•This manual contains the cleaning, disinfection, and sterilization
methods recommended by Olympus for the endoscopes and
accessories listed on the front cover.
•This instruction manual contains essential information on reprocessing
endoscopes and accessories safely and effectively.
•Before reprocessing, thoroughly review this manual and the manuals for
the reprocessing equipment and chemicals that will be used for
reprocessing. Reprocess all the devices as instructed.
•Note that the complete instruction manual set for the endoscope and
accessories consists of this manual and the “OPERATION MANUAL”
with your endoscope model listed on the cover. Both manuals
accompanied the endoscope at shipment.
Chapter 1 General Policy
•Keep this manual and all related manuals in a safe and accessible
location (e.g., in the reprocessing area).
•If you have any questions or comments about any information in this
manual, or if a problem occurs while reprocessing that cannot be solved,
contact Olympus.
EVIS EXERA II TJF TYPE Q180V REPROCESSING MANUAL
1
Chapter 1 General Policy
1.2Importance of cleaning, disinfection, and
sterilization
The medical literature reports incidents of cross-contamination resulting from
improper cleaning, disinfection, or sterilization. It is strongly recommended that
all individuals engaged in reprocessing closely observe all instructions given in
this manual and the manuals for all ancillary equipment, and have a thorough
understanding of the following items:
•Professional health and safety policies of your hospital
•Instruction manuals for the endoscope, accessories, and all the other
reprocessing equipment
•Structure and handling of endoscope and accessories
•Handling of pertinent chemicals
When selecting appropriate methods and conditions for cleaning and disinfection
and sterilization, follow the policies at your institution, applicable national laws
and standards, and professional society guidelines and recommended practices,
in addition to the instructions given in this manual.
1.3Signal words
The following signal words are used throughout this manual:
Indicates a potentially hazardous situation which, if not
avoided, could result in death or serious injury.
Indicates a potentially hazardous situation which, if not
avoided, may result in minor or moderate injury. It may also
be used to alert against unsafe practices or potential
equipment damage.
Indicates additional helpful information.
2
EVIS EXERA II TJF TYPE Q180V REPROCESSING MANUAL
1.4Precautions
Chapter 1 General Policy
•An insufficiently cleaned, disinfected, or sterilized endoscope
and/or accessories may pose an infection control risk to the
patients and/or operators who contact them.
•All disinfection methods (whether performed manually or by
an automated endoscope reprocessor), and all sterilization
methods (whether performed by ethylene oxide gas or
steam) require thorough prior cleaning of the instrument
being reprocessed. If the equipment is not adequately
cleaned prior to disinfection/sterilization, these processes will
be ineffective. Immediately after each patient procedure and
before disinfection/sterilization, thoroughly clean the
endoscope and the accessories used with the endoscope.
•All channels of the endoscope, including the instrument
channel and all accessories used with the endoscope during
the patient procedure, such as all valves, must be cleaned
and high-level disinfected or sterilized after each patient
procedure, even if the channels or accessories were not
used during the patient procedure. Insufficient cleaning and
disinfection or sterilization of these components may pose an
infection control risk to patients and/or operators.
•Disinfectant solutions are hazardous. After disinfection, rinse
all external surfaces and channels of the endoscope and
accessories thoroughly with water to remove residual
disinfectant solution.
•The results of sterilization depend on various factors. These
factors include how the equipment was packaged, and the
placing and loading of the package in the sterilization device.
Verify the sterilization process using biological and/or
chemical indicators. Follow the guidelines for sterilization
issued by national authorities, professional organizations and
infection control professionals, as well as the instruction
manual for the sterilization device.
EVIS EXERA II TJF TYPE Q180V REPROCESSING MANUAL
3
Chapter 1 General Policy
Leakage tester
•Establish an internal system of identifying contaminated
versus reprocessed endoscopes and accessories to prevent
both mix-ups and cross-contamination. Touching a
reprocessed endoscope and/or accessories with
contaminated gloves or placing them on a contaminated
hanger or surface, including letting them touch the floor, will
recontaminate them.
•Prior to each patient procedure, confirm that the endoscope
and accessories have been properly reprocessed and stored.
If there are any doubts or questions, reprocess them again
before the patient procedure, following the instructions given
in this manual.
•Perform a leakage test on the endoscope after each
precleaning procedure. Do not use the endoscope if a leak is
detected. Use of an endoscope with a leak may cause a
sudden loss of the endoscopic image, damage to the
bending mechanism, or other malfunctions. Use of a leaking
endoscope may also pose an infection control risk.
4
Figure 1.1
•Store alcohol in an airtight container. Alcohol stored in an
open container may cause a fire hazard and may result in a
loss of efficacy due to evaporation.
EVIS EXERA II TJF TYPE Q180V REPROCESSING MANUAL
Chapter 1 General Policy
AW channel cleaning
adapter (MH-948)
•Do not use the AW channel cleaning adapter (MH-948) for
patient procedures. It will cause continuous insufflation and
could result in patient injury.
Figure 1.2
•The accessories listed on the front cover of this manual are
consumables, meaning that these accessories cannot be
refurbished or repaired and are intended to be replaced once
they show any signs of wear. Should any irregularity be
observed, use a replacement accessory instead. Using
defective accessories may cause equipment malfunction,
reduce the efficacy of reprocessing, present a risk to patients
and/or operators, or damage the endoscope and/or
accessories.
•Single-use brushes, such as the single use channel cleaning
brush (BW-201T), the single use combination cleaning brush
(BW-412T), the single use channel-opening cleaning brush
(MAJ-1339), and the single use soft brush (MAJ-1888), are
designed for cleaning only one endoscope and its related
accessories. Dispose of the single-use brush immediately
after use. Using a single-use brush to clean multiple
endoscopes and/or accessories may reduce its cleaning
efficacy and may damage the brush leading to brush
breakage or endoscope and/or accessory damage.
EVIS EXERA II TJF TYPE Q180V REPROCESSING MANUAL
5
Chapter 1 General Policy
•Patient debris and reprocessing chemicals are hazardous.
To guard against contact with dangerous chemicals and
potentially infectious material, wear appropriate personal
protective equipment during cleaning, disinfection, and
sterilization. Such protective equipment should include
appropriate eyewear, face mask, cap, moisture-resistant
clothing, shoe covers, and chemical-resistant gloves that fit
properly and are long enough to prevent skin exposure.
•The reprocessing room must be adequately ventilated.
Adequate ventilation protects against the buildup of toxic
chemical fumes.
•Always remove contaminated personal protective equipment
before leaving the reprocessing area to prevent
contamination from spreading.
•Only Olympus-recommended or Olympus-endorsed
automated endoscope reprocessors (AERs) have been
validated by Olympus. When using an AER that is not
recommended by Olympus, the manufacturer of the AER is
responsible for validating compatibility of the AER with each
Olympus endoscope and accessory.
•Before using an AER, confirm that it is capable of
reprocessing the endoscope including all channels, the
forceps elevator recess, and accessories. Be sure to attach
all required connectors. Otherwise, insufficient reprocessing
may pose an infection control risk. If you are uncertain as to
the ability of your AER to reprocess the endoscope including
all channels, the forceps elevator recess, and accessories,
contact the manufacturer of the AER for specific instructions
and information on compatibility and required connectors.
When you use an AER which allows you skip some steps in
precleaning and manual cleaning of endoscopes, confirm
with the AER manufacturer that such skip is applicable to this
endoscope and establish detailed precleaning and manual
cleaning procedures of this endoscope according to both
instructions of this manual and the AER manufacturer.
•Put the forceps elevator in intermediate position of the range
of movement by turning the elevator control lever and set it in
your AER.
6
EVIS EXERA II TJF TYPE Q180V REPROCESSING MANUAL
Chapter 1 General Policy
•Instructions provided in this manual are not valid for Olympus
devices repaired by a non-Olympus facility. The Olympus
recommended reprocessing procedures have not been
validated for reprocessing devices repaired by a
non-Olympus facility. In the event that your device has been
repaired by a non-Olympus facility, contact that repair facility
for instructions regarding reprocessing.
•Prions, which are the pathogenic agent of the
Creutzfeldt-Jakob disease (CJD), cannot be destroyed or
inactivated by the cleaning, disinfection, and sterilization
methods stated in this instruction manual. When using the
endoscope and accessories on patients with CJD or variant
Creutzfeldt-Jakob disease (vCJD), be sure to use them for
such patients only, or immediately dispose of them after use
in an appropriate manner to prevent the usage of exposed
devices on other patients. For methods to handle CJD, follow
the respective guidelines in your country.
•The endoscope and accessories may be damaged by
published methods for destroying or inactivating prions. For
information on the durability of Olympus equipment against a
particular reprocessing method, contact Olympus. In general,
Olympus cannot guarantee the effectiveness, safety, and
durability of cleaning, disinfection, or sterilization methods
not described in this reprocessing manual. If you chose to
use a reprocessing method not recommended in this manual,
the local institution and/or physicians must assume
responsibility for its safety and efficacy. Make sure to
carefully inspect each piece of endoscopic equipment for
irregularities (damage) prior to each patient procedure. Do
not use the equipment if any irregularity is found.
•Good quality control practices typically require appropriate
documentation. Items such as local SOPs (standard
operating procedures), confirmation of operator training,
routine testing of the disinfectant’s MEC (minimal effective
concentration), confirmation of the disinfectant’s use-life,
etc., should be documented as performed.
EVIS EXERA II TJF TYPE Q180V REPROCESSING MANUAL
7
Chapter 1 General Policy
Water resistant
cap (MH-553)
Electrical connector
•When reprocessing the endoscope, confirm that the water
resistant cap (MH-553) is securely attached to the electrical
connector before immersing the endoscope in reprocessing
fluids. If the water resistant cap is not securely attached, the
reprocessing fluids could enter the endoscope and damage
the endoscope.
1.5Reprocessing before the first use
Figure 1.3
•When aerating or irrigating the endoscope channels, the air
or water pressure must not exceed 0.5 MPa (5 kgf/cm
71 psig). Higher pressures may cause damage to the
endoscope.
•Store spare accessories in their original packaging to prevent
damage.
•To prevent damage, do not apply excessive force to the
endoscope and accessories during reprocessing.
•Vapors from disinfectant solutions and alcohol may damage
electronic devices such as computers.
New endoscopes, repaired endoscopes, accessories, and the carrying case for
endoscopes are not cleaned, disinfected, or sterilized prior to shipping from
Olympus, regardless of whether those instruments are for new purchase, demo
or loaner purposes. Reprocess all such endoscopes and accessories received
from Olympus according to the instructions given in this manual before storage
and before using them in a patient procedure.
2
,
8
EVIS EXERA II TJF TYPE Q180V REPROCESSING MANUAL
1.6Reprocessing and storage after use
•Do not reuse rinse water.
•High-level disinfectant solutions are only effective when used
according to the disinfectant manufacturer’s instructions.
Follow the manufacturer’s instructions regarding activation (if
required), concentration, temperature, contact time and use
life required to achieve high-level disinfection.
•If the disinfectant solution is reused, check its efficacy with a
test strip according to the disinfectant manufacturer’s
recommendations prior to use.
•Do not reuse alcohol.
•Alcohol is not a sterilant or high-level disinfectant.
•To maintain sterility of equipment following sterilization, use
sterile packaging and wraps according to national guidelines.
Chapter 1 General Policy
1.7Reprocessing before patient procedure
•Improper storage practices, such as not thoroughly drying
external and internal surfaces (lumens) including the forceps
elevator recess prior to storage, will lead to an infection
control risk.
•Improper handling, such as touching a reprocessed
endoscope and/or accessories with contaminated gloves,
placing a reprocessed device on a contaminated hanger or
surface, allowing devices to touch the floor, etc., will
recontaminate the device.
Some national or professional guidelines recommend
reprocessing endoscopes prior to their first use of the day.
Confirm that the endoscope and accessories have undergone proper
reprocessing following their last use and that they have been stored properly.
Check the storage period of reprocessed endoscopes, and check for surface
contamination (e.g., dust). Check the sterilization expiration date(s) of all items
so marked and for tears or breaches in sterile packaging. If there are any doubts
or questions concerning whether a device is contaminated, reprocess it again
following the instructions given in this manual.
EVIS EXERA II TJF TYPE Q180V REPROCESSING MANUAL
9
Chapter 2 Function and Inspection of the Accessories for Reprocessing
Groove
Venting connector
Seals
Chapter 2Function and Inspection of
the Accessories for
Reprocessing
Certain accessories are required for reprocessing the endoscope. This chapter
describes the function of these accessories. It also describes how to inspect
these accessories before using them to reprocess the endoscope.
2.1Water resistant cap (MH-553)
10
Figure 2.1
EVIS EXERA II TJF TYPE Q180V REPROCESSING MANUAL
Chapter 2 Function and Inspection of the Accessories for Reprocessing
Water resistant
cap (MH-553)
Chain for water-resistant
cap (MAJ-1119)
Electrical connector
Maintenance
unit (MU-1)
Venting
connector
Leakage tester (MB-155)
Function
The water resistant cap is attached to the electrical connector on the endoscope
to protect the connector and the endoscope from water penetration during
reprocessing. During leakage testing, the leakage tester (MB-155) is attached to
the venting connector of the water resistant cap.
Figure 2.2
Figure 2.3
The water resistant cap must be attached to the electrical connector of the
endoscope whenever the endoscope is immersed in reprocessing fluids. It is
detached from the connector whenever the endoscope is used for patient
procedures, being sterilized by ethylene oxide gas, or stored in an endoscope
storage cabinet.
Always use a dry water resistant cap. Any water remaining
inside the cap may cause damage to the endoscope.
EVIS EXERA II TJF TYPE Q180V REPROCESSING MANUAL
11
Chapter 2 Function and Inspection of the Accessories for Reprocessing
Biopsy valve cap
Plug frame
Suction plug
Air/water plug
Use the chain for water-resistant cap (MAJ-1119) to connect
the water resistant cap to the endoscope. The water resistant
cap can remain connected to the endoscope by the chain at
all times (including during patient procedures, reprocessing,
and storage of the endoscope).
Inspection
1. Confirm that the inside of the cap is dry and free from debris. Wipe with a
dry, lint-free cloth if the inside of the cap is wet or if debris is detected.
2. Confirm that the seals inside the cap are free from scratches, cuts, and
debris.
3. Check to ensure that the venting connector on the cap is not loose.
2.2Channel plug (MH-944)
Figure 2.4
12
EVIS EXERA II TJF TYPE Q180V REPROCESSING MANUAL
Chapter 2 Function and Inspection of the Accessories for Reprocessing
Instrument
channel port
Channel plug
Function
The channel plug is used to plug the openings of the instrument channel port
and the suction and air/water cylinders of the endoscope whenever the injection
tube (MH-946) is used to flush the suction and air/water channels of the
endoscope with reprocessing fluids.
Figure 2.5
When attached to the endoscope, the channel plug is
designed to allow a small amount of fluid to exit from the
openings of the endoscope. This enables reprocessing fluids
to contact the endoscope openings.
Inspection
Confirm that the suction plug, air/water plug, and the biopsy valve cap of the
channel plug are free from cracks, scratches, and debris.
The channel plug does not need to be cleaned, disinfected,
or sterilized prior to its first use.
EVIS EXERA II TJF TYPE Q180V REPROCESSING MANUAL
13
Chapter 2 Function and Inspection of the Accessories for Reprocessing
Suction channel tube
Information
card
Connector plug
Suction
channel port
Air pipe port
Air/water
channel port
Suction port
Air/water channel tube
(including the filter mesh)
Filter tube
Filter mesh
Syringe
Air/water channel tube
Suction channel tube
Air pipe port
Suction port
Basin
Reprocessing
fluids
Connector plug
2.3Injection tube (MH-946)
Figure 2.6
Function
The injection tube is used to inject reprocessing fluids into the instrument
channel, suction channel, and air/water channels of the endoscope. It is also
used to flush air through these channels to expel fluids.
Figure 2.7
Inspection
14
1. Confirm that all components of the injection tube are free from cracks,
scratches, flaws, and debris (see Figure 2.6).
2. Confirm that the filter mesh is in the suction port of the injection tube.
EVIS EXERA II TJF TYPE Q180V REPROCESSING MANUAL
Chapter 2 Function and Inspection of the Accessories for Reprocessing
Suction port
Suction channel
port
Suction channel
tube
Syringe
Suction port
Air/water channel port
Air pipe
port
Suction
channel tube
Syringe
3. Attach a clean 30 ml syringe to the suction channel port of the injection tube.
With the suction port of the injection tube immersed in the water referred to
in Section 3.2, withdraw the syringe plunger and confirm that the water is
drawn into the syringe. Depress the plunger and confirm that the water is
emitted from the suction channel tube of the injection tube. Confirm that the
water is not emitted from the suction port when removing the suction port
from the water.
Figure 2.8
4. Move the syringe to the air/water channel port of the injection tube. With the
suction port of the injection tube immersed in the water, withdraw the
syringe plunger and confirm that the water is drawn into the syringe.
Depress the plunger and confirm that the water is emitted from the air pipe
port of the injection tube. Confirm that the water is not emitted from the
suction port when removing the suction port from the water.
Figure 2.9
The injection tube does not need to be cleaned, disinfected,
or sterilized prior to its first use.
EVIS EXERA II TJF TYPE Q180V REPROCESSING MANUAL
15
Chapter 2 Function and Inspection of the Accessories for Reprocessing
Metal tip
Shaft
Brush head
Bristles
Suction cylinder
Instrument channel
Suction channel
2.4Channel cleaning brush (BW-20T)
Figure 2.10
Function
The channel cleaning brush is used to brush the inside of the instrument channel
and suction channel of the endoscope, and the interior and openings of the
suction valve (MH-443), the air/water valve (MH-438) and the biopsy valve
(MB-358).
Figure 2.11
16
EVIS EXERA II TJF TYPE Q180V REPROCESSING MANUAL
Chapter 2 Function and Inspection of the Accessories for Reprocessing
Depress
Suction valve
(MH-443)
Air/water valve
(MH-438)
Biopsy valve (MB-358)
Figure 2.12
Inspection
1. Confirm that the brush head and the metal tip of the distal end are securely
attached. Check the brush head for loose or missing bristles.
2. Check the bristles for damage. If the bristles are crushed, gently straighten
them with your gloved fingertips.
3. Check for bends, scratches, and other damage to the shaft.
4. Visually check for debris on the shaft and/or the bristles of the brush head. If
there is debris on the brush, immerse the brush in the water referred to in
Section 3.2 and clean the brush until no debris is observed on the brush.
The channel cleaning brush does not need to be cleaned,
disinfected, or sterilized prior to its first use.
EVIS EXERA II TJF TYPE Q180V REPROCESSING MANUAL
17
Chapter 2 Function and Inspection of the Accessories for Reprocessing
Weighted end
Connecting end
Suction cleaning
adapter
Connecting end
Weighted end
Suction pump
Instrument
channel port
Suction cylinder
2.5Suction cleaning adapter (MH-856)
Figure 2.13
Function
The suction cleaning adapter is used to aspirate reprocessing fluids through the
instrument channel port of the endoscope.
Figure 2.14
18
Inspection
Check for debris, cracks, scratches, and other damage.
The suction cleaning adapter does not need to be cleaned,
disinfected, or sterilized prior to its first use.
EVIS EXERA II TJF TYPE Q180V REPROCESSING MANUAL
Chapter 2 Function and Inspection of the Accessories for Reprocessing
Information
card
Slider
One-way valve
Piston
Seals
Button
AW channel
cleaning adapter
Air/water
nozzle
Depress
Air channel
Air/water cylinder
Water
container
2.6AW channel cleaning adapter (MH-948)
Figure 2.15
Function
During precleaning of the endoscope, the AW channel cleaning adapter is
attached to the air/water cylinder of the endoscope. When the button of the
adapter is depressed, the water in the water container is fed through the air/
water nozzle of the endoscope to clean the nozzle and air/water channels of the
endoscope. Air is continuously fed through the air/water channels when the
button is not depressed.
Figure 2.16
EVIS EXERA II TJF TYPE Q180V REPROCESSING MANUAL
19
Chapter 2 Function and Inspection of the Accessories for Reprocessing
Tip
Shaft
Brush head
Caution sticker
Bristles
Suction channel
Instrument channel
Suction cylinder
Inspection
Check for debris, cracks, scratches, and other damage.
The AW channel cleaning adapter does not need to be
cleaned, disinfected, or sterilized prior to its first use.
2.7Single use channel cleaning brush (BW-201T)
Figure 2.17
Function
The single use channel cleaning brush is used to brush the inside of the
instrument channel and suction channel of the endoscope and the interior and/or
openings of the suction valve (MH-443), the air/water valve (MH-438), and the
biopsy valve (MB-358).
20
Figure 2.18
EVIS EXERA II TJF TYPE Q180V REPROCESSING MANUAL
Chapter 2 Function and Inspection of the Accessories for Reprocessing
Depress
Suction valve
(MH-443)
Air/water valve
(MH-438)
Biopsy valve (MB-358)
Figure 2.19
Inspection
1. Remove the brush from its packaging just prior to use.
2. Confirm that the tip and brush head at the distal end are securely attached.
Check the brush head for loose or missing bristles.
3. Check the bristles for any damage. If the bristles are crushed, gently
straighten them with your fingertips.
4. Check for bends, scratches, and other damage to the shaft.
The single use channel cleaning brush does not need to be
cleaned, disinfected, or sterilized prior to use.
EVIS EXERA II TJF TYPE Q180V REPROCESSING MANUAL
21
Chapter 2 Function and Inspection of the Accessories for Reprocessing
Brush head
Handle
Instrument
channel port
Suction
cylinder
2.8Single use channel-opening cleaning brush
(MAJ-1339)
Figure 2.20
Function
The single use channel-opening cleaning brush is used to brush the suction
cylinder, the instrument channel port, the distal end, the forceps elevator, and the
forceps elevator recess.
Figure 2.21
22
EVIS EXERA II TJF TYPE Q180V REPROCESSING MANUAL
Chapter 2 Function and Inspection of the Accessories for Reprocessing
Forceps elevator
recess
Forceps elevator
Forceps elevator
recess
(a) Brushing when forceps elevator is lowered.(b) Brushing when forceps elevator is raised.
Figure 2.22
Inspection
1. Remove the brush from its packaging just prior to use.
2. Check the brush head for loose or missing bristles.
3. Check the bristles for any damage. If the bristles are crushed, gently
straighten them with your fingertips.
4. Check for bends, scratches, and other damage to the shaft.
The single use channel-opening cleaning brush does not
need to be cleaned, disinfected, or sterilized prior to use.
EVIS EXERA II TJF TYPE Q180V REPROCESSING MANUAL
23
Chapter 2 Function and Inspection of the Accessories for Reprocessing
Tip
Shaft
Channel cleaning
brush part
Handle
Channel-opening
cleaning brush part
BristlesBristles
2.9Single use combination cleaning brush
(BW-412T)
Figure 2.23
Function
The channel cleaning brush part of the single use combination cleaning brush is
used to brush the inside of the instrument channel and suction channel of the
endoscope, and the interior and/or openings of the suction valve (MH-443), the
air/water valve (MH-438), and the biopsy valve (MB-358). The channel-opening
cleaning brush part of the single use combination cleaning brush is used to
brush the suction cylinder, the instrument channel port, the distal end, the
forceps elevator, and the forceps elevator recess of the endoscope.
Inspection
1. Remove the brush from its packaging just prior to use.
2. Confirm that the channel cleaning brush part and tip at the distal end are
securely attached.
3. Check the channel cleaning brush and the channel-opening cleaning brush
parts for loose or missing bristles.
4. Check the bristles of the channel cleaning brush and the channel-opening
cleaning brush parts for any damage. If the bristles are crushed, gently
straighten them with your fingertips.
5. Check for bends, scratches, and other damage to the shaft.
24
The single use combination cleaning brush does not need to
be cleaned, disinfected, or sterilized prior to use.
EVIS EXERA II TJF TYPE Q180V REPROCESSING MANUAL
Chapter 2 Function and Inspection of the Accessories for Reprocessing
Bristles
Shaft
Brush head
Handle
2.10Single use soft brush (MAJ-1888)
Figure 2.24
Function
The single use soft brush is used to brush around the forceps elevator.
Inspection
1. Check the brush head for loose, missing bristles, and other damage. If the
bristles are crushed and/or bent, gently straighten them with your fingers.
2. Check for bends, scratches, and other damage to the shaft.
3. Check for debris on the shaft and or in the bristles of the brush head.
The single use soft brush does not need to be cleaned,
disinfected, or sterilized prior to use.
EVIS EXERA II TJF TYPE Q180V REPROCESSING MANUAL
25
Chapter 2 Function and Inspection of the Accessories for Reprocessing
Groove
Forceps elevator
Guidewire-locking groove
Forceps elevator
Forceps elevator
Forceps elevator
Groove
(a) Brushing when forceps elevator is lowered.
(b) Brushing when forceps elevator is raised.
Figure 2.25
26
EVIS EXERA II TJF TYPE Q180V REPROCESSING MANUAL
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