clip instruments

1. CLIP INSTRUMENTS

2. ENDO CLIP* (5 &10mm) Super interlock clip design 15� Angled jaw - better visibility Black Instrument shaft (10mm) Partial closure Closes front of clip first Jaws do not close if empty Clip loaded only when required

3. ENDO CLIP II M/L

4. ENDO CLIP*II Medium/Large clip, 9mm 20 Super Interlock Titanium clips Super Interlock Clip 360� Shaft Rotation 15�Angled Jaws

5. Ligaclip ERCA** vs ENDOCLIP II* Less clip security Vs ENDOCLIP II* Fiber optic glare 10� angled jaw No partial close Super Interlock clip No fiber optic glare 15� angled jaw Partial closure possible (Cholangiagram)

7. ENDO CLIP M & L Medium, 10mm shaft, 6mm clip 20 Super Interlock Titanium clips Activate Trigger to load Clip 360� Shaft Rotation 15�Angled Jaws Large 10 mm shaft, 11mm clip 15 Super Interlock Titanium clips Activate Trigger to load Clip 360� Shaft Rotation 15�Angled Jaws

9. ENDO CLIP* 5 MM 5 mm shaft diameter 12 Super Interlock Titanium clips Medium-large clip, 8.5 mm Red indicator on the handle when no clips are left 360� Shaft Rotation 15�Angled Jaws Silver mat finished shaft

10. Ligaclip Allport** vs ENDOCLIP 5mm Sharp & serrated jaw Clip design is back - front closure Blind clip placement - jaw design Paper clip design clips-security Atraumatic jaw Clip closure Front to back Visible clip placement Super Interlock Clip

11. LIGACLIP ALLPORTSUMMARY 10� angled jaw Instrument is in silver - reflection Closes back of clip first Closes on tissue if empty Traumatic serrated jaws

12. �Endoscopic Ligation� or what Ethicon says to sell their products

13. Product Description ERCA A single-patient-use endoscopic, rotating, automatic, ligating clip applier. It delivers 20 titanium clips that individually advance after each firing. Designed to offer a rapid, efficient means of ligation through ENDOPATH disposable surgical trocars.

14. Indications ERCA Intended for use on tubular structures or vessels. The tissue being ligated should be consistent to the size of the clip.

15. Contraindications The LIGACLIP ERCA applier is not intended for contraceptive tubal occlusion. Do not use the LIGACLIP ERCA applier on vessels upon which metal ligating clips would not normally be used.

16. Nomenclature ERCA

17. Steps in Use Remove from sterile package Fully squeeze handle Allow handle to fully retract Visualize clip in chamber

18. Product Coding ERCA

19. Features ERCA 360� rotation knob Fully automatic Wide jaw opening Lateral and transverse grooves Last clip lock-out Tactile and audible feedback Color coding Ratchet mechanism Blackened jaws

20. Benefits ERCA Wide jaw opening enhances visibility of the structure or vessel to be ligated Consecutive vessel ligations without reloading or exchanging loaded appliers Designed to afford excellent visibility during the clip application Innovative and improved method of ligation with the potential of reducing operative time The lubricant coating on the metallic clips facilitates clip dispensing and minimizes instrument jamming

21. Sales Targets Surgeons using competitive single-patient ligation devices Surgeons having difficulties with clip security in the jaws of the applier EES surgeons using single-clip ligation

22. Competition USSC: Endoclip* I and II Richard Allan Origin: Accuclip* (90 degrees) Weck: Hemoclip* M-20 reusable hand piece, disposable clip

23. CompetitionUSSC Semi-automatic No true/complete anti-drop ratchet mechanism on either Endo clip I or II Change in rotating knob position and design Shaft torquing 10mm trocar accomodates large clip applier

24. Product Description Allport AL326, Allport LS AL236 Allport and Allport LS endoscopic clip appliers deliver 20 and 30 pre-formed titanium clips respectively.

25. Indications Allport and Allport LS Allport and Allport LS endoscopic rotating multiple clip appliers have application for use on tubular structures or vessels.

26. Contraindications DO NOT use the clip applier for contraceptive occlusion DO NOT use the clip applier on tissue structures upon which metal ligating clips would not normally be used

27. Nomenclature Allport and Allport LS

28. Steps in Use The instruments have a two-stage firing sequence Partially squeeze the trigger to close the jaws before inserting in the applier Insert applier through trocar Position the jaws of the instrument so that they completely enclose the tissue to be ligated After ensuring that the tissue is properly positioned, fully squeeze the trigger until it stops. A clip will advance on the tissue structure To remove clip applier from trocar, close jaws by partially squeezing trigger and withdraw from trocar

29. Number of Firings Single-patient-use product containing 20-30 preloaded titanium clips Non-reloadable

30. Product Coding Allport

31. Surgeons� Areas of Concern(with an endoscopic ligation device) Clip security Ability to use a more advanced minimally invasive technique

32. Features Allport and Allport LS First to market: 5mm clip applier Rapid, efficient means of ligation 360� shaft rotation in either direction Low-glare shaft surface minimizes reflective distortion Self-adjusting clip Two-stage firing cycle Clip is pre-closed under a force load: fastener opens and is released onto tissue to provide occlusion

33. Benefits Allport and Allport LS Facilitates minimally invasive approach to endoscopic procedure Can be used in open or endoscopic procedure Has no tissue-dividing capability Eliminates need to clean or presterilize 360-degree rotation for enhanced access to operative site Allport allows for proper positioning and ligation of tissues Provides unsurpassed clip security as compared to ligaclip ERCA (ER320) and USSC Endoclip II

34. Sales Targets Surgeons doing lap chole and vessel harvesting procedures Surgeons wanting to decrease trocar wound size Competitive accounts

35. Competition USSC 5mm clip applier visually similar to their Endoclip II clip design clip is not self-adjusting

36. EES Clinical Advantage Provides unsurpassed clip security, as compared with LIGACLIP ERCA (ER320) and USSC Endoclip II Self-adjusting clip Enhanced access to operative site Rapid efficient means of ligation

37. Objections and Rebuttals Objection: Ethicon clip is less secure, Endoclip II stays firmly on the vessel. Rebuttal: EES has lateral and transverse grooves, USSC does not. (Show rubber band demo)

38. Integrity Selling Interview step: What could it happen if a clip fell into the abdomen when entering the trocar? Is it sometimes difficult to visualize the clip before applying it to the vessel? Have you had any experiences with clips falling off vessels?

39. Integrity Selling Demonstration Step: Place Endoclip II through 10mm Surgiport: place ER320 through Surgiport (Endoclip will fall out) Do three business card demos to show unique spring-loaded clip. Stack business cards together, fire USSC clip into cards and then fire Allport clip into cards. Remove the middle business card and watch USSC clip fall off while Allport clip holds

40. Back to us� ERCA : Out of the box there is no clip in the jaws. Large clip applier needs 12 mm port Cannot find real measures of their clip and jaws Cutting edge of jaws Allport: Cannot get the measures of their �clip� Cannot get he �real jaws opening� Crocodile jaws