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ENDOSCOPIC SURGERY OF THE ORBIT AND RELATED STRUCTURES

Abdulla ALREDHA1, FRCS EdNarayanan PREPAGERAN2, FRCS Ed

1Clinical Fellow 2Professor

Department of Otorhinolaryngology, University of Malaya Medical Center

Kuala Lumpur, Malaysia

Endoscopic Surgery of the Orbit and Related Structures4

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Endoscopic Surgery of the Orbit and Related StructuresAbdulla ALREDHA1, FRCS Ed Narayanan PREPAGERAN2, FRCS Ed1 Clinical Fellow2 Professor, Department of Otorhinolaryngology, University of Malaya Medical Center, Kuala Lumpur, Malaysia

Correspondence address: Prof. Narayanan Prepageran, FRCS Ed Department of Otorhinolaryngology, University of Malaya Medical Center Kuala Lumpur, 50603 Malaysia Phone: 60-3-7950-2062 Fax: 60-3-7955-6963 E-mail: [email protected]

© 2014 ® Tuttlingen, Germany ISBN 978-3-89756-190-8, Printed in Germany P.O. Box, D-78503 Tuttlingen, Germany Phone: +49 74 61/1 45 90 Fax: +49 74 61/708-529 E-mail: [email protected]

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Prof. Narayanan Prepageran, FRCS Ed

Abdulla ALREDHA, FRCS Ed

5Endoscopic Surgery of the Orbit and Related Structures

Contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Endoscopic Dacryocystorhinostomy (DCR) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Orbital Decompression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10History of the Procedure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Endoscopic Orbital Decompression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Postoperative Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Results and Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Conclusions and Clinical Cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Endoscopic Optic Nerve Decompression (EOND) . . . . . . . . . . . . . . . . . . . . . . . 15Recommended Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Surgical Steps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Endoscopic Transnasal Repair of Orbital Blow-out Fractures . . . . . . . . . . . . . 18Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Clinical Case: Endoscopic Trans nasal Repair of Orbital Blow-out Fracture . . . . . . . . 20

Management of Intraorbital Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Clinical Cases: Endoscopic Surgical Management of Intraorbital Tumors . . . . . . . . . . 21

Recommended Instrumentation and Video Equipment for Endoscopic Surgery of the Orbit and Related Structures . . . . . . . . . . . . . . . . . 23


Introduction

In recent years, there has been a growing trend towards the use of minimally invasive techniques in surgery. This is, for the most part, governed by the objective of achieving a better cosmetic outcome while reducing the morbidity rate associated with extensive tissue dissection. Endoscopic surgery exemplifies these attempts and has been enthusiastically adopted by the ear nose throat (ENT) surgeons.

Endoscopic surgery of the orbit is a challenging frontier which is becoming the standard of surgical care for pathologies within and around the orbit.

Endoscopic orbital and paraorbital surgery, however, has evolved over the years and is performed primarily via sinonasal approaches by ENT surgeons. Transnasal endoscopic approaches are well established for dacrocystorhinostomy, orbital decompression, orbital medial wall fracture repair and optic canal decompression.

In this pictorial manual we will demonstrate the surgical steps of the most common diseases we have managed comfortably with the aim of helping the practicing intermediate level endoscopic sinus surgeon to easily reproduce these maneuvers.

The following endoscopic procedures will be demonstrated in this booklet: Dacryocystorhinostomy (DCR) Orbital Decompression Optic Nerve Decompression Management of Intraorbital Tumors Management of Orbital Floor Fractures

We would like to thank Prof. Dr Omkara Rubini Lingham for editing the text.

Abdulla Alredha1 and Narayanan Prepageran2

1Clinical Fellow, 2Professor Dept. of Otorhinolaryngology, University of Malaya Medical Center University of Malaya, Kuala Lumpur, Malaysia


Endoscopic Dacryocystorhinostomy (DCR)

Endoscopic dacryocystorhinostomy (DCR) is indicated for patients with lacrimal sac obstruction or nasolacrimal duct obstruction (NLDO).

NLDO is common, and presenting symptoms include epiphora and dacryocystitis (infection). Endoscopic DCR is usually considered for patients who have been refractory to conventional treatment such as probing and flushing of the nasolacrimal duct.

Established advantages of the endoscopic approach include the absence of external incision and scar formation, preservation of the orbicularis oculi pump mechanism, preservation of medial canthal anatomy, improved visualization, decreased operating time, less intraoperative bleeding, and the ability of the surgeon to address con current intranasal pathology, including septal deviations and ethmoid disease.

Endoscopic DCR is also useful to revise failed external DCR. The nasal endoscope directly visualises the cause(s) of failure such as an inadequately sized osteotomy and nasal synechiae, allowing to provide more specific treatment.

The success rates of the external approach have been reported to range above 90%. Endonasal laser-assisted approaches were found to yield lower success rates from 60% to 86%, probably due to thermal scarring of the fistula. The advent of powered drilling instruments to remove the hard bone adjacent to the lacrimal sac has improved the success rates of endoscopic DCR to 95%.1–3

TechniqueThere are various methods to successfully perform EDCR. Thus, it is advisable to use a method that is easily performed, in the shortest time and with good results. We describe a method that we have been using for the last 9 years with a mean success rate of 94.5% and average operating time of 25 minutes.4–5

Endoscopic DCR is usually performed under general anesthesia. Collaboration with an ophthalmic surgeon is recommended as most cases are seen by them and their help in cannulating the punctum is invaluable for a beginning surgeon. We manage our cases together with the ophthalmologist. The nasal cavity is first packed with patties or ribbon gauze soaked with a decongestant. A lacrimal fiberoptic light probe is passed through a dilated and probed lacrimal punctum which aids in endonasal diaphanoscopic localization of the outline of the lacrimal sac (Figs. 1–5).

1 Punctum dilator. 2 Punctum cannulation by use of a Bowman probe.

3 Insertion of a light probe.

4 Endonasal endoscopic view of the illuminated lacrimal sac and maxillary line.

5 Outline of the lacrimal sac and duct.


7 The bone adjacent to the lacrimal sac is fully exposed after elevating the mucosal flap.

Lacrimal bone illuminated via lacrimal sac

Elevator

10 Mucosa of the lacrimal sac.

13 A wide fistula has been created between the lacrimal sac and nasal mucosa.

8 The cutting burr is used for creating the initial osteotomy.

11 Wide osteotomy with lacrimal sac tented.

14 Punctum probe demonstrating the upper border of the osteotomy.

9 The diamond burr is used to finally thin the lacrimal bone.

12 Vertical incision of mucosa.

Once the sac has been identified, a mucosal flap is elevated, prior to which the area is injected with a standard marcaine-adrenaline mixture via a dental syringe. This will allow the lacrimal bone to be demonstrated with the sac brightly lighted, defining clearly the outline and margins of the sac. The bone overlying the illuminated sac is removed in one of the next operative steps.

The bone at the superior margin of the osteotomy is often very thick and angled in a position that makes it ackward for removal by a Kerrison ronguer. Thus, a curved DCR diamond-tipped burr is employed for this, and is applied until the lacrimal sac can be seen. The bone is drilled to such an extent that all margins of the illuminated sac are clearly seen. The latter is tented up with a No. 3/0 Bowman probe placed horizontally through the inferior canaliculus (Figs. 6–11).

A corresponding vertical or C-shaped incision is made along the entire length of the lacrimal sac and its posterior flap is apposed to that of the nasal mucosa. The anterior flaps of both mucosal linings are then positioned to cover the raw bony edges of the osteotomy. Both upper and lower canalicular stenting using (O’Donaghue or Jones) tubes is performed to maintain patency of the DCR site, and the stents are removed 12 weeks later (Figs. 12–20).

6 Incision of nasal mucosa.

Elevated mucosal flap

Drilled out lacrimal bone

Tented up lacrimal sac

Incomplete incision of lacrimal sac mucosa

Complete incision of lacrimal sac mucosa


15 Pulling through the punctum probe. 16 A single Jones tube has been pulled through the fistula.

19 The nasal mucosa has been repositioned over the Liga clips.

17 Double Jones tubes secured with Liga clips.

20 Intranasal aspect of cut ends of Liga clips.18 Jones tubes in position without tension in the inter-palpebral fissure.

The nasal cavity may be left without packing as in most cases the bleeding is very minimal. The post-operative regimen is similar to that of external DCR surgery (the avoidance of strenuous activities, straining, blowing the nose, sneezing and pulling on the stent). Patients are also put on nasal decongestants, antibiotics and eye drops.

Advantages of Endoscopic DCR

Easy identification of the lacrimal sac which can be difficult without using an external light probe, as in some cases the lacrimal sac can be sclerotic due to repeated infections and abscess formation.

The illuminated sac allows easy identification of the its borders. The entire sac can be easily exposed by “just following the light”.

The ophthalmologist is directly involved in the surgery hence improving the relationship between departments and facilitating the setting up of a “Lacrimal Clinic”.

Bone is removed or drilled according to the transilluminated area thus minimizing accidental exposure and iatrogenic injury to the orbit.

In our experience of about 100 cases, the use of tubes for cannulating the punctum was shown to be associated with minimal complications. We had only 2 cases of tube extrusion in children. Almost all patients are comfortable with the tubes in situ.

The method, in our opinion, is the easiest and fastest (average of 25 mins) with excellent results (94–95% success), and has the added benefit of a quick learning curve.

References1. HARTIKAINEN J, ANTILA J, VARPULA M,

PUUKKA P, SEPPA H, GRENMAN R. Prospective randomized comparison of endonasal endoscopic dacryocystorhinostomy and external dacryocystorhinostomy. Laryngoscope 1998;108:1861–6.

2. MUELLNER K, BODNER E, MANNOR GE, WOLF G, HOFMANN T, LUXENBERGER W. Endolacrimal laser assisted lacrimal surgery. Br J Ophthalmol 2000;84:16–8.

3. TSIRBAS A, WORMALD PJ. Mechanical endo nasal dacryocystorhinostomy with mucosal flaps. Br J Ophthalmol 2003;87:43–7.

4. KRISHNAN G, PREPAGERAN N, MUTHU K. Endonasal endoscopic dacryocystorhino stomy. Med J Malaysia 2002;57:404–7.

5. RASAN MI, SHAILENDRA S, PREPAGERAN N, GOPALA K, SATHANANTHAR KS. Endoscopic dacryocystorhinostomy. Med J Malaysia 2008;63:143–5.

Jones tubes

Liga clips


Orbital Decompression

History of the ProcedureGraves disease, originally called Graves-Basedow disease, was first described as the triad of hyperthyroidism, goiter, and exophthalmos in 1835. Dollinger, who described lateral orbital decompression, initially advocated surgical decompression of the orbit for thyroid ophthalmopathy in 1911. Naffziger described an intracranial approach to orbital decompression in 1930.1 This technique was not widely adopted because of the morbidity associated with the procedure and postoperative intra cranial complications (eg, meningitis, transmission of CNS pulsations to the orbit).

Otolaryngologists became involved in orbital decompression in 1936 when Sewall described an external ethmoidectomy approach for decompression of the medial orbital wall. This involvement continued with the development of the Walsh-Ogura technique, presented in 1957, which involved a transantral approach to remove both the medial and inferior orbital walls of the bony orbit.2 The Walsh-Ogura technique became the mainstay of surgical treatment for Graves disease. Even though effective decompression can be achieved with this method, the incidence of newly onset postoperative diplopia can be high.

In 1993, Garrity et al. monitored 428 patients undergoing orbital decompression for Graves ophthalmopathy and reported a 64% incidence of recurrent onset post operative diplopia.3 Although the reported incidence rate is often lower, newly onset diplopia is a concern for all patients faced with orbital decompression. The advent of advanced endoscopic techniques has enabled surgeons to decompress the orbit endoscopically, providing effective decompression with less morbidity. This is primarily a result of circumventing a gingival incision and a low incidence of cranial nerve V2 hypoesthesia. Although an endoscopic approach to the medial and inferior walls can be performed in isolation, a balanced approach, incorporating a lateral decompression with repositioning of the lower lid, can be required.

Endoscopic Orbital DecompressionOrbital decompression for the treatment of Graves’ orbitopathy is an invaluable technique for patients with proptosis, exposure keratopathy and optic neuropathy. The expanding role of transnasal endoscopic surgery leads to a natural extension of the management of selected orbital tumors and fibro-osseous lesions with orbital extension. Traditional open approaches that have been described over the past century are limited by suboptimal visualization and carry the morbidity of incisions within the facial skin, oral cavity or conjunctiva. Endoscopic orbital decompression allows for safe and effective decompression of the medial and inferior orbital walls with minimal morbidity to the patient.

Indications

Endocrine Graves’ Orbitopathy (associated with exophthalmos, exposure keratopathy, diplopia, and optic neuropathy).

To gain access to the orbit for removal of benign orbital tumors, biopsy of lesions or as palliative therapy for malignant tumors causing visual symptoms.

As an approach to tumors located medial to the optic nerve, as well as sinonasal or skull base tumors with extension into the orbital compartment.


Technique

Objective

The objective of endoscopic orbital decompression is the removal of the entire medial orbital wall and the medial portion of the orbital floor up to the infraorbital nerve.

Preoperative Examination and Surgical Planning

CT (Axial + Coronal) is mandatory as a baseline and roadmap for surgery.

Visual and eye movement assessment is also vital.

Patient Positioning and Preoperative Setup

The patient is positioned supine on the operating room table similar to the surgical set-up for endoscopic sinus surgery. A slight extension of the head may help in visualizing the orbit during surgery. Topical vasoconstriction is achieved with either oxymetazoline (0.05%) or cocaine (4%). The eyes are left uncovered and lubricated with a topical antibiotic as it will be “balloted” during surgery to help identify the orbit endoscopically. The mucosa of the middle turbinate and lateral nasal wall are infiltrated with lidocaine (1%) and epinephrine (1:100,000) (Fig. 1).

If a septal deviation obstructs visualization of the middle meatus, a septoplasty is performed before commencing orbital decompression.

Technique

Initially, an uncinectomy is performed to obtain access to the middle nasal meatus.

A large middle meatal antrostomy (MMA) is then carried out to visualize the floor of the orbit. The surgical boundaries extend from the posterior border of the nasolacrimal duct up to the posterior wall of the maxillary antrum and inferiorly flush with the inferior turbinate (to provide access to the orbital floor). A large medial meatotomy is also important so that the prolapsed orbital contents do not occlude the maxilla.

A complete ethmoidectomy (anterior and posterior ethmoidectomy) is performed with skeletonization of the lamina papyracea as far posterior as to the orbital apex to create adequate space for the herniated orbital contents and provide landmarks of the sphenoid ostia and ethmoid roof for maximal decompression (Figs. 2–3).

1 Infiltration of the lateral nasal wall.

3 Anterior ethmoidectomy.2 Uncinectomy.

a

Right ethmoid bulla.

b

Uncinate process

Right ethmoid bulla


The lamina papyracea is then elevated with an elevator or ball-tipped probe from a few millimeters posterior to the posterior margin of lacrimal sac all the way to the anterior wall of sphenoid (Fig. 4). In this way, the entire periorbita is exposed allowing to visualize a large medial meatal antrostomy (Fig. 5). The bony fragments can be removed with a Blakesley forceps. Bone can be removed superiorly up to the skull base, and usually the entry of both anterior and posterior ethmoidal arteries into the orbit can be visualized (Fig. 6).

The inferomedial portion of the orbital floor is removed by downfracturing the bone with a heavy curette. Subsequently, the floor or the orbit is removed as far as the infraorbital nerve. This challenging step can be managed with the aid of a 30° HOPKINS® endoscope and angled forceps assisting in the bone removal. A buttress of bone is preserved anteriorly at the juncture of the inferior and medial orbital walls to avoid excessive inferior herniation of the globe (Fig. 7).

Following removal of the lamina papyracea and medial orbital floor, a sickle knife is used to make 3–4 horizontal incisions along the exposed periorbita up to the posterior limit of decompression (anterior sphenoid sinus wall). Care must be taken not to plunge the tip of the sickle knife as there is a risk of iatrogenic injury to the orbital contents (Figs. 8–9). Other sharp instruments can also be used e.g., pterygium knife.

The horizontal incisions are made in a posterior-to-anterior direction, starting inferiorly and proceeding superiorly, so that the prolapse of herniated fat does not obstruct visualization. The periorbita can be removed between incisions to maximize pro lapse of orbital contents into the nasal cavity. Palpating the globe externally can help identify these bands and facilitate prolapse or fat herniation (Figs. 9–11).

Nasal packing is not done to avoid pressure to the orbital apex and optic nerve.

Postoperative CarePatients are kept overnight to observe for hemorrhage and are discharged with a 10-day course of broad spectrum antibiotics and instructed to douche the nose with saline solution twice a day, to clear mucus and debris. The rest of the follow up is similar to those who have undergone standard endoscopic sinus surgery.

4 Elevation of the lamina papyracea exposing the periorbita.

b

9 Superior periorbital incision with orbital fat.

Right periorbita incisedSickle knife

Orbital fat

5 A wide medial meatal antrostomy (MMA) is made and the periorbita exposed.

6 Elevation of the lamina papyracea exposing the periorbita.

a

8 Right periorbita.

Inferomedial orbital fl oorRight orbit

Wide MMA

Rightperi-orbita

Downfracturing the inferomedial orbital fl oor

Right orbit

Wide right MMA

Inferomedial orbital floor

7 Downfracturing the inferomedial orbital floor.


Results and ComplicationsSuccessful outcome of orbital decompression is defined by the indication of surgery. Accordingly, for patients with optic neuropathy secondary to compressive pathology, recovery of vision indicates the success while in cases with exposure keratopathy or severe proptosis, cosmetic appearance and resolution of exposure keratitis is the goal.

The clinical scenario dictates the extent of orbital decompression required. In endo-scopic orbital decompression, the medial wall and part of the inferior orbital wall are removed. In the authors’ experience of around 40 cases, this provides an ocular reduction of proptosis of 3.0 mm. Complications include diplopia and epistaxis. Diplopia can be prevented to some extent by preserving an anterior bony strut that will prevent the orbit from rotating medially. The authors had only one case of diplopia with this technique.

Conclusions and Clinical CasesEndoscopic orbital decompression provides successful treatment for patients with Graves’ orbitopathy (Figs. 12–15). Excellent visualization of the orbital apex and skull base allow for effective reduction in proptosis with minimal patient morbidity. The expanding role of transnasal endoscopic sinus and skull base surgery leads to a natural extension for the management of selected orbital tumors and fibro-osseous lesions with orbital extension. These advanced procedures should be performed by surgeons who have significant experience in endoscopic techniques. An example of endoscopic tumor excision and orbital decompression of extensive ossifying fibroma in a 6 year old child is illustrated in Figs. 16–18.

10 Inferior and superior periorbital incisions.

Superior incision

Inferiorincision

12 Proptotic eye before surgery: This patient had difficulty sleeping as he couldn’t fully

close his eyes.

a

11 Orbital content decompression. Note: the frontal recess and maxillary ostium are free

of obstruction to prevent mucocele formation.

Right frontal sinus recess

Right orbit decompressed

Right MMA

Proptotic eyes: semi-profile view.

b

Proptotic eyes despite under general anesthesia with muscle relaxant: note failure of eyelid closure and marked esposure keratitis.

c

Preoperative Views


13 Eyes open: Reduction of exposed scleral and improvement of exposure keratitis.

a

14 Axial CT scan: Note the proptosis and hypertrophic rectii muscles.

a

15 Axial CT scan: Medial orbital contents herniating into the nose. Reduction of

proptosis 1 year post surgery.

Eyes closed: Complete closure of eyelid.

b

Coronal CT scan: Note the hypertrophic medial and inferior rectii muscles.

b

16 Recurrent fibromyxoma compressing the orbit.

Postoperative Views

CT Images – Preoperative Views

CT Images – Postoperative Views

17 Endoscopic view after tumor excision and orbital decompression.

18 Close-up view of the rectus muscle following endoscopic tumor removal and

orbital decompression.

References1. NAFFZIGER HC. Progressive Exophthalmos

Following Thyroidectomy; Its Pathology and Treatment. Ann Surg 1931;94:582–6.

2. WALSH TE, OGURA JH. Transantral orbital decompression for malignant exophthalmos. Laryngoscope 1957;67:544–68.

3. Garrity JA, Fatourechi V, Bergstralh EJ, et al. Results of transantral orbital decompression in 428 patients with severe Graves’ ophthalmopathy. Am J Ophthalmol 1993;116:533–47.


Endoscopic Optic Nerve Decompression (EOND)

Endoscopic decompression of optic nerve is indicated in cases of traumatic and /or inflammatory compression or damage to the optic nerve in the area of the orbital apex, the optic canal or along its course in the walls of the posterior ethmoid bone and the sphenoid sinus. In our setting, the decision-making for EOND is developed jointly with the ophthalmologist and / or neurosurgeon.

Optic nerve decompression can be performed as a stand-alone procedure or in combination with orbital decompression.

Recommended Indications

Treatment of papilledema accompanying pseudotumor cerebri (idiopathic intracranial hypertension).

Surgical treatment of traumatic optic neuropathy is indicated, if — visual acuity does not improve to 20/400 or better despite 24–48 hours of steroid therapy or — if visual acuity is 20/200 or better, but deteriorates during or after completion of steroid therapy.

Non-arteritic anterior ischemic optic neuropathy (NAION).

Surgical StepsThe use of an image-guided navigation system is not compulsory, however the system offers the advantage of anatomical identification. The entire surgical procedure can be performed with a HOPKINS® 0°-telescope and involves that the patient is placed in the supine position with the head slightly extended.

A standard sphenoethmoidectomy is performed (anterior ethmoidectomy, posterior ethmoidectomy and transethmoidal sphenoidotomy), the optic nerve and the prominence of the internal carotid artery are identified in the sphenoid sinus (Fig. 1).

The sphenoid sinus is enlarged laterally, flush with the orbital apex (Fig. 2).

2 Dissecting the left orbital apex region.

Left orbital apex region

1 Anatomy of the left orbital apex region, view of the sphenoid via transethmoid sphenoido tomy.

Left orbital apex region

Left ICA

Left optico-carotid recess

Left optic nerve

a b


3 Drilling the left orbital apex.

Orbital apex

Optic nerve

ICA

Diamond burra

Curetting the right optic tubercle and optic canal.

Curetting the right optic tubercle and optic canal

Right ICA

b

Next, the lamina papyracea is entered with a small curette or Freer elevator, 1 cm anterior to the sphenoid face. The lamina is removed posteriorly towards the optic nerve using curettes and Blakesley forceps. The thick bone (of the optic canal) posteriorly can usually be removed with a curette, however in 10% of cases, the bone is thick and can make drilling with a diamond burr mandatory (Figs. 3–5).

The optic nerve with its sheath is exposed for a distance of approximately 10–15 mm (Fig. 6). The bony opening created in this way should expose at least 120° of the nerve’s circumference (Fig. 7). Some authors advocate a longitudinal incision of the annulus of Zinn in order to open the optic nerve sheath. Clinical indications for opening these structures have not been clearly defined. Once the bony canal has been removed and the sheath has been incised, the procedure is concluded. No intra-nasal packing is placed. As mentioned earlier, the optic nerve can be decompressed as an adjunct procedure to that of orbital decompression, however it is advisable to incise the periorbita secondary to optic nerve decompression.

Figs. 8–10 show images of endoscopic orbital and optic nerve decompression performed in a patient with tuberculosis and concomitant loss of vision. Figs. 11a–d are images of endoscopic optic nerve decompression in a patient with marked vision loss (optic neuritis) after radiotheraphy for nasopharyngeal carcinoma.

4 Curetting the right optic canal.

Right optic nerve

6 Curetting the right optic canal.

Right optic nerve

5 Right optic nerve decompressed.

Right optic canal skeletonized

ICARight optic nerve

7 Right optic nerve decompressed.

Left ICALeft optic canal drilled out exposing optic n.

Left optic n.

8 Final aspect of decompressed right orbit and optic nerve.

Right ethmoid roof

Right optic nerve

Right orbit decompressed

Right ICARight MMA

10 Close-up view of decompressed right optic nerve.

DuraRight opticnerve

Right ICA

Right optico-carotid recess

9 Close-up view of decompressed right orbit and optic nerve.

Right optic n.Right orbit

Right ICA


TipsThe orbit is shaped like an ice cream cone that tapers posteriorly, medially and slightly inferior as well. To identify the optic nerve, just follow the orbit as it tapers posteriorly guiding you to the optic nerve. A sphenoidotomy is important as the optic canal seen within the sphenoid will facilitate identifying the orbital apex.

11 Endoscopic optic nerve decompression for optic neuritis after radiotheraphy for naso pharyngeal carcinoma (a–c).

a

Optic nerve sheath opened.

d

b

c

References1. KOUNTAKIS SE, MAILLARD AA, EL-HARAZI SM,

LONGHINI L, URSO RG. Endoscopic optic nerve decompression for traumatic blindness. Otolaryngol Head Neck Surg 2000;123:34–7.

2. TANG IP, PREPAGERAN N, SUBRAYAN V, TAJUNISAH I. Endoscopic orbital decompression for optic neuropathy in thyroid ophthalmopathy. Med J Malaysia 2008;63:337–8.

12 CT scan of the patient above demonstrating edematous orbital apex

post radio theraphy.

13 CT scan of patient post trauma with optic nerve compressed by bony fragments.

14 Endoscopic view of bony fragment impinging on nerve.

15 Endoscopic view of fractured bony pieces overlying the optic nerve.

16 Endoscopic view after removal of the fractured bony pieces.


Endoscopic Transnasal Repair of Orbital Blow-out Fractures

BackgroundThis procedure must be carried out in collaboration with an ophthalmologist. Nasal endoscopy provides direct visualization of the orbital floor fracture and unimpeded access to the target site of repair which involves complete reduction of herniat ed orbital soft tissues in addition to release of the entrapped muscle without globe retraction.

This approach averts the need for lower eyelid incisions and their associated risk of complications (eyelid malposition, enophthalmos).

This procedure is ideal for management of trap door and medial blow-out fractures.

However, this technique can be augmented with a trans-antral endoscopy via a sub-labial antrostomy for anterior placed fractures.

TechniqueThis procedure commences with a standard uncinectomy and wide middle meatal antrostomy (Figs. 1, 2).

The maxillary mucosa is then dissected off the fracture site with a ball probe or another suitable instrument and the demarcation between fracture edges and prolapsed orbital content is identified. The orbital contents can then be released from the fracture edges and additionally reduced with a ball probe or gauze back into the orbital cavity.

1 Uncinectomy. 2 Enlarging the maxillary sinus ostium with a back-biter.

3 Right inferior rectus muscle is entrapped.

4 Axial view of orbital floor fracture.

Infraorbitalnerve

Orbitalfl oorfracture

5 Sagittal view of orbital floor fracture.

Infraorbitalfl oor fracture

6 Endoscopic view of maxilla and orbital floor fracture via medial meatotomy.

Margins of blow-outfracture

Posterior wallof R maxilla

R orbitalcontents inR maxillarysinus

R maxillary roof /R orbital fl oor


7 Dissecting the fracture and delineating the margins/contents and reducing the

prolapsed orbit.

8 Maxillary view of orbital floor fracture contents.

Bonyfragments

Herniatedorbital fat

9 Gauze assisted orbital content reduction.

10 Identification of inferior rectus muscle.

R InferiorRectus Muscle

11 Inferior rectus muscle released and confirmed with forced duction test.

12 Transnasal insertion of balloon catheter.

13 Transnasal insertion of balloon catheter. 14 Postioning the balloon catheter. 15 Filling of the balloon catheter.

The rectus muscle can be tested via a forced duction test to assess the mobility and to check if it is entrapped. If the muscle is entrapped, it can then be released with a ball probe from the fractured edges until its free movability is confirmed by using again the forced duction test (Figs. 3–10).

The bony fragments are repositioned and secured in place with a saline-filled (15 ml) Foley balloon catheter in the maxillary sinus, positioned under direct vision at the fracture site. The balloon is left in position for two weeks (Figs. 11–15). If the orbital pressure is too high, a few milliliters of saline can be drained off.


Clinical Case: Endoscopic Trans nasal Repair of Orbital Blow-out Fracture

16 Preoperative view. 17 Immediate postoperative view.

18 View at 1-year follow-up.

Management of Intraorbital Tumors

BackgroundEndoscopic orbital decompression is an excellent minimally invasive technique permitting access to orbital tumors (infero-medial to the optic nerve) and para-orbital tumors (with orbital extensions) for diagnostic and therapeutic uses. This technique improves visualization with minimal manipulation of tissues allowing adequate exposure of the operative site, yet avoiding undue pressure on the globe and unnecessary compromise of its neurovascular supply.

TechniqueFollowing a standard exposure of orbital walls using the aforementioned technique of orbital decompression, the lamina papyracea (can be selectively) removed to permit access to the tumor.

By elevating the orbital fat and retracting the recti muscles, access is obtained to the intra-conal lesions posterior to the globe.

Albeit, care must be taken to avoid injury to the optic nerve as well as a number of important structures contained in the posterior orbit, namely the ophthalmic artery, vein, and the ocular muscles with their motor nerves.

The use of interactive image-guidance can be helpful in identifying landmarks, but should not be solely relied on as the orbital contents shift with decompression maneuvers.

This technique leads to an excellent cosmetic result and reduced morbidity which is found to be associated with bleeding secondary to an open procedure.


In the following presentation of clinical cases, a sinonasal tumor extending into the right orbit and skull base (extradurally) (Figs. 1–5) was surgically managed by standard endoscopic excision of tumor with removal of the intraorbital lesion. Next, the tumor was debulked and cleared intraorbitally (until the medial rectus was free of tumor). In another case, endoscopic excision of sinonasal malignancy with optic nerve decompression was performed to restore visual acuity (Figs. 6, 7).

1 Axial view of right sinonasal tumor extending into the right orbit.

2 Coronal view: Right sinonasal tumor extending into the right orbit and skull

base.

3 Preoperative view of intraorbital tumor.

Tumor

4 Debulking of tumor with Blakesley forceps.

Tumor

5 Medial rectus muscle visible after tumor clearance.

Medial rectus

Orbital fat

6 Left optic nerve prior to tumor clearance.

Optic nerve

7 Left optic nerve prior to tumor clearance.

Dura

Optic nerve

ICA

Clinical Cases: Endoscopic Surgical Management of Intraorbital Tumors


In another clinical case, a schoolgoing child presented with proptosis of the right globe. A lesion, shown on CT scan in the superomedial aspect of the orbital rim, above the orbit, was found to compress the superior rectus muscle.

Endoscopically, the orbit and anterior ethmoidal artery were identified and the orbit was pushed inferiorly to visualize and excise the tumor. Histopathology revealed the presence of an Ewing’s sarcoma (Figs. 8–12).

Another gentlemen presented with reduced vision and loss of color vision. CT scan revealed an intraorbital tumor compressing on the rectus muscles and impinging on the optic nerve. Endoscopically, after removing the periorbita, the tumor was extirpated completely until the rectus muscles came into view. Vision and color vision returned to normal within 24 hours after surgery (Figs. 13–16).

8 CT scan of tumor at the right superomedial aspect of the orbit.

9 Tumor above the middle rectus muscle. 10 Intraoperative view of orbital fat and anterior ethmoidal artery.

11 View of tumor superior to orbit. 12 Postoperative view after tumor removal at the superior part of orbital rim, above the

anterior ethmoidal artery.

13 CT scan revealing an intraorbital tumor accounting for vision loss.

14 Tumor excision from the rectus muscles following periorbital removal.

15 Tumor remnant after partial excision. 16 Final view after tumor removal; view of the rectus muscles.


Recommended Instrumentation and Video Equipment for

Endoscopic Surgery of the Orbit and Related Structures


HOPKINS® Telescopesfor Diagnosis, Surgery and Treatment of Nose and Paranasal Sinuses, diameter 4 mm, length 18 cm

7230 AA – CA

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

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

7230 CA HOPKINS® Lateral Telescope 70°, enlarged view, diameter 4 mm, length 18 cm, autoclavable, fiber optic light transmission incorporated, color code: yellow

7229 AA – CA

7229 AA HOPKINS® Straight Forward Telescope 0°, enlarged view, diameter 2.7 mm, length 18 cm, autoclavable, fiber optic light transmission incorporated, color code: green

7229 BA HOPKINS® Forward-Oblique Telescope 30°, enlarged view, diameter 2.7 mm, length 18 cm, autoclavable, fiber optic light transmission incorporated, color code: red

7229 FA HOPKINS® Forward-Oblique Telescope 45°, enlarged view, diameter 2.7 mm, length 18 cm, autoclavable, fiber optic light transmission incorporated, color code: black

7229 CA HOPKINS® Lateral Telescope 70°, enlarged view, diameter 2.7 mm, length 18 cm, autoclavable, fiber optic light transmission incorporated, color code: yellow

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


FESS InstrumentsAccessories

723770 STAMMBERGER Telescope Handle, flat, standard model, length 11 cm, for use with HOPKINS® Straight Forward Telescopes 0° with diameter 4 mm and length 18 cm

723772 STAMMBERGER Telescope Handle, round, standard model, length 11 cm, for use with HOPKINS® Telescopes 30° – 120° with diameter 4 mm and length 18 cm

723774 STAMMBERGER Telescope Handle, round, length 11 cm, for use with HOPKINS® Telescopes with diameter 1.9/2.7 mm and length 18 cm

723750 B Protection Tube, for HOPKINS® Telescopes with length 18 cm

723750 A Protection Tube, for HOPKINS®

Telescopes with length 11 cm

723005 A Trocar and Cannula for Sinuscopy, fenestrated beak, outer diameter 5 mm, length of the cannula 8.5 cm, for use with HOPKINS® Telescopes with diameter 4 mm

723005 B Trocar and Cannula for Sinuscopy, oblique beak, outer diameter 5 mm, length of the cannula 8.5 cm, for use with HOPKINS® Telescopes with diameter 4 mm

723103 B Trocar and Cannula for Sinuscopy, oblique beak, outer diameter 3.3 mm, length of the cannula 7.5 cm, for use with HOPKINS® Telescopes with diameter 2.7 mm


456001 B

456000 B – 456003 B

456500 B – 456502 B

456801 B456801 B – 456803 B

456803 B456802 B

456601 B456601 B

456500 B

456003 B456002 B

456000 B

456601 B

456000 B – 456003 B

456502 B456501 B

456000 B BLAKESLEY RHINOFORCE® II Nasal Forceps, straight, size 0, with cleaning connector, working length 13 cm

456001 B Same, size 1456002 B Same, size 2456003 B Same, size 3

456500 B BLAKESLEY-WILDE RHINOFORCE® II Nasal Forceps, 45° upturned, size 0, with cleaning connector, working length 13 cm

456501 B Same, size 1456502 B Same, size 2

456801 B BLAKESLEY-WILDE RHINOFORCE® II Nasal Forceps, 90° upturned, size 1, with cleaning connector, working length 13 cm

456601 B BLAKESLEY-WILDE RHINOFORCE® II Nasal Forceps, 45° upturned, handle in right horizontal position, size 1, with cleaning connector, working length 13 cm

456802 B Same, size 2456803 B Same, size 3

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



451000 B – 451010 B

451000 B GRÜNWALD-HENKE RHINOFORCE® II Nasal Forceps, straight, through-cutting, tissue-sparing, BLAKESLEY shape, size 0, width 3 mm, with cleaning connector, working length 13 cm

451500 B GRÜNWALD-HENKE RHINOFORCE® II Nasal Forceps, 45º upturned, through-cutting, tissue-sparing, BLAKESLEY shape, size 0, width 3 mm, with cleaning connector, working length 13 cm

451501 B Same, size 1, width 3.5 mm451502 B Same, size 2, width 4 mm

451001 B Same, size 1, width 3.5 mm451002 B Same, size 2, width 4 mm

Size 1

Size 2

Size 1

Size 2

455010

452001 B MACKAY-GRÜNWALD RHINOFORCE® II Nasal Forceps, through-cutting, tissue-sparing, straight, delicate, 8 x 3 mm, size 1, with cleaning connector, working length 13 cm

452002 B Same, 11.5 x 3.5 mm, size 2

452501 B MACKAY-GRÜNWALD RHINOFORCE® II Nasal Forceps, through-cutting, tissue-sparing, 45º upturned, delicate, 8 x 3 mm, size 1, with cleaning connector, working length 13 cm

452502 B Same, 11.5 x 3.5 mm, size 2

455010 STRUYCKEN RHINOFORCE®II Nasal Cutting Forceps, with cleaning connector, working length 13 cm



459012

459016

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

459011 Same, right side backward cutting

459012 Same, left side backward cutting

459016 STAMMBERGER RHINOFORCE® Antrum Punch, backward cutting, sheath 360° rotatable, with fixing screw, take apart, working length 10 cm, for use with cleaning adaptor 459015 LL

459015 LL Cleaning Adaptor



459030

459036

459030 STAMMBERGER RHINOFORCE® II Antrum Punch, small pediatric size, slender, upside backward cutting, with cleaning connector, working length 10 cm

459031 Same, right side backward cutting

459032 Same, left side backward cutting

459036 STAMMBERGER RHINOFORCE® Antrum Punch, small pediatric size, slender, backward cutting, sheath 360° rotatable, with fixing screw, take apart, working length 10 cm, for use with cleaning adaptor 459015 LL

459015 LL Cleaning Adaptor



459051459052

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

459052 Same, left side downward and forward cutting

449201–449203

449202 Same, curved to right

449203 Same, curved to left

449201 RHINOFORCE® II Nasal Scissors, straight, with cleaning connector, working length 13 cm



651010

651010 STAMMBERGER RHINOFORCE® II Forceps, cupped jaws, vertical opening, 65° upturned, with cleaning connector, working length 12 cm, cupped jaws diameter 3 mm

651020 STAMMBERGER RHINOFORCE® II Forceps, cupped jaws, horizontal opening, 65° upturned, with cleaning connector, working length 12 cm, cupped jaws diameter 3 mm

651055

651050 STAMMBERGER Punch, circular cutting, for sphenoid, ethmoid and choanal atresia, with cleaning connector working length 18 cm, diameter 4.5 mm

651055 Same, diameter 3.5 mm

651060 STAMMBERGER Punch, circular cutting, 65° upturned, for frontal sinus/recess, with cleaning connector, working length 17 cm, diameter 3.5 mm


651061 STAMMBERGER Punch, tip egg-shaped, circular cutting, 65° upturned, for frontal sinus / recess, with cleaning connector, working length 17 cm, diameter 3.5 mm



662102-662104

662102 KERRISON Micro Punch, detachable, rigid, 90° upbiting, not through-cutting, size 2 mm, working length 17 cm

662104 KERRISON Punch, detachable, rigid, 90° upbiting, not through-cutting, size 4 mm, working length 17 cm

Nose Sinuses Microscopic/Endoscopic Surgery in the Area of Paranasal Sinuses, Skull Base and Pituitary Surgery


628001 –628002

628001

628002

628001 Sickle Knife, pointed, length 19 cm

628002 Same, round, double-cutting

223300

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

629820 474000

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

474000 FREER Elevator, double-ended, length 20 cm



629826

629826 KUHN Frontal Sinus Seeker, double-ended, No. 2, both sides curved 90°, one tip straight, one tip reverse angle, length 22 cm

629830 KUHN Frontal Ostium Seeker, double-ended, No. 6, both sides curved 77°, one tip straight, other tip reverse angle, length 22 cm

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

628714628712

628712

628714

628714 Same, 90º curved

628712 KUHN-BOLGER Frontal Sinus Curette, small, oblong, 55° curved, forward cutting, length 19 cm

628702



586325 –586340

586325 v. EICKEN Antrum Cannula, LUER-Lock, long curved, outer diameter 2.5 mm, working length 11 cm, length 15 cm

586330 Same, outer diameter 3 mm586340 Same, outer diameter 4 mm

529305 FRAZIER Suction Tube, with mandrin and cut-off hole, with distance markings at 5 – 9 cm, 5 Fr., working length 10 cm

529307 Same, 7 Fr.529309 Same, 9 Fr.

529305 –529309


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)

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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.

[ ]

[ ]

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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 Reprocessable 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 Reprocessable in a cleaning machinel Maximum torque 6 Ncm

## 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

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Special Features:

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Dri

llCut

-X®

II

4071

2050

Dri

llCut

-X®

II N

40

7120

55

DrillCut-X® Shaver HandpiecesSpecial Features

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 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 Shaver Handpiece

Special Features:## Powerful motor## Absolutely silent running## Enhanced ergonomics## Lightweight 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## Lightweight 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

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:


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

## The adjustable handle can be mounted to DrillCut®-X II or -X II N Shaver Handpiece

## 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:## Tool-free closing and opening of the drill## Right/left rotation## Max. rotating speed up to 40,000 rpm / 80,000 U/min

## Detachable irrigation channels

## Lightweight construction## Operates with little vibrations## Low maintenance## Reprocessable in a cleaning machine## 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:## Tool-free closing and opening of the drill## Right/left rotation## Max. rotating speed up to 40,000 rpm / 80,000 U/min

## Detachable irrigation channels

## Lightweight construction## Operates with little vibrations## Low maintenance## Reprocessable in a cleaning machine## 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

For use with High-Speed Drills, shaft diameter 2.35 mm and 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

For use with High-Speed Drills, shaft diameter 2.35 mm and 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


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.


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

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 104

TH 104 IMAGE1 S H3-ZA Three-Chip FULL HD Camera Head, 50/60 Hz, IMAGE1 S compatible, autoclavable, 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-ZA

TH 104

3x 1/3" CCD chip

39 x 49 x 100 mm

299 g

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

F 1.4/1.17 Lux

standard eyepiece adaptor

non-detachable

300 cm

Specifications:

IMAGE1 S Camera Heads n

TH 100


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.


20131501 Cold Light Fountain XENON NOVA® 175 power supply: 100–125 VAC/220–240 VAC, 50/60 Hz

including: Mains Cord

20132026 XENON Spare Lamp, only, 175 watt, 15 volt

Cold Light Fountain XENON NOVA® 175

LED NOVA® 150, High-Performance LED Cold Light Fountain

20 1612 01 LED Nova 150, High-Performance LED Cold Light Fountain with one KARL STORZ light outlet, power supply 100 - 240 VAC, 50/60 Hz

including: Mains cord

Cold Light Fountains and Accessories

495 NT Fiber Optic Light Cable, with straight connector, diameter 2.5 mm, length 180 cm

495 NTW Fiber Optic Light Cable, diameter 2.5 mm, length 180 cm with 90° deflection to the light source

495 NTX Same, length 230 cm

Cold Light Fountain XENON 300 SCB

20 133101-1 Cold Light Fountain XENON 300 SCB

with built-in antifog air-pump, and integrated KARL STORZ Communication Bus System SCB power supply: 100 –125 VAC/220 –240 VAC, 50/60 Hz

including: Mains Cord SCB Connecting Cable, length 100 cm20133027 Spare Lamp Module XENON

with heat sink, 300 watt, 15 volt20133028 XENON Spare Lamp, only,

300 watt, 15 volt


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


Notes:

ENDOSCOPIC SURGERY OF THE - KARL STORZ VJG NCETKOCN DQPG VQ DG FGOQPUVTCVGF YKVJ VJG UCE DTKIJVN[...

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