Buffalo Filter: LapEvac Evaluation

LapEvac Evaluation

The following form is for new product evaluations for LapEvac sent through Buffalo Filter’s sampling program. Please take a moment to fill out the sheet below so that we can record your feedback. If you have questions please contact Customer Support at 1-800-343-2324. Thank you!


*Name:
Title:
Facility:
Address:
City:
State:
Zip Code:
Phone:
Ext:
*E-Mail:
What is the name of your representative or Distributor?
Procedure type:
Length of time to complete:
Length of time LapEvac ran?
Name of Surgeon(s) using the device:
Method of Smoke Evacuation Previously used Evacuation Used: None Wall Suction Smoke Evacuator with a Laparoscopic Tubing Set Passive Device \| Please Specify:
Please describe the position of the LapEvac the procedure (in relation to patient):
Surgical Tools Used (please specify Brand also):
Insufflator Type:
Insufflator Settings:
Number of liters used during procedure:
Number of Trocars (indicate type or brand also):
Diameter of each Trocar:
Packaging allowed efficient transfer to sterile field: Comments:
Attached to trocars easily: Comments:
Attached to insufflation gas port easily: Comments:
Length of tubing is acceptable: Comments:
White drape clip was effective and easy to use: Comments:
Camera didn’t seem to fog as much: Comments:
Noise level of this product is acceptable: Comments:
Suction/Smoke capture is adequate: Comments:
Overall, this product is convenient to use: Comments:
Facility will likely purchase this product in the future: Comments:
LapEvac is preferred over previous method for smoke evacuation: Comments:
Additional comments/observations/feedback: