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ENDOSCOPIC DISSECTION TRAINING FOR NOSE, PARANASAL SINUSES AND SKULL BASE

USING A REALISTIC SYNTHETIC MODELA Tutorial for Hands-On Training with the

Sinus Model Otorhino-Neuro Trainer (S.I.M.O.N.T.)

Leonardo BALSALOBRE, M.D.Aldo C. STAMM, M.D., Ph.D.*

São Paulo ENT CenterEdmundo Vasconcelos Clinical Complex

São Paulo, Brazil*) Director of Sao Paulo ENT Center

®

Endoscopic Dissection Training for Nose, Paranasal Sinuses and Skull Base Using A Realistic Synthetic Model4

AcknowledgementThe authors would like to thank Samuel Zymberg, M.D., Ph.D., for assistance during the dissection.

Endoscopic Dissection Training for Nose, Paranasal Sinuses and Skull Base Using A Realistic Synthetic Model – A Tutorial for Hands-On Training with the Sinus Model Otorhino-Neuro Trainer (S.I.M.O.N.T.)Leonardo Balsalobre, M.D.Aldo C. Stamm, M.D., Ph.D.*

São Paulo ENT Center, Edmundo Vasconcelos Clinical ComplexSão Paulo, Brazil*) Director of Sao Paulo ENT Center

Correspondence address of the author: Leonardo Balsalobre, M.D.Complexo Hospitalar Edmundo VasconcelosRua Borges Lagoa, 1450Vila ClementinoMoema, São Paulo 04038-004, Brazilwww.centrodeorl.com.brwww.hospitaledmundovasconcelos.com.br

All rights reserved.1st edition 2013© 2015 ® GmbHP.O. Box, 78503 Tuttlingen, GermanyPhone: +49 (0) 74 61/1 45 90Fax: +49 (0) 74 61/708-529E-mail: [email protected]

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05.15-0.3

ISBN 978-3-89756-204-2

Important notes:Medical knowledge is ever changing. As new research and clinical experience broaden our knowledge, changes in treat ment and therapy may be required. The authors and editors of the material herein have consulted sources believed to be reliable in their efforts to provide information that is complete and in accord with the standards accept ed at the time of publication. However, in view of the possibili ty of human error by the authors, editors, or publisher, or changes in medical knowledge, neither the authors, editors, publisher, nor any other party who has been involved in the preparation of this booklet, warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or for the results obtained from use of such information. The information contained within this booklet is intended for use by doctors and other health care professionals. This material is not intended for use as a basis for treatment decisions, and is not a substitute for professional consultation and/or use of peer-reviewed medical literature.

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Endoscopic Dissection Training for Nose, Paranasal Sinuses and Skull Base Using A Realistic Synthetic Model 5

Table of Contents

1.0 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

2.0 The Sinus Model Otorhino-Neuro Trainer (S.I.M.O.N.T.) . . . . . . . 7

Advantages of S.I.M.O.N.T. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

3.0 Training Section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Dissection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Endoscopic Inspection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Uncinectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Middle Meatal Antrostomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

The Frontal Sinusotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Anterior Ethmoidectomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Posterior Ethmoidectomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Sphenoidotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Skull Base Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Other Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Identifi cation of the Sphenopalatine Artery . . . . . . . . . . . . . . . 22Orbital Decompression. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Recommended Set: Endoscopic Dissection Training for Nose, Paranasal Sinuses and Skull Base Using the Sinus ModelOtorhino-Neuro Trainer (S.I.M.O.N.T.) . . . . . . . . . . . . . . . . . . . . . . . . . . 23


1.0 Introduction

Endoscopic sinus surgery (ESS) is among the most widely used surgic al procedures in otorhinolaryngology and has become a mainstay in the surgic al treatment of many diseases related to the sinuses and nasal cavity. Given its importance, training of surgeons is a constant concern. Hands-on maneuvering of operating instruments during endoscopic procedures can pose a challenge for inexperienced surgeons due to the inherently complex nature of intranasal anatomy and a variety of close relationships to surrounding vital structures, such as the brain, carotid artery and orbital components.

Hands-on training in dissection labs using cadaver specimens or virtual-reality simulators is of signifi cant importance and should be constantly encouraged. However, most training sessions are still held in operating rooms under the supervision of more experienced surgeons. Endoscopic sinus surgery has an overall complication rate ranging about 5 to 10%. Persistent efforts should be made to prevent or reduce to the very minimum the occurrence of complications. Cadaver dissection has some limitations related to ethical and legal problems, but also those linked to fi nancial and technical resources impeding acquisition of human or animal cadaver specimens. For these reasons, the routine practice of hands-on surgical training in otorhinolaryngology is tending gradually to the use of surgical simulators.

Surgical simulators can be divided into virtual-reality models and realistic anatomical models that allow for next-to-real tactile contact and feedback. The fi rst one is based on interactive computer programs, i.e., including virtual-reality elements and algorithms that have been specifi cally designed to control direct interaction with users. Although promising, virtual-reality simulation models are expensive and still have the disadvantage of not giving the option to use real surgical instruments. Realistic anatomical models have many advantages of which the most important are the use of real surgic al instruments and materials employed in routine practice, and the option to build collaborative skills while working simultaneously with another trainee on the same anatomical model.


2.0 The Sinus Model Otorhino-Neuro Trainer (S.I.M.O.N.T.)

The Sinus Model Otorhino-Neuro Trainer (S.I.M.O.N.T.), a realistic anatomic al model developed by Brazilian ENT doctors in close collaboration with engineers, is based on images of anatomical structures obtained by computed tomography (CT) and videoendoscopic anatomical dissection of cadavers.

The fi rst step in prototype development of this realistic anatomical simulator was to fashion the lateral nasal wall, which is made of a special resin simulating the consistency of human bone. Among others, it comprises a frontal recess and frontal sinus, ethmoid cells, and provides free space for positioning the maxillary sinus, lamina papyracea and anterior sphenoid sinus wall. The lining of the lateral nasal wall is made of Neoderma®, a material that mimics the consistency of mucosal structures. The nasal septum, turbinates, uncinate process and other soft tissue structures are fashioned separately using resin and Neoderma®. These elements are fi nally inserted in both lateral walls. Upon assembly of all components and their fi xation to each other, a face element made of Neoderma® is added.

S.I.M.O.N.T. is now in its fourth generation, and since its inception in 2008, it is constantly adapted to the needs of surgeons.

One of the core components of the S.I.M.O.N.T. model, the lateral nasal wall without middle turbinate. A white hard resin body is covered by a lining made of Neoderma®.

1

Parasagittal view of the anatomy of the lateral nasal wall.2

Ostiomeatal complex. The middle turbinate is shown following its eversion.

3

Key to AcronymsBE bulla ethmoidalisFS frontal sinusIT inferior turbinateMT middle tubinate

SS sphenoid sinusST superior turbinateUP uncinate process


Advantages of S.I.M.O.N.T.S.I.M.O.N.T has many advantages when compared with animal models, human cadavers or with virtual-reality simulators:

� No special requirements with regard to site / type of storage � Ease of cleaning and maintenance after use � Allows to train with the same instruments used in routine practice � Permits simulation of bleeding � The peristaltic pump included in the model, can be used for irrigation or aspiration of the sinus cavity

� Provides the option to modify and reconfi gure the model for simulating a variety of diseases

� Eliminates the risk of infection inherent to traditional cadaver dissections. � Allows to hold training sessions at any place available.

3.0 Training Section

DissectionThe aim of this brochure is to provide a guide for training endoscopic dissection of the nose, paranasal sinuses and skull base with the S.I.M.O.N.T. model. There is no new technique involved in hands-on dissection with the S.I.M.O.N.T model. The brochure gives a systematic stepwise introduction to the procedures that can be trained on it and aims to help students develop a good sense of spatial orientation, which is mandatory to reach an adequate level of profi ciency in endoscopic techniques.

In terms of safety, the basic materials used to build the model – acrylic and resin – are odorless, nontoxic and do not decompose over time, and therefore pose no chemical or biological risk to trainees.

Sagittal view of the model showing a metal probe inserted through the natural sphenoid sinus ostium.

4 Frontal view of the model showing a few important structures of the nasal cavity.

5

The face element with eyes, skin and nasal pyramid covering the model.

6

The Sinus Model Otorhino-Neuro Trainer (S.I.M.O.N.T.)

7

Key to AcronymsBE bulla ethmoidalisFS frontal sinusIT inferior turbinateMT middle tubinate

S nasal septumSS sphenoid sinusST superior turbinateUP uncinate process


Endoscopic InspectionIn the fi rst step, a HOPKINS® rod lens telescope (0° direction of view, diameter 4 mm) is inserted parallel to the nasal fl oor, which allows to identify a few structures of the nasal cavity, such as inferior turbinate, inferior meatus, nasal fl oor, nasal septum and middle turbinate (Fig. 8).

Introducing the endoscope through the right middle meatus, some struct ures that belong to the ostiomeatal complex can be viewed: middle turbinate, uncinate process and bulla ethmoidalis (Fig. 9). A double-ended maxillary sinus ostium seeker is used to probe the retrobullar space (Fig. 10).

Left nasal cavity: the superior turbinate can be identifi ed, which partially conceals the sphenoid ostium. Caudally, the choanal arch comes into view (Fig. 11).

Endoscopic view of the right nasal cavity.8

Angled maxillary sinus ostium seeker pointing toward the retrobullar space.

10

Endoscopic view of right middle meatus.9

Left sphenoethmoidal recess.11

BE bulla ethmoidalisC choanaIM inferior meatusIT inferior turbinateMT middle turbinateNF nasal fl oor

S nasal septumST superior turbinateUP uncinate process

natural sphenoid sinus ostium

Key to Acronyms


UncinectomyUpon proper identifi cation of the relevant anatomical reference structures, dissection begins with an uncinectomy. Figs. 12 and 13 demonstrate the use of a backward cutting STAMMBERGER antrum punch for resection of the uncinate process. Taking into account the consistency of the Neoderma® lining, resection is facilitated when using a through-cutting forceps instead of its non-cutting counterpart. The superior portion of the uncinate process is removed with a through-cutting, 45°-upturned GRÜNWALD-HENKE RHINOFORCE® II nasal forceps (Fig. 14).

Uncinectomy using an upward-backward cutting STAMMBERGER antrum punch.

12

Resection of the superior portion of the uncinate process.14

Left middle meatus following resection of the inferior portion of the uncinate process.

13

BE bulla ethmoidalisMT middle turbinateUP uncinate process

Key to Acronyms


Uncinectomy. Shown is a small residual superior portion of the uncinate process.

15 Straight ahead view of the natural maxillary sinus ostium.16

Forward-oblique view of the natural maxillary sinus ostium using a 45°-scope.

17

The uncinate process should be totally resected (Fig. 15) in order to expose the primary maxillary sinus ostium, which can be viewed in Fig. 16. To improve visualization of the ostium, the line of sight should be changed by using a 45°-HOPKINS® telescope (Fig. 17).

BE bulla ethmoidalisMT middle turbinateUP uncinate process

natural maxillary sinus ostium

Key to Acronyms


Middle Meatal AntrostomyThe middle antrostomy is performed by creating an enlarged primary maxillary sinus ostium. A through-cutting, 45°-upturned GRÜNWALD-HENKE RHINOFORCE® II nasal forceps and a through-cutting, straight MACKAY-GRÜNWALD RHINOFORCE® II nasal forceps are used to remove the posterior fontanelle of the maxillary sinus (Figs. 18, 19). The bulla ethmoidalis is preserved. The inferior edge of the antrostomy is resected using a backward-cutting STAMMBERGER antrum punch (Fig. 20). At this point, once a wide antrostomy has been created, the posterior wall of the maxillary sinus comes into view (Fig. 21).

Endoscopic view of the natural maxillary sinus ostium following its enlargement with a through-cutting 45°-upturned GRÜNWALD-HENKE RHINOFORCE® II forceps.

18

Resection of the inferior portion of the antrostomy. 20

Resection of the posterior fontanelle. 19

Final aspect of the middle antrostomy (HOPKINS® 0°-scope). 21

BE bulla ethmoidalisMS maxillary sinusMT middle turbinate

Key to Acronyms


Endoscopic 45°-view of agger nasi cell removal with a curette.23

Endoscopic view of a curved frontal ostium seeker in the frontal sinus.

25

Endoscopic 45°-view of a circular punch in the frontal recess.24

Frontal sinus cavity as seen through the enlarged frontal recess.26

AN agger nasi cellBE bulla ethmoidalisFS frontal sinusLP lamina papyraceaMT middle turbinate

Key to Acronyms

The Frontal SinusotomyFrontal recess and frontal sinus surgery are accomplished employing the so called intact bulla technique. The bulla ethmoidalis is a great landmark in fi nding the frontal recess. The uncinate process is removed superiorly to expose the medial wall of the agger nasi cell, also named vertical bar ( ) (Fig. 22).

Next, the 0°-scope is switched for a 45°-scope to facilitate visualization of the frontal recess. The agger nasi cell is opened with a curette, exposing the frontal sinus ostium (Fig. 23). In order to enlarge the space of the frontal recess, a 65°-upturned, circular cutting STAMMBERGER punch may be used, removing some bone and mucosal debris (Fig. 24).

Finally, using a 45°-scope, an oblique view is given of the completely extended opening of the frontal sinus. Due care should be taken to preserve the mucosa of the frontal recess and thus help to prevent the formation of scars and secondary restenosis (Figs. 25, 26).

Endoscopic view (0° scope) upon completion of uncinectomy; note the vertical bar ( ).

22


Anterior EthmoidectomyThe fi rst step of anterior ethmoidectomy involves resection of the bulla ethmoidalis. A through-cutting, 45°-upturned GRÜNWALD-HENKE RHINO-FORCE® II nasal forceps is used to remove the ethmoidal bulla and a through-cutting, straight MACKAY-GRÜNWALD RHINOFORCE® II nasal forceps is applied in the next step of dissection (Figs. 27, 28). A red liquid, simulating blood, may be aspirated using a straight suction tube.

Resection of the bulla ethmoidalis with a through-cutting, 45°-upturned GRÜNWALD-HENKE RHINOFORCE® II nasal forceps.

27 Dissection of the anterior ethmoid cells with a through-cutting forceps.

28

BE bulla ethmoidalisMS maxillary sinus

Key to Acronyms

Forty-fi ve degree panoramic view following complete dissection of the ethmoid cells.

29 Dissection of the posterior ethmoid cells with a BLAKESLEY forceps.

30

FE fovea ethmoidalisFS frontal sinusLP lamina papyracea

Key to Acronyms

MS maxillary sinusMT middle turbinate

anterior ethmoid artery

Posterior EthmoidectomyThe posterior ethmoid cells are cleared using a straight forceps, such as a BLAKESLEY-type. The entire ethmoid cells must be removed exposing the medial orbital wall and the ethmoid roof. The 45°-scope is used to inspect the anterior skull base at the fovea ethmoidalis, a small portion of the anterior ethmoid artery ( ) crossing this region and the frontal sinus. Note, that the mucosa of the ethmoid roof may be removed without risk of scar formation in this region (Fig. 29). Using a 0°-scope, affords a view of the complete antero-posterior ethmoidectomy and allows to identify the medial orbital wall, middle turbinate and maxillary sinus opening (Fig. 30).


Creation of an opening in the anterior sphenoid sinus wall via the transethmoidal approach.

31 Outcome of the sphenoethmoidectomy.32

SphenoidotomyThe approach to the sphenoid sinus is usually accomplished in two ways: via the transethmoidal or the direct transnasal route.

The fi rst route involves that a complete ethmoidectomy be performed as described above. Fenestration of the anterior face of the sphenoid sinus is initiated in the infero-medial angle of the posterior ethmoidal bone by exerting controlled focal pressure using a rounded blunt-tipped curette.

Next, the opening made in the anterior sphenoid sinus wall is enlarged and completed by dissecting from medial to lateral using a CASTELNUOVO sphenoid punch (Fig. 31).

Once sphenoethmoidectomy has been fully completed, a 0°-scope may be used to visualize the posterior sphenoid sinus wall, lamina papyracea, maxillary sinus and the fovea ethmoidalis (Fig. 32).

MS maxillary sinusMT middle turbinateLP lamina papyraceaSS sphenoid sinus

Key to Acronyms


The direct transnasal approach to the sphenoid sinus in the fi rst place involves that the sphenoid sinus ostium in the sphenoethmoidal recess needs to be localized and identifi ed properly; the superior turbinate is a good landmark (Fig. 33). In order to allow passage of operating instruments, the middle and superior turbinates may be displaced laterally, making the spheno ethmoidal recess wide enough. The next step is to enlarge it with a circular-cutting STAMMBERGER punch, diameter 3.5 mm, which is well-suited in this region (Fig. 34). For creating a wide sphenoidotomy, a CASTELNUOVO sphenoid punch may be used to remove the entire anterior bony wall of the sphenoid sinus (Fig. 35).

In fi nal stages of the procedure, the fully enlarged opening of the sphenoid sinus and the restored drainage pathway are demonstrated (Fig. 36).

Close-up view of the left natural sphenoid sinus ostium.33

Completion of the endoscopic direct transnasal sphenoidotomy with a CASTELNUOVO sphenoid punch.

35

Enlargement of the natural sphenoid sinus ostium.34

Panoramic view of a wide sphenoidotomy.36

C choanaMT middle turbinateS nasal septumSS sphenoid sinusST superior turbinate

Key to Acronyms


Skull Base ProceduresA large variety of endoscopic endonasal approaches to the skull base can be trained using the Sinus Model Otorhino-Neuro Trainer, namely the transclival, transplanum, transcribriform and transellar approaches.

The endoscopic transsphenoidal approach for sellar lesions has been chosen to exemplify a transnasal skull base procedure, because this access route is the most widely accepted in the fi eld, today.

In a fi rst step, the natural sphenoidal ostium is identifi ed and enlarged. Initially, a circular-cutting STAMMBERGER punch (Fig. 37) is used for this purpose, followed by a wide bilateral sphenoidotomy, extending from the planum sphenoidale superiorly to the sphenoid fl oor inferiorly (Figs. 38, 39).

Enlargement of the natural ostium of the right sphenoid sinus.37 Wide sphenoidotomy38

The 0° scope offers a close-up view of the fully enlarged opening of the right sphenoid sinus.

39 Panoramic view of a left wide sphenoidotomy. Note, that the inferior mucosal portion, which is vascularized by the posterior septal artery (----) and its branches, are preserved in order to feed the nasoseptal fl ap.

40

Due care should be taken to preserve the vascular pedicle (posterior septal artery and branches) of the nasoseptal fl ap that will be used to reconstruct the skull base (Fig. 40).

ISS intersinus septumS nasal septumSS sphenoid sinusST superior turbinate

Key to Acronyms


Once, the openings made in both sphenoid sinuses have been fully enlarged, a posterior septectomy is performed, resecting 1 – 2 cm of the posterior nasal septum with a backward-cutting forceps (Fig. 41). Bilateral instrumentation using a four-hand technique is feasible without running the risk that the septum might get into the path of the scope. The user is given the advantage of increased lateral angulation and improved range of motion for maneuvering instruments (Fig. 42).

Prior to proceeding with the sellar stage, a pedicled nasoseptal fl ap is elevated. A sickle knife is guided along the boundaries of the fl ap, defi ned by the following landmarks: superior, the level of the middle turbinate insertion; anterior, 1 – 2 cm anteriorly of the middle turbinate; inferior, the junction of the nasal septum to the nasal fl oor.

The posterior edge of the nasal septum is resected with back-ward-cutting forceps to provide space for instrumentation and improve visualization.

41 Panoramic view offered by a 0° scope following bilateral sphenoidotomy of standard expansion and posterior septectomy.

42

An anterior septal incision is made to tailor the nasoseptal fl ap in the left nasal cavity.

43 Submucous septal dissection with a FREER Elevator.44

Next, a submucous septal dissection is performed in order to elevate the fl ap, which is kept in the nasopharynx until the sellar stage of the procedure has been completed (Figs. 43 – 47).

ISS intersinus septumMT middle turbinateS nasal septumSS sphenoid sinus

Key to Acronyms


Elevation of a nasoseptal fl ap (F) in the left nasal cavity.45 Following its elevation, the fl ap is kept in the nasopharynx until the sellar stage of the procedure has been completed.

46

Panoramic view of the left nasal cavity during a transphenoidal approach (0° scope). Note, the posterior septectomy using a four-hand-technique, and the nasoseptal fl ap. The left superior and middle turbinates are dislocated laterally with a FREER elevator to widen the visual fi eld.

47 Resection of the sphenoid intersinus septum using a GRÜNWALD-HENKE RHINOFORCE® II nasal cutting forceps.

48

Wide bilateral sphenoidotomy.49 Resection of the inferior portion of the sphenoid sinus using a high-speed drill with cutting burr.

50

The intersinus septum of the sphenoid sinus should be removed using cutting forceps (Figs. 48, 49). In this way, inadvertent bony fractures, that may precipitate vascular injuries, like internal carotid artery rupture or CSF leakage, can be avoided. The inferior portion of the sphenoid sinus may be removed using a high-speed drill with a cutting burr (Fig. 50).

F nasoseptal fl apICA sulcus of intercavernous internal carotid arteryIT inferior turbinateS sella turcicaSS sphenoid sinus

Key to Acronyms


The next step of the procedure is called the sellar stage. The bony sellar fl oor is drilled with a diamond burr and thinned down to “egg-shell” thickness. For posterior bone removal, a Kerrison micro punch is used (Figs. 51 – 53). Following resection of the sellar bone, an opening is made in the dura mater using micro scissors (Fig. 54).

The intradural endoneurosurgical technique is performed using dedicated instruments. A binostril four-hand dissection technique should be employed, applying traction and counter-traction maneuvers to detach the tumor from the neurovascular structures. Micro scissors, delicate dissectors, and a long, small-diameter suction tip have shown to be very useful to manage these situations (Figs. 55 – 57). A fi nal inspection should be done with a 0°-scope and/or 30°/45°-scope to search for tumor remnants (Fig. 58).

The bony sellar fl oor is drilled with a diamond burr. Note, how the suction tube located at the fl oor of the sphenoid sinus is used to aspirate irrigation liquid.

51 Sellar bone resection using a KERRISON micro punch.52

Sellar bone resection using a KERRISON micro punch. Note, that the dura mater underlying the bone, is preserved.

53 Creation of a dural opening using straight micro scissors. Two surgeons collaborate employing a binostril four-hand technique.

54

ICA sulcus of intercavernous internal carotid arteryS sella turcicaC clivus

Key to Acronyms


Wide sellar exposure reaching the boundaries of the cavernous sinus, laterally and extending from the planum sphenoidale, superiorly to the clivus, inferiorly. The binostril four-hand technique is advocated for sharp dissection of an intradural tumor.

55 The intrasellar view afforded by the scope is a great advantage of this technique, allowing to perform a complete dissection.

56

Tumor removal after completion of sharp dissection.57 Final inspection of the sella by use of a 0°-scope demonstrating intracranial neurovascular structures.

58

Once the tumor has been removed successfully, skull base reconstruction is completed by using the pedicled nasoseptal fl ap to cover the sellar defect (Figs. 59, 60).

CS cavernous sinusF nasoseptal fl ap pedicle of the fl ap

Key to Acronyms

The nasoseptal fl ap (F) is used to cover the defect. Note, the pedicle of the fl ap is located on the left side (arrow).

59 Final aspect of skull base reconstruction with a nasoseptal fl ap (boundaries of which are delineated by the dotted line) elevated in the left nasal cavity at the beginning of the procedure.

60


A FREER elevator is used to penetrate the lamina papyracea.62 Upon removal of the medial orbital wall, the content of the orbit can be visualized with a 0°-scope.

63

F orbital fatFE fovea ethmoidalisMS maxillary sinusMT middle turbinateSS sphenoid sinusST superior turbinate

sphenopalatine artery

Key to Acronyms

Other Procedures

Identifi cation of the Sphenopalatine ArteryThe endoscopic approach for sphenopalatine artery ligation usually involves the use of a 0°- or 30°-scope. In the fi rst step, the scope is introduced through the middle meatus. The posterior fontanelle of the maxillary sinus is palpated with a seeker until a bony portion is identifi ed. Then, a mucoperiostal fl ap is elevated with a FREER elevator, approximately 1 cm anterior to the posterior insertion of the middle turbinate. The next step is to identify the artery emerging from the sphenopalatine foramen and to proceed with posterior ligation (Fig. 61). There is no need to perform a middle antrostomy.

Orbital DecompressionTransnasal endoscopic orbital decompression is indicated in some conditions, like Graves’ ophthalmopathy or in case of orbital complications as a sequela of rhinosinusitis.

Once a complete uncinectomy has been performed, the maxillary sinus ostium is enlarged and the agger nasi and bulla ethmoidalis are removed. Then, a complete antero-posterior ethmoidectomy is performed. The skull base is identifi ed and the junction between the lamina papyracea and skull base is clearly visualized. A FREER elevator is used to penetrate the lamina papyracea until orbital fat is exposed (Fig. 62).

Finally, the medial orbital wall is removed and its content can be visualized using a 0°-scope (Fig. 63).

Exposure of the sphenopalatine artery ( ) at the site where the artery enters the sphenopalatine foramen.

61


Recommended Set: Endoscopic Dissection Training for Nose, Paranasal Sinuses and Skull Base Using the Sinus Model Otorhino-Neuro Trainer (S.I.M.O.N.T.)


Special Features:## Exact reproduction of human anatomy (particularly the nasal and sphenoidal regions)

## Realistic surgical conditions including filled blood vessels## Tactile feedback owing to specific synthetic materials simulating the consistency and texture of real human tissue structures

## Consumables can be replaced after use or when worn

28199 LS S.I.M.O.N.T. Head Model, for training endoscopic dissection of the nose, paranasal sinuses and skull base

including: Insert Head Power Supply Base Joystick Pump Head Support

28199 LSA S.I.M.O.N.T. Insert, for use with S.I.M.O.N.T. Head Model 28199 LS

Sinus Model Otorhino-Neuro Trainer (S.I.M.O.N.T.)Realistic head model for training endoscopic dissection of the nose, paranasal sinuses and skull base

It is recommended to check the suitability of the product for the intended procedure prior to use.


7230 AA

7230 AA HOPKINS® Straight Forward Telescope 0°, enlarged view, diameter 4 mm, length 18 cm, autoclavable, fiber optic light transmission incorporated, color code: green

7230 FA HOPKINS® Forward-Oblique Telescope 45°, enlarged view, diameter 4 mm, length 18 cm, autoclavable, fiber optic light transmission incorporated, color code: black

HOPKINS® Telescopes – autoclavablediameter 4 mm, length 18 cm

7230 BA HOPKINS® Forward-Oblique Telescope 30°, enlarged view, diameter 4 mm, length 18 cm, autoclavable, fiber optic light transmission incorporated, color code: red


FESS Instrumentsfor Endoscopic Diagnosis, Surgery and Postoperative Treatment of Nasal Sinuses and Anterior Skull Base

459010 STAMMBERGER RHINOFORCE® II Antrum Punch, upside backward cutting, with cleaning connector, working length 10 cm

459010

451501 B

451501 B GRÜNWALD-HENKE RHINOFORCE® II Nasal Cutting Forceps, 45º upturned, through-cutting, tissue-sparing, BLAKESLEY shape, size 1, width 3.5 mm, with cleaning connector, working length 13 cm

452002 B MACKAY-GRÜNWALD RHINOFORCE® II Nasal Cutting Forceps, straight, through-cutting, extra delicate, tissue-sparing, 11.5 x 3.5 mm, size 2, with cleaning connector, working length 13 cm

452002 B



456001 B

456001 B BLAKESLEY RHINOFORCE® II Nasal Forceps, straight, size 1, with cleaning connector, working length 13 cm

459052

459051 STAMMBERGER Antrum Punch, right side downward and forward cutting, working length 10 cm

459052 Same, left side downward and forward cutting

651055

651055 STAMMBERGER Punch, circular cutting, for sphenoid, ethmoid and choanal atresia, diameter 3.5 mm, with cleaning connector, working length 18 cm

651060 Same, 65° upturned, for frontal sinus recess, working length 17 cm


615010 Antrum Punch, for removal of small bone fragments on natural ostium, rigid, not through-cutting, 65° upbiting forward cutting, size 3.5 x 3.7 mm, working length 11 cm

615010


662300

662300 Scissors, straight, working length 15 cm


615025

615025 CASTELNUOVO Sphenoid Punch, rigid, 30° upturned, not through-cutting, upbiting forward cutting, fixed jaw extra flat, size 2 x 2 mm, working length 11 cm


662101 K

662101 K KERRISON Micro Punch, detachable, short model, rigid, 90° upbiting, not throughcutting, size 1 mm, working length 12 cm



204812 FERGUSON Suction Tube, with cut-off hole and stylet, LUER, 12 Fr., working length 11 cm

628702 Antrum Curette, oblong, small size, length 19 cm

223300 PLESTER Sickle Knife, double-edged, standard model, slightly curved, length 16 cm

474000 FREER Elevator, double-ended, semisharp and blunt, length 20 cm

629820 Probe, double-ended, maxillary sinus ostium seeker, ball-shaped ends diameter 1.2 and 2 mm, length 19 cm

204812 628702

628702

1/1

223300 474000 629820


UNIDRIVE® S III ENT SCB/UNIDRIVE® S III ECOThe multifunctional unit for ENT

UNIDRIVE® S III ENT SCB UNIDRIVE® S III ECO

Touch Screen: Straightforward function selection via touch screen

Optimized user control due to touch screen

Set values of the last session are stored

Choice of user languages

Operating elements are single and clear to read due to color display

One unit – multifunctional: – Shaver system for surgery of the paranasal sinuses and anterior skull base– INTRA Drill Handpieces (40,000 rpm and 80,000 rpm)– Sinus Shaver– Micro Saw– STAMMBERGER-SACHSE Intranasal Drill– Dermatome– High-Speed Handpieces (60,000 rpm and 100,000 rpm)

Two motor outputs: Two motor outputs for simultaneous connection of two motors: For example, a shaver and micro motor

Integrated irrigation and coolant pump:– Absolutely homogeneous, micro-processor controlled irrigation rate throughout

the entire irrigation range– Quick and easy connection of the tubing set

Easy program selection via automated motor recognition

Irrigator rod included

Continuously adjustable revolution range

Maximum number of revolutions and motor torque: Microprocessor-controlled motor rotation speed. Therefore the preselected parameters are maintained throughout the drilling procedure

Maximum number of revolutions can be preset

SCB model with connections to the KARL STORZ Communication Bus (KARL STORZ-SCB)

l –

l l

l –

Special Features:

l –

l –

l l

l l

l –

l –

l l

l l

l –

l l

l

l l

l –

Soft start function

Textual error messages l –

UN

IDR

IVE

® S

III

EC

O

UN

IDR

IVE

® S

III

EN

T S

CB


Motor SystemsSpecifications


Touch Screen: 6.4" / 300 cd/m2

Weight: 5.2 kg 4.7 kg

Certified to: IEC 601-1 CE acc. to MDD IEC 60601-1

Available languages: English, French, German, numerical codes Spanish, Italian, Portuguese, Greek, Turkish, Polish, Russian

System specifications

Mode Order No. rpm

Shaver mode oscillating Operation mode: in conjunction with Handpiece: Max. rev. (rpm): DrillCut-X® II Shaver Handpiece 40 7120 50 10,000*

DrillCut-X® II N Shaver Handpiece 40 7120 55 10,000*

Sinus burr mode rotating Operation mode: in conjunction with Handpiece: Max. rev. (rpm): DrillCut-X® II Shaver Handpiece 40 7120 50 12,000

DrillCut-X® II N Shaver Handpiece 40 7120 55 12,000

High-speed drilling mode counterclockwise or clockwise Operation mode: in conjunction with: Max. rev. (rpm): High-Speed Micro Motor 20 7120 33 60,000/100,000

Drilling mode counterclockwise or clockwise Operation mode: in conjunction with: Max. rev. (rpm): micro motor 20 7110 33 40,000/80,000

and connecting cable 20 7111 73

Micro saw mode in conjunction with: Max. rev. (rpm): micro motor 20 7110 33 15,000/20,000

and connecting cable 20 7111 73

Intranasal drill mode in conjunction with: Max. rev. (rpm): micro motor 20 7110 33 60,000 and connecting cable 20 7111 73

Dermatome mode in conjunction with: Max. rev. (rpm): micro motor 20 7110 33 8,000 and connecting cable 20 7111 73

Power supply: 100 – 240 VAC, 50/60 Hz

Dimensions: 300 x 165 x 265 mm (w x h x d)

Two outputs for parallel connection of two motors

Integrated irrigation pump: Flow: adjustable in 9 steps

* Approx. 4,000 rpm is recommended as this is the most efficient suction/performance ratio.

[ ]

[ ]

[ ]

[ ]


Motor SystemsSpecial features of high-performance EC micro motor IIand of the high-speed micro motor

l Self-cooling, brushless high-performance EC micro motor

l Smallest possible dimensionsl Autoclavablel Can be processed in a cleaning machinel Detachable connecting cable

## INTRA coupling for a wide variety of applications

## Maximum torque 4 Ncm## Number of revolutions continuously adjustable up to 40.000 rpm

## Provided a suitable handle is used, the number of revolutions is continuously adjustable up to 80,000 rpm

20 7110 33

20 7110 33 High-Performance EC Micro Motor II, for use with UNIDRIVE® II/UNIDRIVE® ENT/OMFS/NEURO/ECO and Connecting Cable 20 7110 73, or for use with UNIDRIVE® S III ENT/ECO/NEURO and Connecting Cable 20 7111 73

Special features of high-performance EC micro motor II:

l Brushless high-speed micro motorl Smallest possible dimensionsl Autoclavablel Can be processed in a cleaning machinel Maximum torque 6 Ncm

## Number of revolutions continuously adjustable up to 60.000 rpm

## Provided a suitable handle is used, the number of revolutions is continuously adjustable up to 100,000 rpm

Special Features of the high-speed micro motor:

20 7120 33

20 7120 33 High-Speed Micro-Motor, max. speed 60,000 rpm, including connecting cable, for use with UNIDRIVE® S III ENT/NEURO

20 7111 73 Connecting Cable, to connect High-Performance EC Micro Motor 20 7110 33 to UNIDRIVE® S III ENT/ECO/NEURO


UNIDRIVE® S III ENT SCB UNIDRIVE® S III ECORecommended System Configuration

* mtp medical technical promotion gmbh, Take-Off GewerbePark 46, D-78579 Neuhausen ob Eck, Germany

40 7016 20-1 40 7014 20

40 7016 01-1 UNIDRIVE® S III ENT SCB, motor control unit with color display, touch screen, two motor outputs, integrated irrigation pump and SCB module, power supply 100 – 240 VAC, 50/60 Hz

including: Mains Cord Irrigator Rod Two-Pedal Footswitch, two-stage, with proportional function Silicone Tubing Set, for irrigation, sterilizable Clip Set, for use with silicone tubing set SCB Connecting Cable, length 100 cm Single Use Tubing Set*, sterile, package of 3


Specifications:

Touch Screen

Flow

Power supply

UNIDRIVE® S III ENT SCB: 6,4"/300 cd/m2

9 steps

100-240 VAC, 50/60 Hz

Dimensions w x h x d

Weight

Certified to

300 x 165 x 265 mm

5.2 kg

EC 601-1, CE acc. to MDD

40 7014 01 UNIDRIVE® S III ECO, motor control unit with two motor outputs and integrated irrigation pump, power supply 100 – 240 VAC, 50/60 Hz

including: Mains Cord Two-Pedal Footswitch, two-stage, with proportional function Silicone Tubing Set, for irrigation, sterilizable Clip Set, for use with silicone tubing set


DrillCut-X® II N Shaver Handpiece, optional adaptability to Shaver Tracker, for use with UNIDRIVE® S III ECO/ENT/NEURO

40 7120 55

20 7116 40

Silicone Tubing Set

U N I T S I D E

P A T I E N T S I D E

Shaver Blade

41305 DN

Shaver Blade, curved

41201 KN

41302 KN

Sinus Burr

Two-Pedal Footswitch

20 0166 30

DrillCut-X® II Shaver Handpiece, for use with UNIDRIVE® S III ECO/ENT/NEURO

40 7120 50

252660 – 252692

High-Speed Handpiece

High-Speed Micro-Motor

20 7120 33

660000

Intranasal Drill

High-Performance EC Micro Motor II

20 7110 3320 7111 73

252575 – 252590

INTRA Drill Handpiece

UNIDRIVE® S III ENT SCB UNIDRIVE® S III ECOSystem Components


* mtp medical technical promotion gmbh, Take-Off GewerbePark 46, D-78579 Neuhausen ob Eck, Germany

Optional Accessoriesfor UNIDRIVE® S III ENT SCB and UNIDRIVE® S III ECO

031131-10* Tubing Set, for irrigation, for single use, sterile, package of 10

280053 C Spray Nozzle, for the reprocessing of INTRA burr handpieces, for use with Universal Spray 280053 B

280053 Universal Spray, 6x 500 ml bottles – HAZARDOUS GOODS – UN 1950 including: Spray Nozzle


Max. 10,000 rpm for shaver blades, max. 12,000 rpm for sinus shaver

Straight suction channel

Integrated irrigation channel

Powerful motor, also suitable for harder materials

Absolutely silent running, no vibration

Completely immersible and machine-washable

LOCK allows fixation of shaver blades and sinus shavers

Extremely lightweight design

Optional, ergonomic handle, detachable

Can be adapted to navigation tracker

l

Special Features:

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l

l

l

l

–

l

l

l

l

l

l

l

l

l

l

l

l

Dri

llCut

-X®

II

4071

2050

Dri

llCut

-X®

II N

40

7120

55

DrillCut-X® Shaver HandpiecesSpecial Features

40 7120 50 DrillCut-X® II Shaver Handpiece, for use with UNIDRIVE® S III ECO/ENT/NEURO/OMFS

40 7120 50

40 7120 55 DrillCut-X® II N Shaver Handpiece, optional adaptability to Shaver Tracker 40 8001 22, for use with UNIDRIVE® S III ECO/ENT/NEURO/OMFS

40 7120 55


DrillCut-X® II Shaver Handpiece

Special Features:## Powerful motor## Absolutely silent running## Enhanced ergonomics## Lighweight design## Oscillation mode for shaver blades, max. 10,000 rpm

## Rotation mode for sinus shavers, max. 12,000 rpm## Straight suction channel and integrated irrigation

40 7120 50 DrillCut-X® II Shaver Handpiece, for use with UNIDRIVE® S III ECO/ENT/NEURO/OMFS

## The versatile DrillCut-X® II Shaver Handpiece can be adapted to individual needs of the user

## Easy hygienic processing, suitable for use in washer and autoclavable at 134° C

## Quick coupling mechanism facilitates more rapid exchange of work inserts

## Proven DrillCut-X® blade portfolios can be used

40 7120 90

40 7120 90 Handle, adjustable, for use with DrillCut-X® II 40 7120 50 and DrillCut-X® II N 40 7120 55

41250 RA

41250 RA Cleaning Adaptor, LUER-Lock, for cleaning DrillCut-X® shaver handpieces

Optional Accessory:

40 7120 50


DrillCut-X® II Shaver N Handpiece

Special Features:## Powerful motor## Absolutely silent running## Enhanced ergonomics## Lighweight design## Oscillation mode for shaver blades, max. 10,000 rpm

## Rotation mode for sinus shavers, max. 12,000 rpm

## Straight suction channel and integrated irrigation## The versatile DrillCut®-X II Shaver N Shaver Handpiece can be adapted to the individual needs of the user

40 7120 55 DrillCut-X® II N Shaver Handpiece, optional adaptability to Shaver Tracker 40 8001 22, for use with UNIDRIVE® S III ECO/ENT/NEURO/OMFS

## Easy hygienic processing, suitable for use in washer and autoclavable at 134° C

## Quick coupling mechanism facilitates more rapid exchange of working inserts

## Proven DrillCut-X® blade portfolios can be used## Optional adaptability to Shaver Tracker 40 8001 22## Allows shaver navigation when used with NPU 40 8000 01

40 7120 90


41250 RA

41250 RA Cleaning Adaptor, LUER-Lock, for cleaning DrillCut-X® shaver handpieces

Optional Accessory:

40 7120 55


Handle for DrillCut-X® II Shaver Handpiecefor use with DrillCut-X® II 40 7120 50 and DrillCut-X® II N 40 7120 55

Special Features:## Ergonomic design## Ultralight construction## Easy handle control allows individual adjustment

40 7120 90

## Variable mounting options to DrillCut-X® II or DrillCut-X® II N Shaver Handpieces

## Easy fixation via rotary lock## Sterilizable



Shaver Blades, straightfor Nasal Sinuses and Skull Base Surgery

For use with DrillCut-X® II and DrillCut-X® II N

41201 GN

serrated cutting edge, diameter 4 mm, color code: blue-red

concave cutting edge, oblique cutting window, diameter 4 mm, color code: blue-black

straight cutting edge, diameter 4 mm, color code: blue-blue



Shaver Blade length 12 cmDetail 40 7120 50 DrillCut-X® II Handpiece

40 7120 55 DrillCut-X® II N Handpiece

41201 KN

41201 KK

41201 GN

41201 LN

41201 SN

41201 KSA

double serrated cutting edge, diameter 3 mm, color code: blue-yellow

41201 LSA


concave cutting edge, oval cutting window, diameter 4 mm, color code: blue-green


41201 KKSB

Shaver Blades, straight, sterilizable

for use with

41201 KKSA

41200 RA Cleaning Adaptor, LUER-Lock, for cleaning the inner and outer blades of reusable Shaver Blades 412xx

Optional Accessory:


Shaver Blades, curvedfor Nasal Sinuses and Skull Base Surgery


41204 KKB

curved 35°, cutting edge serrated backwards, diameter 4 mm, color code: blue-red

curved 40°, cutting edge serrated backwards, double serrated, diameter 4 mm, color code: blue-yellow

41202 KN

curved 40°, cutting edge serrated forwards, double serrated, diameter 4 mm, color code: blue-yellow

41204 KKF

41204 KKB


41204 KKFA

41204 KKBA




Shaver Blades, curved 35°/40°, sterilizable

for use with


Optional Accessory:




41203 KKF

curved 65°, cutting edge serrated forwards, diameter 4 mm, color code: blue-red


41203 KNF


41203 KKF

41203 KNB


curved 65°, concave cutting edge, oval cutting window, forward opening, diameter 4 mm, color code: blue-green

curved 65°, concave cutting edge, oval cutting window, backward opening, diameter 4 mm, color code: blue-green

41203 KKB

41203 KKFA

41203 KKBA

41203 GNF

41203 GNB





Shaver Blades, curved 65°, sterilizable

for use with


Optional Accessory:


Shaver Blades, straightfor Nasal Sinuses and Skull Base Surgery

41301 KK



straight cutting edge, diameter 4 mm, color code: blue-blue





concave cutting edge, oval cutting window, diameter 4 mm, color code: blue-green

41301 KN

41301 KK

41301 GN

41301 LN

41301 SN

41301 KSA

41301 KKSA

41301 LSA

Shaver Blade length 12 cm Detail 40 7120 50 DrillCut-X® II Handpiece



41301 KKSB

for use with

Shaver Blades, straight, for single use , sterile, package of 5





41302 KN

for use withShaver Blade length 12 cmDetail 40 7120 50 DrillCut-X® II Handpiece







Shaver Blades, curved 35°/40°, for single use , sterile, package of 5

41302 KN

41304 KKF

41304 KKB

41304 KKFA

41304 KKBA



41303 KKB


Shaver Blades, curved 65°, for single use , sterile, package of 5

41303 KNF

41303 KKF

41303 KNB

41303 KKB

41303 KKFA

41303 KKBA

41303 GNF

41303 GNB

curved 65°, cutting edge serrated forwards, diameter 4 mm, color code: blue-red




curved 65°, cutting edge concave forwards, oval cutting window, diameter 4 mm, color code: blue-green

curved 65°, cutting edge concave backwards, oval cutting window, diameter 4 mm, color code: blue-green



Shaver Blade length 12 cmDetail

for use with

40 7120 50 DrillCut-X® II Handpiece40 7120 55 DrillCut-X® II N Handpiece


Sinus Burrs, curvedfor Nasal Sinuses and Skull Base Surgery


41305 RN

Sinus Burrs, curved 70°/55°/40°/15°, for single use , sterile, package of 5

41303 WN

41303 DT

41304 W

41305 RN

41305 DN

41305 D

Sinus Burr length 12 cmDetail 40 7120 50 DrillCut-X® II Handpiece


for use with

curved 55°, cylindric, drill diameter 3.6 mm, shaft diameter 4 mm, color code: red-blue

curved 15°, bud drill, drill diameter 4 mm, shaft diameter 4 mm, color code: red-black

curved 15°, diamond head, drill diameter 3 mm, shaft diameter 4 mm, color code: red-yellow

curved 70°, diamond head, drill diameter 3.6 mm, shaft diameter 4 mm, color code: red-yellow

curved 40°, cylindric, drill diameter 3 mm, shaft diameter 4 mm, color code: red-blue


41305 DW



Accessories for Shaver

39550 A Wire Tray, provides safe storage of accessories for KARL STORZ paranasal sinus shaver systems during cleaning and sterilization

for storage of: – Up to 7 shaver attachments

– Connecting cable

39550 A

Please note: The instruments displayed are not included in the sterilizing and storage tray.


INTRA Drill Handpiecefor Surgery in Ethmoid and Skull Base Area

252571

252571 INTRA Drill Handpiece, angled, length 15 cm, transmission 1:1 (40,000 rpm), for use with KARL STORZ high-performance EC micro motor II and burrs

252574 Same, Transmission 1:2 (80.000 rpm)

Special Features:l Tool-free closing and opening of the drilll Right/left rotationl Max. rotating speed up to

40,000 rpm / 80,000 U/minl Detachable irrigation channels

l Lightweight constructionl Operates with little vibrationsl Low maintenancel Reprocessable in a cleaning machinel Safe grip

252574

252591

SizeDetail Dia. mm Standard Diamond Diamond

coarse

014 1.4

018 1.8

023 2.3

027 2.7

031 3.1

035 3.5

040 4

045 4.5

050 5

060 6

649614

649618

649623

649627

649631

649635

649640

649645

649650

649660

649714 –

–649718

649723

649727

649731

649735

649740

649745

649750

649760

649723 G

649727 G

649731 G

649735 G

649740 G

649745 G

649750 G

649760 G

070 7 649670 649770 649770 G

649700 Diamond Straight Shaft Burr, stainless, size 014 – 070, length 9.5 cm, set of 11

649700 G Rapid Diamond Straight Shaft Burr, stainless, with coarse diamond coating for precise drilling and abrasion without hand pressure and generating minimal heat, size 023 – 070, length 9.5 cm, set of 9, color code: gold

280033 Rack, for 36 straight shaft burrs with a length of 9.5 cm, foldable, sterilizable, size 22 x 14 x 2 cm

9.5 cm

649600 – 649770 G

649600 Standard Straight Shaft Burr, stainless, size 014 – 070, length 9.5 cm, set of 11

252591 INTRA Drill Handpiece, straight, length 13 cm, transmission 1:1 (40,000 rpm), for use with KARL STORZ high-performance EC micro motor II and burrs


INTRA Drill Handpiecefor Surgery in Ethmoid and Skull Base Area

Special Features:l Tool-free closing and opening of the drilll Right/left rotationl Max. rotating speed up to

40,000 rpm / 80,000 U/minl Detachable irrigation channels

l Lightweight constructionl Operates with little vibrationsl Low maintenancel Reprocessable in a cleaning machinel Safe grip

252572

252575

252575 Same, transmission 1:2 (80,000 rpm)

252572 INTRA Drill Handpiece, angled, length 18 cm, transmission 1:1 (40,000 rpm), for use with KARL STORZ high-performance EC micro motor II and burrs

649700 GL Rapid Diamond Straight Shaft Burr, stainless, with coarse diamond coating for precise drilling and abrasion without hand pressure and generating minimal heat, sizes 023 – 070, length 12.5 cm, set of 9, color code: gold

649700 L Diamond Straight Shaft Burr, stainless, size 014 – 070, length 12.5 cm, set of 11


649600 L Standard Straight Shaft Burr, stainless, size 014 – 070, length 12.5 cm, set of 11

12.5 cm

649600 L – 649770 GL

SizeDetail Dia. mm

Standard Diamond Diamond coarse

014 1.4

018 1.8

023 2.3

027 2.7

031 3.1

035 3.5

040 4

045 4.5

050 5

060 6

649614 L

649618 L

649623 L

649627 L

649631 L

649635 L

649640 L

649645 L

649650 L

649660 L

649714 L –

–649718 L

649723 L

649727 L

649731 L

649735 L

649740 L

649745 L

649750 L

649760 L

649723 GL

649727 GL

649731 GL

649735 GL

649740 GL

649745 GL

649750 GL

649760 GL

070 7 649670 L 649770 L 649770 GL

sterilizable sterilizable sterilizable

252592 INTRA Drill Handpiece, straight, length 17 cm, transmission 1:1 (40,000 rpm), for use with KARL STORZ high-performance EC micro motor II and burrs252592


Accessories for Burrs

Please note: The burrs displayed are not included in the racks.

280033 280034



280043 Rack, flat model, to hold 21 straight shaft burrs with a length of 7 cm (6 pcs) and 9.5 cm (15 pcs), folding model, sterilizable, size 17.5 x 11.5 x 1.2 cm

280043

n


Accessories for Burrs

39552 B

39552 A Wire Tray, provides safe storage of accessories for KARL STORZ drilling/grinding systems during cleaning and sterilization, includes tray for small parts, for use with Rack 280030, rack not included

for storage of: – Up to 6 drill handpieces

– Connecting cable – EC micro motor – Small parts

39552 B Wire Tray, provides safe storage of accessories for KARL STORZ drilling/grinding systems during cleaning and sterilization, includes tray for small parts, for use with Rack 280030, rack included

for storage of: – Up to 6 drill handpieces

– Connecting cable – EC micro motor – Up to 36 drill bits and burrs – Small parts

Tray for small parts included

Please note: The instruments displayed are not included in the sterilizing and storage tray.


UNIDRIVE® S III ENT SCBHigh-Speed Handpieces, angled, 100,000 rpm

For use with High-Speed Drills, shaft diameter 3.17 mm and with High-Speed Micro Motor 20 7120 33

100,000 rpm

diameter 7.5 mm

252681 High-Speed Handpiece, medium, angled, 100,000 rpm, for use with High-Speed Micro-Motor 20 7120 33

252682 High-Speed Handpiece, long, angled, 100,000 rpm, for use with High-Speed Micro-Motor 20 7120 33

252681

252682

53 mm

93 mm

7.5 mm

7.5 mm

20 7120 33


UNIDRIVE® S III ENT SCBHigh-Speed Handpieces, angled, 60,000 rpm

252661 High-Speed Handpiece, short, angled, 60,000 rpm, for use with High-Speed Micro-Motor 20 7120 33

252662 High-Speed Handpiece, medium, angled, 60,000 rpm, for use with High-Speed Micro-Motor 20 7120 33


252661

252662

51 mm

71 mm

252663 High-Speed Handpiece, long, angled, 60,000 rpm, for use with High-Speed Micro-Motor 20 7120 33

252663

91 mm

60,000 rpm

diameter 5.5 mm

5.5 mm

5.5 mm

5.5 mm

20 7120 33


UNIDRIVE® S III ENT SCBHigh-Speed Handpieces, straight, 60,000 rpm

252691 High-Speed Handpiece, short, straight, 60,000 rpm, for use with High-Speed Micro-Motor 20 7120 33

252692 High-Speed Handpiece, medium, straight, 60,000 rpm, for use with High-Speed Micro-Motor 20 7120 33


252691

252692

51 mm

71 mm

60,000 rpm

diameter 5.5 mm

5.5 mm

5.5 mm

20 7120 33


UNIDRIVE® S III ENT SCBHigh-Speed Handpieces, malleable, slim, angled, 60,000 rpm

252671 High-Speed Handpiece, extra long, malleable, slim, angled, 60,000 rpm, for use with High-Speed Micro-Motor 20 7120 33

252672 High-Speed Handpiece, super long, malleable, slim, angled, 60,000 rpm, for use with High-Speed Micro-Motor 20 7120 33

For use with High-Speed Drills, shaft diameter 1 mm and with High-Speed Micro Motor 20 7120 33

252672

128 mm

252671

108 mm

60,000 rpm

diameter 4.7 mm

malleable

The handpieces have malleable shafts that can be bent up to 20° according to user requirements.

4.7 mm

4.7 mm

20 7120 33


UNIDRIVE® S III ENT SCBHigh-Speed Standard Burrs, High-Speed Diamond Burrs

For use with High-Speed Handpieces, 100,000 rpm

252681 252682

High-Speed Standard Burrs, 100,000 rpm, for single use , sterile, package of 5

Diameter in mm

1

medium long

350110 M –

2 350120 M 350120 L

3 350130 M 350130 L

4 350140 M 350140 L

5 350150 M 350150 L

6 350160 M 350160 L

7 350170 M 350170 L

High-Speed Diamond Burrs, 100,000 rpm, for single use , sterile, package of 5

Diameter in mm

1

medium long

350210 M –

2 350220 M 350220 L

3 350230 M 350230 L

4 350240 M 350240 L

5 350250 M 350250 L

6 350260 M 350260 L

7 350270 M 350270 L

100,000 rpm

diameter 7.5 mm


UNIDRIVE® S III ENT SCBHigh-Speed Diamond Burrs, High-Speed Acorn,High-Speed Barrel Burrs, High-Speed Neuro Fluted Burrs


252681 252682

High-Speed Coarse Diamond Burrs, 100,000 rpm, for single use , sterile, package of 5

Diameter in mm

3

medium long

350330 M 350330 L

4 350340 M 350340 L

5 350350 M 350350 L

6 350360 M 350360 L

7 350370 M 350370 L

High-Speed Acorn, 100,000 rpm, for single use , sterile, package of 5

Diameter in mm

7.5

medium

350675 M

9 350690 M

High-Speed Barrel Burrs, 100,000 rpm, for single use , sterile, package of 5

Diameter in mm

6

medium

350960 M

9.1 350991 M

High-Speed Neuro Fluted Burrs, 100,000 rpm, for single use , sterile, package of 5

Diameter in mm

1.8

medium

350718 M

3 350730 M

long

350718 L

350730 L

100,000 rpm

diameter 7.5 mm


UNIDRIVE® S III ENT SCBHigh-Speed Standard Burrs, High-Speed Diamond Burrs


252661 252662

252691 252692

252663

High-Speed Standard Burrs, 60,000 rpm, for single use , sterile, package of 5

Diameter in mm

1

short medium

330110 S 330110 M

2 330120 S 330120 M

3 330130 S 330130 M

4 330140 S 330140 M

5 330150 S 330150 M

6 330160 S 330160 M

7 330170 S 330170 M


Diameter in mm

0.6

short medium

330206 S –

1 330210 S 330210 M

1.5 330215 S –

2 330220 S 330220 M

3 330230 S 330230 M

4 330240 S 330240 M

5 330250 S 330250 M

long

–

330120 L

330130 L

330140 L

330150 L

330160 L

330170 L

long

–

–

–

330220 L

330230 L

330240 L

330250 L

6 330260 S 330260 M 330260 L

7 330270 S 330270 M 330270 L

60,000 rpm

diameter 5.5 mm


UNIDRIVE® S III ENT SCBHigh-Speed Diamond Burrs, High-Speed Cylinder Burrs,LINDEMANN High-Speed Fluted Burrs



Diameter in mm

3

short medium

330330 S 330330 M

4 330340 S 330340 M

5 330350 S 330350 M

6 330360 S 330360 M

7 330370 S 330370 M

long

330330 L

330340 L

330350 L

330360 L

330370 L

High-Speed Cylinder Burrs, 60,000 rpm, for single use , sterile, package of 5

Diameter in mm

4

short

330440 S

6 330460 S

LINDEMANN High-Speed Fluted Burrs, 60,000 rpm, for single use , sterile, package of 5

Size in mm (diameter x length)

Diameter 2.1/11

short

330511 S

Diameter 2.3/26 330526 S

252661 252662

252691 252692

252663

60,000 rpm

diameter 5.5 mm


UNIDRIVE® S III ENT SCBHigh-Speed Diamond Burrs


252671 252672


Diameter in mm

2

extra long

320220 EL

super long

320220 SL

3 320230 EL 320230 SL

4 320240 EL 320240 SL


Diameter in mm

2

extra long

320320 EL

super long

320320 SL

3 320330 EL 320330 SL

4 320340 EL 320340 SL

60,000 rpm

diameter 4.7 mm


TELE PACK X LED Documentation Terminal, Compact, Mobile

n

TELE PACK X LED is a compact, portable and flexible system that can be used for a wide range of applications from the doctor’s office through to the emergency room in various disciplines such as gynecology, uro lo gy, anesthesiology or plastic surgery.

To enable swift and easy work with the TELE PACK X LED, the system combines all that is needed: Monitor, camera

and light source. Consideration has also been given to documentation: Integrated data management enables comprehensive recording of medical examinations or surgical interventions. Multiple USB ports and an SD card slot are available to store the data.

Crystal-clear display## 15" LED backlight display## Image rotation## 24-bit color depth for natural color rendition## DVI-D video output for connecting monitors

Flexible storage possibilities## SD card slot for high storage capacity## USB ports for external hard drives, USB flash drives

## MPEG4 video recording with sound via microphone input

## Compatible with medical-grade USB Color Printer 549 M

## Picture gallery for recordings## Playback of saved videos## Patient information input and reports

Natural illumination## High-performance LED light source similar to Power LED 175

## Color temperature of 6400 K, similar to daylight, guarantees color fidelity

## Average lamp life up to 30,000 hours

Easy control combined with highest safety## Membrane keyboard for wipe-down disinfection## Hot keys for rapid and direct adjustment## Arrow keys for intuitive control

Appendix## Sturdy, portable housing## Ergonomically designed handle for convenient transport

## Stroboscopy function via a separate special footswitch

## Universal power supply: 100 – 240 VAC, 50/60 Hz## Dimensions (w x h x d): 450 x 350 x 150 mm## Weight: 7 kg


Telecam SL IICamera Head

For use with TELECAM SL II FI Camera Control Unit 20 2130 11U1, TELECAM SL II Camera Control Unit 20 2130 11U, TELECAM DX II Camera Control Unit 20 2330 11, TELE PACK 20 0430 20-020 and TELE PACK X 20 0450 01-EN

20 2120 30

20 2120 30 PAL TELECAM® 20 2121 30 NTSC One-Chip Camera Head

color system PAL/NTSC, soakable, gas-sterilizable, with integrated Parfocal Zoom Lens, f = 25 - 50 mm (2x), 2 freely programmable camera head buttons

TELE PACK X LED Sample Configuration

n

TP 100EN

Specifications:

Power input

Power supply


Weight

Interface

Light source

100 W

100-240 VAC

450 x 350 x 150

7 kg

- video interface: DVI-D (in/out) - audio: 3.5 mm phonejack (1x lateral,

1x rear), Line in, Line out- footswitch port: 5-pin socket for two-pedal

footswitch- printer port: USB- printer language: PostScript

- lamp: Metal halid 50 W- color temperature: 5700 K- average service life: approx. 1000 h

Image format

Video codec

Video format

Memory interface

TFT monitor

Loudspeaker output

JPG

MPEG-4

PAL/NTSC

USB 2.0; SD memory card (SDHC compatible)

- screen size: 15“ - resolution: 1024 x 768 - contrast: 700:1

2 W

TP 100EN TELE PACK X LED

endoscopic video unit for use with all KARL STORZ TELECAM one-chip camera heads and video endoscopes, incl. LED light source similar to Xenon technology, with integrated digital Image Processing Module, 15" LCD TFT-monitor with LED backlight, USB/SD memory module, color systems PAL/NTSC, power supply 100 - 240 VAC, 50/60 Hzincluding:USB Silicone Keyboard, with touchpad, US character setUSB Flash Drive, 4 GBMains CordMains Cord, US version


Innovative Design## Dashboard: Complete overview with intuitive menu guidance

## Live menu: User-friendly and customizable## Intelligent icons: Graphic representation changes when settings of connected devices or the entire system are adjusted

## Automatic light source control## Side-by-side view: Parallel display of standard image and the Visualization mode

## Multiple source control: IMAGE1 S allows the simultaneous display, processing and documentation of image information from two connected image sources, e.g., for hybrid operations

Dashboard Live menu

Side-by-side view: Parallel display of standard image and Visualization mode

Intelligent icons

Economical and future-proof## Modular concept for flexible, rigid and 3D endoscopy as well as new technologies

## Forward and backward compatibility with video endoscopes and FULL HD camera heads

## Sustainable investment## Compatible with all light sources

IMAGE1 S Camera System n


Brillant Imaging## Clear and razor-sharp endoscopic images in FULL HD

## Natural color rendition

## Reflection is minimized## Multiple IMAGE1 S technologies for homogeneous illumination, contrast enhancement and color shifting

FULL HD image CHROMA

FULL HD image SPECTRA A *

FULL HD image

FULL HD image CLARA

SPECTRA B **

* SPECTRA A : Not for sale in the U.S.** SPECTRA B : Not for sale in the U.S.



TC 200EN* IMAGE1 S CONNECT, connect module, for use with up to 3 link modules, resolution 1920 x 1080 pixels, with integrated KARL STORZ-SCB and digital Image Processing Module, power supply 100 – 120 VAC/200 – 240 VAC, 50/60 Hz

including: Mains Cord, length 300 cm DVI-D Connecting Cable, length 300 cm SCB Connecting Cable, length 100 cm USB Flash Drive, 32 GB, USB silicone keyboard, with touchpad, US

* Available in the following languages: DE, ES, FR, IT, PT, RU

Specifications:

HD video outputs

Format signal outputs

LINK video inputs

USB interface SCB interface

- 2x DVI-D - 1x 3G-SDI

1920 x 1080p, 50/60 Hz

3x

4x USB, (2x front, 2x rear) 2x 6-pin mini-DIN

100 – 120 VAC/200 – 240 VAC

50/60 Hz

I, CF-Defib

305 x 54 x 320 mm

2.1 kg

Power supply

Power frequency

Protection class


Weight

TC 300 IMAGE1 S H3-LINK, link module, for use with IMAGE1 FULL HD three-chip camera heads, power supply 100 – 120 VAC/200 – 240 VAC, 50/60 Hz, for use with IMAGE1 S CONNECT TC 200ENincluding:Mains Cord, length 300 cm

Link Cable, length 20 cm

For use with IMAGE1 S IMAGE1 S CONNECT Module TC 200EN


TC 300 (H3-Link)

TH 100, TH 101, TH 102, TH 103, TH 104, TH 106 (fully compatible with IMAGE1 S) 22 2200 55-3, 22 2200 56-3, 22 2200 53-3, 22 2200 60-3, 22 2200 61-3, 22 2200 54-3, 22 2200 85-3 (compatible without IMAGE1 S technologies CLARA, CHROMA, SPECTRA*)

1x

100 – 120 VAC/200 – 240 VAC

50/60 Hz

I, CF-Defib

305 x 54 x 320 mm

1.86 kg

Camera System

Supported camera heads/video endoscopes

LINK video outputs

Power supply

Power frequency

Protection class


Weight

Specifications:

TC 200EN

TC 300

* SPECTRA A : Not for sale in the U.S.** SPECTRA B : Not for sale in the U.S.


TH 100 IMAGE1 S H3-Z Three-Chip FULL HD Camera Head, 50/60 Hz, IMAGE1 S compatible, progressive scan, soakable, gas- and plasma-sterilizable, with integrated Parfocal Zoom Lens, focal length f = 15 – 31 mm (2x), 2 freely programmable camera head buttons, for use with IMAGE1 S and IMAGE 1 HUB™ HD/HD

IMAGE1 FULL HD Camera Heads

Product no.

Image sensor


Weight

Optical interface

Min. sensitivity

Grip mechanism

Cable

Cable length

IMAGE1 S H3-Z

TH 100

3x 1/3" CCD chip

39 x 49 x 114 mm

270 g

integrated Parfocal Zoom Lens, f = 15 – 31 mm (2x)

F 1.4/1.17 Lux

standard eyepiece adaptor

non-detachable

300 cm

Specifications:

TH 100

For use with IMAGE1 S Camera System IMAGE1 S CONNECT Module TC 200EN, IMAGE1 S H3-LINK Module TC 300 and with all IMAGE 1 HUB™ HD Camera Control Units

IMAGE1 S Camera Heads n


9826 NB

9826 NB 26" FULL HD Monitor, wall-mounted with VESA 100 adaption, color systems PAL/NTSC, max. screen resolution 1920 x 1080, image fomat 16:9, power supply 100 – 240 VAC, 50/60 Hzincluding:External 24 VDC Power SupplyMains Cord

9619 NB

9619 NB 19" HD Monitor, color systems PAL/NTSC, max. screen resolution 1280 x 1024, image format 4:3, power supply 100 – 240 VAC, 50/60 Hz, wall-mounted with VESA 100 adaption,including:

External 24 VDC Power SupplyMains Cord

Monitors


Monitors

Optional accessories:9826 SF Pedestal, for monitor 9826 NB9626 SF Pedestal, for monitor 9619 NB

26"

9826 NB

l

–

l

l

l

l

l

–

l

–

l

l

l

l

l

l

19"

9619 NB

l

–

–

l

l

l

l

l

l

l

–

l

l

l

l

l

KARL STORZ HD and FULL HD Monitors

Wall-mounted with VESA 100 adaption

Inputs:

DVI-D

Fibre Optic

3G-SDI

RGBS (VGA)

S-Video

Composite/FBAS

Outputs:

DVI-D

S-Video

Composite/FBAS

RGBS (VGA)

3G-SDI

Signal Format Display:

4:3

5:4

16:9

Picture-in-Picture

PAL/NTSC compatible

19"

optional

9619 NB

200 cd/m2 (typ)

178° vertical

0.29 mm

5 ms

700:1

100 mm VESA

7.6 kg

28 W

0 – 40°C

-20 – 60°C

max. 85%

469.5 x 416 x 75.5 mm

100 – 240 VAC

EN 60601-1, protection class IPX0

Specifications:

KARL STORZ HD and FULL HD Monitors

Desktop with pedestal

Product no.

Brightness

Max. viewing angle

Pixel distance

Reaction time

Contrast ratio

Mount

Weight

Rated power

Operating conditions

Storage

Rel. humidity


Power supply

Certified to

26"

optional

9826 NB

500 cd/m2 (typ)

178° vertical

0.3 mm

8 ms

1400:1

100 mm VESA

7.7 kg

72 W

5 – 35°C

-20 – 60°C

max. 85%

643 x 396 x 87 mm

100 – 240 VAC

EN 60601-1, UL 60601-1, MDD93/42/EEC, protection class IPX2


Data Management and DocumentationKARL STORZ AIDA® – Exceptional documentation

The name AIDA stands for the comprehensive implementation of all documentation requirements arising in surgical procedures: A tailored solution that flexibly adapts to the needs of every specialty and thereby allows for the greatest degree of customization.

This customization is achieved in accordance with existing clinical standards to guarantee a reliable and safe solution. Proven functionalities merge with the latest trends and developments in medicine to create a fully new documentation experience – AIDA.

AIDA seamlessly integrates into existing infrastructures and exchanges data with other systems using common standard interfaces.

WD 200-XX* AIDA Documentation System, for recording still images and videos, dual channel up to FULL HD, 2D/3D, power supply 100-240 VAC, 50/60 Hz

including: USB Silicone Keyboard, with touchpad ACC Connecting Cable DVI Connecting Cable, length 200 cm HDMI-DVI Cable, length 200 cm Mains Cord, length 300 cm

WD 250-XX* AIDA Documentation System, for recording still images and videos, dual channel up to FULL HD, 2D/3D, including SMARTSCREEN® (touch screen), power supply 100-240 VAC, 50/60 Hz

including: USB Silicone Keyboard, with touchpad ACC Connecting Cable DVI Connecting Cable, length 200 cm HDMI-DVI Cable, length 200 cm Mains Cord, length 300 cm

*XX Please indicate the relevant country code (DE, EN, ES, FR, IT, PT, RU) when placing your order.


Workflow-oriented use

Patient

Entering patient data has never been this easy. AIDA seamlessly integrates into the existing infrastructure such as HIS and PACS. Data can be entered manually or via a DICOM worklist. ll important patient information is just a click away.

Checklist

Central administration and documentation of time-out. The checklist simplifies the documentation of all critical steps in accordance with clinical standards. All checklists can be adapted to individual needs for sustainably increasing patient safety.

Record

High-quality documentation, with still images and videos being recorded in FULL HD and 3D. The Dual Capture function allows for the parallel (synchronous or independent) recording of two sources. All recorded media can be marked for further processing with just one click.

Edit

With the Edit module, simple adjustments to recorded still images and videos can be very rapidly completed. Recordings can be quickly optimized and then directly placed in the report. In addition, freeze frames can be cut out of videos and edited and saved. Existing markings from the Record module can be used for quick selection.

Complete

Completing a procedure has never been easier. AIDA offers a large selection of storage locations. The data exported to each storage location can be defined. The Intelligent Export Manager (IEM) then carries out the export in the background. To prevent data loss, the system keeps the data until they have been successfully exported.

Reference

All important patient information is always available and easy to access. Completed procedures including all information, still images, videos, and the checklist report can be easily retrieved from the Reference module.


20 1614 01-1 Cold Light Fountain Power LED 175 SCB, with integrated SCB, high-performance LED and one KARL STORZ light outlet, power supply 110–240 VAC, 50/60 Hz

including: Cold Light Fountain Power LED Mains Cord SCB Connecting Cable, length 100 cm

Cold Light Fountain Power LED 175 SCB

Accessories for Video Documentation

495 NA Fiber Optic Light Cable, with straight connector, diameter 3.5 mm, length 230 cm


UG 540 Monitor Swifel Arm, height and side adjustable, can be turned to the left or the right side, swivel range 180°, overhang 780 mm, overhang from centre 1170 mm, load capacity max. 15 kg, with monitor fixation VESA 5/100, for usage with equipment carts UG xxx

UG 540

Equipment Cart

UG 220

UG 220 Equipment Cart wide, high, rides on 4 antistatic dual wheels equipped with locking brakes 3 shelves, mains switch on top cover, central beam with integrated electrical subdistributors with 12 sockets, holder for power supplies, potential earth connectors and cable winding on the outside,

Dimensions: Equipment cart: 830 x 1474 x 730 mm (w x h x d), shelf: 630 x 510 mm (w x d), caster diameter: 150 mm

inluding: Base module equipment cart, wide Cover equipment, equipment cart wide Beam package equipment, equipment cart high 3x Shelf, wide Drawer unit with lock, wide 2x Equipment rail, long Camera holder


Recommended Accessories for Equipment Cart

UG 310 Isolation Transformer, 200 V – 240 V; 2000 VA with 3 special mains socket, expulsion fuses, 3 grounding plugs, dimensions: 330 x 90 x 495 mm (w x h x d), for usage with equipment carts UG xxx

UG 310

UG 410 Earth Leakage Monitor, 200 V – 240 V, for mounting at equipment cart, control panel dimensions: 44 x 80 x 29 mm (w x h x d), for usage with isolation transformer UG 310

UG 410

UG 510 Monitor Holding Arm, height adjustable, inclinable, mountable on left or right, turning radius approx. 320°, overhang 530 mm, load capacity max. 15 kg, monitor fixation VESA 75/100, for usage with equipment carts UG xxx

UG 510

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