SIMPOSIO TECNOLOGIA Voyant Intelligent Energy System Animation

The Voyant Intelligent Energy System is an advanced bipolar system indicated for sealing and dividing tissue bundles and vessels up to and including 7 mm in diameter.

Applied Medical supplies a full line of Voyant devices to fulfill specific surgical needs.

To use the Marylander 5 mm fusion device, properly position the jaws using the 360 degree rotation knob.

Then grasp tissue by actuating the handle lever until latched.

To activate energy, press the fuse button on the back of the device.

Hold the button down until the generator emits an end tone, informing the user that the seal cycle is complete.

Once energy has been delivered, the user may choose to transect the tissue using the blade lever.

Fully actuate the blade lever for a complete transection.

Once the blade lever has returned to its original position, pull back on the handle lever to unlatch the device.

The jaws will automatically open.

To use the OpenFusion device, properly position the jaws using the 180 degree rotation knob.

Hold the button down until the generator emits an end tone, informing the user the seal cycle is complete.

Once the blade lever has returned to its original position, pull back on the handle lever to unlatch.

The jaws will automatically open.

To use the fine fusion device, grasp tissue by closing the ring handles of the device.

To activate energy, compress the ring handles together to depress the fuse button.

Maintain compression until the generator emits an end tone, informing the user the seal cycle is complete.

While maintaining pressure on the ring handles, fully actuate the blade lever for a complete transection.

Once the blade lever has returned to its original position, release pressure on the ring handles to open the jaws.

The Voyant Electrosurgical Generator offers a small profile for limited space and an easy-to-use interface.

Setup requires three simple steps.

steps. Plug the power cord into a wall outlet, not a power strip, and insert the other end

of the cord into the back of the generator. Press the power button, which will turn green

in color. Wait for the screen to display ready, then insert the device key or plug into the

generator with the Delta Applied Medical logo facing up, and the system is ready for use.

During a procedure, alarm conditions may occur. When one does occur, the generator will emit

a pulse tone and the screen will display a message describing the alarm condition.

A check device alarm indicates the system detects a condition preventing

the delivery of energy such as excessive char on the jaws, an insufficient amount

of tissue in the jaws, metal such as clips or staples between the jaws, or the

jaws are submerged in fluid. To continue, correct the issue then re-grasp the

tissue and reactivate the device. An early button release alarm means that

that the fuse button was released by the user

before the seal cycle was completed.

Reactivate the device by pressing the fuse button

until the end tone is heard.

My name is Karina with Applied Medical.

Today, I am pleased to share

our Applied Medical Key Trocar Systems with you.

Our Key Trocar product line is comprehensive,

offering clinical innovation and choice

for your procedural needs.

I look forward to providing you

with a high-level overview of our trocar offering.

To start, it's helpful to break down a trocar into three different components

which ultimately create a trocar system. The seal, the cannula, and an obturator.

Every key trocar features our key universal seal to continuously maintain

pneumoperitoneum during instrument exchanges regardless of the size

instrument being used. On the seal housing you'll find a stopcock that can

be opened and closed to attach insufflation tubing and release smoke plume.

Additionally, the seal housing can be removed from the trocar cannula by pressing the two tabs

on the side and lifting up on the seal. This is helpful at the end of the case for specimen

removal, rapid desufflation, and to facilitate the release of CO2 from the patient's abdomen.

We have three different style cannulas available to meet your needs.

For surgeons who utilize a cut-down approach as their entry method, we offer our Key Balloon Blunt

tip. Our key balloon blunt tip features a gel cone and latex-free non-fragmenting balloon

which create an atraumatic seal to maintain pneumoperitoneum while allowing for enhanced

instrument articulation. The gel cone slides down and locks in place to conform to the abdominal

wall. It has suture ties on each side that allow for easy placement of sutures if desired. There

are two ports. The white stopcock connects to the insufflation tubing and the clear stopcock is the

balloon inflation port. The 5 mm key balloon blunt tip uses 5 cc of air to inflate the balloon

and the 12 mm key balloon blunt tip uses 20 cc to inflate the balloon. The appropriate syringe

is packaged with each system. Keep the syringe on hand to deflate the balloon at the end of the case.

The next cannula I'll discuss is our key advanced fixation cannula. This technology is unique to

applied medical and provides bi-directional fixation. The key advanced fixation trocar

provides minimal cannula penetration, maximizing the intra-abdominal working space and minimizing

trocar migration. Additionally, balloon trocars such as key advanced fixation have recently been

recommended by several domestic and international surgical societies, including SAGES as a precaution

during the COVID-19 pandemic to minimize the aerosolation of particulate during

surgery and to reduce possible exposure of operating room staff. When you

unpackage the trocar, insert the obturator in the cannula and pull the

retention disc to the top prior to handing it to the surgeon. Once the

trocar is placed into the abdomen, inflate the balloon with five cc's of

air using the clear stopcock and the provided syringe. Keep the syringe on

hand to deflate the balloon at the end of the case. Pull up on the trocar and

slide the retention disc down to just above the patient's skin. The advanced

fixation trocars are available in 5, 11, 12, and 15 millimeter sizes and varying

lengths. Lastly, we have our threaded cannulas which feature our Z-thread

technology. The Z-thread cannulas provide necessary retention during procedures

and are available in 5, 8, 11, 12, and 15 mm sizes and varying lengths.

Both the Z-thread and advanced fixation cannulas can be used with an optical or bladed obturator.

The final component of a trocar is the obturator.

Our key optical obturators feature a sequential helix design

that separates the tissue along its natural fibers, creating a minimal fascial defect.

effect.

Our Key Files trocar is the only optical trocar indicated for establishing pneumoperitoneum

under direct visualization and with insufflation.

There is a small aperture at the tip of the obturator.

This unique design allows surgeons to enter the abdomen with the insufflation on, enabling

insufflation as soon as the aperture tip has entered into the abdominal space, usually

about 3 mm of penetration through the peritoneum.

For clear visualization, it is recommended to dry the incision site prior to insertion

and to focus the camera when the obturator tip is placed in the incision.

When utilizing the key FiOS trocar and our separator technology,

it is best to insert the trocar with a 10 to 2 twist motion with consistent downward pressure.

Our shielded bladed obturator has a switch at the top of the obturator.

A red window indicates the blade is armed and ready for insertion.

There is a two-click feedback mechanism during insertion.

The first click provided audible and tactile confirmation that the shield has retracted and the blade is exposed.

The second click confirms that the shield has returned to its original position to lock over the blade.

My name is Mushtaba Kambiz with Applied Medical.

Today, I am pleased to share our Applied Medical Alexis Protector Retractor products with you.

Our ALEXIS O and ALEXIS product offerings are comprehensive, providing clinical innovation and choice for your procedural needs.

I look forward to presenting you with a high-level overview of our ALEXIS product family.

To start, we will review the indication of the ALEXIS devices.

The ALEXIS O and ALEXIS devices are indicated to allow surgeons access to the abdominal cavity through an atraumatically retracted wound, providing maximum exposure with minimum incision size.

size.

Both ALEXIS configurations are intended to protect against wound contamination during

laparoscopic and open surgery.

In addition, indicated sizes may be used to access the thoracic cavity and retract soft

tissue during cardiac and general surgical procedures.

Every ALEXIS Protector Retractor features two rings spanned by a durable non-latex sheath.

The ALEXIS device comes in two product line configurations, the ALEXIS-O Rigid and ALEXIS

Flexible.

The rigid configuration offers maximum retraction and visualization,

while the flexible configuration conforms to different patient anatomies and provides retraction versatility.

In addition, all of our extra-extra small to small Alexa sizes come with a tether for easy removal through small incisions.

The Alexa's protector retractors are available in multiple sizes to meet a wide range of surgical incisions.

The Alexa's protector retractors are used in a variety of specialties and procedures,

procedures, ranging from thyroidectomies to exploratory laparotomies.

For proper use of the ALEXIS Protector, we have surgical footage demonstrating the placement

of the device in an abdominal procedure to illustrate its working principles.

The ALEXIS device functions as a protector and a retractor which requires minimal to

no change in your technique.

Once the incision is made, choose the appropriate size ALEXIS device.

Squeeze the two green inner rings together and insert into the incision.

Pull up on the white outer ring and finger sweep the areas beneath the ring to ensure no unintended tissue is trapped between the inner ring and the underlying tissue layers.

Roll the outer rings inwards or outwards based on preference until optimal visualization is achieved.

For removal, if necessary, loosen and unroll the outer ring two to three times, grasp the inner ring, and pull up and out of the incision.

For applicable models, repeat the first removable step and then pull on the tether until it has been completely removed.

I am Robert Grepo, and I am part of the clinical development team at Applied Medical.

I am pleased to share a high-level overview of Applied Medical's GelPoint Advanced Access

platforms with you.

The GelPoint and GelPoint Mini platforms may be used for single-site or reduced-port techniques.

These product offerings are versatile, providing clinical innovation and choice for your minimally

invasive surgery needs.

We will begin by reviewing the indications, components, and features of these products.

products. The GelPoint and GelPoint Mini advanced access platforms are intended for use in obtaining

abdominal access by instrumentation. The devices are for patients undergoing laparoscopic surgery

for procedures such as nephrectomy, colectomy, and splenectomy. They may also be used in

neurological, colorectal, and general surgery to access the surgical site. Each GelPoint

and GelPoint Mini advanced access platform consists of a gel seal cap, an Alexis O-Wound

protective retractor, three 10mm sleeves, one 12mm sleeve, and an obturator for the

sleeves.

Additionally, the GelPoint includes an optional instrument shield.

The GelSeal cap is intended to maintain insufflation, facilitate smoke evacuation, and provide a

flexible fulcrum to aid in the triangulation of standard instruments.

The GelPoint has an insufflation and smoke evacuation port, while the GelPoint Mini has

two interchangeable insufflation and smoke evacuation ports.

supports.

The sleeves have a low-profile, self-retaining design.

The 10mm sleeves accommodate 5-10mm instruments and the 12mm sleeve accommodates 5-12mm instruments.

The universal actuator accommodates the 10mm and 12mm sleeves to facilitate insertion into

the gel seal cap.

If needed, the sleeves can be repositioned during the procedure without compromising

the integrity of the gel.

Depending on the clinical need, the ALEXIS O-Wound Protective Retractor accommodates

1.5 to 7 cm incisions with the GelPoint and 1.5 to 4 cm incisions with the GelPoint Mini.

It offers 360 degrees of atraumatic protection and retraction for enhanced exposure, access

and cosmetic results.

The Alexis O-Wound Protector Retractor also facilitates extracorporeal anastomosis and

specimen retrieval while protecting the incision site.

The Alexis O-Wound Protector Retractor has a tether attached to the inner ring to facilitate

removal from the small incisions.

incisions.

Additionally, the GelPoint Advanced Access Platform has an optional instrument shield

to guide instruments into the incision.

To demonstrate the proper use of the GelPoint Advanced Access Platforms, our surgical footage

illustrates the placement of the GelPoint Mini in a laparoscopic cholecystectomy procedure.

The placement of the GelPoint follows similar steps.

Once an appropriately sized incision is made at the desired location, collapse the inner

ring of the Lexus O-Wound Protector Retractor.

Squeeze the two sides together and insert it through the incision until the

desired position is reached. Pull up on the outer ring and sweep the area to

ensure tissue is not trapped between the inner ring and the anchoring layer. Roll

the white ring inward until the desired retraction is achieved. Perform a final

sweep of the inner ring to verify there is no unintended tissue entrapment.

Before attaching the gel seal cap to the Lexus O-Wound Protector retractors

white ring, insert the gel point sleeves through the gel seal cap. The desired

locations of the sleeve should be at least 1.5 centimeters from the outside

perimeter of the cap and the insufflation or smoke evacuation ports.

To insert the sleeves, begin by placing the obturator into the sleeve until the

tip is exposed. Apply force downward until the flange passes through the gel

seal cap. Remove the obturator and gently pull up on the sleeve to ensure that the

flange rests up against the underside of the gel seal cap. Once the sleeves are in

their desired position, the instrument shield can be placed within the outer

ring and on top of the incision site to facilitate intermittent passage.

Securely attach the gel seal cap of the GelPoint or GelPoint Mini to the white

ring of the Lexus Ogwin protective retractor. This step must be completed

before closing the lever and locking it into place. Insufflation tubing can be

connected to the insufflation port. Before insufflating, ensure that the

stopcock valve on the smoke evacuation port is in the closed position. To

evacuate smoke during the procedure, open and close the stopcock valve as needed.

Remove the gel seal cap before inserting additional sleeves or sleeve

repositioning during the procedure. If specimen removal or exteriorization is

needed, open the lever and remove the gel seal cap from the Olexus O-Wound

Protector Retractor. Extract the specimen through the Olexus O-Wound Protector

Retractor as needed. Reattach the gel seal cap to continue the procedure if

applicable. At the end of the procedure, before removing the gel seal cap from

the Olexus O-Wound Protector Retractor, ensure the instruments have been

removed from the cap. If the optional instrument shield was used, remove it by gently pulling

the instrument shield out of the outer white ring of the Olexus Ogwin Protector Retractor.

Then grasp the outer ring at the 10 and 2 o'clock positions and roll it outward until

loose. Continue by grasping the tether and pulling upward, allowing the inner ring to

to be removed from the incision.