Ackermann
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
Ackermann
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.
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.
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).
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.
Ackermann
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.
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
Ackermann