GEM COUPLER Instructions D'utilisation page 11

13. To remove the jaw assembly turn the Anastomotic Instrument
knob fully counterclockwise (See Figure 13). Press the release
button, located near the arrow on the Anastomotic Instrument,
and remove the jaw assembly (See Figure 14).
14. Rinse the Anastomotic Instrument with water after use.
3.5mm COUPLER Size or Larger:
End-to-End Anastomosis:
1. to 7. Follow the same directions as for 3.0mm COUPLER Size
or Smaller End-to-End Anastomosis (Steps 1 through 7).
8. Take a bite of approximately one to two pin diameters of the
vessel wall and intimal lining, evert 90 degrees and impale onto
the pin situated nearest to the open part of the Jaw Assembly
(open end of the U portion of the jaw). Impale the opposite
side of the vessel opening to the pin directly across from the
initial pin. Next, impale the vessel onto the pins located near
the sides of the ring, keeping the vessel as evenly spaced as
possible between the four pins (See Figure 15). Continue
vessel placement on the ring by impaling the vessel onto the
two remaining pins near the open end of the Jaw Assembly.
Complete by impaling the vessel onto the last two pins near the
bottom of the Jaw Assembly (bottom of the U portion of the
jaw); this final step prevents the ring from sliding out of the Jaw
Assembly prematurely (See Figure 16). Ensure that both the
vessel wall and the intimal lining are fully impaled upon each
pin to reduce the risk of thrombosis. Should the vessel wall tear
during impalement, remove the vessel, trim the end, and repeat
the procedure. For examples of improper impalement of the
vessel see Figure 17.
9. to 14. Follow the same directions as for 3.0mm COUPLER Size
or Smaller End-to-End Anastomosis (Steps 9 through 14).
All COUPLER Sizes:
End-To-Side Anastomosis:
Using conventional microsurgical technique, mobilize a
minimum of 1 cm of the "end" vessel. Clamp-off the vessel and
irrigate the vessel lumen. Mobilize a minimum of 2 cm of the
"side" vessel and clamp off the vessel.
1. When performing an end-to-side anastomosis with this
COUPLER device, the lumen of the "side" vessel is narrowed
slightly. For this reason, the diameter of the "side" vessel should
be larger than that of the "end" vessel when completing such a
procedure.
2. Estimate the outer diameter of the "end" vessel using the Vessel
Measuring Gauge. The circular guides on the gauge should not
be placed inside the vessel lumen (See Figure 1).
3. Select the appropriate size COUPLER Device.
4. Remove the lid from the outer tray and aseptically remove
the inner tray; the inner tray may be placed in the sterile field.
Inspect the inner tray. Do not use if the inner tray is damaged
or if the seals are not intact. Remove the lid from the inner tray.
5. Turn the Anastomotic Instrument knob fully counterclockwise,
and then insert the COUPLER onto the Anastomotic
Instrument. The matching indicator arrows on the COUPLER
Device and the Anastomotic Instrument should be pointing
11
EN