Instruments/Supplies
Lateral retractor with 10-12mm blade (i.e. Young or Army-Navy type)

Dissector with air:
Air inflation bulb (provided with Balloon Dissector, refer to recommended number of pumps on product label).

Dissector with saline:
(2) 60cc or 150cc (luer tip)
sterile saline (refer to recommended fill volume on
product label for amount)
standard wall suction and tubing

Technique
1. Make a small infraumbilical incision slightly lateral to the midline. Incise the fascia transversely over the rectus muscle.

2. Identify the proper layer between the rectus muscle and the posterior rectus sheath.

3. Insert a 10mm endoscope into the scope cover. Please note that the scope cover will accommodate any 10mm endoscope, but for optimal visualization a 30 degree angled endoscope is recommended. When inserting an endoscope, the endoscope light source connection is opposite the printed side of the scope cover handle.

4. Completely insert the endoscope into the scope cover.

5. Close the suction outlet with the attached clamp.

6. Introduce the balloon dissector through the incision, making sure that the device is properly oriented (refer to "up" arrows on handle of device).Slowly advance the device as desired. Do not force. The advance of the balloon dissector may be monitored by direct visual observation with the endoscope, and by manual palpation.

7. Inflate the balloon visually using either air or saline (recommended maximum volume for both saline and air are indicated on the device label).

8. When the inflation is complete, open the clamp and begin deflating the balloon (evacuation of saline may be aided with a syringe, or by a standard OR suction line for saline) through the device's suction outlet line.

9. Once deflated, sequentially remove the endoscope, scope cover, and balloon. (The recommended sequence of component removal may be altered at the surgeon's discretion, but the balloon should always be deflated prior to removal).

For models with SpaceSEAL^™ EPS:
10. Introduce the EPS into the incision until the distal portion has advanced to the desired space

11. Using the air bulb provided, inflate the balloon through the balloon inflation port with 4 pumps of the bulb.

12. Set foam collar and lock.

13. Pull back on the handle assembly to remove the obturator.

14. If insufflation is desired, attach the gas line to the luer port marked CO₂ using a male luer lock/adapter. A two-way stopcock (provided with the device) can be used between the gas line and the CO₂ port.

15. Additional trocars should be inserted under direct vision. Care should be taken to avoid damaging the balloon with a secondary trocar.

16. Endoscopic instruments can be introduced and removed through the EPS sleeve.

17. The reducer seal is provided on the body of the device to allow for use of 5mm instruments. To use, push the cap over the main seal until it reaches a positive stop.

18. To remove the EPS, place the deflation end of the bulb in the balloon inflation port. Pump the bulb until the balloon is fully deflated.

19. Upon completion of the endoscopic procedure, detaching the gas line will quickly deflate the adominal cavity.