ENDOSCOPIC TRANSCANAL EAR ANATOMY AND … Section of Otolaryngology, American Hospital Dubai, United Arab Emirates 2 Department of Otolaryngology, University Hospital of Modena, Italy

Muaaz TARABICHI, Daniele MARCHIONI Livio PRESUTTI, Dave POTHIER

João Flávio NOGUEIRA

ENDOSCOPIC TRANSCANAL EAR ANATOMY AND

DISSECTION MANUAL

®

ENDOSCOPIC TRANSCANAL EAR ANATOMY AND

DISSECTION MANUAL

Muaaz TARABICHI1 MDDaniele MARCHIONI2 MD

Livio PRESUTTI2 MDDave POTHIER3 MD

João Flávio NOGUEIRA4 MD

1Section of OtolaryngologyAmerican Hospital Dubai, United Arab Emirates

2Department of OtolaryngologyUniversity Hospital of Modena, Italy

3Department of OtolaryngologyHead and Neck Surgery, University of Toronto, Canada

4Department of OtolaryngologyHospital Geral de Fortaleza, Fortaleza, Brazil

®

Endoscopic Transcanal Ear Anatomy and Dissection Manual 4

Endoscopic Transcanal Ear Anatomy and Dissection ManualMuaaz Tarabichi1 MD, Daniele Marchioni2 MD, Livio Presutti2 MD,Dave Pothier3 MD, and João Flávio Nogueira4 MD1 Section of Otolaryngology, American Hospital Dubai, United Arab Emirates2 Department of Otolaryngology, University Hospital of Modena, Italy 3 Department of Otolaryngology, Head and Neck Surgery, University of Toronto,

Canada4 Department of Otolaryngology, Hospital Geral de Fortaleza, Fortaleza, Brazil

Correspondence address of the author: Muaaz Tarabichi MDSection of Otolaryngology, American Hospital Dubai, United Arab ErimatesE-mail: [email protected] [email protected]

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Table of ContentsEndoscopic Dissection of the Middle Ear . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Working Place Set Up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Instrumentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Dissection Tasks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6–22

Elective Dissection Tasks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23


Endoscopic Dissection of the Middle EarObjectivesa) Develop an understanding of the endoscopic anatomy of the middle and inner

ear as viewed through a transcanal access.b) Develop the necessary hand-eye coordination and manual skills to perform

endoscopic ear surgery.c) Perform in the lab the specifi c steps involved in tympanoplasty. d) Understand the anatomy of those areas of the middle ear prone to harbor

cholesteatoma.e) Perform in the lab the exploration of all areas of the middle ear frequently involved

in cholesteatoma growth.

Working Place Set UpThe head/temporal bone holder should be positioned such that the axis of the external auditory canal (EAC) is aligned on-axis with the surgeon’s line of vision. In view of the upsloping orientation of the EAC (Fig. 1), the surgeon’s fi eld of view should be centered on the lateral short process of the malleus rather than the umbo of the tympanic membrane. The anatomic specimen should be positioned between the video monitor and the surgeon. When using a 0°-endoscope, and for most of the dissection course, the specimen’s top should be to your right for the right ear and to your left for the left ear. When using scopes with viewing angles other than 0°, you should always be able to rotate the anatomic specimen around as you explore the various spaces of the middle ear. The orientation of the scope’s angled view should always face away from the surgeon and directed toward the monitor.

Instrumentation

Item No. Designation

226825 Round Knife 45°, 16 cm, diameter: 2.5 mm.

223100 PLESTER Knife, round, vertical, 16 cm, standard size 3.5 x 2.5 mm

224303 WULLSTEIN Needle, 16.5 cm, light curve.

222604 R BELLUCCI Scissors, working length 8 cm, delicate, curved right

222605 L BELLUCCI Scissors, working length 8 cm, delicate, curved left

222800 HOUSE-DIETER Malleus Nipper, working length 8 cm, upbiting.

224001 HOUSE Curette, 15 cm, large size.

204200 FISCH Adaptor, with cut-off hole, LUER cone 5.5 cm.

204015 Suction Cannula, angular, LUER- Lock, working length 6 cm, O.D.: 1.5 mm

7220 AA HOPKINS® 0° Straight Forward Telescope, diameter 3 mm, length 14 cm.

7220 BA HOPKINS® 30° Forward-Oblique Telescope, diameter 3 mm, length 14 cm.

Dissection Tasks � Endoscopic inspection of the EAC: It is important to take a few minutes to inspect the anatomy of the EAC, the tympanic membrane (TM) and whatever is visible through the transparent TM.

Observe 1. Many of the vessels of the TM emanate from the EAC. They supply the TM in a

lateral-to-medial direction; this is very distinct under in-vivo conditions and might not be noticeable in an anatomic specimen. So, by removing the skin of the EAC and the epithelial layer of the TM, you have largely eliminated the bleeding elements of the external ear and TM. (Fig. 2)

2. The axis of the EAC is angled superiorly and the scutum (rather than the mesotympanum) forms the medial end of the ear canal. (Fig. 1)

3. The location and extent of any anterior overhang. Please note, that in many anatomical specimens an inferior overhang may also be found (Fig. 3).

Right Ear: Coronal CT section through the external auditory canal (EAT) and middle ear. Note, that the axis of the EAT slopes upward. The scutum represents the real “bottom of the EAT” rather than the mesotympanum. If the scutum is removed, this would allow direct access to the attic, the area frequently involved in chole steatoma growth.

1


� Outline the vascular strip: Use the round knife to place the medial cut 2–3 mm away, and in parallel with the annulus, and then use the Plester fl ap knife to extend the cuts laterally, and in parallel with the axis of the ear canal.

Observe

1. The fi brous annulus of the TM almost disappears in the upper posterior part of the TM. (Figs. 2, 4)

2. You need to palpate the bony edge of the middle ear before making your deep cut at the distal end of the vascular strip. It is usually the fi brous annulus that is visible. Even though the fi brous annulus, visible inferiorly, serves as a good landmark for placing the cut, be aware that incompleteness of the fi brous annulus at its upper and superior margins, along with engorgement of the vascular strip after injection of xylocaine and epinephrine, can cause lack of defi nition of the bony annulus rim separating the ear canal from the middle ear.

� Removal of canal skin along with the epithelial layer of TM. Using the round knife, a circular lateral incision is made that connects the two limbs of the vascular strip incision across the anterior canal in preparation for removal of the ear canal skin. Please note, that the incision needs to be made lateral enough to any anterior bony overhang. Next, the skin of the ear canal should be elevated under direct vision. All overhanging bone is curetted away as we proceed medially in the canal. Care should be taken to preserve integrity of the temporomandibular joint. As the annulus is reached, it should not be elevated; the skin of the canal should be elevated in contiguity with the epithelial layer of the TM. This can be accomplished either by use of the round knife which is carried over and then moved in the same direction of the annulus, or with a cuffed forceps by peeling off the epithelial layer covering the lateral short process of the malleus superiorly. Attention should be paid that the fi brous annulus remains anchored in its bony groove.

Endoscopic view of the tympanic membrane (TM) in a right ear with cholesteatoma showing through. Note the blood vessels arising from the EAC and supplying the TM.

2

Left ear: Endoscopic view of an anatomic specimen with a small per foration. Note the size and location of the considerable anterior bony overhang in the external auditory canal.

3

Left ear: The skin of the canal has been removed along with the epithelial layer of the TM. The EAC has been enlarged. Note the boundaries of the fi brous annulus (white spots); Chorda tympani (Ct); Posterior mallear ligament (Pml).

• •Pml

Ct

4

Right ear: The canal wall is curetted to obtain a panoramic view of the tympanic ring using the 0° HOPKINS® endoscope.Vascular strip (VS); Fibrous layer of tympanic membrane (FLTM);Cholesteatoma (CH).

5


Observe

1. The glistening white annulus and fi brous layer of the TM (Fig. 4).2. The friable skin and epithelial layer of the TM. Compare Figs. 3 and 4.

� Enlargement of the ear canal. The EAT should be curetted out in all directions to achieve a panoramic view of both the annulus and the EAT using the 0°-scope. Given the fact that the bony annulus separating the middle ear from the EAT is very variable in relationship to other structures, always consider the possibility of a low dura, anterior sigmoid, facial nerve, and a high jugular bulb as you enlarge the ear canal. (Figs. 5, 6)

� Elevation of the annulus up to 3 and 9 o’clock: Using the cuffed forceps, the fi brous layer of the TM is detached from the upper part of the malleus handle, mobilized from the bony sulcus, and the elevated TM is defl ected inferiorly.

Schematic anatomical representation of the left EAT with surrounding structures that need to be considered when enlarging the ear canal.

6

Left ear: The fi brous layer of the TM along with the fi brous annulus have been removed and separated from the malleus handle.The tendon of the tensor tympani (TT).

TT

8

Left ear: Endoscopic view of the retrotympanum.Incudostapedial joint (IS); pyramidal eminence (PE); ponticulus (PO); sinus tympani (ST); subiculum (SU); round window (RW).

IS FE

SU

ST

PO

RW

10

Right ear: Fibrous layer of the TM is pulled down off the malleus handle revealing the posterior mallear ligament (Pml) and the chorda tympani (Ct).

Pml

Ct

7

Left ear. Endoscopic view through a transcanal endoscopic access after minor removal of bone; the facial recess (FR) is very shallow and more of a fl at depression, superfi cial to the pyramidal eminence (PE) and the vertical segment of facial nerve (FN). Also note the horizontal segment of the facial nerve.

FRPE

FN

9


Observe

1. The posterior mallear ligament overlying the chorda tympani and almost parallel to it. (Fig. 7)

2. The undersurface of the TM and the malleus handle.

� Next, the Wullstein needle is used to separate the remnant of the TM from the malleus handle, starting from the lateral short process of the malleus and extending downward toward the umbo. Subsequently, an angled Belluci scissors is used to separate the TM remnant from the umbo. (Fig. 8)

� Take down the bony annulus posteriorly to gain full access to the facial recess and sinus tympani. Make sure, that the posterior canal wall is almost fl ush with the pyramidal eminence (Fig. 9), which marks very accurately the level of the vertical segment of the facial nerve and allows for safe curetting of bone super fi cial to that level. This, however, is not the case more inferiorly in the EAC and the horizontal segment of the facial nerve can have a variable course that appears to run laterally in the posterior canal wall.

Observe

1. Using a 0°-scope, the facial recess is readily accessible presenting as a small depression on the posterior wall of the tympanic cavity. (Fig. 9)

2. Using the 30°-scope, the anatomical specimen should be placed in a position so that its posterior aspect faces away from you, and also make sure, that the axis of the scope’s direction of view points away from you. Inspect the retrotympanic anatomy. (Fig. 10)

3. Observe the pyramidal eminence and look for the presence of a subpyramidal space. (Fig. 11)

4. Identify the entry point of any subpyramidal space. Study the various possible variations (Fig. 12). Continued overleaf.

11 Schematic drawing of subpyramidal space (sps) of a right ear. Facial nerve (fn);

pyramidal eminence (pe); stapes tendon (st); ponticulus (p); posterior sinus tympani (pts); stapes (s); sinus tympani (st); promontory (pr); round window (rw); subiculum (su); sinus subtympanicus (ss).

a1 a2

12 Variable morphology of the pyramidal eminence (pe) in a right ear demonstrated by two types of perspectives: an anatomic view

(a1, b1, c1), and a surgical endoscopic view (a2, b2, c2) through an angled-view scope while looking in the posterior direction.a Morphological variations of the pe, sinus tympani (st) and posterior

sinus tympani (pts) communicating through the sub pyramidal space (sps).

b Partial morphology of the pe. The subpyramidal space (sps) is communicating with the sinus tympani.

c Partial morphology of the pe. The subpyramidal space (sps) is communicating with the posterior sinus tympani (pts).The refers to the communication of sps; facial nerve (fn); stapes (s); ponticulus (p); promontory (pr); round window (rw); subiculum (su). c1 c2

b1 b2


Continued from page 9. Inspect your specimen and compare it with other specimens being dissected. Note, that in the specimen shown here, there is an extension of both sinus tympani and posterior tympanic sinus (Fig. 13).

5. Study the variable anatomical morphology of the sinus tympani. (Fig. 14)

Left ear. The entry points of the subpyramidal space ( ) of this specimen are a specifi c feature of ‘type A’, connecting both the sinus tympani (ST) and posterior tympanic sinus (PTS).Pyramidal eminence (PE).

PE

ST

PTS

13

14 The variable morphological appearance of the sinus tympani.

Facial nerve (fn); posterior sinus tympani (pts); pyramidal eminence (pe); stapes (s); round window (rw); subiculum (su); jugular bulb (jb); sinus subtympanicus (ss); sinus tympani (st); ridge separating the sinus tympani into two parts ( ); superior part of sinus tympani (sts); inferior part of sinus tympani (sti).

a b

c d


6. Study the classifi cation of depth and extension of the sinus tympani. (Figs. 15, 16)7. Study the shape and depth of the sinus tympani in your specimen. Try to classify

(palpate, if necessary) the type of sinus tympani of your specimen as well as the one shown in this manual. (Fig. 10)

8. Observe the ponticulus promontorii and its possible variations. (Fig. 17)

The various types of sinus tympani classifi ed according to depth and extension in relation to the facial nerve. Cochlear promontory (pr); facial nerve (fn); sinus tympani (st)

Type A Type B Type C

15

16 Schematic drawing of a ‘Type C’ sinus tympani. The indicates the

posterior extension of the sinus tympani with respect to the third portion of the facial nerve (fn). Chordal ridge (cr); chorda tympani nerve (ctn); lateral tympanic sinus (lts);

facial sinus (fs); incus (in); malleus (ma); ponticulus (p); pyra midal eminence (pe); cochlear promontory (pr); posterior sinus tympani (pts); stapedial tendon (st); stapes (s); subiculum (su); round window (rw).

17 The variable morphological appearanceof the ponticulus promontorii (p). Ridge

ponticulus (Type A); incomplete ponticulus (Type B), bridge ponticulus (Type C). Facial nerve (fn); incus (in); ponticulus (p); pyramidal eminence (pe); posterior sinus tym pani (pts);cochlear promontory (pr); stapedial tendon (st); stapes (s); subiculum (su); sinus subtympanicus (ss).

c

Type A

Type C

Type B

b

a


19 Right ear. Schematic anatomical survey drawing of the retrotympanum and

hypo tympanum. The fi niculus (fi ) appears as a bony ridge which arises from the anterior and inferior lip of the round window and separates the inferior retrotympanum from the hypo tympanum. The subiculum (su) marks the boundary between the superior and inferior retrotympanum.

Right ear. Endoscopic view of the round window niche. Tegmen of the round window niche (TE); anterior pillar (AP); posterior pillar (PP); round window membrane (�).

AP

TEPP

��

�18

9. Try to inspect the round window membrane and niche. Identify the tegmen of the round window niche and the anterior and posterior pillars. (Fig. 18)

� Take down any “inferior overhang” and enlarge the access to the inferior retro-tympanum and hypotympanum, next inspect the hypotympanum. This should be done with a 30°-scope, with the line of vision and the postero-inferior part of the specimen facing straight ahead, away from the surgeon. (Fig. 19)

Right side. Facial nerve (fn); pyramidal eminence (pe); oval window (ow); cochleariform process (cp); sinus tympani (st); ponticulus (p); subiculum (su); posterior pillar (pp); tegmen of round window niche (te); cochlear promontory (pr); Eustachian tube (et); round window (rw); styloid eminence (sty); sinus subtympanicus (ss); anterior pillar (ap); fi niculus (fi ); jugular bulb (jb).


20 Right ear: Anatomical variations of the subiculum. Ridge subiculum (Type A).

a

Type A

Bridge subiculum (Type B).

b

Type B

Absent subiculum (Type C), in which the sinus subtympanicus is confl uent with the sinus tympani.

c

Type C

Left ear: Endoscopic panoramic view of the tympanic cavity with special focus on theretrotympanum. Facial nerve (FN); subiculum (SU); sinus subtympanicus (SS); styloid eminence (SE); round window (RW); fi niculus (FIN); carotid artery (CA); hypotympanic air cell (HC).

PE

FN

CA

SU

SE

SSHC

FIN

RW

21

Observe

1. Study the anatomy of the subiculum and its variations. (Fig. 20)2. Observe the subiculum, the inferior border of the sinus tympani and the superior

border of the sinus subtympanicus. Identify the type of subiculum in your specimen. (Fig. 21)

Key to abbreviations: Facial nerve (fn); pyramidal eminence (pe); oval window (ow); cochleariform process (cp); sinus tympani (st); ponticulus (p); subiculum (su); cochlear

pro montory (pr); sinus subtympanicus (sst);round window (rw); Eustachian tube (et);styloid eminence (sty); ponticulus (p).


3. Identify the fi niculus, delineating the inferior border of the sinus subtympanicus. Determine the type of fi niculus in your specimen. (Fig. 22)

4. Trace the styloid eminence, basically delineating the vertical segment of the facial nerve. (Fig. 21)

5. Try to determine the height and size of the jugular bulb.6. Take a panoramic view and inspect the infracochlear space. If this area is well

pneumatized, you should be able to visualize the curvature of the basal turn of the cochlea. (Fig. 21)

� Next, limited atticotomy is performed with meticulous care. Make sure that you stop at the insertion point of the lateral incudomallear ligament and the lateral mallear ligament on the medial aspect of the scutum. Exercise due restraint and caution while performing this step to preserve integrity of these friable ligaments.

22 Anatomical variations of the fi niculus (fi ). Right side. Ridge fi niculus (Type A);

a

Type A

Bridge fi niculus (Type B).

b

Type B

Absent fi niculus (Type C).

c

Type C

Key to abbreviations: facial nerve (fn); pyramidal eminence (pe); oval window (ow); cochleariform process (cp); sinus tympani (st);

ponticulus (p); subiculum (su); roundwindow (rw); cochlear pro montory (pr);Eustachian tube (et); styloid eminence (sty);

sinus subtympanicus (sst); fi niculus (fi ); jugular bulb (jb); styloid eminence (sty); ponticulus (p); hypotympanic air cell (hc).

Left ear: Endoscopic panoramic view of the tympanic cavity with special focus on the retrotympanum. Facial nerve (FN); subiculum (SU); sinus subtympanicus (SS); styloid eminence (SE); round window (RW); fi niculus (FIN); carotid artery (CA); hypotympanic air cell (HC).

PE

FN

CA

SU

SE

SSHC

FIN

RW

21


Left ear: Prussak’s space (PR); posterior mallear ligament (PML).

PMLPR

23

Left ear: The relatively straight insertion line of the lateral incudo-mallear ligament (LIML) and the downward sloping insertion line of the lateral mallear ligament (LML).

LIMLLIML

LML

24

Observe

1. The shape of the lateral ligaments and how they are made up, along with the neck of malleus, the roof and medial aspect of Prussak’s space. (Fig. 23)

2. Notice, that these suspensory ligaments form the lateral part of the epitympanic diaphragm separating the area between scutum and ossicles, and preventing any ventilation of the attic via this lateral route. Take note of the straight insertion points on the ossicles of the lateral incudomallear ligament and the curvilinear insertion of the lateral mallear ligament. These are key landmarks because they act as gateways for the spread of attic cholesteatoma. (Fig. 24)


� Proceed with extending the atticotomy, but leave untouched the lateral mallear fold, saucerize the anterior part of the scutum, and expose the malleus while preserving the incudal part of the lateral incudo-mallear folds. (Fig. 25)

Observe

1. Anterior to the malleus head, look for the anterior epitympanic space (Fig. 25). Note, how in most specimens, this space is separated from the supratubal recess by the cog and the tensor folds bridging the gap between tensor tympani tendon and the cog.

2. Look for the presence of Sheehy’s cog and confi rm integrity of the tensor folds, separating this space from the supratubal recess. (Fig. 26)

Left ear: Anterior epitympanic space (AES); tensor tympani folds (TF), partially visible and closing off the attic from direct ventilation of the supratubal recess and the Eustachian tube.

TF

AES

25

Left ear: Close up view of the anterior epi tympanic space (AES).

TF

AES

26


� Proceed with removing the whole scutum including the lateral incudo-mallear folds, and expose the whole incus along with the malleus head. (Fig. 27)

� Bone removal is carried anteriorly along the anterior bony annulus in order to create adequate space for the 3-mm 30°-scope, which is introduced between malleus handle and bony annulus. Subsequently, inspect anteriorly, superiorly and posteriorly. (Fig. 28)

Left ear: The ossicles have been fully exposed within the attic allowing to clearly visualize the incudo-mallear articulation line.Incudo-mallear joint (IMJ); anteriorepitympanic space (AES); tensor tympani fold (TF), partially visible and preventing the attic from direct ventilation via the supratubal recess and the Eustachian tube.

IMJ

TF

AES

27

Left ear: handle of malleus (HM); supratubal recess (STS); anterior surface of Sheehy’s cog (COG) separating the attic from thesupratubal recess; vertical segment of the tensor tympani fold (TFV), which – given its entire integrity – closes off the attic from the Eustachian tube; horizontal segment of the tensor tympani fold (TFH) which partially contributes to the fl oor of the supratubal recess anteriorly; bony encasement of the tensor tympani muscles (TTM); bony annulus (BA); carotid artery (CA).

STS

CA

TTM

ET

BA COG

TFV

TFH

HM

28


Observe

1. Look down the Eustachian tube. Examine the relationship between the carotid artery and the bony encasement of the tensor tympani muscle (Fig. 29)

2. You can use a 45°- or 70°-scope to gain a look further down the Eustachian tube, allowing occasionally identifi cation of the nasopharyngeal opening. (Fig. 30)

3. On-axis rotation of the angled-view scope allows to view superiorly and examine the size and depth of the supratubal recess which varies considerably in size and degree of development. The size of the supratubal recess does not correlate with the degree of pneumatization of the mastoid cavity and attic. (Fig. 31)

4. Rotate further superiorly and posteriorly to visualize the tensor tympani fold which, when complete, separates the anterior attic from the supratubal recess. The shape and position of the tensor tympani fold seems to be subject to high variability, and is related to the size of the supratubal recess. If the supratubal recess is poorly developed, the tensor tympani fold is almost a horizontal structure that closes up the anterior attic and seperates it from the Eustachian tube. It starts with the tendon of the tensor tympani and inserts along a bony ridge formed by the encasement of the tensor tympani muscle, and extends almost into the anterior tympanic spine, as shown in Figs. 32–33. If the supratubal recess is well-developed as in the anatomic specimen shown in this manual, then the tensor tympani fold has two parts. The almost vertical part attaches to the area just anterior to the cog and forms the wall that seperates the supratubal recess from the anterior attic. The second part is a horizontal segment that attaches to the tensor tympani tendon and the most anterior part of the bony ridge, which is formed by the bony encasement of the tensor tympani muscle. So, in the presence of a well-developed supratubal recess, the horizontal part of the tensor tympani fold partly contributes to the fl oor of the supra tubal recess. (Fig. 31)

Left ear: Endoscopic view down the Eustachian tube (ET). Bony encase mentof the tensor tympani muscle (TTM);bony annulus (BA); carotid artery (CA).

TTM

ET

CA

STS

29

Using a 45°-scope, it is occasionally possible to view the opening of the Eustachian tube to the naso pharynx. Carotid artery (CA);tensor tympani muscle (TTM).

TTM

CA

30


Another way of conceptualizing this, is to think of a well-developed supratubal recess ballooning into the tensor fold and shaping it into these two segments. (Fig. 34)

Histologic section through a dome-shaped supra tubal recess ( ). The outermost plate (�� )of the petrosa; a spur (’) projecting toward the mallear head, to which attaches a mucosal fold that stems from the anterior mallear ligament; Sheehy’s cog (

� �

); tensor tympani folds (�);geniculate ganglion (G); cochlea (C); lateral semicircular canal (L).

’

�

� �

31

Left ear: Endoscopic anatomy of the tensor tympani fold in a specimen with a well-developed supratubal recess (STS). The tensor tympani folds are composed of two segments, a vertical part (TFV) that attaches to Sheehy’s cog (COG), and a horizontal part (TFH) that partlycontri butes to the fl oor of the supratubal recess anteriorly; bony encasement of the tensor tympani muscle (TTM).

COG

STS

TTM

TFH

TFV

32

Right ear: Unlike the anatomic specimen shown in Fig. 31, this is a poorly-developed supratubal recess in a surgical case. View through a 70°-scope, upward and backward. The tensor tympani fold (TF) here, different from the one shown in Fig. 31, is almost a horizontal structure. Handle of malleus (HM); tensor tympani muscle (TTM), anterior bony annulus (ABA).

ABA

TF

HM

TTM

33

Right ear: Endoscopic close-up view of the tensor tympani fold (TF) shown in Fig. 32. Bony encasement of the tensor tympani muscle (TTM); tensor tympani tendon (TTT) inserting on the neck of the malleus. Funnel-shaped entrance to the Eustachian tube (�).

TTM

TF

TTT

34


5. Provided the lateral attic space is closed off by the lateral mallear and incudo-mallear folds, and in the presence of a complete tensor tympani fold – preventing any direct ventilation through the anterior attic – the only area for epitympanic ventilation is the tympanic isthmus which is interposed between the incudostapedial joint and the tensor tympani tendon. (Fig. 35)

� Mobilize the incus to expose the articular facet with malleus and stapes. Then, proceed with disarticulating the stapes and malleus from the incus. (Fig. 36)

Observe

1. The horizontal segment of the facial nerve and the second genu.2. The lateral semicircular canal.3. The remnant of the previously released attachment of the superior incudal

ligament to the tegmen tympani. (Fig. 37)

� Using a malleus nipper, transect the neck of the malleus at a relatively superior level in order to preserve the anterior mallear ligament and the tensor tympani tendon which attaches to the handle and neck of the malleus. Remove the head of malleus, taking care that the suspensory ligaments stabilizing the handle are preserved. Mobilize the handle anteriorly. (Fig. 38)

Left ear: tympanic isthmus (IM) forms the only passageway for attic ventilation in the pre sence of complete tensor folds. Tensor tympani tendon (TT); incudo-stapedial joint (ISJ).

TT

ISJ

IM

35

Left ear: Endoscopic view after removal of the incus. Articular facet of the head of malleus (AS); horizontal segment of the facial nerve (FN); lateral semi circular canal (LSC); Additus ad antrum (AA); chorda tympani (CD); tensor tympani tendon (TT).

FN

LSC

AF

CD

AA

TT

36


Observe

1. The tensor tympani tendon attaching to the neck of the malleus.2. The broken off vertical segment of the tensor tympani fold.3. The course of the chorda tympani nerve (Fig. 37)4. The anterior aperture of the chorda tympani nerve running in its bony canal.5. the topographical relationship of the chorda tympani nerve to the anterior mallear

ligament.6. The anterior tympanic spine and the attachment of the anterior mallear ligament.

Left ear: Endoscopic view of the attic after removal of the incus. Articular surface of the head of malleus (AS); remnant of the superior ligament (SL) of the incus attaching to the tegmen tympani.

SLAS

37

Left ear: The handle of malleus has been mobilized anteriorly to expose the tensor tympani fold which is released from its attachments; the starting point of the white arrows indicate the original position of the fold and the tips show the current point following lateralization of the malleus handle. Tensor tympani tendon (TT); chorda tympani (CT); tensor tympani fold (TF) after dislocation from its original position; anterior mallear ligament (AML).

CTAML

TF

TT

38


Left ear: Endoscopic view of the horizontal segment of the facial nerve demonstratingits topographical relationship to the lateral semi circular canal. First genu (1G); second genu (2G); lateral canal (LC); cochleariform process (CP).

LC

1G

CF

2G

40

� Transect the tensor tympani tendon and remove the malleus handle. (Fig. 39)

Observe

1. You can almost see the fi bers of the horizontal segment of the facial nerve, and its fi rst genu as it performs the fi rst turn after arising from the internal auditory canal.

2. The relationship of Sheehy’s cog to the geniculate ganglion of the facial nerve.3. The remnant of the tensor tympani fold.4. Examine the relationship between the second genu of the facial nerve and the

lateral semicircular canal. (Fig. 40)

Left ear: Endoscopic view after transection of the tensor tympani tendon and removal of the malleus handle, the anterior tympanic spine, anterior mallear ligament and the chorda tympani. Sheehy’s cog (COG); remnant of the tensor tympani fold (TM); insertion point ( ) of the partially removed vertical segment of the tensor tympani fold; insertion point ( ) of the completely removed horizontal segment of the tensor tympani fold; supratubal recess (STR); Eustachian tube (ET); cochleariform process (CP); fi rst genu (1G) of the facial nerve and neighbouring geniculate ganglion; lateral semicircular canal (LC).

LCCOG

ET

STR

TF

STR

1G

��

�

�

�

��

�

39


Elective Dissection Tasks � Using a curette or a drill, if available, attempt to slowly remove the bony encasement of the facial nerve, starting with the horizontal segment and following the nerve proximally and distally into the fi rst and second genus.

Observe

1. The acute right angle bend of the fi rst genu and the upward “kink” in that area. 2. The thin wall of bone overlying the facial nerve especially over the geniculate

ganglion which forms the medial wall of the attic at the area of the cog.3. Try to identify the ramifi cation of the facial nerve’s fi rst genu, giving off the greater

(superfi cial) petrosal nerve.4. Remove the bony encasement of the facial nerve along the course of its vertical

segment and try to identify the fi ne ramifi cation of facial nerve, innervating the stapedius muscle.

� Using a curette, remove the round window niche. Remove the round window membrane and enlarge the round window inferiorly and anteriorly to expose the beginning of the scala tympani and the basal turn of the cochlea.

Observe

1. The relationship between the round window and the scala tympani and its slightly angulated spacial orientation.


Instrument Set for Endoscopic Ear Surgery

1 2 4 5 7

9 bl bm bn

bo bp bq br bs bt bu cl

cm

cn

co cp cq cr

6

8

3


Instrument Set for Endoscopic Ear Surgery

1 227201 Ear Hook, curved right, length 16 cm2 227202 Same, curved left 3 227203 Same, curved backwards

4 227206 Ear Dissector, curved right, length 16 cm 5 227207 Same, curved left 6 227208 Same, curved backwards

7 227211 Curette, spoon-shaped, diameter 1.0 mm, length 16 cm

8 227213 Curette, double-ended, spoon-shaped tips: diameter 1.0 mm and 1.5 mm, 90° curved, length 17 cm

9 226212 Dissector, double-ended, tips double curved right and left, length 18 cmbl 226211 Same, distal tips with single curve to right or to left

bm 224003 HOUSE Curette, medium, spoon sizes 1 x 1.8 mm and 2 x 3.5 mm, length 15 cm

bn 227230 Suction round knife, diameter: 3 mm, easy to handle due rotatable tubing connector, length 19 cm

bo 204357 Suction Cannula, curved 3 mm, LUER-Lock, outer diameter 0.6 mm, length 10 cm bp 204358 Same, outer diameter 0.8 mm bq 204359 Same, outer diameter 1.0 mm

br 204360 Suction Cannula, curved 6 mm, LUER-Lock, outer diameter 0.8 mm, length 10 cmbs 204361 Same, outer diameter 1.0 mmbt 204362 Same, outer diameter 1.2 mm

bu 204365 Suction Cannula, curved 8 mm, LUER-Lock, outer diameter 1.2 mm, length 10 cmcl 204366 Same, outer diameter 1.6 mm, length 10 cm

cm 204200 FISCH Suction Handle, with cut-off hole, LUER cone, length 5.5 cm

cn 600019 LUER Cone Connector, male, rotating

co 227255 Ear Forceps, curved downwards, retrograde, extra delicate, oval cupped jaws, 0.9 mm, working length 10 cmcp 227253 Same, 45° curved upwards, extra delicate, oval cupped jaws, 0.6 mmcq 227251 Same, 45° curved rightcr 227252 Same, 45° curved left

It is recommended to check the suitability of the product for the intended procedure prior to use.


Endoscopic-Guided Middle Ear DiagnosisRecommended Set according to Dr. M. TARABICHIHOPKINS® Telescopes and Accessories

1215 AA Tele-Otoscope with HOPKINS® Straight Forward Telescope 0°, diameter 4 mm, length 6 cm, autoclavable, fiber optic light transmission incorporated, color code: green

1215 BA Tele-Otoscope with HOPKINS® Forward-Oblique Telescope 30°, diameter 4 mm, length 6 cm, autoclavable, fiber optic light transmission incorporated, color code: red

1230 AA HOPKINS® Straight Forward Telescope 0°, diameter 2.7 mm, length 11 cm, autoclavable, fiber optic light transmission incorporated, color code: green

1230 BA HOPKINS® Forward-Oblique Telescope 30°, diameter 2.7 mm, length 11 cm, autoclavable, fiber optic light transmission incorporated, color code: red

1218 S Stand, for 3 tele-otoscopes 1215, 1216, 1218, cartridges with color codes green, red and yellow, autoclavable, dimensions: 180 x 105 x 80 mm (w x h x d)

723773 STAMMBERGER Telescope Handle, round, length 6.5 cm, for use with HOPKINS® telescopes with diameter 2.7/ 3 mm and length 11 cm

203710 Suction Tube, cylindrical, LUER, outer diameter 1 mm, working length 9 cm

203705203707203710203715

203710

1215 AA/BA 1230 AA/BA


LED Battery Light Sources for Endoscopes

11301 D4 LED Battery Light Source for Endoscopes, with fast screw thread, brightness > 110 lm / > 150 klx, burning time > 120 min, weight approx. 150 g ready for use, suitable for wipe disinfection

11301 DE Battery Light Source LED for Endoscopes, rechargeable, with click connection, boost mode for temporary increase in brightness, color temperature 5500 K, lithium-ion batteries, charging time 60 min, burning time at 100% brightness 40 min, weight approx. 150 g, suitable for wipe disinfection

11301 DF Battery Light Source LED for Endoscopes, rechargeable, with fast screw thread, boost mode for temporary increase in brightness, color temperature 5500 K, lithium-ion batteries, charging time 60 min, burning time at 100% brightness 40 min, weight approx. 150 g, suitable for wipe disinfection

11301 DG Charging Unit, for 11301 DE/11301 DF, for two LED battery light sources, with fix integrated power supply and adaptor for EU, UK, USA and Australia, power supply 110 – 240 VAC, 50/60 Hz, suitable for surface disinfection

094129 Battery Charger Li-Ion, for charging the rechargeable Battery Box 091424 or Battery Light Source 11301 DE/DF, for use with Mains Cord 094127, power supply 100 – 240 VAC, 50/60 Hz

094127 Mains Cord, for Battery Charger 094129, length 150 cm

11301 DG11301 D4


Endoscopic-Guided Middle Ear SurgeryRecommended Set according to Dr. M. TARABICHIHOPKINS® Telescopes and Accessories

7230 AA HOPKINS® Straight Forward Telescope 0°, enlarged view, diameter 4 mm, length 18 cm, autoclavable, fiber optic light transmission incorporated, color code: green

7230 BA HOPKINS® Forward-Oblique Telescope 30°, enlarged view, diameter 4 mm, length 18 cm, autoclavable, fiber optic light transmission incorporated, color code: red

7220 AA HOPKINS® Straight Forward Telescope 0°, enlarged view, diameter 3 mm, length 14 cm, autoclavable, fiber optic light transmission incorporated, color code: green

7220 BA HOPKINS® Forward-Oblique Telescope 30°, enlarged view, diameter 3 mm, length 14 cm, autoclavable, fiber optic light transmission incorporated, color code: red

152201 WAGENER Ear Hook, ball end, size 1, length 15.5 cm

152202 Same, size 2

152203 Same, size 3

152301 Ear Hook, without ball end, size 1, length 15.5 cm

152302 Same, size 2

204250 FISCH Adaptor, for Suction Tubes 204352 – 204354, with long thumb grip, cut-off hole diameter 1 mm, inner diameter 1.7 mm, LUER cone, length 5.5 cm

204005 Suction Cannula, angular, LUER-Lock, outer diameter 0.5 mm, working length 6 cm

204007 Same, outer diameter 0.7 mm


204010 Same, outer diameter 1 mm



204020 Same, outer diameter 2 mm


7220 AA/BA

152202152201

152201 – 152302

152203

152302

204250204005 – 204025

7220 AA/BA

152301

7230 AA/BA


221100 – 221310

221100 HARTMANN Ear Forceps, extra delicate, serrated, 1 x 4.5 mm, working length 8 cm

221150 Same, working length 12.5 cm

221210 FISCH Ear Forceps, extra delicate, pointed, smooth, 1 x 4.5 mm, working length 8 cm

221201 FISCH Ear Forceps, extra delicate, serrated, 0.4 x 3.5 mm, working length 8 cm

221304 Ear Forceps, extra delicate, serrated, curved to right, working length 8 cm

221305 Same, curved to left

221307 Same, curved upwards

221310 THOMASSIN Ear Forceps, very fine, serrated, retrograde backwards curved, working length 8 cm

162500

162500 STRÜMPEL Ear Forceps, working length 8 cm


222900

222800 HOUSE-DIETER Malleus Nipper, upbiting, working length 8 cm

222900 Same, downbiting

221450 – 221454

221454 FISCH Ear Forceps, round cupped jaws, working length 12.5 cm, diameter 3 mm

221406 – 221709

221509 WULLSTEIN Ear Forceps, extra delicate, oval cupped jaws, curved to right, oval, 0.9 mm, working length 8 cm

221609 Same, curved to left

221709 Same, curved upwards


222500 – 222605 L

222602 HOUSE-BELLUCCI Scissors, extra delicate, working length 8 cm

222604 R BELLUCCI Scissors, delicate, curved to right, working length 8 cm

222605 L Same, curved to left

152301 Ear Hook, without ball end, size 1, length 15.5 cm

152301 223100

223101

223100 PLESTER Knife, round, vertical, standard size: 3.5 x 2.5 mm, length 16 cm

223101 Same, medium size: 4 x 2 mm

223500

223500 ROSEN Elevator, tip angled 15°, 12 mm long, width 1.5 mm, length 16 cm

223890 Seeker, extra delicate, angled 25°, with ball end diameter 0.6 mm, length 16 cm

223890


224001 HOUSE Curette, large, spoon sizes 2 x 3.2 mm and 1.6 x 2.6 mm, length 15 cm

224002 Same, small, spoon sizes 1 x 1.6 mm and 1.3 x 2 mm

224003 Same, medium, spoon sizes 1 x 1.8 mm and 2 x 2.8 mm

224005 HOUSE Curette, angular, extra small, spoon sizes 0.6 x 0.8 mm and 0.8 x 1 mm, length 17 cm

224011 HOUSE Curette, straight, extra large, spoon sizes 2.3 x 3.5 mm and 2.7 x 4.3 mm, length 15 cm

224301 WULLSTEIN Needle, strong long curve, length 16.5 cm

224302 Same, medium curve224303 Same, slight curve

226211 THOMASSIN Dissector, double-ended, distal tips with single curve to right or to left, length 18 cm

226212 Same, distal tips with double curve to right or to left

224005224001 – 224003

224301 – 224303

226212226211 226815 – 226835

226815 Round Knife 45º, diameter 1.5 mm, length 16 cm

226825 Same, diameter 2.5 mm226835 Same, diameter 3.5 mm


UNIDRIVE® S III ENT SCB/UNIDRIVE® S III ECOThe multifunctional unit for ENT

UNIDRIVE® S III ENT SCB UNIDRIVE® S III ECO

Touch Screen: Straightforward function selection via touch screen

Optimized user control due to touch screen

Set values of the last session are stored

Choice of user languages

Operating elements are single and clear to read due to color display

One unit – multifunctional: – Shaver system for surgery of the paranasal sinuses and anterior skull base– INTRA Drill Handpieces (40,000 rpm and 80,000 rpm)– Sinus Shaver– Micro Saw– Dermatome– High-Speed Handpieces (60,000 rpm and 100,000 rpm)

Two motor outputs: Two motor outputs enable simultaneous connection of two motors: For example, a shaver and micro motor

Integrated irrigation and coolant pump:– Absolutely homogeneous, micro-processor controlled irrigation rate throughout

the entire irrigation range– Quick and easy connection of the tubing set

Easy program selection via automated motor recognition

Irrigator rod included

Continuously adjustable revolution range

Maximum number of revolutions and motor torque: Microprocessor-controlled motor rotation speed. Therefore the preselected parameters are maintained throughout the drilling procedure

Maximum number of revolutions can be preset

SCB model with connections to the KARL STORZ Communication Bus (KARL STORZ-SCB)

l –

l l

l –

Special Features:

l –

l –

l l

l l

l –

l –

l l

l l

l –

l l

l l

l l

l –

Soft start function

Textual error messages l –

UN

IDR

IVE

® S

III

EC

O

UN

IDR

IVE

® S

III

EN

T S

CB



Touch Screen: 6,4" / 300 cd/m2

Weight: 5.2 kg 4.7 kg

Certified to: IEC 601-1 CE acc. to MDD IEC 60601-1

Available languages: English, French, German, numerical codes Spanish, Italian, Portuguese, Greek, Turkish, Polish, Russian

Motor SystemsSpecifications

System specifications

Mode Order No. rpm

Shaver mode oscillating Operation mode: in conjunction with Handpiece: Max. rev. (rpm): DrillCut-X® II Shaver Handpiece 40 7120 50 10,000*

DrillCut-X® II N Shaver Handpiece 40 7120 55 10,000*

Sinus burr mode rotating Operation mode: in conjunction with Handpiece: Max. rev. (rpm): DrillCut-X® II Shaver Handpiece 40 7120 50 12,000

DrillCut-X® II N Shaver Handpiece 40 7120 55 12,000

High-speed drilling mode counterclockwise or clockwise Operation mode: in conjunction with: Max. rev. (rpm): High-Speed Micro Motor 20 7120 33 60,000/100,000

Drilling mode counterclockwise or clockwise Operation mode: in conjunction with: Max. rev. (rpm): micro motor 20 7110 33 40,000/80,000

and connecting cable 20 7111 73

Micro saw mode in conjunction with: Max. rev. (rpm): micro motor 20 7110 33 15,000/20,000

and connecting cable 20 7111 73

Dermatome mode in conjunction with: Max. rev. (rpm): micro motor 20 7110 33 8,000 and connecting cable 20 7111 73

Power supply: 100 – 240 VAC, 50/60 Hz

Dimensions: 300 x 165 x 265 mm (w x h x d)

Two outputs for parallel connection of two motors

Integrated irrigation pump: Flow: adjustable in 9 steps

* Approx. 4,000 rpm is recommended as this is the most efficient suction/performance ratio.

[ ]

[ ]

[ ]


Motor SystemsSpecial features of high-performance EC micro motor IIand of the high-speed micro motor

l Self-cooling, brushless high-performance EC micro motor

l Smallest possible dimensionsl Autoclavablel Reprocessable in a cleaning machinel Detachable connecting cable

## INTRA coupling for a wide variety of applications

## Maximum torque 4 Ncm## Number of revolutions continuously adjustable up to 40.000 rpm

## Provided a suitable handle is used, the number of revolutions is continuously adjustable up to 80,000 rpm

20 7110 33

20 7110 33 High-Performance EC Micro Motor II, for use with UNIDRIVE® II/UNIDRIVE® ENT/OMFS/NEURO/ECO and Connecting Cable 20 7110 73, or for use with UNIDRIVE® S III ENT/ECO/NEURO and Connecting Cable 20 7111 73

Special features of high-performance EC micro motor II:

l Brushless high-speed micro motorl Smallest possible dimensionsl Autoclavablel Reprocessable in a cleaning machinel Maximum torque 6 Ncm

## Maximum torque 6 Ncm## Number of revolutions continuously adjustable up to 60.000 rpm

## Provided a suitable handle is used, the number of revolutions is continuously adjustable up to 100,000 rpm

Special Features of the high-speed micro motor:

20 7120 33

20 7120 33 High-Speed Micro-Motor, max. speed 60,000 rpm, including connecting cable, for use with UNIDRIVE® S III ENT/NEURO

20 7111 73 Connecting Cable, to connect High-Performance EC Micro Motor 20 7110 33 to UNIDRIVE® S III ENT/ECO/NEURO


UNIDRIVE® S III ENT SCB UNIDRIVE® S III ECORecommended System Configuration

40 7016 20-1 40 7014 20

40 7016 01-1 UNIDRIVE® S III ENT SCB, motor control unit with color display, touch screen, two motor outputs, integrated irrigation pump and SCB module, power supply 100 – 240 VAC, 50/60 Hz

including: Mains Cord Irrigator Rod Two-Pedal Footswitch, two-stage, with proportional function Clip Set, for use with silicone tubing set SCB Connecting Cable, length 100 cm Single Use Tubing Set*, sterile, package of 3


Specifications:

Touch Screen

Flow

Power supply

UNIDRIVE® S III ENT SCB: 6,4"/300 cd/m2

9 steps

100–240 VAC, 50/60 Hz

Dimensions w x h x d

Weight

Certified to

300 x 165 x 265 mm

5.2 kg

EC 601-1, CE acc. to MDD

40 7014 01 UNIDRIVE® S III ECO, motor control unit with two motor outputs and integrated irrigation pump, power supply 100 – 240 VAC, 50/60 Hz

including: Mains Cord Two-Pedal Footswitch, two-stage, with proportional function Clip Set, for use with silicone tubing set Single Use Tubing Set*, sterile, package of 3

*mtp medical technical promotion gmbh, Take-Off GewerbePark 46, 78579 Neuhausen ob Eck, Germany


UNIDRIVE® S III ENT SCB UNIDRIVE® S III ECOSystem Components

High-peformance EC Micro Motor II

20 7110 3320 7111 73

High-Speed Micro Motor

20 7120 33

U N I T S I D E

P A T I E N T S I D E

20 0166 30

Two-Pedal Footswitch

253000 – 253300252660 – 252692

High-Speed Handpieces

252575 – 252590

INTRA Drill Handpieces Micro Saw

254000 – 254300

Dermatome

031131-10

Single Use Tubing Set


Optional Accessoriesfor UNIDRIVE® S III ENT SCB and UNIDRIVE® S III ECO

031131-10* Tubing Set, for irrigation, for single use, sterile, package of 10

280053 C Spray Nozzle, for the reprocessing of INTRA burr handpieces, for use with Universal Spray 280053 B

280053 Universal Spray, 6x 500 ml bottles – HAZARDOUS GOODS – UN 1950 including: Spray Nozzle

*mtp medical technical promotion gmbh, Take-Off GewerbePark 46, 78579 Neuhausen ob Eck, Germany


INTRA Drill Handpiecesfor Ear Micro Surgery

Special Features:## Tool-free closing and opening of the drill## Right/left rotation## Max. rotating speed up to 40,000 rpm / 80,000 U/min

## Detachable irrigation channels

## Lightweight construction## Operates with little vibrations## Low maintenance## Reprocessable in a cleaning machine## Safe grip

20 7110 33/20 7111 73

252570 INTRA Drill Handpiece, angled, length 12.5 cm, transmission 1:1 (40,000 rpm), for use with KARL STORZ high-performance EC micro motor II and straight shaft burrs

252570

252590 INTRA Drill Handpiece, straight, length 11 cm, transmission 1:1 (40,000 rpm), for use with KARL STORZ high-performance EC micro motor II and straight shaft burrs

252590

252573 INTRA Drill Handpiece, angled, length 12.5 cm, transmission 1:2 (80,000 rpm), for use with KARL STORZ high-performance EC micro motor II and straight shaft burrs

252573


Burrs

7 cm

Straight Shaft Burrs, length 7 cm, for use with INTRA Drill Handpieces 252590, 252570, 252573

SizeDetail Dia.mm Standard Tungsten

Carbide Diamant Diamond,coarse

006 0.6

007 0.7

008 0.8

010 1

014 1.4

018 1.8

023 2.3

027 2.7

031 3.1

035 3.5

260006

260007

260008

260010

260014

260018

260023

260027

260031

260035

262006

262007

262008

262010

262014

262018

262023

262027

262031

262035

–

–

–

–

–

–

262223

262227

262231

262235

040 4 260040

261006

261007

261008

261010

261014

261018

261023

261027

261031

261035

261040

Transverse Tungsten Carbide

–

–

–

–

261114

–

261123

–

261131

–

261140 262040 262240

045 4.5 260045 261045 – 262045 262245

050 5 260050 261050 261150 262050 262250

060 6 260060 261060 261160 262060 262260

070 7 260070 261070 – 262070 262270

260000 Standard Straight Shaft Burr, stainless, sizes 006 – 070, length 7 cm, set of 15

261000 Tungsten Carbide Straight Shaft Burr, stainless, sizes 006 – 070, length 7 cm, set of 15

262000 Diamond Straight Shaft Burr, stainless, sizes 006 – 070, length 7 cm, set of 15

262200 Rapid Diamond Straight Shaft Burr, stainless, with coarse diamond coating for precise drilling and abrasion without hand pressure and generating minimal heat, sizes 023 – 070, length 7 cm, set of 9, color code: gold

261100 Tungsten Carbide Straight Shaft Burr, with cross cut, stainless, sizes 014 – 060, length 7 cm, set of 6


Straight Shaft Burrs, length 5.7 cm, for use with INTRA Drill Handpieces 252590, 252570, 252573

Burrs

SizeDetail Dia. mm Standard Tungsten

Carbide Diamond Diamond, coarse

014 1.4

018 1.8

023 2.3

027 2.7

031 3.1

035 3.5

040 4

045 4.5

050 5

060 6

649614 K

649618 K

649623 K

649627 K

649631 K

649635 K

649640 K

649645 K

649650 K

649660 K

649714 K

649718 K

649723 K

649727 K

649731 K

649735 K

649740 K

649745 K

649750 K

649760 K

649723 GK

–

–

649727 GK

649731 GK

649735 GK

649740 GK

649745 GK

649750 GK

649760 GK

070 7 649670 K

649614 HK

649618 HK

649623 HK

649627 HK

649631 HK

649635 HK

649640 HK

649645 HK

649650 HK

649660 HK

649670 HK

Transverse Tungsten Carbide

649614 Q

–

649623 Q

–

649631 Q

–

649640 Q

–

649650 Q

649660 Q

– 649770 K 649770 GK

Size Dia. mm

cylindrical

length 7 cm

barrel-shaped bud-shaped

050 5

060 6

070

040

7

4

265050 –

–

–

262561–

020 2 262560 –

–

263050

263060

263070

–

265060

265070

5.7 cm

Straight Shaft Burrs, cylindrical, barrel-shaped, and bud-shaped 265050 – 265070

649600 K Standard Straight Shaft Burr, stainless, sizes 014 – 070, length 5.7 cm, set of 11

649700 K Diamond Straight Shaft Burr, stainless, sizes 014 – 070, length 5.7 cm, set of 11

649700 GK Rapid Diamond Straight Shaft Burr, stainless, with coarse diamond coating for precise drilling and abrasion without hand pressure and generating minimal heat, sizes 023 – 070, length 5.7 cm, set of 9, color code: gold

649600 HK Tungsten Carbide Straight Shaft Burr, stainless, sizes 014 – 070, length 5.7 cm, set of 11


Burrs and Accessories

280090

LINDEMANN Burrs, conical, stainless, length 7 cm

280080 280120

280080 Brush, for cleaning atraumatic jaws, sterilizable, package of 5

280120 Temporal Bone Holder, bowl-shaped, with 3 fixation screws for tensioning the petrosal bone and with evacuation tube for irrigation liquid

280090 Size Template, for drills, stainless steel, sterilizable

Burrs Accessories

Size Diameter mm

Conical

018 1.8

021 2.1

023 2.3

263518

263521

263523

sterilizable


Accessories for Burrs

280030 Rack, for 36 straight shaft burrs with a length of 7 cm, foldable, sterilizable, size 22 x 11.5 x 2 cm

280030

280033 280034

280040 280043

280033 Rack, for 36 straight shaft burrs with a length of 9.5 cm, foldable, sterilizable, size 22 x 14 x 2 cm

280034 Rack, for 36 straight shaft burrs with a length of 12.5 cm, foldable, sterilizable, size 22 x 17 x 2 cm

280040 Rack, flat model, to hold 21 straight shaft burrs with a length of up to 6 cm (6 pcs) and 7 cm (15 pcs), folding model, sterilizable, size 17.5 x 9.5 x 1.2 cm

280043 Rack, flat model, to hold 21 straight shaft burrs with a length of 7 cm (6 pcs) and 9.5 cm (15 pcs), folding model, sterilizable, size 17.5 x 11.5 x 1.2 cm

280035

280030 K Metal Bar, for fixation at Rack 280030, to hold 18 burrs with a length of 7 cm and 16 burrs with a length of 5.7 cm, size 16 x 2.5 x 1 cm

280030 K

Please note: The burrs displayed are not included in the rack.

280035 Rack, for 54 straight shaft burrs with a length of 5 cm (36 pieces) and 7 cm (18 pieces), foldable, sterilizable, size 22 x 12.5 x 3 cm


Accessories for Burrs

39552 A Wire Tray, provides safe storage of accessories for KARL STORZ drilling/grinding systems during cleaning and sterilization, includes tray for small parts, for use with Rack 280030, rack not included

for storage of: – Up to 6 drill handpieces

– Connecting cable – EC micro motor – Small parts

39552 B

Tray for small parts included

39552 B Wire Tray, provides safe storage of accessories for KARL STORZ drilling/grinding systems during cleaning and sterilization, includes tray for small parts, for use with Rack 280030, rack included

for storage of: – Up to 6 drill handpieces

– Connecting cable – EC micro motor – Up to 36 drill bits and burrs – Small parts

Please note: The instruments displayed are not included in the sterilizing and storage trays.


UNIDRIVE® S III ENT SCBHigh-Speed Handpieces, angled, 100,000 rpm

252680 High-Speed Handpiece, short, angled, 100,000 rpm, for use with High-Speed Micro-Motor 20 7120 33

252681 High-Speed Handpiece, medium, angled, 100,000 rpm, for use with High-Speed Micro-Motor 20 7120 33

For use with High-Speed Drills, shaft diameter 3.17 mm and with High-Speed Micro Motor 20 7120 33

252681

53 mm

252680

33 mm

100,000 rpm

diameter 7.5 mm

7.5 mm

7.5 mm

20 7120 33


UNIDRIVE® S III ENT SCBHigh-Speed Handpieces, angled and straight, 60,000 rpm

For use with High-Speed Drills, shaft diameter 2.35 mm and with High-Speed Micro Motor 20 7120 33

252661

51 mm

252660

31 mm

60,000 rpm

diameter 5.5 mm

252691

51 mm

252690

31 mm

5.5 mm

5.5 mm

5.5 mm

5.5 mm

20 7120 33

252660 High-Speed Handpiece, extra short, angled, 60,000 rpm, for use with High-Speed Micro-Motor 20 7120 33

252661 High-Speed Handpiece, short, angled, 60,000 rpm, for use with High-Speed Micro-Motor 20 7120 33

252690 High-Speed Handpiece, extra short, straight, 60,000 rpm, for use with High-Speed Micro-Motor 20 7120 33

252691 High-Speed Handpiece, short, straight, 60,000 rpm, for use with High-Speed Micro-Motor 20 7120 33


UNIDRIVE® S III ENT SCBHigh-Speed Standard Burrs, High-Speed Diamond Burrs

For use with High-Speed Handpieces, 100,000 rpm

252680 252681

100,000 rpm

diameter 7.5 mm

High-Speed Standard Burrs, 100,000 rpm, for single use , sterile, package of 5

Diameter in mm

1

short

350110 S

medium

350110 M

2 350120 S 350120 M

3 350130 S 350130 M

4 350140 S 350140 M

5 350150 S 350150 M

6 350160 S 350160 M

7 350170 S 350170 M

High-Speed Diamond Burrs, 100,000 rpm, for single use , sterile, package of 5

Diameter in mm

1

short

350210 S

medium

350210 M

2 350220 S 350220 M

3 350230 S 350230 M

4 350240 S 350240 M

5 350250 S 350250 M

6 350260 S 350260 M

7 350270 S 350270 M


UNIDRIVE® S III ENT SCBHigh-Speed Diamond Burrs, High-Speed Acorns,High-Speed Barrel Burrs, High-Speed Neuro Fluted Burr


252680 252681

100,000 rpm

diameter 7.5 mm

High-Speed Coarse Diamond Burrs, 100,000 rpm, for single use , sterile, package of 5

Diameter in mm

3

short

350330 S

medium

350330 M

4 350340 S 350340 M

5 350350 S 350350 M

6 350360 S 350360 M

7 350370 S 350370 M

High-Speed Acorns, 100,000 rpm, for single use , sterile, package of 5

Diameter in mm

7.5

short

350675 S

medium

350675 M

9 350690 S 350690 M

High-Speed Barrel Burrs, 100,000 rpm, for single use , sterile, package of 5

Diameter in mm

6

short

350960 S

medium

350960 M

9.1 350991 S 350991 M

High-Speed Neuro Fluted Burr, 100,000 rpm, for single use , sterile, package of 5

Diameter in mm

1.8

short

350718 S

medium

350718 M

3 350730 S 350730 M


UNIDRIVE® S III ENT SCBHigh-Speed Standard Burrs, High-Speed Diamond Burrs


252660 252661 252690 252691

60,000 rpm

diameter 5.5 mm

High-Speed Standard Burrs, 60,000 rpm, for single use , sterile, package of 5

Diameter in mm

1

extra short

330110 ES

short

330110 S

2 330120 ES 330120 S

3 330130 ES 330130 S

4 330140 ES 330140 S

5 330150 ES 330150 S

6 330160 ES 330160 S

7 330170 ES 330170 S

High-Speed Diamond Burrs, 60,000 rpm, for single use , sterile, package of 5

Diameter in mm

0.6

extra short

330206 ES

short

330206 S

1 330210 ES 330210 S

1.5 330215 ES 330215 S

2 330220 ES 330220 S

3 330230 ES 330230 S

4 330240 ES 330240 S

5 330250 ES 330250 S

6 330260 ES 330260 S

7 330270 ES 330270 S


UNIDRIVE® S III ENT SCBHigh-Speed Diamond Burrs, High-Speed Cylinder Burrs,LINDEMANN High-Speed Fluted Burrs

For use with High-Speed Handpieces, 60,000 rpm 60,000 rpm

diameter 5.5 mm

252660 252661 252690 252691

High-Speed Coarse Diamond Burrs, 60,000 rpm, for single use , sterile, package of 5

Diameter in mm

3

extra short

330330 ES

short

330330 S

4 330340 ES 330340 S

5 330350 ES 330350 S

6 330360 ES 330360 S

7 330370 ES 330370 S

High-Speed Cylinder Burrs, 60,000 rpm, for single use , sterile, package of 5

Diameter in mm

4

extra short

330440 ES

short

330440 S

6 330460 ES 330460 S

LINDEMANN High-Speed Fluted Burrs, 60,000 rpm, for single use , sterile, package of 5

Size in mm (diameter x length)

Diameter 2.1/11

extra short

330511 ES

short

330511 S

Diameter 2.3/26 330526 ES 330526 S


254000

Saw blades, short shaft, for use with 254000

254000 Oscillating Micro Saw, inbuilt irrigation tube, max. recommended number of revolutions 15,000 rpm corresponds to 15,000 oscillations/min., without saw blades, with fork wrench

254024 Saw Blade, short shaft, blade thickness 0.3 mm, width of blade 6 mm, working length 11 mm, package of 1, for use with 254000

254025 Same, width of blade 10 mm


254030 Same, blade thickness 0.15 mm, width of blade 6 mm

Saw blades, long shaft, for use with 254000



254031 Same, blade thickness 0.15 mm, width of blade 6 mm

254027 Saw Blade, long shaft, blade thickness 0.3 mm, width of blade 6 mm, working length 26 mm, package of 1, for use with 254000

Oscillating Micro Saws


Micro Compass Saws, Osseo Scalpel

Saw blades, for use with 254100


254100

254200

254100 Micro Sagittal Saw, without saw blades, integrated irrigation tube, with fork wrench, recommended maximum speed: 20,000 rpm

254170 Saw Blade, blade thickness 0.35 mm, width of blade 4 mm, working length 10 mm, package of 12, for use with Micro Sagittal Saw 254100

254171 Same, width of blade 6 mm, working length 10 mm





254200 Osseo Scalpel, Micro Saw, with axial/sagittal channel, pendulum stroke, especially appropriate for 3-dimensional incision guiding, without saw blades, inbuilt irrigation tube, max. recommended number of revolution 20,000 rpm, with fork wrench

254235 Saw Blade, blade thickness 0.35 mm, working length 12 mm, package of 12, for use with Osseo Scalpel, Micro Saw 254200

254236 Same, working length 18 mm



Micro Compass Saws

254300

254300 Micro Compass Saw, without saw blades, detachable irrigation tube, with fork wrench, recommended maximum speed: 15,000 rpm


254312 Saw Blade, blade thickness 0.25 mm, working length 11 mm, package of 12, for use with 254300






Micro Saws – Accessories

39553 A Sterilizing and Storage Basket, provides safe storage of accessories for the KARL STORZ micro saw system during cleaning and sterilization, includes basket for small parts

for storage of: – Up to 6 saw handpieces

– Connecting cable – EC micro motor – Saw blades

39553 A

including basket for small parts


Dermatomes

253000 Dermatome, with INTRA coupling, width of incision 12 mm, max. number of rev. 8000 rpm

253001 Replacement Blades, for dermatome 253000, width of incision 12 mm, non-sterile, package of 10




253201 Replacement Blades, for dermatome 253200, width of cut 50 mm, non-sterile, package of 10



Special features:## For removing skin and mucosa ## Dermaplaning for obtaining small pieces of skin from behind the ear

## Can be easily adapted to motor## Optimal setting of the incision depth## Lightweight construction


Dermatome – Accessories

39554 A Sterilizing and Storage Basket, provides safe storage of accessories for the KARL STORZ dermatome system during cleaning and sterilization

for storage of: – Up to 2 dermatomes

– Connecting cable – EC micro motor with INTRA coupling

39554 A


Innovative Design## Dashboard: Complete overview with intuitive menu guidance

## Live menu: User-friendly and customizable## Intelligent icons: Graphic representation changes when settings of connected devices or the entire system are adjusted

## Automatic light source control## Side-by-side view: Parallel display of standard image and the Visualization mode

## Multiple source control: IMAGE1 S allows the simultaneous display, processing and documentation of image information from two connected image sources, e.g., for hybrid operations

Dashboard Live menu

Side-by-side view: Parallel display of standard image and Visualization mode

Intelligent icons

Economical and future-proof## Modular concept for flexible, rigid and 3D endoscopy as well as new technologies

## Forward and backward compatibility with video endoscopes and FULL HD camera heads

## Sustainable investment## Compatible with all light sources

IMAGE1 S Camera System n


Brillant Imaging## Clear and razor-sharp endoscopic images in FULL HD

## Natural color rendition

## Reflection is minimized## Multiple IMAGE1 S technologies for homogeneous illumination, contrast enhancement and color shifting

FULL HD image CHROMA

FULL HD image SPECTRA A *

FULL HD image

FULL HD image CLARA

SPECTRA B **

* SPECTRA A : Not for sale in the U.S.** SPECTRA B : Not for sale in the U.S.



TC 200EN* IMAGE1 S CONNECT, connect module, for use with up to 3 link modules, resolution 1920 x 1080 pixels, with integrated KARL STORZ-SCB and digital Image Processing Module, power supply 100 – 120 VAC/200 – 240 VAC, 50/60 Hz

including: Mains Cord, length 300 cm DVI-D Connecting Cable, length 300 cm SCB Connecting Cable, length 100 cm USB Flash Drive, 32 GB, USB silicone keyboard, with touchpad, US

* Available in the following languages: DE, ES, FR, IT, PT, RU

Specifications:

HD video outputs

Format signal outputs

LINK video inputs

USB interface SCB interface

- 2x DVI-D - 1x 3G-SDI

1920 x 1080p, 50/60 Hz

3x

4x USB, (2x front, 2x rear) 2x 6-pin mini-DIN

100 – 120 VAC/200 – 240 VAC

50/60 Hz

I, CF-Defib

305 x 54 x 320 mm

2.1 kg

Power supply

Power frequency

Protection class


Weight

TC 300 IMAGE1 S H3-LINK, link module, for use with IMAGE1 FULL HD three-chip camera heads, power supply 100 – 120 VAC/200 – 240 VAC, 50/60 Hz, for use with IMAGE1 S CONNECT TC 200ENincluding:Mains Cord, length 300 cm

Link Cable, length 20 cm

For use with IMAGE1 S IMAGE1 S CONNECT Module TC 200EN


TC 300 (H3-Link)

TH 100, TH 101, TH 102, TH 103, TH 104, TH 106 (fully compatible with IMAGE1 S) 22 2200 55-3, 22 2200 56-3, 22 2200 53-3, 22 2200 60-3, 22 2200 61-3, 22 2200 54-3, 22 2200 85-3 (compatible without IMAGE1 S technologies CLARA, CHROMA, SPECTRA*)

1x

100 – 120 VAC/200 – 240 VAC

50/60 Hz

I, CF-Defib

305 x 54 x 320 mm

1.86 kg

Camera System

Supported camera heads/video endoscopes

LINK video outputs

Power supply

Power frequency

Protection class


Weight

Specifications:

TC 200EN

TC 300

* SPECTRA A : Not for sale in the U.S.** SPECTRA B : Not for sale in the U.S.


For use with IMAGE1 S Camera System IMAGE1 S CONNECT Module TC 200EN, IMAGE1 S H3-LINK Module TC 300 and with all IMAGE 1 HUB™ HD Camera Control Units

TH 100 IMAGE1 S H3-Z Three-Chip FULL HD Camera Head, 50/60 Hz, IMAGE1 S compatible, progressive scan, soakable, gas- and plasma-sterilizable, with integrated Parfocal Zoom Lens, focal length f = 15 – 31 mm (2x), 2 freely programmable camera head buttons, for use with IMAGE1 S and IMAGE 1 HUB™ HD/HD

IMAGE1 FULL HD Camera Heads

Product no.

Image sensor


Weight

Optical interface

Min. sensitivity

Grip mechanism

Cable

Cable length

IMAGE1 S H3-Z

TH 100

3x 1/3" CCD chip

39 x 49 x 114 mm

270 g

integrated Parfocal Zoom Lens, f = 15 – 31 mm (2x)

F 1.4/1.17 Lux

standard eyepiece adaptor

non-detachable

300 cm

Specifications:

TH 104

TH 104 IMAGE1 S H3-ZA Three-Chip FULL HD Camera Head, 50/60 Hz, IMAGE1 S compatible, autoclavable, progressive scan, soakable, gas- and plasma-sterilizable, with integrated Parfocal Zoom Lens, focal length f = 15 – 31 mm (2x), 2 freely programmable camera head buttons, for use with IMAGE1 S and IMAGE 1 HUB™ HD/HD

IMAGE1 FULL HD Camera Heads

Product no.

Image sensor


Weight

Optical interface

Min. sensitivity

Grip mechanism

Cable

Cable length

IMAGE1 S H3-ZA

TH 104

3x 1/3" CCD chip

39 x 49 x 100 mm

299 g

integrated Parfocal Zoom Lens, f = 15 – 31 mm (2x)

F 1.4/1.17 Lux

standard eyepiece adaptor

non-detachable

300 cm

Specifications:

IMAGE1 S Camera Heads n

TH 100


9826 NB

9826 NB 26" FULL HD Monitor, wall-mounted with VESA 100 adaption, color systems PAL/NTSC, max. screen resolution 1920 x 1080, image fomat 16:9, power supply 100 – 240 VAC, 50/60 Hzincluding:External 24 VDC Power SupplyMains Cord

9619 NB

9619 NB 19" HD Monitor, color systems PAL/NTSC, max. screen resolution 1280 x 1024, image format 4:3, power supply 100 – 240 VAC, 50/60 Hz, wall-mounted with VESA 100 adaption,including:

External 24 VDC Power SupplyMains Cord

Monitors


Monitors

Optional accessories:9826 SF Pedestal, for monitor 9826 NB9626 SF Pedestal, for monitor 9619 NB

26"

9826 NB

l

–

l

l

l

l

l

–

l

–

l

l

l

l

l

l

19"

9619 NB

l

–

–

l

l

l

l

l

l

l

–

l

l

l

l

l

KARL STORZ HD and FULL HD Monitors

Wall-mounted with VESA 100 adaption

Inputs:

DVI-D

Fibre Optic

3G-SDI

RGBS (VGA)

S-Video

Composite/FBAS

Outputs:

DVI-D

S-Video

Composite/FBAS

RGBS (VGA)

3G-SDI

Signal Format Display:

4:3

5:4

16:9

Picture-in-Picture

PAL/NTSC compatible

19"

optional

9619 NB

200 cd/m2 (typ)

178° vertical

0.29 mm

5 ms

700:1

100 mm VESA

7.6 kg

28 W

0 – 40°C

-20 – 60°C

max. 85%

469.5 x 416 x 75.5 mm

100 – 240 VAC

EN 60601-1, protection class IPX0

Specifications:

KARL STORZ HD and FULL HD Monitors

Desktop with pedestal

Product no.

Brightness

Max. viewing angle

Pixel distance

Reaction time

Contrast ratio

Mount

Weight

Rated power

Operating conditions

Storage

Rel. humidity


Power supply

Certified to

26"

optional

9826 NB

500 cd/m2 (typ)

178° vertical

0.3 mm

8 ms

1400:1

100 mm VESA

7.7 kg

72 W

5 – 35°C

-20 – 60°C

max. 85%

643 x 396 x 87 mm

100 – 240 VAC

EN 60601-1, UL 60601-1, MDD93/42/EEC, protection class IPX2


Cold Light Fountains and Accessories

495 NT Fiber Optic Light Cable, with straight connector, diameter 2.5 mm, length 180 cm

495 NTW Fiber Optic Light Cable, with 90° deflection to the cold light fountain on the fountain side, diameter 2.5 mm, length 180 cm

495 NTX Same, length 230 cm

20131501 Cold Light Fountain XENON NOVA® 175, power supply: 100–125VAC/220–240VAC, 50/60 Hz

including: Mains Cord20132026 XENON Spare Lamp,

175 watt, 15 volt

Cold Light Fountain XENON NOVA® 175

Cold Light Fountain XENON 300 SCB

20 133101-1 Cold Light Fountain XENON 300 SCB

with built-in antifog air-pump, and integrated KARL STORZ Communication Bus System SCB power supply: 100 –125 VAC/220 –240 VAC, 50/60 Hz

including: Mains Cord SCB Connecting Cord, length 100 cm20133027 Spare Lamp Module XENON

with heat sink, 300 watt, 15 volt20133028 XENON Spare Lamp, only,

300 watt, 15 volt


Data Management and DocumentationKARL STORZ AIDA® – Exceptional documentation

The name AIDA stands for the comprehensive implementation of all documentation requirements arising in surgical procedures: A tailored solution that flexibly adapts to the needs of every specialty and thereby allows for the greatest degree of customization.

This customization is achieved in accordance with existing clinical standards to guarantee a reliable and safe solution. Proven functionalities merge with the latest trends and developments in medicine to create a fully new documentation experience – AIDA.

AIDA seamlessly integrates into existing infrastructures and exchanges data with other systems using common standard interfaces.

WD 200-XX* AIDA Documentation System, for recording still images and videos, dual channel up to FULL HD, 2D/3D, power supply 100-240 VAC, 50/60 Hz

including: USB Silicone Keyboard, with touchpad ACC Connecting Cable DVI Connecting Cable, length 200 cm HDMI-DVI Cable, length 200 cm Mains Cord, length 300 cm

WD 250-XX* AIDA Documentation System, for recording still images and videos, dual channel up to FULL HD, 2D/3D, including SMARTSCREEN® (touch screen), power supply 100-240 VAC, 50/60 Hz

including: USB Silicone Keyboard, with touchpad ACC Connecting Cable DVI Connecting Cable, length 200 cm HDMI-DVI Cable, length 200 cm Mains Cord, length 300 cm

*XX Please indicate the relevant country code (DE, EN, ES, FR, IT, PT, RU) when placing your order.


Workflow-oriented use

Patient

Entering patient data has never been this easy. AIDA seamlessly integrates into the existing infrastructure such as HIS and PACS. Data can be entered manually or via a DICOM worklist. All important patient information is just a click away.

Checklist

Central administration and documentation of time-out. The checklist simplifies the documentation of all critical steps in accordance with clinical standards. All checklists can be adapted to individual needs for sustainably increasing patient safety.

Record

High-quality documentation, with still images and videos being recorded in FULL HD and 3D. The Dual Capture function allows for the parallel (synchronous or independent) recording of two sources. All recorded media can be marked for further processing with just one click.

Edit

With the Edit module, simple adjustments to recorded still images and videos can be very rapidly completed. Recordings can be quickly optimized and then directly placed in the report. In addition, freeze frames can be cut out of videos and edited and saved. Existing markings from the Record module can be used for quick selection.

Complete

Completing a procedure has never been easier. AIDA offers a large selection of storage locations. The data exported to each storage location can be defined. The Intelligent Export Manager (IEM) then carries out the export in the background. To prevent data loss, the system keeps the data until they have been successfully exported.

Reference

All important patient information is always available and easy to access. Completed procedures including all information, still images, videos, and the checklist report can be easily retrieved from the Reference module.


UG 540 Monitor Swifel Arm, height and side adjustable, can be turned to the left or the right side, swivel range 180°, overhang 780 mm, overhang from centre 1170 mm, load capacity max. 15 kg, with monitor fixation VESA 5/100, for usage with equipment carts UG xxx

UG 540

Equipment Cart

UG 220

UG 220 Equipment Cart wide, high, rides on 4 antistatic dual wheels equipped with locking brakes 3 shelves, mains switch on top cover, central beam with integrated electrical subdistributors with 12 sockets, holder for power supplies, potential earth connectors and cable winding on the outside,

Dimensions: Equipment cart: 830 x 1474 x 730 mm (w x h x d), shelf: 630 x 510 mm (w x d), caster diameter: 150 mm

including: Base module equipment cart, wide Cover equipment, equipment cart wide Beam package equipment, equipment cart high 3x Shelf, wide Drawer unit with lock, wide 2x Equipment rail, long Camera holder


Recommended Accessories for Equipment Cart

UG 310 Isolation Transformer, 200 V – 240 V; 2000 VA with 3 special mains socket, expulsion fuses, 3 grounding plugs, dimensions: 330 x 90 x 495 mm (w x h x d), for usage with equipment carts UG xxx

UG 310

UG 410 Earth Leakage Monitor, 200 V – 240 V, for mounting at equipment cart, control panel dimensions: 44 x 80 x 29 mm (w x h x d), for usage with isolation transformer UG 310

UG 410

UG 510 Monitor Holding Arm, height adjustable, inclinable, mountable on left or right, turning radius approx. 320°, overhang 530 mm, load capacity max. 15 kg, monitor fixation VESA 75/100, for usage with equipment carts UG xxx

UG 510

with the compliments of

KARL STORZ — ENDOSKOPE

Documents

ENDOSCOPIC TRANSCANAL EAR ANATOMY AND … Section of Otolaryngology, American Hospital Dubai, United Arab Emirates 2 Department of Otolaryngology, University Hospital of Modena, Italy