COOK Medical Duette Instructions For Use Manual page 7

WARNINGS
Failure to isolate the tissue to be biopsied or the pseudopolyp to be removed by pulling
it away from the mucosal wall may result in fulguration of normal mucosa and/or
perforation.
Contact of the snare wire with the endoscope during electrosurgery may cause
grounding, which could result in injury to the patient and/or operator as well as
damage to the endoscope and/or snare wire.
Use of ligation bands is contraindicated in patients with a known hypersensitivity to
latex.
COMPONENT PARTS
• Barrel with preloaded Bands & attached Trigger Cord
• Multi-Band Ligator Handle
• Loading Catheter
• Irrigation Adapter
• Soft, Braided mini-hexagonal snare
SYSTEM PREPARATION – MULTI-BAND LIGATOR
1. Examine the features of the Multi-Band Ligator handle. The handle has two positions,
which control rotation. The firing position (Fig. 1) allows the handle to be rotated in the
forward direction only. The two-way position (Fig. 2) allows the handle to rotate in both
directions. Prior to introducing the endoscope, keep the handle in the two-way position.
2. Insert the Multi-Band Ligator handle into the endoscope accessory channel following the
instructions below for the appropriate endoscope. Olympus - see Fig. 3a, Pentax - see Fig. 3b,
Fujinon-see Fig. 3c.
3. Introduce the loading catheter through the white seal in the Multi-Band Ligator handle
and advance, in short increments, until it exits the tip of the endoscope (Fig. 4).
4. Attach the trigger cord to the hook on the end of the loading catheter, leaving
approximately 2 cm of trigger cord between the knot and the hook (Fig. 5). Withdraw the
loading catheter and trigger cord up through the endoscope and out through the Multi-Band
Ligator handle. Dispose of the loading catheter per institutional guidelines for biohazardous
medical waste.
5. Attach the barrel to the tip of the endoscope, ensuring the barrel is advanced onto the tip
as far as possible (Fig. 6).
6. With the endoscope tip straight, place the trigger cord into the slot on the spool of the
Multi-Band Ligator handle (Fig. 7a) and pull down until the knot is seated in the hole of the
slot (Fig. 7b). Note: The knot must be seated into the hole or the handle will not function
properly.
7. With the Multi-Band Ligator handle in the two-way position, slowly rotate the handle
clockwise to wind the trigger cord onto the handle spool until it is taut (fig. 8).
Note: Care must be taken to avoid deploying a band while winding the trigger cord.
8. Check the endoscopic view. To maximize visualization, the position of the trigger cord
may be altered by rotating the barrel. Note: The endoscopic view broadens after each band
deployment.
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