SALES RELEASE
Ligation System
B|BRAUN
Michael Chow
Al Hicks
Aesculap Marketing
April 2003
Ligation System
TABLE OF CONTENTS
I.
INTRODUCTION .................................................................................. 1
II. CUSTOMERS/MARKET ....................................................................... 1
III. PRODUCT INFORMATION .................................................................. 3
IV. FEATURES AND BENEFITS ................................................................ 5
V
OFFERING AND PRICING ................................................................. 12
VI. COMPETITION ................................................................................... 13
VII. SALES STRATEGY............................................................................ 20
VIII.SALES TOOLS ................................................................................... 23
IX. CLINICAL DATA ................................................................................. 29
X. APPENDIX ......................................................................................... 36
Confidential - for internal use only
Ligation System
I.
INTRODUCTION
Ligating clips have been used in surgery for over 80 years. These clips were designed to
perform two basic functions: ligation of a vessel and marking a specific surgical site which
would later show up on X-Ray. Ligating clips are permanently implanted in the human
body and are radiopaque.
II.
CUSTOMERS/MARKET
According to IMS, the market in the United States for metal manual ligation clips is $55
million. Weck has a 70% market share and Ethicon has the remaining 30%. The key
surgical procedures that consume the largest total of manual clips include Coronary
Artery Bypass Grafting (CABG), Open Colon Resection, Femoral-Popliteal Bypass, and
Carotid Endarterectomy. Table 1 illustrates the key surgical procedures utilizing ligating
clips and estimates the total annual number of clips used per procedure.
Table 1: Key Surgical Procedure Targets
Procedure
Relevant
Sizes (2)
Clips Total Clips
80% Mic,M,Sm,
S/M,M,(L)
70% M,L
(ML)(HOL)
80% ML,L(HOL)
75 21,000,000
15%
85%
17,850,000
50 14,175,000
50%
50%
7,087,500
50
1,200,000
50%
50%
600,000
10
400,000
50%
50%
200,000
100,000
110,000
20% M,L
(ML)(HOL)
70% M,ML(HOL)
90% ML
10
8
700,000
792,000
50%
15%
50%
85%
350,000
673,200
830,000
98% ML(HOL)
8
6,507,200
95%
5%
325,360
30
35
35
60
20
50
50
20
702,000
567,000
315,000
1,200,000
300,000
1,350,000
750,000
1,280,000
0%
50%
95%
40%
10%
20%
25%
25%
100%
50%
5%
60%
90%
80%
75%
75%
702,000
283,500
15,750
720,000
270,000
1,080,000
562,500
960,000
# of
Cases
US(1)
CABG
350,000
Colon Resection,
Open
Colon Resection,
Lap
Appendectomy,
Open
Appendectomy, Lap
Cholecystectomy,
Open
Cholecystectomy,
Lap
Lymphadenectomy
Splenectomy, Open
Splenectomy, Lap
Pancreatectomy
Adrenalectomy
Gastrectomy
Vagotomy
Gastric Bypass,
Open
405,000
30,000
200,000
26,000
18,000
9,000
20,000
15,000
30,000
15,000
80,000
%
Cases
Use
Clips
90%
90%
100%
100%
100%
90%
100%
80%
M,L (ML)
M,L (ML)
ML
M,L (ML)
M,ML,L
M,L(ML)
M
(M)ML,L
1
%
%
Total Manual
Auto Manual
Clips
(3)
(3)
Confidential - for internal use only
Ligation System
Gastric Bypass, Lap
Nissen
Fundoplication
Liver Resection
Gastric Bypass
Repair
Lap Exploratory
Adhesiolysis
Lung Resection
Femoral-Popliteal
Bypass
Carotid
Endarterectomy
Abdominal Aortic
Aneurysm
Other Vascular
Bypass
Vein Stripping
Saphenous
Perforator, Endo
Open Nephrectomy
Lap Nephrectomy
Radical
Prostatectomy
Cystectomy
Vericocele Repair
Gynecological
Oncology
Hysterectomy
Anterior Spinal
Access
Mastectomy
ENT-Head/Neck
Plastic
Reconstructive
10,000
120,000
20% ML,L
50% ML
10
20
20,000
1,200,000
95%
98%
5%
2%
1,000
24,000
80% Sm, S/M, M
95% M,L (ML)
50
60
800,000
142,500
50%
25%
50%
75%
400,000
106,875
200,000
235,000
72,000
165,000
90%
80%
75%
85%
15
15
15
60
2,700,000
2,820,000
810,000
8,415,000
30%
20%
15%
10%
70%
80%
85%
90%
1,890,000
2,256,000
688,500
7,573,500
141,000
85% M, Sm, S/M
50
5,992,500
10%
90%
5,393,250
75,000
20% M,L
20
300,000
30%
70%
210,000
40,000
90% Sm,M,(L)
60
2,160,000
10%
90%
1,944,000
80,000
25,000
50% Sm,S/M,M
80% Sm,S/M
60
60
2,400,000
1,200,000
20%
60%
80%
40%
1,920,000
480,000
20
30
703,000
270,000
50%
95%
50%
5%
351,500
13,500
80
4,420,000
15%
85%
3,757,000
90
15
50
1,147,500
405,000
2,550,000
15%
0%
50%
85%
100%
50%
975,375
405,000
1,275,000
20,000
2,500
37,000
9,000
65,000
15,000
30,000
60,000
M,L (ML)
M,L (ML)
L,M
M,L
95% M,ML,L
100% M,ML,(L)
(HOL)
85% M,L (ML),
(HOL)
85% M
90% M
85% L,M
624,000
120,000
15% L,M
50% M,Sm,S/M
15
15
1,404,000
900,000
50%
50%
50%
50%
702,000
450,000
120,000
40,000
30,000
90% Sm,S/M,M
90% Mic,Sm,S/M
90% Mic,Sm
60
40
30
6,480,000
1,440,000
810,000
30%
10%
0%
70%
90%
100%
4,536,000
1,296,000
810,000
(1) Bold is this column: Based on published source. Others are educated estimates.
(2) Parenthesis indicates less likely use.
Mic=SLS Micro
Sm=Small
S/M=SLS Small/Med.
M=Medium
ML=Medium Large
L=Large
HOL=Key Hem-o-lok Target
(3) Figures in these columns are rough estimates
2
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Ligation System
III.
PRODUCT INFORMATION
Since 1992, the Vitalitec SLS ligating clip has been manufactured and marketed in
Europe, as well as Asia, with great success. In fact, the Vitalitec SLS ligating clip system
holds the leading market share for manual-load ligating clips in Great Britain, France,
Germany and Asia.
The success of the Vitalitec ligating clip system can be attributed to exacting quality
engineering and product design targeted at superior clinical performance, emphasizing
upgrades in key security-performance variables. These variables include design features
calculated to improve: 1) visibility of the clip in the cartridge for precise pick-up, 2)
security and stability of the clip in sturdy Vitalitec appliers, 3) and clip-grip surfacing
designed for high-friction grip on vessel surfaces.
Due to its quality and superior design, Vitalitec SLS clip success continues to grow every
year, and with Aesculap’s strong sales organization, the product is poised for penetration
of the United States market.
Ligating Clips and Cartridges
Aesculap offers six different sizes of ligating clips. The
small/medium size is an Aesculap exclusive product. 6
and 24 clip cartridges are available. Clips are made
from titanium. Titanium is clearly the metal of choice
because it does not interfere with C.T. or M.R.I scans,
has an extensive surgical implant history, and is less
expensive than tantalum. The clips are widely spaced in
a high contrast cartridge providing superior visibility for
clip pick-up. The cartridges contain an adhesive backing which allow nurses to stick the
cartridge near the surgical site or to their wrist.
Size
Micro
Small
Small
Small/Medium
Small/Medium
Medium
Medium
Medium/Large
Large
Color
White
Yellow
Yellow
Lilac
Lilac
Blue
Blue
Green
Orange
Part #
W6060-1
J1180-1
J1120-1
L5180-1
L5120-1
B2180-1
B2120-1
V3120-1
O3120-1
Packaging
30 cartridges of 6 clips / 180 clips
30 cartridges of 6 clips / 180 clips
5 pouches of 4 cartridges / 120 clips
30 cartridges of 6 clips / 180 clips
5 pouches of 4 cartridges / 120 clips
30 cartridges of 6 clips / 180 clips
5 pouches of 4 cartridges / 120 clips
20 cartridges of 6 clips / 120 clips
20 cartridges of 6 clips / 120 clips
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Ligation System
Clip Appliers
Clip appliers for open surgery are offered in three
different sizes (6”, 7 ½”, and 11”) and two different
curves (curved and angled) to satisfy various
surgeon preferences. The handles of the appliers
are color coded to match the color of the clip
cartridges. The appliers are stainless steel.
The appliers contain sturdy and firm springs to
minimize inadvertent squeezing of jaws. The jaws of
the appliers are specifically designed to promote clip security. There is a V-to-V perfect fit
of the clip-spine to the applier jaw groove. The jaws are specially treated to provide
resistance to clip slip back and encourage secure pick up.
Size
Micro
Color
White
6”
PW615-1R
7 ½”
PW619-1R
Small
Yellow
PJ115-1R
PJ119-1R
Small/M
edium
Medium
Lilac
PL515-1R
PL519-1R
Blue
PB215-1R
PB219-1R
Medium/
Large
Large
Green
PV319-1R
Orange
PO419-1R
4
7 ½” RA
PWC6191R
PJC1191R
PLC5191R
PBC2191R
PVC3191R
POC4191R
11”
PJ128-1R
PL528-1R
PB228-1R
PV328-1R
PO428-1R
11” RA
PJC1281R
PLC5281R
PBC2281R
PVC3281R
POC4281R
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Ligation System
Endoscopic Clip Appliers
The endoscopic clip appliers are
stainless steel, reusable, and
manually loaded. The lengths are
13” and different trocar diameters are
needed for the various clip sizes.
The appliers can be dismantled for
easy cleaning.
Size
Small
Small / Medium
Medium
Medium
Medium / Large
Large
IV.
Part #
LCASLS1R
LCASLS2R
LCASLS3R
LCASLS4R
LCASLS5R
LCASLS6R
Outer Diameter
5.5 mm
5.5 mm
6.5 mm
10.0 mm
10.0 mm
12.5 mm
FEATURES AND BENEFITS
The following pages summarize the features and benefits of the Vitalitec ligating clips vs.
three competitive product offerings (Weck Horizon, Weck Hemoclip, and Ethicon
Ligaclip).
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Ligation System
Performance
Category
CartridgeLoading
Applier PickUp of Clip
Vitalitec SLS
Weck Horizon
Specific Vitalitec Advantage

Easy-Loading of
Chevron Clip

Easy-Loading of Chevron Clip

Widely-spaced clips on high-contrast
Vitalitec cartridge provides superior visibility
(esp. small) vs. Horizon

Special Friction
Surfacing on inner jaws
for all sizes
“V”-to-“V” “perfect fit” of
clip-spine to applier jaw
groove

Special Friction Surfacing on
Inner Jaws of Red Small
Appliers only;
V-to-V “perfect fit” of clipspine to applier jaw groove

Facilitate more secure pick-up (“feel the
friction pick-up”)
Resistance to slide-back in applier during
application to vessel
Firm applier springs
Friction treatment on
jaws
High-visibility cartridges

Two and possibly three
different patterns


Resistance to
Dropping of
Clips (key
ligating clip
problem)


Proper clip
closure, vs.
gaps and
scissored
closure





Positive-traction

treatment on jaws
V”-to-“V” “perfect fit” of
clip-spine to applier jaw 
groove
Robust jaws and jaw
profiling resist pressures
that can twist jaws


Friction treatment of appliers is 
available on Small Red
appliers only
Pointed jaw profile of small
applier may be more

susceptible to catching in tray
perforations
6
Weaker spring tensions on Horizon appliers
based on age and pattern leads to
inadvertent squeezing that causes dropped
clips
Positive-traction friction treatment on
Vitalitec appliers helps to maintain the clip in
proper position in the applier discouraging
dropped clips
Universal positive-traction treatment across
all sizes and lengths of appliers encourages
proper positioning of clip in jaws of the
applier and therefore proper closure
Small jaw of Horizon applier is profiled to
allow easier insertion into mesh of
instrument tray or basket and subsequent
twisting of jaws, which causes scissoring of
clips
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Ligation System
Performance
Category
Vitalitec SLS
Weck Horizon
Clip sizes


Only four size clips

The small size clip is set very
narrow on the Small Red wide
slot applier, apparently to fight
a slide-back problem.
Surgeons may find it too
narrow for easy use on
vessels

Grip on tissue

Offers six size clips,
including the Micro and
exclusive SmallMedium sizes
The Small clip mouth
opening allows slightly
more space for vessel
insertion than the
Horizon Small clip in the
Red system
Positive-grip Microserration design
Specific Vitalitec Advantage



Smooth surfacing with a
narrow internal groove
7

Micro size: Likely to be a popular choice for
tiniest radial artery branches, many
distinctively smaller (1mm or less) than
other branches ligated in cardiovascular
graft harvesting. Micro clip is also a
possible choice for some saphenous vein
branches and certain neurosurgical
placements and free flap plasticreconstructive surgery, as well as pediatric
surgery
Small-Medium: Only slightly wider and
deeper than the SLS small clip (about 1
mm.), it holds significantly more tissue. It
may become a popular choice for IMA
surgery, which generates some surgeon
complaints about the narrow seating of the
Horizon Red Small. This exclusive clip
provides ammunition to break GPO
contracts!
Dr. Peter Samuels, designer of the original
Hemoclip clip, first suggested the idea of a
clip with teeth for enhanced grip
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Ligation System
Performance
Category
CartridgeLoading
Applier PickUp of Clip
Vitalitec SLS
 Easy-Loading Chevron
Clip
Weck Hemoclip
Specific Vitalitec Advantage

Clip is Friction-Fit on Cartridge
Seat

Easy-Loading SLS vs. Weck Hemoclip, for
less damage to appliers

Special Friction
Surfacing on inner jaws
for all sizes
“V”-to-“V” “perfect fit” of
clip-spine to applier jaw
groove

No special surfacing of inner
jaws;
Round spine of clip sits on Vshaped groove of applier—
two-point contact only

Doubly-improved pick-up traction and
resistance to slide-back compared to a
system that is neither perfect-fit nor tractionenhanced in the jaw (Hemoclip Traditional)
Firm applier springs
Friction treatment on
jaws
High-visibility cartridges

Longest lineage of in-place
appliers in the field
Loading stresses of a rigid
friction-fit cartridge

Compare the all-new Vitalitec applier
tension to the various sizes and vintages of
Weck appliers! Combine that with the
Vitalitec SLS (Soft Loading System) and you
maximize applier integrity and likely reduce
the incidence of twisted jaws (and scissored
clips), or spread jaws (and clip-slide back)

Resistance to
Dropping of
Clips (key
ligating clip
problem)





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Ligation System
Performance
Category
Proper clipclosure, (vs.
gaps and
scissored
closure)
Vitalitec SLS
 Positive-traction friction
treatment on jaws
combined with V-to-V fit
of clip in jaws, helps to
maintain clip in the
proper position in
applier jaws for proper
closure
 Sturdy jaws and profiling
resist pressures that can
twist jaws and create
twisted, scissored clips
Weck Hemoclip
Specific Vitalitec Advantage
 Clips rounded at the clip spine,  The Vitalitec benefits of positive traction and
sit in a V-shaped groove in the
perfect fit contrast to the Hemoclip
applier—an unstable
Traditional instability of clip-applier-fit and
mismatch that adds little to
Small jaw construction
security of grip or resistance to  Vitalitec appliers offer solid-jaw construction
slide back
behind the clip closure area to eliminate the
closure hazard posed by the Weck Window
 Small applier jaws are
especially weak and
vulnerable
 Appliers are troubled by a
large gap just behind the clip
closure area, called the Weck
Window. A clip which slips
back into this area can close
with a large-loop gap
Clip Size

Offers six size clips,
including the Micro and
exclusive SmallMedium sizes

Four clip sizes only. The
Small clip size is sometimes
rejected as too wide by some
surgeons who prefer the
Ethicon clip for its slightly
smaller width

Offering of additional clip sizes will be a
particular advantage in cardiovascular
surgery where grafts from the Radial Artery,
Internal Mammary Artery (IMA) and
Saphenous Vein bridge the aorta to the
coronary arteries, often relying on clips to
hold the branches of these critical conduits
under extremely strong pressure
Grip on tissue

Positive-Grip Microserration design

Narrow channel design
provides smooth surfacing on
each side of the groove

Dr. Peter Samuels, designer of the original
Hemoclip clip, first suggested the idea of a
clip with teeth for enhanced grip
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Ligation System
Performance
Category
CartridgeLoading
Applier PickUp of Clip
Vitalitec SLS
 Easy-Loading Chevron
Clip
Ethicon Ligaclip
 Easy-Loading V-Profile Clip
Specific Vitalitec Advantage
 Vs. Ethicon: Chevron-shaped clips maintain
their shape in cartridge for proper loading
with less applier dependence

Special Friction
Surfacing on inner jaws
for all sizes
“V”-to-“V” “perfect fit” of
clip-spine to applier jaw
groove

Exterior grooves on clip
necessary to aid pick-up of
“V”-shaped design [“V” refers
to clip- profile, not the spine,
which is flat-wire]
Grooves on inside of jaw
match exterior clip grooves

The Vitalitec clip is a preformed chevronshaped clip(constructed from a beam of wire
rather than a ribbon of wire like the Ligaclip)
and is designed to offer more stable loading
into the applier and therefore for more
consistent closure as well
Firm applier springs
Friction treatment on
jaws
High-visibility cartridges

The V-shaped profile of the
Ethicon Ligaclip clip is notched
on the exterior legs in order to
take a chevron shape in the
applier. This weakens the clip
and may destabilize it
Ethicon springs are not as firm
as Vitalitec

Firm Vitalitec springs prevent inadvertent
pre-closure squeeze that can produce clip
dropouts
Positive-traction friction treatment on
Vitalitec appliers helps to maintain this
preformed chevron-shaped clip in proper
position in the applier, helping to discourage
dropped clips and promoting proper closure

Resistance to
Dropping of
Clips (key
ligating clip
problem)





Proper clip
closure, vs.
gaps and
scissored
closure


Positive-traction friction 
treatment on jaws
combined with V-to-V fit 
of clip in jaws, helps to
maintain clip in the
proper position in
applier jaws for proper
closure
Sturdy jaws and profiling

Jaws are formed into a pointed 
profile
Exterior grooves do not help
much in preventing clip slipback or clip-drops

10
The Vitalitec benefits of positive traction and
perfect fit encourages proper positioning of
clip in jaws of the applier and therefore
proper closure
Small Ethicon jaw profile allows easier
insertion into perforations of instrument tray
or basket and subsequent twisting of jaws,
which causes scissoring of clips
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Ligation System
Performance
Category
Clip sizes
Grip on tissue
Vitalitec SLS
 Offers six size clips,
including the Micro and
exclusive SmallMedium sizes
Ethicon Ligaclip
 Only four size clips; Small clip
is often preferred to Weck
Hemoclip Small because of its
narrower width and thinner
wire profile
Specific Vitalitec Advantage
 Micro: May be superior choice for tiniest
radial artery branches, which have been
called “spider vein size”. Micro clip is also a
possible choice for some saphenous vein
branches, certain neurosurgical placements
free flap plastic-reconstructive surgery, as
well as pediatric surgery
 Small-Medium: Only slightly wider and
deeper than the SLS small clip (about 1
mm.), it holds significantly more tissue. It
may become a popular choice for IMA
surgery, which generates some surgeon
complaints about the narrow seating of the
Horizon Red Small. This exclusive clip
provides ammunition to break GPO
contracts!



Positive-Grip Microserration design
The system now on the
market, Ethicon Ligaclip Extra,
essentially copies the internal
serrations of the Weck
Hemoclip clip
11

Dr. Peter Samuels, designer of the original
Hemoclip clip, first suggested the idea of a
clip with teeth for enhanced grip
Ethicon’s smooth-surface grooving is no
design match for Vitalitec Micro-serrations
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Ligation System
V.
OFFERING AND PRICING
The customers will have the option to purchase their clip appliers or accept a
consignment agreement. Since the purchase of clip appliers requires an upfront cost, we
believe most high volume hospitals will choose the consignment option.
Weck has been frustrating its customer base by boldly raising clip prices over the years
and charging customers for new appliers. Ethicon historically has high prices for their
product offerings. Aesculap will utilize a Fair Pricing Program to limit future price
increases on ligating clips and appliers.
The following bullets are responses to the question: Why Choose Aesculap for your
ligating clips needs?

World’s Largest Surgical Instrument Company: Reusable clip appliers are surgical
instruments! As the largest surgical instrument manufacturer in the world, Aesculap
is an expert in the technical issues that affect mechanical hemostasis. Aesculap’s
experience includes both surgical hemostats and neurosurgical aneurysm clips (a type
of hemostatic clip). In fact, Aesculap manufactures the industry’s leading endoscopic
ligating clip applier for Weck!

Superior Repair Service: Aesculap has been repairing Weck ligating clip appliers for
years.  Hospitals understand Aesculap’s core compentency in instrument repairs.

Centrally Located Repair Depot: Aesculap’s repair operation is optimally located to
promptly service all regions from a central hub facility in St. Louis, Missouri, that is
home to our applier repair specialists.

Aesculap Service Applier Program (ASAP): Your Aesculap representative is
committed to providing a program of regular service visits to minimize your applier
downtime awaiting repairs.

Free-Applier Consignment Program: A free applier consignment program is
available for certain hospitals based on annual clip usage and approved by marketing.
This program will you be able to replace all the appliers on your sets with brand new
appliers, but you will also be able to select between free-applier and purchased
applier programs!

Fair-Pricing Program: Aesculap knows how frustrating it is to absorb strong price
increases on surgical ligating clips and appliers. The goal of our Fair Pricing Program
is to limit future price increases on ligating clips and appliers.

Customers selected Aesculap for applier repairs despite the fact that Aesculap is not an authorized repair vendor for
Weck.
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Ligation System
VI.
COMPETITION
The ligating clip market in the United States is dominated by two competitors, Weck and
Ethicon. Weck has approximately 70% market share with Ethicon claiming the remaining
30% share. A cross reference sheet for the clips and appliers have been provided to
identify competitive part numbers to the Aesculap equivalent.
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Ligation System
Competitive Ligating Clip Cross Reference Sheet
Aesculap
Weck
J1180-1
J1180-1
J1120-1
J1120-1
30
180
5
120
S/M
S/M CardioPak
L5180-1
L5120-1
30
5
180
120
N/A
N/A
Medium
Med CardioPak
Reusable Auto Applier
Reusable Auto Applier
B2180-1
B2120-1
30
5
180
120
2200
2204
30
25
180
600
2100
2104
30
25
180
600
523800
523700
527200
527203
20
10
10
10
200
250
200
100
523300
523100
20
10
200
250
Med/Large
Med/Large
V3120-1
V3120-1
20
20
120
120
3200
3204
20
15
120
360
3100
20
120
523860
523760
16
20
160
200
523360
523160
16
20
Large
Large
O4120-1
O4120-1
20
20
120
120
4200
4204
20
15
120
360
4100
20
120
523870
523770
12
10
120
150
523370
523170
12
10
1200
1201
1204
1205
30
30
25
25
180
180
600
600
1100
1101
1104
1105
30
30
25
25
180
180
600
600
N/A
N/A
14
Part #
N/A
Hemoclip
Titanium
Cart/ Clips/
box
box
Weck
SMALL
Wide Slot/Strongpoint
SMALL CardioPak
Wide Slot/Strongpoint
Part #
N/A
Horizon
Tantalum
Cart/ Clips/
box box
Weck
Micro
Part #
N/A
Horizon
Titanium
Cart/ Clips/
box
box
Weck
SLS-Clip®
Titanium
Cart/ Clips/
Part #
box
box
W6060-1
30
180
Part #
N/A
Hemoclip
Tantalum
Cart/ Clips/
box box
Ethicon
Part #
N/A
Ligaclip
Titanium
Cart/ Clips/
box
box
523835
24
240
523335
24
240
LT100
36
216
523735
12
300
523135
12
300
LT102
15
300
LT200
LT202
36
15
216
300
160
200
LT300
18
108
120
150
LT400
18
108
N/A
N/A
N/A
N/A
N/A
N/A
Confidential - for internal use only
Ligation System
Competitive Clip Applier Cross Reference Sheet
Aesculap SLS-Clip® Appliers
Micro
Curved
Angled
15cm (6")
PW 615-1R
19cm (7.5")
PW 619-1R
SMALL
Curved
Angled
15cm (6")
PJ 115-1R
15cm (6") Wide Slot
19cm (7.5")
PJ119-1R
19cm (7.5") Wide Slot
28cm (11")
PJ128-1R
28cm (11") Wide Slot
Small Medium
Curved
Angled
15cm (6")
PL 515-1R
19cm (7.5")
PL 519-1R
Medium
Curved
Angled
15cm (6")
PB 215-1R
19cm (7.5")
PB 219-1R
28cm (11")
PB 228-1R PBC 228-1R
Med / Large
Curved
Angled
19cm (7.5")
PV 319-1R
28cm (11")
PV 328-1R PVC 328-1R
Large
Curved
Angled
19cm (7.5")
PO 419-1R
28cm (11")
PO 428-1R POC 428-1R
Weck Horizon
Appliers
Curved
Angled
N/A
N/A
Curved
Angled
137061
137062
137081
137085
137082
137086
137111
137112
137116
Curved
Angled
N/A
N/A
N/A
N/A
Curved
Angled
237061
237081
237085
237111 237115 + 6
Curved
Angled
337081
337085
337111
337115
Curved
Angled
437081
437085
437111
437115
15
Weck HemoClip Plus
Appliers
Curved
Right
45º
Angled Angled
N/A
N/A
533140
534140
533150
534150
533151
534151
Curved
N/A
N/A
Curved
533109
533110
533111
Curved
533165
533166
Curved
533175
533180
533152
534152
Right
N/A
N/A
Right
533105
533106
Right
533167
533168
Right
533177
533178
533153
534153
45º
N/A
N/A
45º
533108
45º
533164
45º
533173
533181
Ethicon Ligaclip
Appliers
Curved
Angled
N/A
N/A
Curved
Angled
LX105
LX107
LX110
LX130
Curved
N/A
N/A
Curved
LX205
LX207
LX210
Curved
LC307
LC310
Curved
LC407
LC410
Angled
N/A
N/A
Angled
LX230
Angled
LC330
Angled
LC430
Confidential - for internal use only
Ligation System
Competitive Endoscopic Clip Appliers Cross Reference Sheet
Lap Appliers
Small
Small / Medium
Medium
Medium
Medium / Large
Large
33cm
33cm
33 cm
33 cm
33cm
33cm
Aesculap
Curved
Trocar
LCA SLS 1
5.5mm
LCA SLS 2
5.5mm
LCA SLS 3
6.5mm
LCA SLS 4
11mm
LCA SLS 5
11mm
LCA SLS 6
12.5mm
Weck
Curved
Trocar
Ethicon
Curved
Trocar
238110
238200
338110
438110
EL214
11mm
5-7mm
10mm
11mm
16
EL314
EL414
Confidential - for internal use only
Ligation System
The table below is a summary of key performance features of the Vitalitec clip vs. the major
competing product lines such as Weck Horizon, Weck Hemoclip Traditional, and Ethicon
Ligaclip.
Performance
Feature
Fit of Clip in
Applier Jaw
Vitalitec
Horizon
V-to-V fit
V-to-V fit
Surfacing of
Applier Jaws
Special Traction
Treatment All
Sizes
Special Traction
Treatment Small
Red Applier
Only
Clip Visibility
on Cartridge
Easy-vision
cartridge for
precise pick-up
of clips: contrast
and spacing
Narrow spacing
of clips on
cartridge, clip
deep in seat
Ease of
Loading
Easy-Loading of
chevron-shaped
clip
Difficult to see
clips vs. empty
slots on Small:
narrow spacing,
shadowing, poor
background
contrast
Easy-Loading of
chevron-shaped
clip
Yes
No
Yellow Small
applier has weak
jaw; Red is
strong, but
pointed design
Very flimsy and
pointed
Strong but pointed
4
4
4
Backing
Yes
Adhesive
Small Applier
Sturdy jaws;
Jaw
Small profile
Configuration designed to help
resist insertion
in tray mesh
and subsequent
twisting of jaws
Size of Clips 6, extra clips for
cardiovascular,
micro, plastic
17
Hemoclip
Traditional
Rounded Clip
Spine in VShaped Applier
Groove
No Special
Traction
Treatment
Friction-Fit of
Clips on
Cartridge
Ethicon Ligaclip
Flat Wire in Flat Jaw
Ridges on internal
surface of applier to
match external ridges
on clip—to aid pick-up,
not to resist slide-back
Only equal to Weck in
slide-back resistance
Broad flat wire
provides good visibility,
though spacing
between clips is not
wide
Easier than Hemoclip
Traditional, but not as
easy as Vitalitec; Clip
in V-profile in cartridge,
subject to misshaping
No
Confidential - for internal use only
Ligation System
Metal
Composition
Titanium
Applier
Spring
Features
Consistent, firm
springs to fight
clip dropout,
unlatch for
cleaning
Laparoscopic
Applier
Yes, good
quality, small,
medium,
medium-large,
and large;
Small and
medium for
saphenous
Happy to
customize for an
extra fee
Special
Appliers
Loading Base
as option
Yes
Titanium
About half of
Nearly all clips
clips are
titanium, a few still
tantalum or
stainless steel
stainless steel
More than one
Many vintages Many different vintages
pattern of applier of appliers in the in the field undermine
in the field
field, some quite consistency; almost no
appliers open for
creates
weak leading to
cleaning, though a new
inconsistency,
clip drop-out,
version does
most springs not especially when
as firm, unlatch
combined with
for cleaning
stresses of
friction-fit
cartridge,
unlatch for
cleaning
Yes, good quality,
None
Poorly designed
medium, mediumlaparoscopic applier for
large, and large;
medium-large clips:
Pistol grip
asymmetrical jaw
saphenous
closure; limited 180
applier for small,
degree tip rotation;
medium, longer
Difficult
Multi-Angle
Access (MAA)
applier for IMA—
Not popular;
Spinal Access
applier for Small
and Medium clips,
exactly the same
applier as
standard long
applier, except for
gold rings; long
delays and heavy
red tape on
customizing; extra
fee
No
18
360-degree
nonlaparoscopic
appliers are no
longer popular;
no reported
customizing
No reported
customizing
Yes
Yes
Confidential - for internal use only
Ligation System
Clip
Remover?
No, use blunt
nosed needleholder
No, use blunt
nosed needleholder
Yes, for open
surgery
Yes, but the remover
has sharp teeth that
can tear vessels
Repair
Central location
for efficient
service to all
US-- St. Louis,
Missouri
East Coast
East Coast
East Coast
Applier
Availability
Based on
Commitment
and Pricing
Free swaps to
start accounts.
Appliers mostly
purchased now;
accounts
sometimes
serviced with rep
“trunk stock”.
These largely
second-hand
appliers can
worsen
performance
problems
Free swaps to
start accounts.
Appliers mostly
purchased now;
accounts
sometimes
serviced with
rep “trunk
stock”. These
largely secondhand appliers
can worsen
performance
problems
Free swaps to start
accounts, though it is
not clear that these are
always new appliers.
Other appliers mostly
purchased
19
Confidential - for internal use only
Ligation System
VII.
SALES STRATEGY
With the anticipated strong demand for this product and upfront costs invested in consigned
appliers, an account qualification process will be utilized to prioritize opportunities. Marketing
has developed a Four Step process to be followed. These forms are included in the Appendix
of this Marketing bulletin and this process is summarized below:
Step 1: Quotation Worksheet – Information needed in order to provide pricing such as clip
volume, applier volume, duration of contract, and repair expectations. The pricing strategy is
to price the product below competitive averages.
Step 2: Qualification Checklist – After the account approves the price structure, the
qualification checklist needs to be completed. This checklist includes information such as the
requested start date of the evaluation, # of appliers requested, and # of procedures required.
Approval from your Regional Sales Director is required prior to submitting Step 2.
Step 3: Customer Evaluation Agreement – Signed agreement from customer indicating that if
the evaluation is successful, the customer intends to purchase and convert to the Aesculap
ligation system. Includes the evaluation criteria that the hospital will use.
Step 4: Purchasing and Consignment Agreement – Signed agreement that customer agrees to
pricing for a specified contract period (typical is three years). Also the quantity of consigned
appliers is indicated with the statement that consigned appliers must be returned if the
customer no longer wishes to purchase the clips from Aesculap. A charge of $110 per applier
is due to Aesculap for any applier not returned or returned in non-repairable condition.
A recommended approach for converting an account from a competitive product to the
Aesculap ligating clip is provided below.
I.
Prospecting, Investigate—With Nurses, Surgeons, Other Reps, Other Hospital
Personnel: Uncover Need to Convert
A. Current Usage
B. Satisfaction Level
C. Contracts
II.
Study Aesculap Positioning Guide on Target Competitive System In This Account
A. Topics
B. Probes
C. Comparative Advantage
III.
Meeting With OR Supervisor (followed by meeting with Purchasing
Administration on Worksheet)
A. Confirm Info on Hospital
B. Probes for Advantage
1. Satisfaction Level, Problems
20
Confidential - for internal use only
Ligation System
2. Contract and Pricing Situation
a) Current Contract Term
b) Provisions, Required Term Provisions for Future Contracts
C. Demo 1-3 Key Product Advantages
D. Explain Advantages
1. Positive interface (or “security interface”, etc.), relating theme to key individual
comparative advantages
2. Fair Pricing, to counter ligating clip price increases of recent years. Display
paperwork to compute pricing offer, while expressing confidence Aesculap can
save account money.
a) Applier Consignment Program
b) Applier Purchase Program
3. Aesculap Service Program: Explain key commitments of warranty and service
program .
4. Exclusive sizes: Weck and Ethicon do not offer the micro and small-medium
sized clips. This will allow the hospital to break the current contract.
IV.
Follow-up Meeting
A. Evaluation Set-up
1. Decide with OR Supervisor on Storage and Availability of Evaluation Appliers
(Peel Packs—in cabinets, OR sterile storage?; in surgical sets; in separate trays,
etc.)
a) Point Person for Applier Readiness and Care
b) Handling of Appliers
c) Checking of Appliers After or Before Each Use
d) Identify key CS staff to in-service
2. Establish Duration—Start and End Dates
3. Get buy-in on feedback forms goals. What needed for success? Key surgeons?
Chief? Percent of surgeons? Committee? What are standards of committee? Do
you meet and summarize with committee? What dates?
4. Number of Appliers and Clips Needed?
5. Establish In-Service and Feedback Process (Loading technique; Applier-Clip
Security Demonstration; Serrations Under Magnifying Glass; Tubing):
a) Meetings?
b) Hall Demo Stations?
c) Lounge Displays?
d) Can you hang flyers?
e) In operating room as info resource?
6. Submit Worksheets to Aesculap [Michael Chow] [Will be returned with quotation
for account, with purchased and consigned appliers.]
7. Schedule Aesculap Ligating Clip Supporting Personnel for Evaluation: Cox, Hicks,
Knupp, Chow if needed
8. Hospital Customer Approves Pricing (OR, Materials Management)
21
Confidential - for internal use only
Ligation System
9. Authorize Contact with Key Approval Target Surgical Users (Surgeons and PA,
Head Nurse). Get Supervisor Buy-In on Approval Forms Before Submitting Them
for User Signatures.
V.
Clinical Coordination
A. Key Surgical Users
1. Discuss Prospective Evaluation Beforehand if Possible
2. Demonstrate Product and Explain Comparative Advantages
3. Establish goals in surgery: what to expect (usually just acceptability, with target
benefits noticeable long-term: reduced applier damage, reduced clip dropout,
precise clip closure, etc.)
4. Mention Prospective Cost Savings to Account
5. Evaluation Schedule
B. Supporting Personnel
1. Demo Product
2. Instruct in Proper Loading Technique—Critical!
a) Rule 1: Don’t use grip that can squeeze the applier
b) Rule 2: Respect the angle of the applier—jaw moves straight down over clip;
applier shanks are angled vs. cartridge to make this happen.
c) Feel the applier-clip positive(or security)interface as it loads!
VI.
Clinical Evaluation
A. Visit day before start of evaluation--Reminders
1. OR Supervisor meeting
a) Goals: Demonstrate acceptability; Many advantages noticeable longer term.
b) Logistics: appliers, in-services, approved location for you and other Aesculap
personnel during evaluation: Operating room? Lounge? Hallway?
c) Start Time Review
d) OR schedule for next day
2. Visit “Point Person”
a) Applier Availability Logistics: (Provide appliers for cleaning and sterilization
now or previously.)
b) In-services scheduling
c) Feedback Logistics
1) Evaluation forms
2) Filling them out
d) Applier Care and Turnaround
B. Coordinate with arriving or expected support personnel. Discuss strategy: Technical
product knowledge, advantages, account leverage points.
C. Evaluation Start
1. Arrive early with Aesculap team and your support materials: Paperwork, fliers.
2. Smile and display confidence in your excellent ligating clip product.
3. Touch base with OR supervisor and Point Person.
4. Situate All Aesculap Support Personnel with appropriate forms. Have evaluation
personnel complete Aesculap Evaluation Form (See Appendix).
22
Confidential - for internal use only
Ligation System
VIII. SALES TOOLS
Sales Probes
Ligation System Sales Brochure (DOC 426)
Sales Rep Sample Kit
23
Confidential - for internal use only
Ligation System
Vitalitec Positioning Guide: Points Conveying Your Advantage to the Customer
Primary Guide: Bullet Version
1-Competitive
Product
2Customer
3-Probe
4-Customer
Response
Horizon
OR
Supervisor
Tell me about
your experience
with Weck clips
We have had a
very positive
experience with
Weck
Horizon
OR
Supervisor
What
performance
features of a
ligation system
are important to
you?
We experience
dropped clips
OR
Supervisor
Surgeon
5-Positioning Points



Emphasize key performance features:
1. Visible cartridge for precise loading of clips
2. improved positive-grip surface on clips
3. specialized process on applier jaw for
positive grip on clip
4. Regular servicing by instrument specialists,
consignment inventory, quick turnaround
from centrally located facility (St. Louis)


Perfect-fit
Special friction treatment on the jaws of all-size
appliers for better traction on clip
Springs of our appliers very sturdy and uniform
Sturdy but trim jaws
We have trouble
loading the clips



Clips are widely-spaced on the cartridge
Good-contrast backdrop colors
Better loads fight dropped clips
“We sometimes
experience
scissored clips”

Jaw profile of our small clip jaws resists
insertion into instrument tray wire mesh
Serrated flat clip surface provides stability of clip
legs (vs. smooth surfaces of Horizon)
24

Confidential - for internal use only
Ligation System
1-Competitive 2Product
Customer
3-Probe
4-Customer
Response
5-Positioning Points
Horizon
What is the
optimal clip for
IMA branches?”
“The Horizon red is
a little small for the
IMA branches”

What are your
thoughts
regarding ligation
clips vs. sutures?
“I trust suture more,
of course, in some
settings. But clips
have worked
relatively well over
the years. I don’t
see how you could
improve them”

“A couple of
surgeons like the
Hem-o-lok clip. Do
you have anything
like that?”

Horizon
Horizon
CV Surgeon
OR
Supervisor
Surgeon
OR
Supervisor
Surgeon
Are you using any
non-metal clips?
Tell me where
and why
25




The Vitalitec Small may be a little more
encompassing for the IMA branches
Vitalitec also offers a Small-Medium, which is
just slightly larger than Small, and a Micro
clip—for tiny vessel branches like Radial Artery
branches
Dr. Peter Samuels, designer of the Weck
Hemoclip, proposed some years ago the idea of
teeth on a clip-- for enhanced grip
Weck internal clip surfaces smooth in
comparison to the Vitalitec clip surface
Vitalitec: Multiple serrations for better grip. 10
years in Europe, great response
We specialize in metal clips (preferred for the
vast range of surgery)
Hem-o-lok clips are priced up to 4-5 times metal
clip prices
Confidential - for internal use only
Ligation System
1-Competitive 2Product
Customer
3-Probe
4-Customer
Response
Hem-o-lok
Surgeon
What features of
Clip security
the Hem-o-lok clip
do you find
beneficial?
Hemoclip
Traditional
OR
Supervisor,
or Head
Nurse
Do you
experience any
issues with the
maintenance
program of your
appliers?
We do have a
regular flow of
repairs
26
5-Positioning Points

The Vitalitec clip shares something in common
with the Hem-o-lok clip: tiny serrations to
achieve security on vessels
 Vitalitec clip can be adjusted, achieving tighter
closure with more pressure
 The Hem-o-lok clip closes to one closure point
and cannot be adjusted tighter past that point: a
“one-closure-fits-all-approach” for each clip
size. That is very different from most clips and
from suture, both of which are adjusted by the
surgeon
 Vitalitec clips have many more teeth and are
trimmer
 Vitalitec clips are X-Ray detectable, so you can
use them as markers
 Vitalitec clips cost a fraction of what Hem-o-lok
clips do
The Vitalitec system is designed to minimize
repairs—
 Soft-Loading-System to reduce stress on
appliers, vs. the friction-load system of Hemoclip
Traditional: the oldest system
 Small appliers with sturdy jaws that won’t get
caught in tray or basket mesh
 Sturdy springs
 Clip cartridge to facilitate precise load vs. narrow
seats of Small HT
 Aesculap Service Applier Program
Confidential - for internal use only
Ligation System
1-Competitive 2Product
Customer
3-Probe
4-Customer
Response
5-Positioning Points
HT-Tantalum
Do you
experience any
issues using
tantalum clips?
1) We’ve used it for
a long time—it
closes well; or 2) I
thought we were
using titanium

I like stainless,
because it is the
strongest metal

HT-Stainless
Steel
Hemoclip
Traditional
Hemoclip
Traditional
Surgeon
Surgeon
OR
Supervisor
Surgeon
OR
Supervisor
Do you
experience any
issues using
stainless steel
clips?
Which system is
more cost
effective automatic
disposable
laparoscopic
appliers or
reusable manual
load?
Do you buy or
consign appliers?



No one ever asks
for a manual
laparoscopic
applier. The
doctors seem
satisfied with the
disposables

In recent years,
yes. It doesn’t
matter though,
because we are
preparing to
upgrade to Horizon





27
Titanium is the most commonly used metal
today for ligation clips
Titanium causes fewer problems on both CT and
MRI scanning
Tantalum is usually priced much higher than
titanium
Vitalitec titanium clips have a long record of
security in surgery designed to withstand
maximum systemic pressures. 10 years Europe
The MRI deflection of stainless steel is 35-50X
that of titanium (though not proven harmful)
That may be due to the fact that you are using a
system (HT) that does not offer a manual-load
laparoscopic applier; the Weck rep can’t sell the
concept
Only a few clips are placed in lap chole
You pay about $100 for a disposable lap
applier, for placing 4-6 clips ($16-$25 per clip).
Clips for manual appliers cost about 70 cents-$1
per used clip
Vitalitec offers a plan that allows you to pay for
clips, with free appliers on consignment
Evaluate Vitalitec at the same time to save
money on Fair-Pricing Program. Get a clip
system with equal or better features than
Horizon
Our Aesculap Service Applier Program
provides a program of regular service visits to
minimize applier downtime awaiting repairs. All
appliers are repaired by instrument
professionals
Confidential - for internal use only
Ligation System
1-Competitive 2Product
Customer
3-Probe
4-Customer
Response
5-Positioning Points
Ethicon Ligaclip OR
Supervisor
Tell me about
your experience
with Ethicon clips
They don’t
complain.
[If complaint go to
that topic]



Ethicon Ligaclip Head Nurse
Surgeon
Ethicon Ligaclip Head Nurse
Surgeon
What
performance
features of a
ligation system do
you feel are
critical?
Same as above
Clip Pick-up



Closure


28
Vitalitec clips are both easier to load and preformed for precise closure
Our Aesculap Service Applier Program
provides a program of regular service visits to
minimize applier downtime awaiting repairs. All
appliers are repaired by instrument
professionals
Vitalitec appliers open for cleaning at the boxlock. Most Ethicon appliers do not
Vitalitec’s clip is a pre-formed chevron to give
you a more consistent load
Ethicon’s clip is “V”-shaped in the cartridge;
only becoming chevron-shaped in the applier
due to two exterior notches which weaken it at
two points
Ethicon’s Ligaclip Extra clip incorporates two
notches in the exterior of the clip legs
The notches weaken the clip at two key points in
an effort to imitate a true Chevron-shaped clip
Vitalitec clips are Chevron-shaped in the
cartridge for stability, loading and closing
Confidential - for internal use only
Ligation System
IX.
CLINICAL INFORMATION
Clip Size
Leading Use
or Strong
Potential
Details
Micro
CABG, IMA;
Radial Artery
Harvest
The Radial Artery
is the newest
frequently used
graft in CABG
Micro
PlasticReconstructive
FreeFlap(30,000)
Plastic
Reconstructive
Surgeons started
asking for Micro
clip 20 years ago
Details
Details
The Radial
Artery
branches are
very tiny,
about 1 mm
diameter
Shallow nature of
the surgery aids
visibility of the clip.
Small clips used
now, but micro
would fit and might
be preferred
Free-Flaps are When a plastic
tissue
reconstructive
transfers to
surgeon tells you
cover tissue
he or she does free
deficits from
flaps “all the time,”
trauma or
he may mean 3-4 a
surgery
month
Thyroid surgery Very small
Micro
Shallow nature
feeding branches of the surgery
aids visibility
of the clip
Italics indicate potential or prospective use. The surgeon is the final authority on selection of clips
for particular vessels. Security of all ligating clips should be confirmed after placement.
29
Confidential - for internal use only
Ligation System
Clip Size
Leading Use
or Strong
Potential
Small-Cardiovascular
IMA
(150,000) part
of CABG
(350,000)
Small—ENT,
Head and Neck
Small—General
Details
Details
Details
IMA is the
internal
mammary
artery
The IMA is
attached to a
coronary
branch to
perfuse it;
can be
unilateral or
bilateral.
Small clips
are currently
the most
popular for
IMA
ENT, Thyroid,
Maxillary
Artery (with
pistol applier),
head and
neck for
trauma, and
palliative
surgery
ENT surgeons
are more
conservative
about clips,
but do use
them
Mastectomy
(Breast)
(120,000)
Modified
radical
mastectomy is
less
destructive
than radical
Lymphatic
node ligation
becoming
more
thoroughly
practiced to
prevent
metastases
of cancer:
near
vessels—
vascular,
breast
Surgeons
currently rely
on medium
and small
30
Axillary
dissection
includes
lymphatics
Confidential - for internal use only
Ligation System
Clip Size
Leading Use
or Strong
Potential
Small-MediumCardiovascular,
Vascular
Carotid
Endarterectomy
Saphenous
Vein Harvest,
Internal
Mammary
Harvest
Small-Medium—
Abdominal
Liver Resection
(20,000)
Small-Medium
Markers
Details
Details
Small
generally
used for
IMA. S/M
can
encompass
slightly more
tissue,
particularly
with its
length
The liver
In a
body is
liver(lobe)
perforated by transplant,
tiny thinthe liver is
walled veins. incised, as in
trauma
cases
Titanium is
Medium
the ideal
usually used;
marker:
S-M would
minimum
cause less
interference
interference
CT, MRI
Details
S/M may be
a more
appropriate
size than
Medium on
some
branches of
Carotid and
Saphenous
vein
31
The tiny
veins are a
challenge
for Medium
clips.
Opportunity
for S-M
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Ligation System
Clip Size
Leading Use or
Strong Potential
Medium--
Saphenous Vein
Harvest
Saphenous is still
the most popular
conduit, because
IMA will only handle
one-two graft cases
General
Abdominal
(500,000+):
Esophageal
(25,000);
Spleen(27,000),
open and lap
General abdominal
includes
gastrectomy, vagus
ligation, exploratory
laparotomy, open
gall bladder,
colon/rectal, small
intestine,
appendectomy
(300,000), anterior
spinal access
Cardiovascular
Medium-General
Details
32
Details
Details
Medium has
been used as
the one-size
that fits all
branches,
though a
gradual trend
has seen the
growth of
mixed Medium
and Small in
some OR‘s
If clips are
used on both
the donor and
graft side,
then
saphenous
tributaries are
a big
challenge for
Medium clips,
because
some
branches are
as small as 1
mm in
diameter
Vascular
A large
includes
portion of
carotid
Weck clips
endarterectomy are comprised
(100,000),
of tantalum or
femoral
stainless
popliteal
steel, which
bypass
can cause
(75,000), aortic scanning
bypass
problems on
(50,000),
MRI
perforator
(Stainless) or
surgery in leg
CT scanner
(25,000);
(Tantalum)
endovascular
repair;
Varicose vein
excision (5075,000)
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Ligation System
Clip Size
Leading Use or
Strong Potential
Details
Medium-Vascular
Vascular(400,000):
Carotid,
FemoralPopliteal; Other
femoral bypass;
AAA; Saphenous
Perforator; Vein
stripping
Urological:
Nephrectomy
Prostatectomy
Cystectomy
Vascular surgeons
use a lot of clips, but
they tend to be more
casual about the
subject than
cardiovascular
surgeons
Specialized:
ENT, Plastic
Head/Neck;
Liver; Pancreas;
Breast;
Lymphatics; Gyn
Oncology (see
under Large)
Plastic and
Reconstructive
Surgeon; ENT;
General Surgeon
Medium-Urology
Medium—
Other
Specialties
33
Details
Details
Vascular
surgeons do
not carry as
much weight in
the clip
decision as
cardiovascular
surgeons
Donor
Nephrectomies
grab the
headlines, but
only 6,000
done annually.
About 40,000
done for
pathology
May be
handled by
general
surgeon
Plastic and
Reconstructive
and Head and
Neck surgeons
perform jaw
and other
reconstructive
work that can
utilize clips
Pancreatectomy
Only about
10,000
cystectomies
done—for
cancer
removal—but
up to 100
clips per case,
mostly
Medium.
Might be
some interest
S-M
(25,000) can
utilize a large
number of
medium clips.
“Whipple”
procedure is
one variety of
this
reconstructive
work
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Ligation System
Clip Size
Leading Use or
Strong Potential
Details
MediumLarge-General
Laparoscopic
Cholecystectomy
(830,000 US)
95% with
Automatic clip
appliers
MediumLarge-Urology
Nephrectomy
A target
procedure for
Weck HOL
MediumLarge—
Urology.
Prostatectomy
(60,000-80,000)
Nerve sparing;
Medium, M-L,
Large
Prostatectomy
is
accomplished
by two
approaches
34
Details
Details
When surgeons
converted this
procedure to
laparoscopic,
they changed
their clip-size
preference from
Medium and
Large to M-L, as
an all-purpose
clip for cystic
artery and cystic
duct
Donor
Nephrectomies
grab the
headlines, but
only 6,000 done
annually. About
40,000 done for
pathology
Radical
retropubic and
perineal.
Potentially a
very bloody
procedure
There are still about
100,000 open
procedures done,
but these are mostly
“incidental
cholecystectomies,”
performed in
conjunction with
another abdominal
procedure
Large portion done
open, where
automatic clip
appliers are not as
compelling. About
20 clips: M, M-L.
As many as 80 clips
can be used, M-L on
lateral pedicals,
Med: vas deferens,
seminal vesicles
Confidential - for internal use only
Ligation System
Clip Size
Leading Use
or Strong
Potential
Details
Large—
Cardiovascular
and Vascular
Various
bypasses:
femoral, other
Large clips may
be used for trunk
remnants of
large vessel
such as
saphenous vein,
used as a graft
Adrenal surgery
places clips at
advantage to
ligate adrenal
vein
Large—General Gastrectomy
Surgery
(30,000)
Adrenalectomy
(15,000)
Large—
General, Colon
& Rectal
Colectomy
(400,000)
Large—
Gynecology
Gynecological
Oncology
Large-Thoracic
Lungs
Details
Adrenal vein
carries
enzymes that
can have
negative effect
on surgery
Surgeons prefer Large vessels
to take large
are identified
bundles of tissue and usually
when cutting
tied. Large
across the
clips are
mesentery, a
usually
connective
employed to
membrane
ligate large
enclosing
tissue bundles
vessels and fat
with inspecific
vessels or
bleeding
Gyn Oncologists Gyn Oncology
(1,000) perform
procedures
up to 100K
are intestinal
procedures per
resection,
year
usually colon
(30-50 clips)
Lobectomy,
Thoracic Aorta
Wedge
Resection
35
Details
Significant
challenge to
security
Many surgeons
use sutures
instead due
their lower
opinion of large
clip security
Confidential - for internal use only
Ligation System
X.
APPENDIX
Sales Qualification Forms
Aesculap Evaluation Form
36
Confidential - for internal use only