CEAA/CEAB Panther Endo

Linear Cutter Staplers

Panther Endo stapler places two triple,

staggered rows of titanium staples and

simultaneously the knife divides the tissue in

between.

The instrument is designed for multiple use

during a single surgical procedure: it can be

used for a total of 25 applications.

The instrument can be used for tissue

resection, transection and anastomosis

Universal handle for all reloading units.

Improved OR efficiency and reduction in inventory codes.

6 rows of staples in all cartridge sizes

Superior staple line security

30mm, 45mm and 60mm cartridges

To be used in all different stages of different surgeries.

2,0mm, 3,5mm, 4,2mm, 4.8mm and 5.0 mm staples

Hemostasis and staple line security in all different tissues. The largest and most complete portfolio of endo reloads in the market!

New Knife Blade with every firing

Maximum sharpness and reduces the risk of cross contamination

Thinner anvil and wide opening of the jaws

Easier placement between tissues

Reinforced Anvil Perfect staple line formation

Smooth closure of the jaws To avoid trauma on tissues

Consistent Stapling Technology

Keeps the anvil and the cartridge perfectly aligned while firing the instrument. Perfect staple line from the beginning until the end!.

CEAA-30

CEAB-30PANTHER ENDOLINEAR CUTTER (STANDARD Handle)

CEAA-60

CEAB-60PANTHER ENDOLINEAR CUTTER (XL- Bariatric Handle)

CEAA-45

CEAB-45PANTHER ENDOLINEAR CUTTER (SHORT- Handle)

CEAA-30

CEAB-30

PANTHER ENDOLINEAR CUTTER (STANDARD Handle)

Central shaft: 16cm Total Handle: 37,7cm

CEAA-60

CEAB-60

PANTHER ENDOLINEAR CUTTER (XL- Bariatric Handle)

Central Shaft: 26cm Total Handle: 47,7cm

CEAA-45

CEAB-45

PANTHER ENDOLINEAR CUTTER (SHORT- Handle)

Central Shaft: 6cm Total Handle: 28,5 cm

Central shaft

Total handle

Ref. Ended

with:

Color

code

Staple

high

Minimum

Tissue

thickness

Maximum

Tissue

thickness

Trocar

requirements

-T-CADA -T

CADB -TWhite 2.5 mm 0.9 mm 1.2 mm 12 mm

-N-CADA- N

CADB- NBlue 3.5 mm 1.3 mm 1.7 mm 12 mm

-S-CADA- S

CADB- SGold 4,2 mm 1,6 mm 2.0 mm 12 mm

-D-CADA- D

CADB- DGreen 4.8 mm 1.8 mm 2.2 mm 15 mm

-R-CADA- R

CADB- RBlack 5,0 mm 1.9 mm 2.4 mm 15 mm

Step 1: Open the packaging and take out the stapler

Nurse: Do not open packaging improperly!

Solution: Box can be opened with an easy tear on one side

Nurse: Dialyzing paper is opened along the arrow indicator.

Always, before loading the Endo Linear Cutter Stapler with an appropriate RU, we must ensure that the black returning Knob is completely placed in its full back position.

WARNING: If we don’t follow these 2 basic steps we can experience problems when trying to reload the Endo Linear Cutter Staplers.

!!Always, before loading any Endo Linear Cutter Stapler, we must ensure that the articulation lever is placed in the central position.

1. To load the Endo Linear Cutter Stapler, insert the pin located at the distal end of the instrument shaft into the RU. Ensure that the LOAD alignment indicator on the RU aligns with the LOAD alignment indicator on shaft. Push the RU inside and twist clockwise 45° relative to the instrument, so that the RU will lock into place. The LOAD alignment indicator on the instrument shaft will align with the LOAD alignment indicator on the RU.

WARNING: If we don’t follow these steps we can destroy the locking system which will leave the instrument useless. It’s very important to follow these instructions in order to ensure a correct loading of the RU.

1st. Alignment

2nd. Push3rd. Twist

After pushing and twist clockwise 45º, a click sound will inform us that both parts are correctly assembled.

2. The RU is packaged in the open position. Do not attempt to close the RU before loading.

3. Do not remove the yellow cover until you load the RU correctly.

Warning, Don’t follow this steps can

provoke:

1)The handle could be accidentally squeezed when the surgeon catch the instrument.

2) 1-2 rows of stapler could come out from the cartridge.

4. Remove the shipping wedge from the RU prior to inserting the instrument into the trocar.

WARNING: Do not

squeeze the handle before the yellow cover was removed. Otherwise the instrument might be unable to fire or reset because the damage of instrument.

5. Close RU jaws

6. Insert Endo linear cutter stapler into trocar sleeve.

Attention green and blackcartridge needs a 15mm Trocar.

5,0 mm

4.8 mm

2,5mm

3.5 mm

4,2 mmAll the other RU

enter through

12 mm trocar

7. Open the jaws. Apply the stapler cross the tissue to be transected.

8. Close jaws.

9. Push the green security button

WARNING:

The green security button only must be pushed when the surgeon start to fire. Otherwise the instrument could be accidentally fired at anytime.

Do not touch the green security button until you

decide to fire the instrument.

PushReady

to fire!

NOTE: IF JAWS ARE CLOSED BUT HANDLE HAS NOT BEEN SQUEEZED YET, IT IS STILL POSSIBLE TO STOP THE FIRING PROCESS.

It is highly recommended to fire the device once the green button has been pushed, in order to avoid a misfiring of the device, however if the surgeon needed, it is still possible to stop the firing process at this level.The surgeon could pull back the returning knob to open the jaws, and the green security button would be automatically activated again, returning to its security position. The surgeon could reposition the tissue between the jaws and start again with the normal firing process

Ready to firePushed

WARNING:

After the green security button is pushed wait 15 seconds before firing. This short time will be enough to get a better compression of the tissue and to better accommodates the tissue between the jaws.

This 15 seconds gets more importance when the tissue is especially thick, for example “Stomach Antrum”, also in this type of situations it’s very important to fire SLOWLY.

Pushed

WARNING:

DO NOT PULL IN EXCES THE TISSUE INSIDE THE JAWS

If we pull the tissue too much inside the reload we can create an overlapping of the tissue and this could cause a brake down

of the instrument or a dilatation of the little ears that keeps the anvil fixed

around the cartridge. If this issue happens then it will not be possible to

retrieve the instrument through the trocar.!!

Always include the quantity of tissue that it can be easily accommodated between the jaws.

WARNING:

There is a big difference between Echelon Endo Staplers and Panther Endo products.There are differences regarding the operation of the staplers due to the big differences

in the structure design between Echelon and Panther Endo products, for which we have a detailed introduction in our instructions of use.

Clinically speaking, when Echelon users transfer to be a Panther users, it is necessary to conduct a proper training for them (like animal test) to intensify their understanding and feeling on Panther products.

(i.e. Some Echelon users fires blue reloads in rectum, while Panther recommendation for rectum is always to use green reloads.)

CEAA/CEAB- Panther Endo

Echelon- Ethicon Endo

WARNING:

Panther Endo compress the tissue gradually meanwhile firing. So it’s important to fire the instrument SLOWLY to let the mechanism enough time to compress the tissue.

This issue becomes of greater importance when the tissue is thicker.

Remember!!. In thick tissue better to fire

SLOWLY to avoid any potential issues!!!

10) Firing the instrument

Problem：The firing strength is very large, and sometimes the handle can‘t be squeezed in the half way of firing.

Solution：Hold from the under part of handle . Use the thumb and the index finger to hold the under part for easy firing.

Problem: The firing strength is very large

Solution：Always select the appropriate cartridge according to the tissue thickness. Do not use 3.5mm staple for the tissue which only can be stapled by 4.8mm height. Otherwise, the instrument could be damaged and cause the fail of procedure.

10) Firing the instrument

Question: Can I fire the instrument only half and then pull the black returning knob back?

Answer: NO. Because you might be facing some staples without being

closed totally. When you fire just half of the instrument you may leave staples at half way of their formation and consequently you could face some small bleeding.

Remember!! Uncomplete firing can

create uncomplete staple formations

The firing distance is different for 30mm, 45mm and 60 mm reloads.

Don’t continue squeezing the firing handle when the reload has

been already totally fired.

Why? You might be facing the situations showed at the pictures below

Remember!! Stop squeezing the handle once the reload has

been totally fired

11) Open the jaws, remove instrument from the tissue.

ATTENTION: Use index finger and middle finger to pull the black returning knob at the tail of instrument.

WARNING: If you don’t follow this step correctly and you pull it back only pulling from one side of the black returning knob, the procedure will be very hard and the returning knob could be broken and leave the instrument useless.

12) Unloading and reloading procedure:

Ensure that the black returning knob is totally pulled in its back position, the articulation lever is in central position and the jaws are completely open.

Do not use the 2.5mm staples on any tissue that compresses to less than 1.0mm in thickness and on any tissue that cannot be comfortably compressed to 1.0mm or on aorta.

Do not use the 3.5mm staples on any tissue that compresses to less than 1.5mm in thickness and on any tissue that cannot be comfortably compressed to 1.5mm or on aorta.

Do not use the 4.8mm staples on any tissue that compresses to less than 2.0mm in thickness and on any tissue that cannot comfortably be compressed to 2.0mm or on aorta.

The Endo Linear Cutter Staple instrument should not be used on tissue such as liver or spleen where compressibility is such that closure of the instrument would be destructive.

Do not use the Endo Linear Cutter Staple where adequacy of hemostasis cannot be verified visually after applications.

These devices are provided STERILE and are intended for use a SINGLE procedure only. DISCARD AFTER USE. DO NOT RESTERILIZE.

CEAA /CEAB

Panther Endo Staplers

Indications in Surgical

Procedures

Abdominal surgery

Thoracic surgery

Bariatric surgery

Colorectal surgery

Gynecologic surgery

Pediatric surgery

Panther Endo Linear Cutter Stapler CEAA/CEAB

“can be used for tissue resection, transection and anastomosis”

Open and Laparoscopic

Surgery

Tissue thickness should be carefully evaluated before firing any stapler. If tissue cannot be

comfortably compressed within the maximum and minimum tissue thickness listed in the below table,

the tissue is contraindicated, as it may be too thick or too thin for the selected staple size.

Selection of the appropriate staple cartridge should be based upon the combined thicknesses of

both the tissue and the staple-line reinforcement material, if any.

WARNING:

REF

Color codeStaple high

Minimum

Tissue thickness

Maximum

Tissue thickness

White 2.5 mm 0.9 mm 1.2 mm

Blue 3.5 mm 1.3 mm 1.7 mm

Gold 4,2 mm 1,6 mm 2.0 mm

Green 4.8 mm 1.8 mm 2.2 mm

Black 5,0 mm 1.9 mm 2.4 mm

Color

codeStaple high

Minimum

Tissue thickness

Maximum

Tissue thickness Type of Tissue

White

Reloads2.5mm 0.9 mm 1.2 mm

Thin and

vascularized

tissues

EXAMPLES

•Ovary artery (in Pan Hysterectomy)

•Pulmonary artery and vein (Pneumonectomy)

•Lobar artery and vein (Lobectomy)

•Appendix resection (Appendectomy)

•Duodenum, Jejunum and Ileum

Color code Staple highMinimum

Tissue thickness

Maximum

Tissue thickness Type of Tissue

Blue

Reloads3.5mm 1.3 mm 1.7 mm Medium

Fundus

Angle

of His

EXAMPLES

•Wedge resection

•Closure of Lobar bronchus (Lobectomy)

•Colon (Colostomy, Colectomy and Right Hemicolectomy)

•Gastroyeyunostomy (Billroth II)

•GBP (Gastric resection, Angle of His)

•Sleeve Gastric (Fundus)

•Reverse gastric tube

•Pancreatic resection

Color code Staple highMinimum

Tissue thickness

Maximum

Tissue thickness Type of Tissue

Gold 4,2 mm 1,6 mm 2.0 mm Medium

Thick

EXAMPLES

•Sleeve gastrectomy (Body, Fundus and

in general, for all different parts in a not

extra thick stomach)

•Sigmoid Colon

•Pulmonary Parenchyma

Fundus

Angle

of His

Body

Antrum

Color code Staple highMinimum

Tissue thickness

Maximum

Tissue thickness Type of Tissue

Green 4.8 mm 1.8 mm 2.2 mm Thick

EXAMPLES

•Main Bronchus (Pneumonectomy)

•Closure of the Head of Pancreas (Whipple)

•Pyloric Sphincter

•Rectum (LAR)

•Obesity Surgery (Antrum of stomach in Sleeve

Gastric)

•Sigmoidectomy (colon Irradiated)

•Irradiated Tissues (colon)

Color code Staple highMinimum

Tissue thickness

Maximum

Tissue thickness Type of Tissue

Black 5,0 mm 1.9 mm 2.4 mm Extra Thick

Fundus

Angle

of His

Body

Antrum

EXAMPLES

•Very thick Stomach Antrum (Sleeve Gastrectomy)

•Pulmonary Parenchyma (Thicker parts)

•Bronchus

•Bariatric procedures review

•Irradiated Colon

Reload Code

Staple

Line

Length

ColorStaple

Height

Tissue

Compression

Requirement

Type of tissue (Reference)

CADA/B-30T 30mm White 2.5 mm 1.0mm Vessel

CADA/B-30N 30mm Blue 3.5 mm 1.5mm Trachea

CADA/B-45T 45mm White 2.5 mm 1.0mm Vessel, Small intestine

CADA/B-45N 45mm Blue 3.5 mm 1.5mmTrachea, Colon, Small Intestine,

Pulmonary lobes, Stomach

CADA/B-45S 45mm Gold 4.2 mm 1.8mmSleeve Gastrectomy. Pulmonary

Parenchyma

CADA/B-45D 45mm Green 4.8 mm 2.0mmTrachea, Interlobar fissure, rectum,

stomach, head of pancreas, snib

CADA/B-45R 45mm Black 5.0 mm 2.2mm

Parenchyma, Bronchus, re-do sleeve or

gastric bypass; stomach antrum, irradiated

colon or rectum

Reload CodeStaple Line

LengthColor Staple Height

Tissue

Compression

Requirement

Type of tissue

(Reference)

CADA/B-60T 60mm White 2.5 mm 1.0mm Small intestine

CADA/B-60N 60mm Blue 3.5 mm 1.5mmColon, Stomach, Lung,

Esophagus

CADA/B-60S 60mm Gold 4.2 mm 1.8mmSleeve Gastrectomy.

Pulmonary Parenchyma

CADA/B-60D 60mm Green 4.8 mm 2.0mmStomach, Interlobar

fissure, rectum

CADA/B-60R 60mm Black 5.0 mm 2.2mm

Parenchyma, Bronchus,

re-do sleeve or gastric

bypass; stomach antrum,

irradiated colon or

rectum

Thank you for your attention!

Questions? Comments?