Computer controlled I NSTANT R ESPONSE ™ system provides safer and more precise electrosurgery. TM

Tissue Response Technology Tissue Impedance INPUT Computer Controlled OUTPUT

Computer Controlled Tissue Response Technology Responds instantly to changes in tissue impedance/resistance. Maintains clinical effect over a wide range of tissue impedances/resistances.

The computer circuit is: Automatically invoked All cut modes All bipolar modes Not applied to coag modes Fulguration capabilities Tissue Response Generator

Tissue types vary in impedance/resistance Effective over a wide range of tissue impedances/resistances Tissue Response Generator The computer circuit senses tissue impedance/resistance

Approximate Tissue Impedance/Resistance Ranges Buzz Hemostats Desiccate - stop bleeding Prostate in nonconductive solution Muscle, Eye, Skin, Kidney, Pancreas Oral Cavity, Liver Gall Bladder Bowel, Brain Gray Matter, Adipose, Spleen Mesentary, Brain White Matter, Omentum Lung, Scar, Adhesions resistance when bloody resistance when dry KEY Resistance in Ohms at Radio Frequency when Cutting or Desiccating Increasing tissue impedance/resistance

Provides instant response to changes in tissue impedance/resistance Produces consistent tissue effect Controls maximum output voltage Reduces capacitive coupling and video interference Minimizes sparking Tissue Response Generator Computer controlled output is automatically adjusted

Thermal Damage Standard ESTissue Response Average thermal spread =.35 mmAverage thermal spread =.14 mm 50% reduction in thermal spread Tissue response produces equivalent tissue effect at lower power settings

Capacitively Coupled Current Measured on a Metal Cannula Tissue Response Standard ES Impedance (ohms) Current (mAmps) Coag at 120 Watts

Peak to Peak Voltage Generator Technology Comparison in Pure Cut Volts Tissue Response Generator

Output Power vs Resistance Tissue Response Pure Cut Mode vs Conventional Pure Cut Modes Resistance in Ohms Output Power in Watts Tissue Response Generator Generator Setting 300W Increasing tissue impedance/resistance

Output Power vs Resistance Tissue Response Generator Tissue Response Blended Cut Mode vs Conventional Blended Cut Mode Resistance in Ohms Output Power in Watts Generator Setting 200W Increasing tissue impedance/resistance

Advantages in Monopolar Provides computer controlled output in: Cut Mode Less thermal damage to adjacent tissue Lower power settings required to achieve desired effect Less sparking Ý reduced stimulation of nerves and muscles Reduced drag Spray Coag Mode Wide area of effect with less spot penetration Tissue Response Generator

Advantages in Bipolar Provides computer controlled output in: Low Delicate tissue Fine control of desiccation Low voltage Ý prevents sparking Med Standard tissue application Low voltage Ý prevents sparking Macro Higher resistance tissue Higher voltage available Designed to function with new generation of laparoscopic instruments Tissue Response Generator

Standard ESTissue Response High voltage causes sticking and charring Reduces power to slow coagulation Reduces power into high impedances to limit cut capability Voltage is limited to reduce sticking and charring Maintains power to speed coagulation Maintains power in high impedance tissue to reduce drag Bipolar Coagulation Macrobipolar

Incorporates previous technology safety features Isolation Return electrode monitoring Functions with other technologies Argon enhanced electrosurgery Accepts current accessories Monopolar electrodes and footswitches Bipolar electrodes and footswitches Tissue Response Generator

Surgical Applications General Laparotomy incision Mastectomy Urology TUR Prostate GYN Orthopedics Plastic Tissue Response Generator Skin Fat Muscle Fascia Peritoneum