US1798124A - Urethral sound and axis-traction prostatic retractor - Google Patents

Urethral sound and axis-traction prostatic retractor Download PDF

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US1798124A
US1798124A US386024A US38602429A US1798124A US 1798124 A US1798124 A US 1798124A US 386024 A US386024 A US 386024A US 38602429 A US38602429 A US 38602429A US 1798124 A US1798124 A US 1798124A
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tubular member
curved
instrument
rod
axis
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Hunn Nellie
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/32—Devices for opening or enlarging the visual field, e.g. of a tube of the body

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  • the object of this invention is to provide an instrument for use in various surgical opera-- tions, and more particularly as a sound and as a retractor.
  • the invention consists of a straight tubular member or barrel, having one end curved outwardly and with a partly circular solid cross section and having the other end provided with a stationary handle member, and a rod arranged within the tubular member and having one end curved concentrically with the curved end of the tubular member and its other end provided with a movable handle member by which the rod may be axially rotated within the tubular member and its curved end brought into alignment with the curved end of the tubular member and also turned outwardly therefrom; the device being provided with a handle rotatively and axially adjustable upon the tubular member, and provided with a grip by which an assistant to the operator may quickly place the instrument and lock it so as to make a perfect axis-traction in all cases, said handle being removable at pleasure, as I will proceed now to explain more fully and finally claim.
  • Figure 1 is a perspective view of the instrument in closed position.
  • Fig. 2 is an elevation in partial section with the tubular member and rod broken away and illustrating also the two adjustments of the terminals.
  • Fig. 3 is a partial sectional elevation of the ends of the tubular member and rod with the curved termi nal of the rod turned in the opposite direc tion or away from the curved terminal of the tubular member.
  • Fig. 4 is a cross section on line 44 of Fig. 2.
  • Fig. 5 is a cross section on line 55 of Fig. 2.
  • the tubular member or barrel, 1 is made straight and of any desired length, with one 'end 2 curved outwardly and preferably solid,
  • this tubular member is provided with a handle 3 arranged at right angles to the axis of the tubular member. 'in Figs. 1 and 3,-the curved end 2 is cut away s o as to leave alater al opening a As indicated lVit-hin this tubular member is arran 'ed a with the curved end 2 of the tubular memher.
  • the opposite end of this rod is provider with a handle 7, which may be secured to the rod by squaring one end of the rod, as at- 8, and providing such end with a screwthreadcd portion 9 to which is applied a locking nut 10.
  • the rod may be rotated axially within the tubular member so as to place its curved end 6 in concentricity with the curved end 2 of the tubular member 1, as shown in Fig. 1 and in full lines, in Fig. 2, and may also be turned away from the curved member 2, as shown in dotted lines in Fig. 2 and in full lines in Fig. 3.
  • Each of the ends 2 and 6 is of uniform curvature.
  • the bar 11 is provided at its outer end with a fixed grip 1 1, for convenience of operation and to give a sufiicient handhold to the operator or h1s asslstant in using the instrument.
  • an axis-traction handle for the reason that by its use it is possible for an assistant to hold the prostate centrally and firmly in the perineum to permit its removal, following the operation.
  • the facility of sliding and turning the handle on the tubular member or barrel 1 makes is possible for an assistant to place it quickly, lock it, and make a perfect axis-traction in all cases.
  • This handle may be removedwhen'the instrument is being usedfor any purpose excepting prostatectomy.
  • the operator is enabled to hold the instrument in position to permit the operation; that is to say, he is given an axis on which to fix the prostate centrally in the perineum and hold it firmly there.
  • the handles give the operator a prying facility, one of them serving'as a fulcrum and the other as a lever.
  • Fig. 1 represents the instrument closed and ready to be introduced into the bladder, as an ordinary urethral sound.
  • the instrument may be opened by separating the curvedend 6 as indicated by the dotted lines in Fig. 2 and the full lines in Fig. 3.
  • the instrument becomes an axis-traction prostatic retractor.
  • the instrument is entirely novel in that it makes possible the performance of perineal prostatectomy without an external urethrotomy, and leaves a perfect hemostasis. It also makes it easily possible to remove the entire bladder for cancer through the perineum and transplant the ureters into the rectum in the male and the vagina in the female.
  • axis-traction handle which is made removable and adjustable to position, andso located that an assistant can hold it out of the way of the operator or surgeon. Tests of the instrument show that a twenty pound pull can be exerted onthe instrument, if needed.
  • Another special'feature of the invention is the curved end. which when closed as shown in Figs. 1 and 2 for insertion as a sound, distinguishes the instrument from an angular end quite common in other sounds. This same curved end when opened as indicated by the dotted lines in Fig. and the full lines in Fig. 3, converts the instrument into a prostatic retractor, for operations on the prostate and seminal-vesiclesand bladder.
  • the prostate may be removed safely and easily, without producing a false urinary passage, and eliminating the dangers of secondary hemorrhage. This greatly shortens the period of a patients convalescence. ⁇ Vhile leaving a perfect hemostasis, it may be possible to safely operate on patients who have'a great quantity of protein-free blood nitrogen in their systems, without danger of shock, such as is produced in any other prostatectomy heretofore used.
  • the instrument may 'beintroduced "closed into the bladder and opened 'lialfway with a gentle firm upward pressure,tli'ereby to gan lm-ger'opeaingints the'anterior wall ofthebladder,'sub perineally, thus avoiding the necessity of resortingto theuseof airor' water for'fill-i-ngthe bladder.
  • this instrument may be introduced into the bladder in a closed position and then opened slightly and withdrawn through the prostatic urethra, thereby breaking up or stretching 'old fibrous bands in the prostate and giving a much better temporary relief fromurinary obstruction than possible by able movement of the adjustable parts with relation "to thetubular member, as by a set screw 15 carried by the hub of theh'andle 3 and bearing against the rod 5.
  • a surgical instrument comprising a" tubular member having one end uniformly curved laterally, and an inclosed rodterminating at one end ina uniformly curvedportion adapted to lie concentrically against the curved end of the tubular member and also to be turned away from said last-mentioned curved end, and means to rotate said rod 'to effect the aforementioned motions of'the rod.
  • a surgical instrument comprising a tubular member having one end partly cut away in the direction of itslength and the remainder of such end uniformly curved laterally, and a rod rotatably mounted in said tubular member and having its outer end uniformly curved to conformto the curvature of the curved end of the tubular member, and means to move said rod into concentric position and also away from such position.
  • a surgical instrument comprising -a tubular member having one end partly cut away in the direction of its length and'the remainder of such end uniform-,ly curved laterally, and a rod rotatably mounted in said tubular member and'having its outer end reduced'to a'half-rou'nd cross sectionand uniformly curved to conform tothe curvature 'of the curvedend of'the tubular member, and ⁇ means tomove'sai'd rod intoeoncentric positionan'dalso "away from such position.
  • a surgical instrument having-a; tubular member arenaeuamm end'fwitha laterally -ext;snding uniformly curved ,portionf'ahd -'co1itainiiig a-ibaterminating oft ins ead adj ac'ent to thej etiived and smearsmam her in a concentrically uniformly curved portion, the curved portions of the tubular member and the rod being half-round in cross section so that when said curved ends are placed concentrically, the end of the instrument will be circular in cross section to facilitate entrance into an organ to be operated on.
  • a surgical instrument comprising a tubular member having one end uniformly curved laterally and opened at the adjacent side, and a rod longitudinally and rotatably mounted in said tubular member and having one end reduced and uniformly curved concentrically with the curved end of the tubular member and projecting through the open side of the tubular member and capable of being turned from concentric position to any intermediate position and locked in given position.
  • a surgical instrument comprising a tubular member having one end uniformly curved laterally, and an inclosed rod terminating at one end in a uniformly curved portion adapted to lie concentrically against the curved end of the tubular member and also to be turned away from said last-mentioned curved end, means to rotate said rod to efiect the aforementioned motions of the rod, and a support for the instrument comprising a bar having a fixed handle at one end and having its other end arranged at an angle to the bar and made as a socket Which is mounted upon the tubular member and adapted to be moved longitudinally and rotatably on the tubular member, and means for placing the bar in adjusted position.

Description

J. T. HU'NN March 24, 1931.
URETHRAL SOUND AND AXIS'TRACTION PROSTATIG RETRACTOR Filed Aug. 15 1929 Patented Mar. 24, 1931 UNITED STATES PATENT OFFICE JOHN T. HUNN, OF HARRISBURG,
.BRINKERHOFF, OF HARRISBURG, SAID JOHN T. HUNN, DECEASED URETHRAL SOUND AND AXIS-TRAGTION IROSTATIC RETRAGTOR Application filed August 15, 1929. Serial No. 386,024.
The object of this invention is to provide an instrument for use in various surgical opera-- tions, and more particularly as a sound and as a retractor.
The invention consists of a straight tubular member or barrel, having one end curved outwardly and with a partly circular solid cross section and having the other end provided with a stationary handle member, and a rod arranged within the tubular member and having one end curved concentrically with the curved end of the tubular member and its other end provided with a movable handle member by which the rod may be axially rotated within the tubular member and its curved end brought into alignment with the curved end of the tubular member and also turned outwardly therefrom; the device being provided with a handle rotatively and axially adjustable upon the tubular member, and provided with a grip by which an assistant to the operator may quickly place the instrument and lock it so as to make a perfect axis-traction in all cases, said handle being removable at pleasure, as I will proceed now to explain more fully and finally claim.
In the accompanying drawings illustrating the invention, in the several figures of which like parts are similarly designated, Figure 1 is a perspective view of the instrument in closed position. Fig. 2 is an elevation in partial section with the tubular member and rod broken away and illustrating also the two adjustments of the terminals. Fig. 3 is a partial sectional elevation of the ends of the tubular member and rod with the curved termi nal of the rod turned in the opposite direc tion or away from the curved terminal of the tubular member. Fig. 4 is a cross section on line 44 of Fig. 2. Fig. 5 is a cross section on line 55 of Fig. 2.
The tubular member or barrel, 1, is made straight and of any desired length, with one 'end 2 curved outwardly and preferably solid,
as indicated in Figs. 3 and 5. The opposite end of this tubular member is provided with a handle 3 arranged at right angles to the axis of the tubular member. 'in Figs. 1 and 3,-the curved end 2 is cut away s o as to leave alater al opening a As indicated lVit-hin this tubular member is arran 'ed a with the curved end 2 of the tubular memher. The opposite end of this rod is provider with a handle 7, which may be secured to the rod by squaring one end of the rod, as at- 8, and providing such end with a screwthreadcd portion 9 to which is applied a locking nut 10. By means of the handle 7 the rod may be rotated axially within the tubular member so as to place its curved end 6 in concentricity with the curved end 2 of the tubular member 1, as shown in Fig. 1 and in full lines, in Fig. 2, and may also be turned away from the curved member 2, as shown in dotted lines in Fig. 2 and in full lines in Fig. 3.
Each of the ends 2 and 6 is of uniform curvature.
For convenience in manipulating the instrument, I provide a bar 11 adapted to stand off from the instrument at'an angle thereto,
and provided with a socket end 12, which isv adapted to engage, the instrument in a slidscrew 18. The bar 11 is provided at its outer end with a fixed grip 1 1, for convenience of operation and to give a sufiicient handhold to the operator or h1s asslstant in using the instrument.
herein referred to as an axis-traction handle, for the reason that by its use it is possible for an assistant to hold the prostate centrally and firmly in the perineum to permit its removal, following the operation. The facility of sliding and turning the handle on the tubular member or barrel 1, makes is possible for an assistant to place it quickly, lock it, and make a perfect axis-traction in all cases. This handle, however, may be removedwhen'the instrument is being usedfor any purpose excepting prostatectomy.
When the handles on the tube and its con- I tainer rod and on the bar 11- are used, the
with a perfect hemostasis r This device ( parts 11, 12, 13 and 14) because of one of its functions, is
operator is enabled to hold the instrument in position to permit the operation; that is to say, he is given an axis on which to fix the prostate centrally in the perineum and hold it firmly there. The handles :give the operator a prying facility, one of them serving'as a fulcrum and the other as a lever.
' Fig. 1 represents the instrument closed and ready to be introduced into the bladder, as an ordinary urethral sound. In this position, the instrument may be opened by separating the curvedend 6 as indicated by the dotted lines in Fig. 2 and the full lines in Fig. 3. In this position the instrument becomes an axis-traction prostatic retractor.
So far as I am aware, the instrument is entirely novel in that it makes possible the performance of perineal prostatectomy without an external urethrotomy, and leaves a perfect hemostasis. It also makes it easily possible to remove the entire bladder for cancer through the perineum and transplant the ureters into the rectum in the male and the vagina in the female.
One of the outstanding and principal features of this instrument, is the axis-traction handle, which is made removable and adjustable to position, andso located that an assistant can hold it out of the way of the operator or surgeon. Tests of the instrument show that a twenty pound pull can be exerted onthe instrument, if needed. Another special'feature of the invention, is the curved end. which when closed as shown in Figs. 1 and 2 for insertion as a sound, distinguishes the instrument from an angular end quite common in other sounds. This same curved end when opened as indicated by the dotted lines in Fig. and the full lines in Fig. 3, converts the instrument into a prostatic retractor, for operations on the prostate and seminal-vesiclesand bladder.
By the use of the instrument,'the prostate may be removed safely and easily, without producing a false urinary passage, and eliminating the dangers of secondary hemorrhage. This greatly shortens the period of a patients convalescence. \Vhile leaving a perfect hemostasis, it may be possible to safely operate on patients who have'a great quantity of protein-free blood nitrogen in their systems, without danger of shock, such as is produced in any other prostatectomy heretofore used.
a In performing a supra-pubic cystotonry in a largely contracted bladder, for'the removal of large hard stones, foreign bodies or large tumors,'the instrument may 'beintroduced "closed into the bladder and opened 'lialfway with a gentle firm upward pressure,tli'ereby to gan lm-ger'opeaingints the'anterior wall ofthebladder,'sub perineally, thus avoiding the necessity of resortingto theuseof airor' water for'fill-i-ngthe bladder.
- in- "old eases net readily "available for "an position may operation, this instrument may be introduced into the bladder in a closed position and then opened slightly and withdrawn through the prostatic urethra, thereby breaking up or stretching 'old fibrous bands in the prostate and giving a much better temporary relief fromurinary obstruction than possible by able movement of the adjustable parts with relation "to thetubular member, as by a set screw 15 carried by the hub of theh'andle 3 and bearing against the rod 5.
Variations in the'details of construction are permissible within the principle "of the invention and the scope of the claims following.
1. A surgical instrument, comprising a" tubular member having one end uniformly curved laterally, and an inclosed rodterminating at one end ina uniformly curvedportion adapted to lie concentrically against the curved end of the tubular member and also to be turned away from said last-mentioned curved end, and means to rotate said rod 'to effect the aforementioned motions of'the rod.
2. A surgical instrument, comprising a tubular member having one end partly cut away in the direction of itslength and the remainder of such end uniformly curved laterally, and a rod rotatably mounted in said tubular member and having its outer end uniformly curved to conformto the curvature of the curved end of the tubular member, and means to move said rod into concentric position and also away from such position.
be secured or locked by a suit- 3. A surgical instrument, comprising -a tubular member having one end partly cut away in the direction of its length and'the remainder of such end uniform-,ly curved laterally, and a rod rotatably mounted in said tubular member and'having its outer end reduced'to a'half-rou'nd cross sectionand uniformly curved to conform tothe curvature 'of the curvedend of'the tubular member, and} means tomove'sai'd rod intoeoncentric positionan'dalso "away from such position. I
4.1 A surgical instrument, having-a; tubular member arenaeuamm end'fwitha laterally -ext;snding uniformly curved ,portionf'ahd -'co1itainiiig a-ibaterminating oft ins ead adj ac'ent to thej etiived and smearsmam her in a concentrically uniformly curved portion, the curved portions of the tubular member and the rod being half-round in cross section so that when said curved ends are placed concentrically, the end of the instrument will be circular in cross section to facilitate entrance into an organ to be operated on.
5. A surgical instrument, comprising a tubular member having one end uniformly curved laterally and opened at the adjacent side, and a rod longitudinally and rotatably mounted in said tubular member and having one end reduced and uniformly curved concentrically with the curved end of the tubular member and projecting through the open side of the tubular member and capable of being turned from concentric position to any intermediate position and locked in given position.
6. A surgical instrument, comprising a tubular member having one end uniformly curved laterally, and an inclosed rod terminating at one end in a uniformly curved portion adapted to lie concentrically against the curved end of the tubular member and also to be turned away from said last-mentioned curved end, means to rotate said rod to efiect the aforementioned motions of the rod, and a support for the instrument comprising a bar having a fixed handle at one end and having its other end arranged at an angle to the bar and made as a socket Which is mounted upon the tubular member and adapted to be moved longitudinally and rotatably on the tubular member, and means for placing the bar in adjusted position.
In testimony whereof I have hereunto set my hand this 12th day of August, A. D. 1929.
JOHN T. HUN N.
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Cited By (25)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3570498A (en) * 1970-03-09 1971-03-16 Charles Weighton Trocar and cannula for veterinary use
US4517965A (en) * 1983-06-27 1985-05-21 Ellison Arthur E Tissue retractor
US4777939A (en) * 1983-03-09 1988-10-18 George Kees Research & Development Co., Inc. Retractor structure
US4874375A (en) * 1987-04-13 1989-10-17 Ellison Arthur E Tissue retractor
EP0609503A1 (en) * 1993-02-05 1994-08-10 Richard Wolf GmbH Medical instrument
US5375591A (en) * 1990-03-20 1994-12-27 Mouret; Philippe Instrument for implementing medical or surgical operations by laparoscopy or coeliscoopy
US5398671A (en) * 1993-08-18 1995-03-21 Ethicon, Inc. Abdominal lift device
US5505689A (en) * 1991-05-29 1996-04-09 Origin Medsystems, Inc. Propertioneal mechanical retraction apparatus
US5514075A (en) * 1991-05-29 1996-05-07 Origin Medsystems, Inc. Properitoneal mechanical retraction apparatus and methods of using
US5545123A (en) * 1994-03-15 1996-08-13 Ethicon, Inc. Surgical lift method and apparatus
US5547458A (en) * 1994-07-11 1996-08-20 Ethicon, Inc. T-shaped abdominal wall lift with telescoping member
US5676636A (en) * 1994-07-22 1997-10-14 Origin Medsystems, Inc. Method for creating a mediastinal working space
EP0804901A2 (en) * 1991-05-29 1997-11-05 Origin Medsystems, Inc. Apparatus for peritoneal retraction
US5716327A (en) * 1991-05-29 1998-02-10 Origin Medsystems, Inc. Body wall retraction system for wide cavity retraction
US5755661A (en) * 1993-06-17 1998-05-26 Schwartzman; Alexander Planar abdominal wall retractor for laparoscopic surgery
US5947895A (en) * 1991-05-29 1999-09-07 Origin Medsystems, Inc. Abdominal retractor with rotating arms and method of using the same
US6689054B2 (en) * 1996-04-26 2004-02-10 Teleflex - Ct Devices Ball and socket coronary stabilizer
US20100041956A1 (en) * 2004-12-15 2010-02-18 Frasier William J Retractor blade extender tower
US20110190591A1 (en) * 2010-01-29 2011-08-04 Palmer Andrew K Surgical retractor
US20130030457A1 (en) * 2011-05-31 2013-01-31 Hock Lim Tan Trocar sleeve
WO2014144900A2 (en) * 2013-03-15 2014-09-18 Smith & Nephew, Inc. Surgical fastening
USD774192S1 (en) 2014-12-19 2016-12-13 Karl Storz Gmbh & Co. Kg Trocar
USD779671S1 (en) 2014-12-19 2017-02-21 Karl Storz Gmbh & Co. Kg Trocar
US9636102B2 (en) 2011-06-02 2017-05-02 Smith & Nephew, Inc. Surgical fastening
US10123813B2 (en) 2014-02-17 2018-11-13 Smith & Nephew, Inc. Drill guide

Cited By (36)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3570498A (en) * 1970-03-09 1971-03-16 Charles Weighton Trocar and cannula for veterinary use
US4777939A (en) * 1983-03-09 1988-10-18 George Kees Research & Development Co., Inc. Retractor structure
US4517965A (en) * 1983-06-27 1985-05-21 Ellison Arthur E Tissue retractor
US4874375A (en) * 1987-04-13 1989-10-17 Ellison Arthur E Tissue retractor
US5460169A (en) * 1990-03-20 1995-10-24 Mouret; Philippe Instrument for implementing medical or surgical operations by laparoscopy or coelioscopy
US5375591A (en) * 1990-03-20 1994-12-27 Mouret; Philippe Instrument for implementing medical or surgical operations by laparoscopy or coeliscoopy
US5947895A (en) * 1991-05-29 1999-09-07 Origin Medsystems, Inc. Abdominal retractor with rotating arms and method of using the same
US5716327A (en) * 1991-05-29 1998-02-10 Origin Medsystems, Inc. Body wall retraction system for wide cavity retraction
US5505689A (en) * 1991-05-29 1996-04-09 Origin Medsystems, Inc. Propertioneal mechanical retraction apparatus
US5514075A (en) * 1991-05-29 1996-05-07 Origin Medsystems, Inc. Properitoneal mechanical retraction apparatus and methods of using
US5941819A (en) * 1991-05-29 1999-08-24 Origin Medsystems, Inc. Apparatus for creating a mediastinal working space
EP0804901A3 (en) * 1991-05-29 1998-03-04 Origin Medsystems, Inc. Apparatus for peritoneal retraction
EP0804901A2 (en) * 1991-05-29 1997-11-05 Origin Medsystems, Inc. Apparatus for peritoneal retraction
DE4303274A1 (en) * 1993-02-05 1994-09-08 Wolf Gmbh Richard Medical instrument
EP0609503A1 (en) * 1993-02-05 1994-08-10 Richard Wolf GmbH Medical instrument
US5558620A (en) * 1993-02-05 1996-09-24 Richard Wolf Gmbh Medical instrument employing curved spreading members to manipulate organs within the body
US5755661A (en) * 1993-06-17 1998-05-26 Schwartzman; Alexander Planar abdominal wall retractor for laparoscopic surgery
US5398671A (en) * 1993-08-18 1995-03-21 Ethicon, Inc. Abdominal lift device
US5545123A (en) * 1994-03-15 1996-08-13 Ethicon, Inc. Surgical lift method and apparatus
US5547458A (en) * 1994-07-11 1996-08-20 Ethicon, Inc. T-shaped abdominal wall lift with telescoping member
US5823946A (en) * 1994-07-22 1998-10-20 Origin Medsystems, Inc. Method for creating a mediastinal working space
US5676636A (en) * 1994-07-22 1997-10-14 Origin Medsystems, Inc. Method for creating a mediastinal working space
US6689054B2 (en) * 1996-04-26 2004-02-10 Teleflex - Ct Devices Ball and socket coronary stabilizer
US9357908B2 (en) * 2004-12-15 2016-06-07 DePuy Synthes Products, Inc. Retractor blade extender tower
US20100041956A1 (en) * 2004-12-15 2010-02-18 Frasier William J Retractor blade extender tower
US20110190591A1 (en) * 2010-01-29 2011-08-04 Palmer Andrew K Surgical retractor
US20130030457A1 (en) * 2011-05-31 2013-01-31 Hock Lim Tan Trocar sleeve
US10603073B2 (en) * 2011-05-31 2020-03-31 Karl Storz Se & Co. Kg Trocar sleeve
US9636102B2 (en) 2011-06-02 2017-05-02 Smith & Nephew, Inc. Surgical fastening
WO2014144900A3 (en) * 2013-03-15 2014-12-11 Smith & Nephew, Inc. Surgical fastening
WO2014144900A2 (en) * 2013-03-15 2014-09-18 Smith & Nephew, Inc. Surgical fastening
US9402650B2 (en) 2013-03-15 2016-08-02 Smith & Nephew, Inc. Surgical fastening
US10405846B2 (en) 2013-03-15 2019-09-10 Smith & Nephew, Inc. Surgical fastening
US10123813B2 (en) 2014-02-17 2018-11-13 Smith & Nephew, Inc. Drill guide
USD774192S1 (en) 2014-12-19 2016-12-13 Karl Storz Gmbh & Co. Kg Trocar
USD779671S1 (en) 2014-12-19 2017-02-21 Karl Storz Gmbh & Co. Kg Trocar

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