NAME of the products CODES. G- Cath TM EZ Delivery Catheter with Snowshoe Suture Anchors code USGI. G- Lix Tissue TM Grasper code USGI

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1 NOTES platform PICTURES IOP - Incisionless Operating Platform Transport Endoscopic Access Device code USGI G- Prox EZ- 33 Endoscopic Grasper code USGI Transport G- Cath TM EZ Delivery Catheter with Snowshoe Suture Anchors code USGI G- Lix Tissue TM Grasper code USGI USGI Medical, San Clemente, CA, USA G Prox IOP consists of a 110 cm 18 mm overtube- like design with a steerable shaft and several channels. The overtube- shaft is capable of stiffening, providing enhanced stability. Specifically designed tools enable the surgeon with enhanced manipulation capabilities and safe closure of entry site. G - Cath Its four channels (7, 6, 4 and 4 mm in size) allow for the passage of specialized equipment and a standard endoscope. The endoscope is independently rotatable within the channel allowing for an adjustable horizon while

2 maintaining instrument position. One channel can be used for high flow carbon dioxide insufflation. G- Prox is a flexible but robust needle driver used to deliver G- cath Snowshoe Suture Anchors. The body of the device accurately conveys torque and the forces necessary to accomplish complex tasks in an incisionless fashion. The G- Prox can be loaded and reloaded with G- Caths without withdrawind or repositioning the instruments. G- Lix The g- Lix is an helical endoscopic tissue grasper designed to engace tissue securely. Its design consist of an easy torque- stable shaft and an ergonomic rotation handle that, when twisted, rotates the helix into tissue. The device allows exceptional forces especially in the tight spaces like oftnely found in natural orifice surgery. UNIQUE DIFFERENCES (to other instruments) Enhanced deflection and stability of the platform together with improved capabilities of tissue manipulation and safe and easy viscerotomy closure FURTHER READING:

3 PICTURES Anubiscope Not commercially available Karl Storz, Germany Anubiscope Flexible endoscopic surgical platform for advanced intraluminal and transluminal tissue manipulation Tip of the platform The flexible surgical platform is provided with a bivalve tip that opens once in the peritoneal cavity with flexible instruments passing through the working channels and exiting in a triangulated fashion. An independent channel holds the place for a small endoscope while lightening is provided by the flexible platform. The ergonomic handling of the instruments and the independent control of the tip of the platform allows for enhanced manipulation and suturing capabilities. Manipulator UNIQUE DIFFERENCES (to other instruments) Two hands manipulation in a triangulated surgical fashion

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5 PICTURES Endosamurai Not commercially available Olympus Company, Japan EndoSamurai Flexible operative platform with multiple degree of freedom of the end effector and intuitve hand control Tip of the instrument The distal end of the scope has two short modified independent arms, which upon entry remain parallel with the scope shaft, however, open in an elbow- like fashion when in position. With 5 degrees of freedom and triangulation capabilities, the arms can tie sutures as well as provide traction and counter traction. In addition to the two conduits, there is a third working channel that may be used for ancillary equipment or suction/irrigation. Stiffened by a locking overtube, the scope articulates in the same manner as a standard endoscope with identical visualization. Interestingly, this system employs a drive, park and move methodology. Where the user navigates to the target with the endoscope, locks the overtube system and scope in position and then proceeds to the user interface. This effectively allows one operator to perform most of the work load. As the arms are married to the camera/scope, it still bears the same image- perspective limitations as the standard endoscope.

6 UNIQUE DIFFERENCES Intuitive, bi- manual interface to control instruments with multiple degrees of freedom FURTHER READING:

7 PICTURES DDES Direct Drive Endoscopic System Not commercially available DDS Boston Scientific, USA Flexible surgical platform with independent channel for endoscope and interchangeable instruments. Tip of the DDS It is a flexible- laparoscopic multitasking platform that consists of a 55- cm steerable guide sheath that houses 3 lumens extending from a rail- based platform with interchangeable 4 mm instruments. A unique system in the handle allows for seven degrees of freedom: surge, pitch, yaw, roll, tool action, heave and sway. Equipment currently available consists of graspers, scissors, needle pushers and cautery devices. These effectors can traverse a distance from the sheath tip independent of the image. While specialized tools are passed through channels in the guide tube, a standard endoscope can be used for visualization. The scope can rotate freely and positioned independent of the DDES end effectors. The sheath serves as a guide that can be docked once in position.

8 UNIQUE DIFFERENCES (to other instruments) Unique user interface that consists of ergonomic rail- guided drive handles situated above the surgeon s waist that allow for seven degrees of freedom FURTHER READING:

9 TEM PLATFORMS Richard Wolf TEM Instrument System PICTURES Richard Wolf TEM Instrument System Stereo Scope Stereoscope: ; Rectoscopes: ; Gra forceps ; Scissors ; Monopolar Ca ; Needle Holder ; Suction ; U- shaped Support Arm Richard Wolf, Germany Rectoscope tubes Transanal Endoscopic Platform for microsurgical removal of neoplasm of the rectum up to 20 cm. Grasping forceps 3D visualization of the tissue, combination of pump/insufflator unit for controlled distension, specially angled hand instruments for precise excision and suturing of the tissue. Support arm to stabilize the platform to the operatory room table for confortable and precise manipulation of the tissue. Scissors UNIQUE DIFFERENCES autoclavable 3D vision systems and pump/insufflator unit for controlled distension

10 Knife Monopolar FURTHER READING: Needle Holder Suture clip forcep Suction Tube U- shaped Support Arm

11 Karl Storz TEO Platform PICTURES TEO Transanal Endoscopic Operations Karl Storz, Germany Operative Rectoscope for transanal operation TEO complete platform Operative rectoscope compatible with numerous standard laparoscopic tools as well as laparoscopic towers without any need to acquire dedicated unit.connected to the operatory room table it offers a stable platform to operate transanally into the rectum uop to 20 cm from anal verge. UNIQUE DIFFERENCES (to other instruments) Available in different lengths up to 20 cm TEO short and long version Special connectors for CO2 insufflation, for effective telescope cleaning and for vapor evaporation Ideal combination with standard 3 mm instruments FURTHER READING: