2. Suction in Surgery In surgery suction can be used to remove blood and waste liquid from the area being operated on to allow surgeons to view and work on the area. Vacuum Source Connecting Tubing Open Surgery For Laparoscopic surgery

3. Problems in Traditional Surgical Suction Methods Not Clean Hard to Keep Artificial Pneumoperitoneum Hard to Identify Small Bleeding Point Tissue Damage caused by Vacuum ？

4. Why is the suctioning unclean? What problems can it cause?

5. When Suctioning Can Not Clean Thoroughly After suctioning, there is still thick blood or other contaminant adhered to organs or operated area.

6. When Suctioning Can Not Clean Thoroughly Source Hazards Common Contaminant Adhered to Organs and Tissue Carbonized Protein and Adipose Tissue caused by forceps/cauterization. Tissue damage factor Digestive Juice: Gastrointestinal Fluid, Bile, Pancreatic Juice, etc. Strong Acid, Strong Base Contaminant, such as fester, bacterium, slough, etc. Wound surface with pathogen, or body cavity infection Residual blood and wound exudates that haven’t been thoroughly cleaned Nutrition solution for pathogen, that can cause infection in body cavity

7. Hazards Caused by Unclean Suctioning Recovery Delay Increase of Hospitalization Expense Misleading Doctors to abuse antibiotics High Incidence of SSI(Surgical Site Infection) Postsurgical abdominal distention – Food-taking delay Weak, joint sore of the whole body, Listless and indifferent Postsurgical Fever

8. Postoperative infections that present in any location along the surgical tract within 0 to 30 days after a surgical procedure or within 1 yr in procedures involving implants. SSI ( Surgical Site Infection)

9. Risk Caused by Residual Contaminants --SSI  Surgical site infections are also frequent: the incidence varies from 0.5 to 15% depending on the type of operation and underlying patient status (Source: WHO)  SSI report in U.S. * : 1.Around 17% of all deaths in surgical patients are with an SSI. 2.SSIs occur in 2%–5% of patients undergoing inpatient surgery. SSIs are believed to account for $3.5 billion to $10 billion annually in healthcare expenditures. 3.Each SSI is associated with approximately 7–11 additional postoperative hospital-days 4.The direct economic costs of an SSI are considerable, usually being approximately twice the amount of in-patient costs for a patient without an SSI  One of the main risk factors to SSI is residual contaminant during surgical operation. * *Ann Surg 2011;253:1082-1093 *Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update

10. Repeated Simultaneous Suction & Irrigation What should we do when the suction is unclean? Clean Surgery A surgical technique that is achieved by suction and irrigating the contaminants such as the residual blood and other types of liquid in the operational area to keep the operational area clean. Quality of Evidence: II ＊ By irrigating the wound timely, we can effectively preventing SSI. *Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update CLEAN SURGERY Achieved

11. Clean Surgery  Time consuming, impeding the surgery moving forward.  One time irrigating just before abdominal closure, part of the contaminants has already been absorbed. Simultaneous irrigating and suction helps Surgeon clean the contaminants needed at any time. Operated by assistant, no impact on the surgery process. Contaminants cleaned timey, low chance to be spread and absorbed.

12. Achieved Clinical Effect by Clean Surgery  Decrease the incidence of SSI.  Decrease the incidence of postsurgical fever.  Decrease the incidence of complicates such as postsurgical abdominal distention, no anal exsufflation, food-taking delay, ache and weak feeling.  Decrease the use of antibiotics, shorten the rehabilitation time.

13. What should we do when it is hard to keep artificial Pneumoperitoneum in Minimally Invasive Surgery?

14. Output Pressure: 0 ～ 3.99Kpa(0 ～ 30 mmHg) Output Flow Rate: 0L/min ～ 30 L/min Patient Side Vacuum Value: 0.02MPa ～ 0.07 MPa Patient Side Flow Rate: ≥30L/min Insufflator Central Vacuum Suction Thanks to the flow rate of the central vacuum suction system is much higher than that of the Insufflator, so it is hard to keep artificial pneumoperitoneum if the suction exceeds 5 seconds when using traditional suction tips. Why is the artificial pneumoperitoneum hard to keep?

15. Traditional Suction Viclear No regulator, 3-5 seconds at most a time. Surgeon’s fingers are easy to be tired because switches are used too often, thus prolong the surgery time consumed. Thanks to designed speed regulator, it is easy to get the air pressure balance inside the body 20-30 seconds suction available without lose the artificial Pneumoperitoneum Smoke that block the Surgeon’s view is cleared by long time continuous suction Difference Between Traditional Suction and Viclear

16. Hard to find small bleeders

17. Unclear View due to thick blood adhered to tissue Traditional Suction Approach

18. Repeated simutaneous irrigation and suction, clear view achieved Red Blood will be found easily in transparent water. Small bleeders show up after clotted blood was diluted by irrigating Viclear

19. Tissue Damage

20. There is a potential risk to damage the tissue thanks to the big suction power that can catch tissue easily.

21. Viclear -- No Tissue Damage Caused by Suction 1.Multi-hole design 2.Split-flow design, avoiding tissue damage by suction.

22. Viclear – Solve all of the problems of traditional suction OK Clean Surgery Easy to Keep Artificial Pneumoperitoneum Easy to Identify Small Bleeding Point No Tissue Damage caused by Vacuum

23. Viclear Assembly Saline （ bagged ） Infusion Set Suction Connecting Tubing Vacuum Source Suction Tubing is connected on grey connector JM-CX4 showed on the diagram Pressurized transfusion bag

24. Viclear Codes JM-CX1A Open Surgery JM-CX4 Minimally Invasive Surgery, da Vinci Surgical System JM-CX1A JM-CX4

25. Innovation on Surgical Technologies