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Ackermann

All you need to know about Clips


History of ligating clips
Edward Weck, Inc. was the innovator of the modern ligating clip. In 1967 a significant
advance from previous ligating clips and cartridges was made by E.C. Wood . He was
awarded U.S. Patents #3,323,216 and #3,363^628. The ligating clip system developed
by Weck introduced important advantages from previous generations of ligating clips. The
Week "Hemoclip" ("Hemostatic clip") was manufactured from tantalum and included a
radius bend on each of the lateral legs of the clip. These bends were in addition to the
center bend available on all previous ligating clip designs. The profile of the pre-formed
ligating clip sold by Weck resembles the shape of a horseshoe or barn. The legs of the
ligating clip were essentially parallel. One of the patent claims made by Weck was their
ligating clip was pre-formed.
The pre-formed clip offered a significant advantage to the surgeon. When the applier jaws
were squeezed together the tip closed distally first in a "tip to tip" manner. This feature
was strongly endorsed by surgeons. For the first time, a surgeon had the vessel contained
within the ligating clip and fully controlled before actual ligation took place. Prior "V"
shaped ligating clip designs had a tendency to squeeze the vessel away from the ligating
clip as the applier jaws were being closed.
The Weck clips were pre-loaded on a disposable clip cartridge which was ready for
immediate use at the surgical site. Tedious hand loading of individual clips onto a
cartridge and sterilization of the assembly just prior to the surgical procedure was no
longer necessary. The appeal to the nursing staff was obvious. Week clips are available in
4 different sizes all available in Tantalum, Stainless Steel, and Titanium. 10, 15, and 25
clip cartridges are available.
Ackermann Advantages
Ackermann has the most athraumatic shaped clip in the world market.
Where competition products only seal once,
Ackermann clips will give double safety.
Each clip is undergoing a unique
surface polishing that will guaranty a
unequaled contact with the tissue.
The real message under all circumstances
is: Ackermann provides your customers with a superior ligating
clip, and an extremely reliable and cost efficient delivery system.
It is not alot more complicated than that. Ackermann is by far the fastest growing ligating
clip manufacturer in the world. In some countries Ackermann has already_become the
dominant seller of ligating clips. Ackermann fully expects to become the largest seller of
ligating clips in the world.

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Ackermann

Compared with competition products the rounded surfaces will ashure best
performance even on week vessels.
The U-shape all trough the clip gives a better resistance and makes
the clip stronger than a square shape used by the competition

A square shaped part will bend much


easier than a U shaped component.
The product is Cardiology approved and certificated.
Each cardridge comes with a sticker which will fix the cardridge on the instrument table or
the surgeons glove.
Ackermann Disadvantages
Ackermann competitors rely on "negative selling" in a desperate
attempt to introduce fear and doubt in the minds of the
customer. There isn't a rumor you can dream up that we
haven't already heard. Our response is universally the same:
"Put it in writing"! Just tell your customers the truth and laugh at your competitors
desperation.
Pilling Weck Advantages
Here is the summary of the benefits Week (now Pilling Weck) introduced to the surgical
community.
The Weck Tantalum Hemoclip was stronger and more
inert than any previous generation of ligating clips. (Do NOT
refer to Ackermann ligating clips as "Hemoclips",
"Ligaclips" et.al. - You sell Ackermann Euroclips!)
The clip closed distally so the surgeon had the vessel
completely under control prior to ligation.
Sterile disposable cartridges eliminated tedious hand loading of individual clips.
Weck offers their ligating clips in stainless steel. This metal has no redeeming
characteristics except that it is dirt cheap. In competitive situations, Weck will bid
their lowest priced metal. Stainless steel clips are not compatible with MRI.
It is your task to educate your customers.
Pilling Weck Disadvantages
Weck has not changed the design of their ligating clip system in over 25
years. They have Tried to improve their product but have never been
successful. Ackermann has solved well recognized problems.
Weck is selling a product from another era.

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Ackermann

Their new "easy load" cartridge is simply a modification of a Pilling cartridge.


The force required to insert an applier into a cartridge may be so extreme the
applier can be damaged during routine use.
The applier slot in a Pilling and Weck Small cartridge is approximately .025"
thick. The thickness of the applier jaws must be thinner than this opening. The
average thickness ("top to bottom") of a Weck SMALL applier is approximately
.022". This extreme thinness has caused Weck enormous problems over the years.
Normal clip loading causes enormous stress on a Weck SMALL applier. The user
must exert significant force to insert the applier into the cartridge. This action
alone may cause applier jaws to become bent. Even slightly misaligned jaws can
compromise clip loading and clip closure. A clip may not load accurately into the
applier jaws or may "scissor" when it is closed. The problem was exacerbated in
the instrument processing area. Unless a SMALL Weck applier was processed as a
delicate micro-vascular surgical instrument it could be severely damaged during
routine instrument processing. Weck had a serious dilemma. How do you increase
the strength of the applier to minimize these problems? Their answer was to make
the applier wider ("side to side"). That solution introduced a NEW problem.
Surgeons, especially cardiovascular surgeons, simply don't like FAT tipped appliers.
All Pilling and Weck ligating clips now include a statement on their box stating
their cartridges may not be re-sterilized. The minimum number of clips per
cartridge offered by Pilling or Weck is 10. The Ackermann 6 clip cartridge
will substantially reduce waste - and save your customers money. Refer to the "Clip
Waste Analysis".
Teleflex paid $62.5 Million for the acquisition of Weck. By FAR, the most
profitable segment of the Weck business was their Hemoclip product line.
Although Teleflex appears to have infinitely deep pockets, it is illogical to think
they will choose to engage in brutal price competition. The Board of Directors of
Teleflex EXPECT a return on their investment. Unfortunately for Teleflex, the
PillingWeck ligating clip system has been made obsolete by Ackermann.
PillingWeck realizes they have nothing positive to tell their customers about THEIR
ligating clip system. They have simply conceded the technical superiority of the
Ackermann Euroclip system. PillingWeck realizes they cannot compete
with Ackermann on matters of product quality, reliability, precision, ease of
use, reduction of waste, or cost. PillingWeck LIVES with negative selling. They
have nothing else to talk about! Present the features and benefits of the Ackermann
ligating clip system with pride and dignity - and ignore the competitive
hype. Let PillingWeck play in the gutter by themselves.
To quote one of our customers: "Weck rested on its laurels too long".
Ethicon Advantages
The Ethicon cartridge significantly improved applier loading compared
with the Pilling Weck product. The clip is not retained on the cartridge by
friction. Instead, the outer legs of the clip are held under alip on the outer walls of the
cartridge. The clip is formed as the applier is inserted into the cartridge. The downward
force required to insert an applier into a cartridge is minimal.

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Ackermann

Ethicon offers their ligating clips in a 6 and 20 clip cartridge. A6 clip cartridge
will significantly reduce waste compared with a 10 or 15 clip cartridge. Ethicon
justifies their higher price per clip by emphasizing the fact their 6 clip cartridge
reduces waste.
Ethicon conducted market research and reached two conclusions: A) Surgeons
wanted SMALL appliers that were narrow ("side to side"I B.) Surgeons wanted
appliers that were durable, reliable, and could not he easily knocked out of
calibration or alignment. How could these seemingly diverse goals be achieved?
The Ethicon solution was brilliant. They made their SMALL appliers substantially
thicker ("top to bottom") AND narrower ("side to side"). The thickness of their
applier increased to an average of .045". Ethicon could make their SMALL
appliers substantially narrower but still retain incredible jaw strength. The fact an
Ethicon applier is thicker than Pilling Weck appliers seemed to have no particular
surgical significance. Almost without exception surgeons preferred the Ethicon
"Thick and Narrow" appliers over Weck "Thin and Wide" appliers. Ironically, this
Ethicon advantage is limited to SMALL size appliers. Appliers for larger size '
Ethicon size clips are quite bulky with big fat tips.
Ethicon appliers have a "stop pin" in the box lock that establishes the maximum
jaw width opening. The user cannot inadvertently alter the jaw width setting as is
possible with the "spring latch" design of other appliers. This feature is especially
valuable in SMALL size clip appliers where clip retention will degrade substantially
with a "too wide" jaw width opening. This feature is far less important on the
larger size clip appliers. The goal of Ethicon for the box lock stop pin was to make
their appliers "nurse proof". Nice idea - but with horrible side effects that are
discussed below.
Johnson & Johnson has enormous marketing muscle and is known for
"bundling" products and offering year end rebates.
Ethicon Disadvantages
The Ethicon clip is "V" shaped and looks
rudimentary compared with Ackermann
clips. It is even crude compared with a Pilling Weck clip.
Ethicon clips are manufactured from a flat rectangular ribbon of metal which
does not have the mechanical strength of the Horizon Surgical triangulated shaped
clip. (See Ackermann advantages)
The Ethicon clip is forced over a mandrel as the applier is inserted into the
cartridge. This action transforms a "V" shape into a "barn" or "chevron" shape
which helps achieve "tip to tip" closure. However, unless the applier is absolutely
perpendicular to the cartridge when it is inserted the clip willbecome skewed. In
turn, the clip will close erratically. Often, one leg of the clip will protrude
substantially beyond the other creating a sharp leading edge.
Despite Ethicon's claim of a "locked in" clip, the clip is notorious for slipping
backward within the applier jaws.
With some Ethicon appliers, especially the SMALL size, the clip slot is very
deep. It is possible for the clip to be completely engulfed within the applier jaws
when the applier is fully closed. This causes the applier jaws to crush surrounding
tissue as the clip is closed.

finest surgical technology

Ackermann

Ethicon appliers have a clip slot that is substantially wider than the clip. When the applier
is inserted into the cartridge it is possible for the clip to become "skewed" within the applier
jaws. Under those circumstances the clip can "scissor" a vessel.
The "stop pin" in the box lock, previously discussed as an advantage, is also a
senous_disadvantage. This pin prevents the ring handles from being spread open so the
box lock can be cleaned. Even with extraordinary care, the box lock of Ethicon appliers
may become filled with "crud" over time. The box lock can get so stiff it willnot spring back
open. Potential patient cross-contamination and severe degradation of performance is the
result.
An Ethicon applier will often "stick" in the cartridge and lift it from the working surface.
Ethicon offers a weighted base, similar to the archaic device offered by Pilling Weck, to
overcome this deficiency.
Ethicon published prices are the highest in the market. Typically, Ethicon does not
discount aggressively. Even with product "bundling" and year end rebates, Ackermann can
provide an Ethicon customer with substantial yearly savings.
(Refer to the cross-reference sheet at the end of this document).
DISPOSABLE CLIP APPLIER BACKGROUND
Ethicon, Pilling Weck and others
have also introduced disposable ligating clip appliers. All of these devices
share similar advantages, disadvantages and prices.
Disposable clip applier advantages
Each ligating clip is loaded into the applier jaws automatically. No human intervention (to
screw things up) is required. The difficulty and frustration of accurately loading a clip into
the applier jaws, found with the Weck, Pilling, Horizon and Ethicon manually loaded
systems, is eliminated.
The jaws of the applier are brand new. Therefore, there is essentially no concern about
jaw misalignment.
The applier has a long, slender shaft which improves surgical access in certain
circumstances.
Concern about improper cleaning, sterilization, and cross contamination is eliminated.
Disposable appliers don't need to be sent out for repair.
Ligating Clips can be fired rapidly - like an automatic rifle.

Disposable clip applier disadvantages


Significant number of catastrophic ligating clip failures by all manufacturers.
(Please refer to the MDR booklet).
The working tip of a disposable ligating applier is bulkier than a Ackermann
reusable applier. This is a significant disadvantage in many circumstances, especially
with the SMALL size clip when used in open heart surgery.
A disposable applier is incredibly expensive! A typical disposable ligating clip applier,
containing 20 ligating clips, costs more than $60.00!! Ackermann can deliver a superior
ligating clip to the surgical site for a fraction of the price.
A 20 clip cartridge wastes a significant number of clips. Please refer to the section on
"Cost Analysis - Reusable vs. Disposable" later in this document.

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Ackermann

Disposable ligating clip applier customers get hit with a double whammy. The purchase
price per unit AND the waste factor is very high. Clips can only be purchased in multiples
of 15 or 20 - which forces the customer to waste a significant number of clips. The true net
cost of each implanted clip is staggering.
Remind the customer thev are really purchasing ligating CLIPS. Only the CLIP walks out
the front door of the hospital as a surgical implant. The applier (reusable or disposable) is
just a vehicle to get the clip to the surgical site. Disposable ligating clip appliers are just an
extremely expensive delivery system with a mediocre clip along for the ride.
Health Care mandates are making hospitals look very closely at the costs involved in
providing a surgical service. Virtually every hospital in the U.S. is under tremendous
pressure to reduce costs. SOMEONE really does care how much it costs to deliver ligating
clips to the surgical site. Your task is to find that person. Keep moving up the management
ranks until you do.
The vast majority of HUGE and VERY prestigious hospitals don't purchase a
single disposable ligating clip applier. Your customers can survive quite nicely
without this expensive toy also.
For years, disposable device manufacturers sold their products as progressive:
"Moving forward" was the pitch. They tried to convince surgeons that returning to a
reusable device was considered "moving backward". That pitch may have been the
second greatest marketing coup of all time. Only "Diamonds = Love" is better. Clearly, the
selling pitch is stale and out of touch with the reality of the marketplace.
Horizon Surgical Advantages
Nice brochures.
Very active sales staff.
Good looking two colour cardridges
Aggressive politic against competition.
Horizon Surgical Disadvantages
Expensive two component cardridge.
Very sharp edges on the clip (traumatic).
Sales are basicly focused on negative talking about the
competition. (They won't talk much about their own product)
LIGATING CLIP MATERIAL SELECTION
Tantalum Advantages
Tantalum has tremendous malleable strength. It is not "springy". A closed
tantalum clip stays closed.
Tantalum is completely inert. The human body simply does not recognize
tantalum as a foreign material.
Tantalum does not deflect in the intense magnetic fields of M.R.I. (Magnetic
Resonance Imaging).

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Ackermann

Tantalum Disadvantages
Tantalum is a very expensive "semi-exotic" metal.
Tantalum is extremely dense. Very few clips can be manufactured from a
pound of tantalum, combined with the high price per pound, tantalum clips are
very expensive to manufacture.
Tantalum clips cause a "starburst" effect on older C.T. (Computerized
Tomography) equipment.
Stainless Steel Advantages
Stainless steel is dirt cheap. The cost of stainless steel is just a fraction of the
cost of titanium or tantalum. This metal was introduced in the late 1970's as a
response to a tremendous price increase for tantalum. When the price of gold
reached $800.00/ounce, tantalum experienced an even greater percentage
increase in price.
Stainless Steel Disadvantages
Stainless steel has no technical merit and is a marginal implant metal. This metal
will not be offered by Ackermann.
A stainless steel clip is not completely inert. Your body recognizes stainless steel
as a foreign object and works hard to destroy it. There are indications a stainless
(stains less than carbon steel) clip will rust over time.
A stainless STEELclip is comprised of Iron, Carbon and other elements that can
be magnetized (unlike both tantalum and titanium). Therefore, a stainless steel clip
condemns a patient to never enjoying the benefits of M.R.I, for the rest of his life.
This is a deficiency of monumental proportions. At one time 100% of U.S.
Surgical ligating clips were manufactured from Stainless Steel. Today, that
percentage is 0%. We fully expect other manufacturers will discontinue their
Stainless Steel clips over time. Of course, that is inevitable. Informed customers
have simply stopped buying stainless steel ligating clips.
Plastic Advantages
Absorbable plastic ligating clips were introduced to the marketplace in
the early1980's to eliminate the problem of C.T. scanner interference
caused by tantalum clips. A plastic clip does not cause interference with
C.T. or M.R.I.
Plastic Disadvantages
Plastic clips have a "latch" on the distal end of the clip that snap the two
halves of the clip together. This prevents the clip from being used without
obtaining complete clearance on the distal side of a vessel. As an example, a
plastic clip cannot be attached to a sheet of paper. The legs of the clips
would not penetrate the paper to permit engagement of the latch.
Plastic clips are extremely bulky. Size-for-size, they are substantially larger than a
comparable metal clip.
Plastic clips are substantially more expensive than metal clips.
Plastic ligating clips are "absorbed" because the body recognizes them as a
foreign object and destroys them. Surgeons appear reluctant to introduce this new
chemistry and complication to a surgical procedure.

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Absorbable clips have not sold well. They represent a minuscule percentage of the
ligating clip market. It is entirely possible absorbable clips are not being used by any
account in your sales territory. However, consistent with their standard policy of introducing
a product that is 10 years too late and instantly obsolete, Pilling Weck has introduced a
non-absorbable plastic clip. This clip can penetrate tissue and eliminate the first problem
define above. However, for a whole series of other reasons, this product has not sold well.
Titanium Advantages
Titanium was introduced to the marketplace in the mid-1980's. Titanium does not
interfere with C.T. or M.R.I, scans.
Titanium has an extensive surgical implant history.
Titanium does not exhibit any of the disadvantages of a plastic clip.
Titanium is clearly the metal of choice. It is less expensive than tantalum, and
has none of the deficiencies of Stainless Steel.
Titanium Disadvantages
Titanium really does not have any technical disadvantages. As background information
you should be aware that certain types of titanium surgical implants contain the element
"Vanadium". Ackermann titanium clips are manufactured from extraordinarily pure titanium
which does not contain any vanadium.
Titanium is an extremely tough metal, and it wears out production tools at an accelerated
rate. In addition, Ackermann incorporates special strand annealing and batch annealing
steps to produce the elegant clips you offer your customers.

Ackermann CROSS REFERENCE / TITANIUM


Ackermann to Pilling Weck to Horizon to Vitalitec
Manufacturer

Part

Size

Metal

M/L
M/L
M/L
M/L

Price

Titanium
Titanium
Titanium
Titanium

6
10
6
6

20
20
20
20

120
200
120
120

Ackermann
Pilling Weck
Horizon Surgical
Vitaitec / SLS

AI74CML6
523760
3200
V 3120-1

Ackermann
Pilling Weck
Horizon Surgical
Vitaitec / SLS

AI74CL6
523770
4200
O 4120-1

Large
Large
Large
Large

Titanium
Titanium
Titanium
Titanium

6
15
6
6

20
10
20
20

120
150
120
120

Ackermann
Pilling Weck
Horizon Surgical
Vitaitec / SLS
Vitaitec / SLS

AI74CM6
523800
2200
B 2180-1
B 2120-1

Med
Med
Med
Med
Med

Titanium
Titanium
Titanium
Titanium
Titanium

6
10
6
6
6

20
20
30
20
20

120
200
180
120
120

Ackermann
Pilling Weck
Horizon Surgical
Vitaitec / SLS

AI74CS6
523835
1200/1201
J 1180-1

Small
Small
Small
Small

Titanium
Titanium
Titanium
Titanium

6
10
6
6

20
24
30
20

120
240
180
120

Ackermann
Pilling Weck
Horizon Surgical
Vitaitec / SLS

AI74CML6
523860
3200
V 3120-1

M/L
M/L
M/L
M/L

Titanium
Titanium
Titanium
Titanium

6
10
6
6

20
16
20
20

120
160
120
120

Ackermann
PillingWeck
Horizon Surgical
Vitaitec / SLS

AI74CL6
523870
4200
O 4120-1

Large
Large
Large
Large

Titanium
Titanium
Titanium
Titanium

6
10
6
6

20
12
20
20

120
120
120
120

A = Number of clips per cartridge


F= Equivalent number of Boxes

B= Number of cartridges per box


C=Total number of clips per box
G=Percentage savings per clip from Ackermann

D= Price per cartridge

E=Price per clip

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