Product Description	Product Technique	Endoscopic Technique Reprint	SEPS Kit
Training Courses	Educational Materials	Reimbursement Codes
SUBFASCIAL ENDOSCOPIC PERFORATOR SURGERY (SEPS) DETAIL

	The SPACEMAKER® SEPS balloon dissector is used in the lower leg to create an endoscopic operative space for performing perforator vein ligation to treat venous stasis ulcers.
	A 10mm-15mm skin incision is made in the medial aspect of the calf, approximately one hands-breath below the popliteal crease.
	A pair of Army-Navy retractors is used to retract the incision so the white fascia is visualized.
	The fascia is sharply incised approximately 10mm.
	Using an Allis clamp to retract the inferior flap of the fascial incision, the SEPS balloon dissector is inserted subfascially toward the medial malleolus.
	Once the balloon dissector has been fully inserted, the black clip on the balloon cover is closed, thereby releasing the balloon cover from the device to allow removal. The balloon cover is used to maintain the integrity of the balloon during device insertion.
	With the balloon fully inserted underneath the fascia, saline is injected through the one-way valve to inflate the balloon. The balloon will accept up to 300cc of saline.
	The balloon first inflates radially and then everts to extend distally. Full distention of the balloon may or may not be necessary depending on the length of the patient's leg.
	Once the balloon is fully inflated, it is immediately deflated. Fluid can be evacuated by draining into a basin or connecting the suction outlet to wall suction. The balloon is removed from the incision by pulling back on the filler tube.
	With the balloon removed, the trocar cannula is rotated into the incision until the skin threads achieve a secure purchase on the fascia. The guide rod is then removed from the cannula. A CO2 line is connected for insufflation. The space is insufflated to a pressure of 15mmHg under medium to high flow rate. A zero-degree 10mm laparoscope is inserted through the cannula to view the operative space.
	Under direct vision on the monitor, a secondary, short 5mm trocar is introduced inferior and lateral to the first port.
	The balloon dissector has gently separated the fascia from the anterior surface of the muscle to create a clean operative space. A perforator vein, integrity maintained, is shown here immediately following balloon dissection.
	A 5mm endoscopic clip applier is used to ligate this perforator vein.
	A 5mm endoscopic dissector is used to dissect a second nearby perforator that was identified during duplex scanning and marked on the leg prior to surgery.
	A right angle dissector is very useful for dissecting behind a perforator in this small space.
	Again, a clip applier is used to ligate the perforator vein.
Order Information SMODEL # PRODUCT DESCRIPTION QUANTITY SVBD-300 SPACEMAKER® balloon dissector for SEPS, 300cc 1 Each SVBD-240T SPACEMAKER® tapered balloon dissector for SEPS, 240cc 1 Each SSPSKT-01 GSI SEPS Procedural Kit , including VBD-300 3 Kits/Box SSPSKT-02T GSI SEPS Procedural Kit , including VBD-240T 3 Kits/Box Order individually or in a kit Please call Customer Service at (800) 980-0300 or send e-mail to customerservice@gsii.com