GEM COUPLER Instructions D'utilisation page 12

toward each other when loading (See Figures 2 & 3). Ensure
that an audible click is heard for proper loading.
6. Remove COUPLER Device from the protective cover by
pulling it firmly away from the Anastomotic Instrument (See
Figure 4).
7. Visually inspect to see that both rings are seated at the
bottom of the U portion of the jaw and the pins are not bent
(See Figures 5a and 5b). If pins are bent, do not attempt to
straighten. Instead use a new COUPLER Device.
8. Place the Anastomotic Instrument handle perpendicular to the
direction of the "end" vessel. Place the "end" vessel upon one
ring as described in Steps 7 and 8 for End-to-End Anastomosis
directions of the appropriate COUPLER size.
9. Create a transverse incision in the "side" vessel of a length no
greater than the internal diameter of the COUPLER device
selected. Slide the clamps together slightly to remove tension
and to open the incision (See Figure 18). Irrigate the vessel
lumen through the created opening.
10. Using microsurgical forceps, grasp the vessel wall and intimal
lining near one end of the transverse incision and pull them
through the remaining ring. Evert the vessel wall and intimal
lining 180 degrees and impale the vessel first upon the pins
situated nearest the incision end (See Figure 19).
11. Proceed in a similar manner at the opposite end of the
incision, impaling the vessel wall and intimal lining upon
the pins situated nearest the incision end (See Figure 20a for
COUPLER sizes 3.0mm and smaller; See Figure 20b for
COUPLER sizes 3.5mm and larger). Complete the pinning
procedure by everting the vessel upon the remaining pins
(See Figure 21a for COUPLER sizes 3.0mm and smaller; See
Figure 21b for COUPLER sizes 3.5mm and larger). Ensure
that both the vessel wall and the intimal layer are fully impaled
upon each pin.
12. Bring the rings together by turning the Anastomotic
Instrument knob clockwise, ONLY until the ejector rod
has just started to move the now joined rings. Hold the
Anastomotic Instrument such that the "end" pinned ring is
brought to the "side" pinned ring during the approximation
(See Figure 22).
13. Prior to ejecting the joined rings, squeeze the end of the
apposed jaws with a small hemostat (See Figure 23) to
ensure ring approximation and a tight friction fit. Turn the
Anastomotic Instrument knob further clockwise to eject the
joined rings.
14. Check the anastomosis under the operating microscope before
opening the vascular clamps. Remove the clamps and inspect
the anastomotic site to ensure that the anastomosis has been
satisfactorily completed (patent vessel without leakage).
15. 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).
16. Rinse the Anastomotic Instrument with water after use.
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