned Cathode Ray Tube TypeMonitorCamera CoversDE-10-25CAMPTCAMETCamera Covers, disposable, (30) polyethylene,13 x 235cm (sterile) £145.00Camera Cover with Perforated Tip250cm x 12.5cm (60 sterile) £145.00Camera cover with Elasticised tip250cm x 12.5cm (60 sterile) £165.00DE-10-25/Single Single Camera Cover (disposable) 13 x 235cm (sterile) £5.95DE-10-01Camera Cover, reusable, waterproof, washable,autoclavable, 12 x 200cm, 1 pc £82.50The latest version of the image capture device captures both still imagesand mpegs directly onto a USB stick ready for transfer to permanentstorage.Capture is activated by pressing a button on the front panel or if thesurgeon prefers to keep control there is an optional foot control.46-USB-200 USB Image Capture Jpeg and Mpeg £2,500.0046-USB-15-1 Footswitch for USB Capture System £150.0077

2 ARTHROSCOPY & LAPAROSCOPYFluid Infusion and OutflowInfusion of fluids or gas into the joint is essential to create an environmentin which the arthroscope can view joint structures. The joint must beexpanded and debris removed to maintain a clear field of view.To maintain an appropriate intra-articular pressure (between 40 and100mm of mercury) (0.053 and 0.133 BAR) fluid inflow and outflow mustbe carefully regulated. Fluid under pressure may be obtained by eithergravity feed systems or a pump. Gravity may be sufficient provided thefluid bags can be lifted high enough but greater, more controllablepressure may be obtained by use of a fluid compression bag.The bag of fluid to be infused is placed into a pressure bag, which isinflated using a hand or machine pump. Without careful monitoring handinflation systems offer erratic pressure levels and use of a regulated pumpoffers much better control. A carbon dioxide powered pump may be usedto pressurize a compression bag or infuse carbon dioxide directly into thejoint. Dedicated roller type pumps are able to maintain a constant linepressure over extended periods but they may require dedicated tubing, areexpensive to purchase and are more prone to breakdown.To create fluid flow through the joint, appropriate fluid outflow or egressmust be maintained. In the smaller joints (elbow, hock and hip), a largebore hypodermic needle may be sufficient. In the larger joints (shoulder,stifle) where greater volumes of fluid are involved, dedicated multifenestrated egress cannulae may be necessary, the waste fluid may becollected by either bag systems or suction devices.Use of direct CO 2 infusion is indicated in some inflamed joints whereinflammatory synovial villae obstruct the visual field, the villae beingflattened under gas pressure rather than floating free in infused fluid. Inaddition, use of CO 2 increases the field of view and image clarity of thearthroscope. CO 2 is usually used intermittently with fluid to allow forflushing.Peristaltic InfusionArthroscopy Infusion PumpHand Pressure Infusion CuffsAR-08-100AR-08-300AR-08-110AR-10-948Pressure Infusion Cuff for 500-1000ml complete withPressure Gauge and Hand Pump, reusable £295.00Pressure Infusion Cuff for 3000-5000ml complete withPressure Gauge and Hand Pump, reusable £345.00Pressure Infusion Cuff for 500-1000ml withoutPressure Gauge, Luer Lock (fem), reusable £195.00Silicon Tube, 7x2mm, 3m, autoclavable,Luer-Lock (m), needle (f), sterile bags/ bottles £130.00X-7-20-10 Spare Silicon Tube, 1 metre, size: 7 x 2mm, colour: natural £13.50LLM-1258AR-10-9Spare Luer-Lock Connector, male,comp. to silicon tubes 7 x 2mm £17.50Spare Needle for infusion bottles/ bags, ID: 5.5mm,comp. to silicon tubes 7 x 2mm £47.50X-180-26 Silicon Tube, ID: 5mm, 180cm, LLm both ends, autoclavable £45.00X-5-15-10LLM-1250Spare Silicon Tube, 1m, autoclavable,size: 5 x 1.5mm, colour: nature £11.50Spare Luer-Lock Connector (m), comp.to silicon tubes (5x1.5mm) £17.50Pressure Pump InfusorFeatures:• automatic control• pressure continouslyadjustable• max. 300mm Hg pressure• easy handling• no mechanical parts• for fluid and CO 2 supplyAR-10-100Pneumatic Pressure Infusor, for Infusion Cuffs,for veterinary arthroscopy, complete 4mm tube tocentral pressure supply, DIN Tube Connection, frontside Luer-Lock (f), Universal Table Fixator, easy pressuresetting, automatic regulation (0-300mmHg) £1,350.00Pressure Infusion Cuffwith fluid bagProvided the surgeon is prepared to commit to the purchase of 100 patientinfusion sets per year Arthrex is prepared to offer its Continuous WaveArthroscopy Pump (AR-6475) (value £3,950) on free loan (with initialpurchase of 2 x boxes of tubing). This pump has been in use in the humansector for some 15 years and is very reliable. Line pressure and flow rateare user defined. This means that the fluid pressure does not have to becontinually monitored and adjusted by nursing staff. In addition, if the tubepressure is correct, any problems with fluid flow can be immediatelylocalised to the arthroscope. This is not the case with inflated cuffs whereonly the pressure within the bag is known.If you are performing 3 or more procedures per day it is cheaper to buy theseparate Machine (one per day) and Patient Tube Sets.AR-6475 Arthroscopy Pump £3,950.00AR-6415 Combination Machine and Patient Tube (10) £325.00AR-6420 Machine Tube Set (10) £355.00AR-6425 Patient Only Tube Set (20) £210.00AR-10-901Connectionto fluid bagPatientFluidSupplyInfusorHand pump or Luer-Lock(fem) for infusorDirect CO 2 supply(only in connection with CO 2 infusor)ThreewaystopcockCO 2 Infusor, for large/ small animal arthroscopy, DINConnector Tube to Pressure Reducer (DIN type) pressuresetting 0-300mm Hg Tube Connection Luer-Lock(f) £1,675.00AR-10-903 Reduction Valve for CO 2-bottles, UK fitting £175.00AR-10-922Sterile Filter System for CO 2 Infusor, disposable,box with 50 pcs £215.0078

www.vetinst.comARTHROSCOPY & LAPAROSCOPY 2Shaver SystemsVirtually the only powered instrument in use in veterinary arthroscopy is theshaver. The shaver is essentially a motorized bur. It may be used to debridecartilage, bone or soft tissues. A range of tips of different designs and sizesare available to manage the different tissues. Tips designed for soft tissuesare typically larger and more aggressively toothed. Suction may be appliedto the cutting tip via the hand piece to remove debris. The hand piece isdriven by a control box operated by finger or foot controls. The speed anddirection of cut are selectable. The tips are usually designed to bedisposable, however with careful use, cleaning and re-sterilisation they maybe re-used. Very expensive to buy new, Veterinary Instrumentationmaintains a stock of high quality ex-hospital units for sale.Linvatec ShaverThe Linvatec ShaverSystem is very interestingfrom a veterinaryarthroscopy point of viewas it is able to use 2.0mmmicro burs. Other majorbrands have a minumumblade diameter of 2.8mmwhich may not seem avery big difference but isalmost half as big again.Includes the all important micro handpiece for the small burs.LINSHAV Linvatec Shaver System Complete £2,650.00SBC9960 2mm Linvatec Micro Gator Shaver Blade £125.00SBC9950 2mm Linvatec Micro Cuda Shaver Blade £145.00SBC9911 2mm Linvatec Micro Spherical Shaver Blade £140.00SBC9961 2.9mm Linvatec Micro Gator Shaver Blade £125.00SBC9962 3.5mm Linvatec Micro Gator Shaver Blade £125.00SBC9264 3.5mm Linvatec Gator Shaver Blade £125.00SBC9253 3.5mm Linvatec Cuda Shaver Blade £125.00SBC9111 4.5mm Linvatec Spherical Shaver Blade £140.00Arthrex Shaver OfferAdapteur Power SystemsAPS II ConsoleAR-8339FHandpieceThe Arthrex Adapteur II shaver is a current shaver with a value of over£11,450. It takes a wide range of blades down to 2.0mm. VeterinaryInstrumentation can offer the Arthrex shaver on FREE loan provided thatthe surgeon is prepared to purchase up front two boxes of blades (totalof 10 blades). The unit is supplied as standard with a foot controlledhandpiece. This unit is also available with hand control. Please specifywhen ordering. Call for the Arthrex shaver blade brochure. Below aredescribed a useful selection.ARTSHAV Arthrex Shaver System Complete £11,450.00AR-7285STAR-7300BTSerrated Tooth Blade Full Radius,2.85mm x 70mm (box of 5) £535.00Oval Bur, Small Joint, 10 flute3.0mm x 70mm (box of 5) £375.00AR-7300DS Dissector Small Joint 3.0mm x 70mm (box of 5) £375.00ElectrocauteryArthroscopic electrocautery or radiofrequency devices focally create heatwithin the tissues to create haemostasis, debridement or to shrink the jointcapsule in selected cases of instability. Long, fine insulated probes areavailable which may be powered by standard surgical electrocautery units.The tips are bathed in fluid at all times but essentially the same processesoccur at the tissue level as in surgical electrosurgery.Radiofrequency devices create heat by inter-molecular friction. Tips areavailable in both monopolar and bipolar formats and may be used to debridestructures such as damaged meniscus or fat pad. Capsular shrinkage byradiofrequency may be used to tighten joint capsules following arthroscopyor injury. Radiofrequency ablation dissolves intra-articular tissues at arelatively low temperature. The resulting debris is removed by suction. Thetechnique is therefore an alternative to the shaver for removing soft tissues.At least one manufacturer supplies combined shaver blades and ablatorwands which offer both options on the same intra-articular device.Arthroscopic Procedure Electrosurgical System (OPES)Ablation wandsA comprehensive orthopaedic electrosurgical system combiningarthroscopic ablation, arthroscopic coagulation, open surgery monopolarand bipolar surgery from one fully digital generator. With 3 in 1 systemflexibility, the OPES Electrical Generator is also capable of controlling ahost of different instruments, including disposable monopolar arthroscopicelectrodes, reusable and disposable monopolar open procedure pencilsand tips, and reuseable bipolar forceps. The need for separate and costlysystems is eliminated. Provided the surgeon is prepared to agree to anannual purchase commitment Arthrex is prepared to offer its OPESConsole (AR-9600) (Value £6,575) on FREE loan. Emailinfo@vetinst.com or phone John to discuss the purchase commitment.AR-9600 OPES Console £6,575.00AR-9600FB Bipolar Foot Pedal £275.00AR-9611SFR Bipolar Forceps £295.00AR-9610 Monopolar Handpiece (disposable) (Box of 5) £90.00VAR-1005-01 Ground Pad £55.00VAR-1005-06 Cable £80.00Ablation Wands and Electrodes from £90.00BROPES Opes Literature £FOC79

2 ARTHROSCOPY & LAPAROSCOPYPositioning AidsManipulation of arthroscopes and instrumentation inside a joint via animage on a monitor screen can be very demanding. Careful positioning ofthe patient and the surgeon is essential.An operating table, fully adjustable for height and tilt is a prerequisite forgood arthroscopy. Once fully draped, orientation around a canine limb canbe difficult. Full use should be made of channels, ties and sand bags to fixthe overall position of the dog. Sandbags may also be necessary to act asa fulcrum to open a joint maximally for investigation, e.g. elbow.To provide multiple fixed positioning during an investigation a Multi-armPositioning Device is available which when attached between the distal limband the table may be lockedinto an infinite range ofpositions. An optionalaccessory allows the stifle tobe accurately positioned foran investigation.Vac Pac Vacuum Positioning Device.Thanks to Pat Ridge for thephotographsMULTI-ARM026000026000 Multi-arm Positioning Devicewith Single Foot Attachment £265.00020062 Double Limb Support for Multi-arm £145.00020065 Stifle Brace Attachment for Multi-arm(designed by Schulz and Ian Holsworth) £145.00MULTIARMSET Multi-arm Set includes all of above £495.00Table Top Stand forLimb Suspension020062020065020065Suspension of a limb can provide significantbenefits in both arthroscopy and otherorthopaedic procedures. The shoulder joint isdistracted and 360 degree access becomesavailable. Height 1.2m (48”)In 2012 our limb suspension stand was redesignedto give greater table-top stability. Acleat for tying off limb suspension ropes hasalso been added and the shaft can bedismantled for storage.TABLETOP STAND FOR SUSPENDING LIMBIMPROVEDDESIGNR463 Tabletop stand £175.00Simply mould the bead filled bag around or under the patient and hook upto any vacuum source, as the air is removed the bag solidifies in the setposition. Especially useful for arthroscopy or any surgery requiring secureaccurate positioning. The Vac Pac is:VAC-PACRe-useableRadiolucentRepairableWarmVP23 Vac-Pac size 23 45 x 50cm £325.00VP30 Vac-Pac size 30 72 x 90cm £445.00VP31 Vac-Pac size 31 98 x 90cm £445.00VP32 Vac-Pac size 32 118 x 90cm £445.00Clear Adhesive Antibacterial Surgical Drapeswith PovidineThe majority of humansurgeries use clearadhesive drapes overthe incision site.Benefits include fluidand pathogenresistance, antibacterial,transparent andpermeable. 4 sizesavailable.CLEAR ADHESIVE SURGICAL DRAPES WITH POVIDINEAD1420 14cm x 20cm 20 pieces/ box £36.50AD2030 20cm x 30cm 20 pieces/ box £46.50AD3045 30cm x 45cm 20 pieces/ box £69.50AD4560 45cm x 60cm 10 pieces/ box £69.50ID6650 Ioban Drape 56 x 45cm Single £31.50Redmark CradlesAvailable individually or as a Set of 3, these cradles are the best available.REDMARK CRADLES026022 Redmark Cradles - Set of 3 (S. M, L) £225.00026022L Redmark Cradle - Large over 32kg £100.00026022M Redmark Cradle - Medium over 13kg - 32kg £95.00026022S Redmark Cradle - Small up to 13kg £90.00See Chapter 18 for Drapes and Draping.80

www.vetinst.comARTHROSCOPY & LAPAROSCOPY 2Fluid ManagementSterile Incise drape with Fluid Collection Pouch.Arthroscopy is messy.Collection of fluid run offwill minimise what fallsto the floor. This opaqueplastic film drape has a100mm x 100mm incisearea and a 200mm x300mm fluid collectionpouch. Free sample onrequest.SterilityArthroscopesDistilled water and an enzymatic cleaner are used to remove grosscontamination from arthroscopes, sheaths and trochars. Arthroscopes areavailable which can be autoclaved. However, repeated autoclaving of eventhese arthroscopes will significantly reduce their working life. Sterility ismore commonly achieved by soaking in an anti-microbial solution.Historically glutaraldehyde based solutions were the norm but health andsafety concerns have led to the use of safer chemicals based on oxidation.Camera systemsMost cameras used for veterinary arthroscopy cannot be autoclaved butthe head and cable can usually be soaked in the same solution as thearthroscope. Care should be exercised to avoid contact of the sterilizingfluid with the electrical contacts at the end of the cable. An alternative isthe use of a sterile disposable camera sleeve to separate the camera headand cable from the sterile arthroscope eyepiece.INCISE DRAPE WITH FLUID COLLECTION POUCH STERILEDD198961 Incise Drape with Pouch (Box 40) £155.00FCP2527 Fluid Collection Pouch 25cm x 27cm (200 Sterile) £295.00Puddle Vac Floor Suction DeviceThe Puddle Vac cancollect an average of700ml of fluid per minute.Simply place whererequired. Connect tostandard suctionapparatus.PerasafePerasafe is a rapid, instrument compatible, user and environmentallyfriendly, chemical sterilant. Supplied as a safe, space-saving powder,Perasafe is activated by simply dissolving in luke-warm tap water. Providesrapid sterilisation and re-use of endoscopy instruments. Aldehyde-freeformulation gives efficacy without harm to instruments, health risks tonursing staff and avoids the need for special fume extraction or wastedisposal systems.Perasafe is a pale blue/ white powderwhich, when in solution, sterilises within10 minutes. Suitable for all surgicalinstruments and fibrescopes. Formulatednot to damage surgical instruments.Supplied in the following packs.PUDDLE VAC FLOOR SUCTION DEVICEPV9321 Puddle Vac (Pack of 5) £70.00Super Absorbent MattingWater, saline, blood or any otherfluid on the theatre floor represent asignificant slip hazard to personnel.In addition free running fluid is muchmore likely to run and penetrateporous areas creating a longer termbiosecurity hazard.Super Absorbent Matting is splashresistant and absorbs 6.5 litres ofwater(3.5 litres of saline)per mat.Supplied in 200cm x 40cm mats,perforated every 25cm for easytearing. Also available as a 23 metreroll.Free sample on request100100 Perasafe Cold Sterilant 24 x 81g (5 litres) £195.00100101 Perasafe Cold Sterilant 6 x 81g (5 litres) £70.00DE-10-425DE-5-17Rapizyme• Three new enzymes• Easy to use measured bottle• 2ml per litre dilution• Removes all organic material• Ideal for endoscopes• Low foam for ultrasonics• Complete rinsibility• BiodegradeableSoak Basin for Chemical Solution Disinfection,consisting of Basin (perforated) Tray& Cover for Basin, size: 42 x 16 x 9.5cm £125.00Cleaning Brush for Small Cannulaewith ID: 2-4mm, length 17cm £24.50• Tested by The Royal Institute of Public HealthRAPIZYME Bottle 0.5 Litre £24.50SUPER ABSORBENT MATTINGABMAT40200 Super Absorbent Mat 200cm x 40cm £7.75ABMATROLL Super Absorbent Matting 23 metre roll x 80cm £180.0081

2 ARTHROSCOPY & LAPAROSCOPYLaparoscopes for MinimallyInvasive SurgeryStandard LaparoscopesGood optics are a pre-requisite for successful laparoscopy. The more yousee the easier it becomes. Fritz ’scopes have a patented large imageoptical system taking in a wide field of vision producing a full screen, veryhigh definition image.All the laparoscopes are autoclavable and have standard eyepiece andlight cable connectors.LAPAROSCOPES - STANDARDT281-5030T281-5000 Wide Angle Telescope, 0˚, OD: 5mm, WL: 29cm,Standard Light Cable Connectors, autoclavable £2,675.00T281-5030 Wide Angle Telescope, 30˚, OD: 5mm, WL: 29cm,Standard Light Cable Connectors, autoclavable £2,675.00T291-1000 Wide Angle Telescope, 0˚, OD: 10mm, WL: 30cm, SIRIUSSystem,Standard Light Cable Connectors, autoclavable£2,475.00T141-2430 Wide Angle Telescope, 30˚, OD: 2.4mm, WL: 14cm,large image technology £2,295.00S140-2433 Examination Sheath, OD: 3.2mm, WL: 12cm,Compatible with T140-2430 and T141-2430 £295.00T181-4030 Wide Angle Telescope, 30˚, large image technology,OD: 4mm, WL: 18cm, autoclavable £2,475.00S180-4033 Examination Sheath, OD: 5.5mm, WL: 17cm, compatibleto T181-4030, Stopcock, inc. Blunt Trochar £375.00ELECTROCAUTERY & SUCTIONLaparoscopy will require abipolar electrocauterygenerator to power thehandpieces. The GIMA unitis very effective andreasonably priced.See Chapter 21 page 350Laparoscopy Start Up KitInstrument choice is determined by personal choice andpatient selection. However, a starter kit is a useful starting pointand offers a discounted approach to setting up.The Laparoscopy kit described is discounted by 10% compared to buyingthe individual components.In addition to laparoscopic hand instrumentation a suitable camera, lightsource, CO 2 insufflator and electrosurgery generator will be required.Several options, including pre-owned units, are available please telephoneor e-mail to discuss options.CodeDescriptionT281-5030 Wide Angle Telescope, 0°OD: 5mm, WL: 29cm,Standard Light Cable Connectors,autoclavableDE4680-52Sterilizing & Storing Tray, 460 x 80 x 52mmperforated stainless steel with silicon bars230-212V Cannula only with Magnetic ValveID: 10mm, WL: 7cm, Inflation Stopcock, 55g230-213V Cannula only with Magnetic ValveID: 10 mm WL: 7cm, 45g230-137V Safety Trocar onlycompatible to cannulas with ID: 10mm, WL: 7cm,fully dismantable, cork screw handle231-213V Cannula only, Magnetic ValveID: 5.5mm, WL: 7cm, Inflation Stopcock231-212V Cannula only, Magnetic ValveID: 5.5mm, WL: 7cm, 30g231-137V Safety Trocar onlycompatible to cannulas ID: 5.5mm, WL: 7cm,fully dismantable, cork screw handle230-505 Reducer Adapterfor Trocar Cannulas with ID: 10 to 5.5mmL-19-120531.23H11V531.02H05VVeress Needle, D: 2mm, 12cm, LL(f)Atraumatic Grasper, curved, 5mm33cm insulated, rotatable, dismantable,inside ratchet, HF ConnectorMini - Metzenbaum Scissors 5mm33cm insulated, rotatable, dismantableAdequate suction is also a pre-requisite forLaparoscopy. Our new Hospivac unit with2 x 2litre bottle capacity and foot control isa high capacity suction unit for manyhospital procedures.See Chapter 21 page 348531.40H11VX-300-26BP-05-321BP2-533-10Dissecting Forceps, (Maryland)5mm, 31cm, insulated, dismantable,silicon handle, inside ratchetSilicon Tube, ID: 5mm, 3m, LLm both endsBipolar Grasping & Cutting Forceps5mm, WL: 320mm,disposable, Universal ConnectorBipolar Grasping Forceps with std. handle5mm, WL: 34cm, jaws: 13 4.5mm with hooktotally dismantableELECTROSURGERY & SUCTIONHF122 GIMA 122 Bipolar Electrosurgery Kit £995.00185H350 HospiVac 350 Suction Unit* £625.00* Carriage extraBP-300-11LAPAROSCOPY STARTER KITBipolar Cable, 3m, comp.to MartinUnit to Martin/ Berchtold InstrumentLAPROKIT Laparoscopy Starter Kit £6,450.0082

www.vetinst.comARTHROSCOPY & LAPAROSCOPY 2Trochars and CannulaeTrochar Cannulas with Magnetic ValvingPalpation, Dissection andPuncture InstrumentsLaparoscopy First Puncture Needle, Veress231-213V231-137VLAPAROSCOPY NEEDLE VERESSL-19-120 Veress Needle 2mm x 100mm Luer Lock £120.00Thoracoscopy First Puncture Needle, Long Version230-212V230-105VTHORACOSCOPY NEEDLETR-03-201Thoracoscopy Needle 3mm x 200mmincludes Sharp Trochar £145.00Palpation Probe and Puncture Cannula5.5MM INNER DIAMETER CANNULAE FOR 5MM ’SCOPES231-213V Cannula only, Magnetic Valve, ID: 5.5mm,WL: 7cm, Inflation Stopcock £275.00231-212V Cannula only, Magnetic Valve, ID: 5.5mm, WL: 7cm, 30g £315.00231-204V Cannula only, Magnetic Valve, ID: 5.5mm, WL: 7cm, 30g £365.00231-137V Safety Trochar only, comp. to cannulas ID: 5.5mm,WL: 7cm, fully dismantable £365.00231-105V Trochar only, with Sharp Tipcompatible to ID: 5.5mm, WL: 7cm £140.0010MM INNER DIAMETER TROCHARS & CANNULAE FOR 10MM ’SCOPES230-212V Cannula only, Magnetic Valve, ID: 10mm, WL: 7cm,Inflation Stopcock, 55g £335.00230-213V Cannula only, Magnetic Valve, ID: 10mm, WL: 7cm, 45g £315.00230-137V Safety Trochar only, compatible to Cannulas with ID: 10mm,WL: 7cm, fully dismantable, cork screw handles £395.00230-105V Trochar only with Pyramidal Tip for Trochars CannulasID: 10mm, WL: 7cm £135.00ACCESSORIESSafety trocar tissue pressure exposes the sharp tipTrochar Cannulas are designed with different types of valves to reduce orto avoid CO 2 loss when changing instruments and telescope duringlaparoscopy and thoracoscopy. Our reusable and patented magnetic valvetrocar system has several advantages compared to other valve types.They are lightweight and because of the valve construction, the insertion ofinstruments and scopes will pass smoothly through without scratching ortouching the front lens like in a so called automatic valve system. Inaddition there is nearly no gas loss even when changing instruments.There are no mechanical parts to clean inside except the magnetic flapitself which is a great help to your staff.230-505 Reducer Adapter for Trochar Cannulaswith ID: 10 to 5.5mm £35.00230-525 Snap Reducer Adapter for Trochar Cannulaswith ID:10 to 5.5mm £88.00231-211 Sealing Caps, for Trochar Cannula 5.5mm 10 pcs £29.00230-211 Sealing Caps for Trochars and Reducer Adapters £29.00231-215 Magnetic Valve Flap 5.5mm, 2 pcs. £38.00230-215 Magnetic Valve Flap 8/ 10mm, 2 pcs. £38.005mm diameter, 330mm long protected interchangeable needle with outertube. Consists of:L-33 Inside tube Luer lock ConnectorL-33-2 Outside Tube/ ProbeL-210 Needle 1 x 26mmPALPATION PROBE & PUNCTURE CANNULAL-33-210 Palpation Probe/ Cannula £215.00L-210 Injection Cannula 1 x 26mm compatible to L-33/47 £55.00L-218 Injection Cannula 1.9 x 26mm compatible to L-33/47 £55.00L-218R Injection Cannula 2 x 28mm Blunt compatible to L-33/47 £55.00Knot Tier and CutterKNOT TIER AND CUTTERMakes it easy to thread andtighten sutures. Integrated cuttingdevice.5mm diameter 310mm long.L-19-532 Knot Tier Long Version £235.00Preparation Safety Sponge Forceps5mm diameter, 3 hooks, 330mm. Matt non reflective surface. Strips fully forcleaning.SAFETY SPONGE FORCEPSGE-10-553 Safety Sponge Forceps £315.00Auto Grasping ForcepsAUTO GRASPING FORCEPS5mm diameter, Working length(WL) 320mm. Easily dismantable.L-19-645 Grasping Forceps £315.0083

2 ARTHROSCOPY & LAPAROSCOPYHand InstrumentsFritz hand instruments have a modular construction. The handles, theconnecting tubes and the working jaw tips are interchangeable.Easily stripped down for cleaning, compatible to 5mm and 10mm trocharcannulas. All handles have a High Frequency connector.HandlesHA 11/HN 82 H 01/H 05/H 115mm Instruments Complete531.40H11V Dissecting Forceps,5mm, 31cm, insulated, dismantleable, rotatable,consisting of: jaws insert (53 M 40), sheath(53 R 1) handle (H 01) colour code: black531.23H11V Atraumatic Grasper,curved 5mm,33cm insulated, rotatable, dismantleable,inside ratchet, consisting of: jaws insert (53 M 23),sheath (53 R 1) handle (H11, HF-connector), colourcode: blackH 21/H 22Tubular sheathsThe handles may have plasticcoated or stainless handles. Theymay or may not have a ratchet. Theratchet may be external orenclosed. See individualinstruments for exact construction.531.22H21V Grasping Forceps,universal use, 5mm, 33cm, insulated, dismantleable,rotatable, outside ratchet, consisting of: jaws insert(53 M 22), sheath (53 R 1) handle (H 21, HFconnector),colour code: black531.27H11V Babcock Grasping Forceps,5 mm, 33 cm, insulated, dismantleable, rotatable,inside ratchet, consisting of: jaws insert (53 M27), sheath (53 R 1) handle (H 11, HFconnector),colour code: black531.35H21V DeBakey GraspingForceps, 5mm, 33cm, insulated,dismantleable, rotatable, HF-connectorconsisting of: jaws insert (53 M 35) sheath(53 R 1 handle (H 21, HF-connector) colourcode: black5mm or 10mm diameter options.Different working lengths which may be rotated through 360 degrees.Insulated or stainless steel.5mm Instruments CompleteScissorsSCISSORS531.02H05V Mini-Metzenbaum Scissors £475.00531.04H05V Hook Scissors £450.00Biopsy ForcepsBIOPSY FORCEPSMini-Metzenbaum Scissors531.02H05VHook Scissors 531.04H05VBiopsy Forceps 531.60H01VBiopsy Forceps 531.61H01V531.60H01V Biopsy Forceps £450.00531.61H01V Biopsy Forceps - Double Action Jaw £450.005MM HAND INSTRUMENTS531.40H11V Dissecting Forceps £450.00531.23H11V Atraumatic Grasper £450.00531.22H21V Grasping Forceps £465.00531.27H11V Babcock Grasping Forceps £465.00531.35H21V DeBakey Grasping Forceps £465.00531.36H21V Bowel Grasping Forceps £465.00536.30H52V Claw Grasping Forceps £465.00BIPOLAR FORCEPSBP-05-321BP2-533-10BP-300-11531.36H21V Bowel Grasping Forceps,5mm, 33cm, insulated, dismantleable, rotatable,outside ratchet, consisting of: jaws insert (53 M36), sheath (53 R 1) handle (H 21), colour code:black536.30H52V Claw Grasping Forceps,5mm, 33cm, metal, fixed tube, outside ratchet,consisting of: jaws insert (53 M 36), sheath(53 R 6) handle (H 52), metal *Only availablewith Axial handles (the frog)Bipolar Grasping & Cutting Forceps 5mm,WL: 320mm, disposable, Universal Connector £295.00Bipolar Grasping Forceps with std. handle 5mm, WL :34cm,jaws: 13 4.5mm with Hook totally dismantable £725.00Bipolar Cable 3 m, comp.to MartinUnit to Martin/ Berchtold Instrument £130.00Laparoscope Instrument Cleaning KitLaparoscope Instrument Cleaning Kit consists of:3 x General Brush Nylon Bristles3 x Laparoscopic Trumpet Valve Brush3 x Nylon Twisted Wire Brush 3mm diameter3 x Nylon Twisted Wire Brush 5mm diameter3 x Nylon Twisted Wire Brush 10mm diameterLAPAROSCOPE INSTRUMENT CLEANING KITLAPROCLEAN Laparoscope Instrument Cleaning Kit £155.0084