COOK Medical Duette Instructions For Use Manual page 8

SYSTEM PREPARATION – SNARE
1. Fully retract and extend the snare to confirm smooth operation of the device.
2. Slide the adjustable marker, located in the handle shaft, to establish a reference point
indicating full retraction of the snare into the sheath. The grid on the handle may be used
to set up reference points, establishing the thickness of the tissue being excised during the
procedure, thereby reducing the possibility of premature guillotining of the pseudopolyp. To
utilize these markings, fully advance and retract the snare to establish the markings which
indicate snare position for the configuration being used (Fig 11).
Illustrations
INSTRUCTIONS FOR RESECTION OF MUCOSA BY BAND
LIGATION
1. Lubricate the endoscope and exterior portion of the barrel. Caution: Do not place
lubricant inside the barrel. Caution: Do not apply alcohol to the device.
2. With the Multi-Band Ligator handle in the two-way position, introduce the endoscope into
the esophagus (Fig. 9). After intubation, place the handle in the firing position (Fig. 10).
3. Visualize the selected area of mucosa to be resected and aspirate it into the barrel.
Caution: Prior to deployment, ensure the endoscopist's hand is positioned on the
handle of the Multi-Band Ligator rather than the endoscope controls.
4. Maintain suction and deploy the band by rotating the Multi-Band Ligator handle clockwise
until band release is felt, indicating deployment (Fig. 10) as above. Note: If the band will not
deploy, place the handle in the two-way position and loosen the trigger cord slightly. Place
the handle in the firing position and continue with the procedure.
5. Release the suction button of the endoscope, insufflate air, then withdraw the scope
slightly to release the ligated pseudopolyp. Note: An irrigation adapter is provided with each
Multi-Band Ligator. If irrigation of the endoscope accessory channel is desired to clear the
viewing field, attach the adapter to a syringe filled with sterile water and insert into the white
seal of the handle. Irrigate as necessary (Fig. 10) as above.
6. With the pseudopolyp in the endoscopic view, introduce the sheath and retracted snare
into the white seal of the handle of the Multi-Band Ligator.
7. Advance the device, in small increments, until it is endoscopically viewed exiting the
endoscope.
8. Advance the snare wire out of the sheath and position it around the pseudopolyp to be
removed. The snare may be placed either above or below the band.
9. Following the electrosurgical unit manufacturer's instructions for settings, verify the
desired settings and activate the electrosurgical unit. Note: The maximum rated input
voltage for this snare is 2 kilovolts peak-to-peak for cut mode and 5 kilovolts peak-to-peak for
coagulation mode.
10. Proceed with resection of the pseudopolyp.
11. Following resection of the pseudopolyp turn the electrosurgical unit off. Retract the snare
from the endoscope while the next pseudopolyp is created.
12. Repeat the process of pseudopolyp creation as needed in order to remove as much of the
mucosa as desired.
13. Following each pseudopolyp resection, if tissue retrieval is desired, follow standard
institutional guidelines.
DISSASSEMBLY OF THE COMPONENTS FROM THE ENDOSCOPE
1. Upon completion of the procedure, disconnect the active cord from the Snare handle and
dispose of the Snare according to institutional guidelines for biohazardous medical waste.
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