Johnson & Johnson EC45A, Инструкция по эксплуатации

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13 To articulate the jaws inside the body cavity, select an appropriate surface (a body structure, organ, or another instrument) to
use as a grounding surface to bend the jaws, ensuring that it stays within the field of view. Rest the lateral side of the jaws
that are opposite to the desired direction of articulation against the grounding surface (the jaws must be open in order to
articulate the instrument). (Illustration 9)
WARNING: Do not attempt to articulate by pressing the front of the jaws against the grounding surface as tissue damage or
tissue trauma may occur. (Illustration 10)
Pull the fins of the rotating knob back with the index finger and apply a sweeping motion towards the side articulation is
wanted while gently pushing the instrument handle towards the grounding surface. Maintain the jaws pressed against the
grounding surface during this action. Once the desired articulation angle is reached, release the rotating knob to lock the angle
(the instrument will only lock at pre-determined angles – 1º, 0º and º).
Caution: The instrument can only achieve a maximum articulation angle of º. When using body structures or organs as a
grounding surface, particular attention should be placed to the visual cues and tactile feedback received from the instrument.
When the maximum angle is reached, the force will increase indicating the maximum angle has been reached. Avoid applying
excessive pressure to the tissue as tissue damage or tissue trauma may occur.
14 Position the instrument around the tissue to be stapled.
Caution: Ensure that the tissue lies flat and is positioned properly between the jaws. Any “bunching” of tissue along the
reload, particularly in the crotch of the jaws, may result in an incomplete staple line.
The distal black lines on the anvil and cartridge channel designate the ends of the staple line. The line on the cartridge
channel that reads “cut” references the cut line on the device. (Illustration 1)
Caution: When positioning the stapler on the application site, ensure that no obstructions such as clips, stents, guide wires,
etc. are within the instrument jaws. Firing over an obstruction may result in incomplete cutting action, improperly formed
staples, and/or inability to open the instrument jaws.
15 After positioning the instrument jaws, close the jaws by squeezing the closing trigger (1) toward the handle until it locks. An
audible/tactile click indicates that the closing trigger and the jaws are locked. (Illustration )
Caution: Ensure tissue has not extended (extruded) proximal to the proximal black line on the instrument. Tissue forced into
the instrument proximal to the black line may be transected without staples.
Caution: If the closing trigger (1) is difficult to lock, reposition the instrument and take a smaller amount of tissue.
Ensure that the proper reload selection has been made. (Refer to the ECHELON Reload Product Codes table.)
Caution: If the clamping mechanism becomes inoperative and the jaws do not clamp on tissue, do not fire the instrument.
Remove and do not continue to use instrument.
Note: When firing across thick tissue, holding the jaws in place for 1 seconds after closing and prior to firing may result in
better compression and staple formation.
16 Fire the instrument. The complete firing action requires complete strokes to cut the full reload length and return the knife
to its home position. For each stroke, squeeze and release the firing trigger () completely with a continuous, smooth stroke
until it rests on the closing trigger (1). (Illustration 11) The numbers on the stroke count indicator will advance with each
stroke. After the third stroke, the knife direction indicator will display an arrow pointing towards the proximal end of the
instrument to indicate the knife is in the return mode. At the end of the fourth stroke, the stroke count indicator will display
“0” to indicate the knife has returned to its home position. The status of the transection can also be determined by observing
the knife blade indicator throughout the firing action.
Note: Once the firing cycle has been initiated, it should be completed by completing all four strokes of the firing cycle to
return the knife to the home position. If it is necessary to interrupt the firing sequence, push the red manual knife reverse
switch downward to reverse the knife motion; the knife direction indicator will display an arrow pointing towards the
proximal end of the instrument to indicate the knife is in the return mode. To complete, squeeze the firing trigger ()
completely until it rests on the closing trigger (1), after which the stroke count indicator will display “0” to indicate the knife
has returned to its home position.
Caution: Attempting to force the trigger to complete the firing stroke with too much tissue between the jaws, or with dense/
thick tissue between the jaws, may result in increased forced to fire or instrument failure.
Caution: If the instrument locks out, the stroke count indicator will display a lockout symbol. Stop and push the red manual
knife reverse switch downward to reverse the knife motion; the knife direction indicator will display an arrow pointing
towards the proximal end of the instrument to indicate the knife is in the return mode. Squeeze firing trigger () completely
until it rests on the closing trigger (1). The stroke count indicator will display “0” to indicate the knife has returned to its
home position. Then press the anvil release button to release the jaws from the tissue. Close the instrument jaws by pressing
the closing trigger (1), remove the instrument, and replace the cartridge. Firing through the lockout mechanism will break
the instrument.
Caution: The use of staple line reinforcement material with the instrument may require an increased force to fire and may
reduce the number of times the device may be fired. When using staple line reinforcement material, the instructions of the
manufacturer of the material should be followed.
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Press the anvil release button to separate the instrument jaws and allow both triggers to return to their original positions.
(Illustration 8)
Caution: If the jaws do not automatically open after the anvil release button is pressed, first ensure that the knife is in the
retracted position by verifying that the stroke count indicator displays “0” and knife direction indicator points towards the
proximal side of the instrument, or that the knife blade indicator is in the home position. If the stroke count indicator or knife
blade indicator is not in the home position, push the red manual knife reverse switch downward to reverse the knife motion
and squeeze the firing trigger () completely until it rests on the closing trigger (1). Press the anvil release button. If the jaws
do not open at this point, then gently pull the closing trigger (1) upward (away from the handle) until both firing and closing
triggers return to their original positions.
Caution: If the firing mechanism becomes inoperative, do not continue to use the instrument.
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Gently pull the instrument away from the transected tissue and ensure it is released from the jaws. Examine the staple lines
for pneumostasis/hemostasis and proper staple closure. Minor bleeding can be controlled with electrocautery, manual sutures
or other appropriate techniques.
19 Before removing articulating instruments, move the jaws away from any obstruction inside the body cavity while keeping
the jaws open and within the field of view, and pull on the fins of the rotating knob. The jaws will return to the straight
position automatically.
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To remove the instrument from the cavity, squeeze the closing trigger (1) until it locks, closing the jaws. Completely
withdraw the instrument in the closed position. (Illustration 1)