A new revolutionary Sutureless Technique & Device developed by Dr. Erwin De Winter

1. A new revolutionary Sutureless Technique & Device developed by Dr. Erwin De Winter ASD SD Receptor- bloodvessel

2. A New Revolutionary Sutureless Technique & DeviceDr Erwin De Winter 1. Studies: Doctor in Veterinary Medicine (University Gent, 1982) Doctor in Tropical Veterinary Medicine and Zootechnique (ITM, 1984) Human and Veterinairy Mycology (ITM, Antwerp, 1985) Medical Doctor (University Gent, 1990) Specialist Neurosurgery 2001 2. Residencies Assistent in General Surgery (orthopaedic, gynaecology, urology, gastro-enteral surgery and general vascular surgery)(1990 -1993) Basic techniques in vascular surgery, anastomosis - and bypass surgery, occlusive and non – occlusive methods microsurgical techniques: “Basic Course Microsurgery” (Erasmus, Rotterdam, 1993) Resident Cardiovascular Surgery, assisted in more than 100 Coronary Artery Bypass-Graft (CABG) Resident Neurosurgery, AZ Sint-Jan Brugge: learning basic neurovasculair microsurgical techniques in approach of aneurysm- and AVM operations. A new revolutionary Sutureless Technique & Device, developed by Dr. Erwin De Winter © 2008 all rights reserved

3. History As a neurosurgeon I have gained vast experience in neurovascular surgery. During my residency I also operated in the fields of General vascular surgery Heart surgery, bypass operations (CABG) I discovered that the present vascular techniques are far from perfect: The suturing techniques demand an extermely high technical competence from the surgeon and therefore require a long training period. Suturing blood vessels causes a lot of mircotrauma to the vessel wall, which may lead to deformation and even to stenosis of the vessel. Bypass operations take a long time as a result of the suturing technique. The suturing technique is primitive: it has been around for more than 100 years. As a result, I realized that different techniques and devices were needed to improve vascular surgery. From 1995 onward, I have designed and developed different anastomosis devices to replace classic suturing techniques. Starting from my experimental work on blood vessels and artificial vessels, I developed the idea to screw blood vessels (and other hollow anatomical structures) together end-to-side. Experimental implementation showed that this new technique took only seconds, whereas minutes are needed with the traditional suturing methods. Moreover, the new technique is much easier to learn and to apply. My two inventions, the Screw-Device (SD) and the Anchoring Screw Device, (ASD) were filed in Brussels on April 28 2003 as patent applications PCT/BE2003/00074 and PCT/BE2003/00126. A new revolutionary Sutureless Technique & Device, developed by Dr. Erwin De Winter © 2008 all rights reserved

5. OcclusionTarget Cell – Tissue Celdysfunction, Cell death - Nerve cell < 3 min. - Muscle cell < 10-30 min. - Other cells: Liver, Kidney, Hormonal Tissuel. Nutrients Oxigen Glucose Normal temperature A new revolutionary Sutureless Technique & Device, developed by Dr. Erwin De Winter © 2008all rights reserved

7. Bypass Operations Global bypass operations performed: more than 2 million worldwide/year Cardiac surgery coronary artery bypass graft (CABG) more than1 million ww/year Vascular surgery, (bypass) more than 1 million ww/year neurosurgery , neurovascular bypass-operations c. 1000- ww/year? Classical bypass-operations are performed by suturing the bloodvessels together. In more than 2 million bypass-operations performed ww./year, the anastomosic site is opened mechanically, with a surgical instrument, punch or a bistoury. A new revolutionary Sutureless Technique & Device , developed by Dr. Erwin De Winter © 2008 all rights reserved

8. Suture Sutureless suture sutureless Screwing bloodvessels together is much faster (seconds instead of minutes) 2 . The anastomosis has a rigid form, cannot collapse Less microtrauma of the bloodvessel wall, fewer deformations of the bloodvessel wall 4. Easy to learn, smaller learning curve for the surgeon A longer operation time, more sutures(4 – 8) The anastomosis site may collapse More microtrauma of the bloodvessel wall, manipulations, punctures by the needle, all this may cause deformations 4. Difficult technique, longer learningcurve for the surgeon ASD “Screw-technique“ Anchoring S. D. SUTURING The use of mynewsuturelesstechniqueand devices has a lot of advantagesforvascularsurgery and bypass procedures . A new revolutionary Sutureless Technique & Device , developed by Dr. Erwin De Winter © 2008 all rights reserved

9. ANASTOMOSIS, END-TO-SIDE Suturing Sutureless ASD “Screw-technique“ withAnchoring Screw-Device SUTURING A new revolutionary Sutureless Technique & Device , developed by Dr. Erwin De Winter © 2008 all rights reserved

10. THE SCREW-DEVICE FOR ANASTOMOSIS SD SD SD SD A new revolutionary Sutureless Technique & Device, developed by Dr. Erwin De Winter © 2008 all rights reserved

11. THE SCREW-DEVICE & ANCHORING SCREW-DEVICE ASD SD Receptor- bloodvessel A new revolutionary Sutureless Technique & Device , developed by Dr. Erwin De Winter © 2008all rights reserved

12. ANASTOMOSIS, END-TO-SIDE, suturing sutureless ASD ScrewtechniquewithAnchoringScrew-Device SUTURING A new revolutionary Sutureless Technique & Device, developed by Dr. Erwin De Winter © 2008 all rights reserved

13. A new revolutionary Sutureless Technique & Device, developed by Dr. Erwin De Winter © 2008all rights reserved

14. A new revolutionary Sutureless Technique & Device, developed by Dr. Erwin De Winter © 2008 all rights reserved

15. A new revolutionary Sutureless Technique & Device, developed by Dr. Erwin De Winter © 2008 all rights reserved

16. A new revolutionary Sutureless Technique & Device, developed by Dr. Erwin De Winter © 2008 all rights reserved

17. A new revolutionary Sutureless Technique & Device, developed by Dr. Erwin De Winter © 2008 all rights reserved

18. A new revolutionary Sutureless Technique & Device, developed by Dr. Erwin De Winter © 2008 all rights reserved

19. A new revolutionary Sutureless Technique & Device, developed by Dr. Erwin De Winter © 2008 all rights reserved

20. A new revolutionary Sutureless Technique & Device, developed by Dr. Erwin De Winter © 2008 all rights reserved

21. A new revolutionary Sutureless Technique & Device, developed by Dr. Erwin De Winter © 2008 all rights reserved

22. A new revolutionary Sutureless Technique & Device, developed by Dr. Erwin De Winter © 2008 all rights reserved

23. A new revolutionary Sutureless Technique & Device, developed by Dr. Erwin De Winter © 2008 all rights reserved

24. A new revolutionary Sutureless Technique & Device, developed by Dr. Erwin De Winter © 2008 all rights reserved

25. A new revolutionary Sutureless Technique & Device, developed by Dr. Erwin De Winter © 2008 all rights reserved

26. Sculptor Ronald De Winter

27. Coronary Artery Bypass Graft with Screw-Device A new revolutionary Sutureless Technique & Device, developed by Dr. Erwin De Winter © 2008 all rights reserved

28. THE SUCCESS OF THIS INVENTION - Technical advantages - Commercial advantages A new revolutionary Sutureless Technique & Device, developed by Dr. Erwin De Winter © 2008 all rights reserved

29. TECHNICAL ADVANTAGES, suturingsutureless It takes less time to perform vascular bypass operation with this sutureless technique and devices. It is very easy to apply this device, and the technique is easy to learn. 3. It causes far less microtraumaand requires fewer manipulations than traditional suturing. 4. The anastomosic site remains open and will not collapse. Collapse is prevented by the rigid structure of the anastomis devices (SD & ASD) ASD “Screw-technique“ Anchoring S. D. SUTURING A new revolutionary Sutureless Technique & Device, developed by Dr. Erwin De Winter © 2008 all rights reserved

30. Commercial advantages The product is market driven, it is in demand The product and the technique are both inventive, novel and patented The product is significant to the business and to employment The product is functional, capable of being produced and economical The product has a suitable level of technology The product can be launched quickly Personal commitment by the inventor Dr. E. De Winter, neurosurgeon Investors and different academic departments are interested A new revolutionary Sutureless Technique & Device, developed by Dr. Erwin De Winter © 2008 all rights reserved

31. MARKET Bypass-operations Global bypass operations performed: more than 2 million worldwide/year Cardiac surgery: coronary artery bypass graft (CABG) more than 1 million ww/year General vascular surgery (bypass) more than 1 million ww/year Neurosurgery: neurovascular bypass-operations c. 1000- ww/year Classical bypass-operations are performed by suturing the bloodvessels together. In more than 2 million bypass-operations performed ww./year, the anastomosic site is opened mechanically, with a surgical instrument, punch or a bistoury. A new revolutionary Sutureless Technique & Device , developed by Dr. Erwin De Winter © 2008 all rights reserved

32. FUTURE MARKET GROWTH Size of the total market: Only 1.5 billion out of 6 billion people have access to Modern Medicine. Number one mortality cause in the world: Vascular diseases, cardiovascular diseases, and strokes. Worldwide, 1 out of 3 persons die of a vascular disease. In industrialised countries: life expectancy is much longer A new revolutionary Sutureless Technique & Device, developed by Dr. Erwin De Winter © 2008 all rights reserved

33. Most important causes of mortality Vascular diseases, like blood vessel stenosis, aneurysms (fusiform, saccular,...) dilatations of the bloodvessel, are the most important causes of disability and death. Worldwide 1/3rd of global deaths is due to a cardiovascular disease. 43% of these deaths are caused by coronary artery (heart bloodvessel) and 32% by a “stroke “ (brain-infarct). (*)(“The prevention of cardiovasular disease worldwide: whose task and WHO’s task?”, Philip Poole-Wilson, Clinical Medicine vol 5 No 4 july/augustus 2005)

34. Most important causes of mortality The prevention of cardiovascular disease worldwide: whose task and WHO’s task? Philip Poole-Wilson, Clinical Medicine vol 5 No 4 july/August 2005 A new revolutionary Sutureless Technique & Device, developed by Dr. Erwin De Winter © 2008 all rights reserved

35. MARKET LEADERSHIP Radical innovation: breakthroughs : New-to-the world product; SD and ASD New technique will launch the company into new markets will make the company a market leader Sustainable Competitive advantage unique, difficult to replicate, superior to competitors’ innovation new product development is the key driver to competitive advantage growth and profitability Creates a revolutionary change that will tranform existing markets and will create new ones Enables rapid growth and creates high return on investment A new revolutionary Sutureless Technique & Device, developed by Dr. Erwin De Winter © 2008 all rights reserved

36. Criteria to determine success PATENTED WORLDWIDE: for both technique and devices IMPROVEMENT: The new device and technique are much better than the gold standard for anastomosis: Suturing versus screwing bloodvessels together POTENTIAL MARKET for vascular surgery and bypass procedures: more than 2 million operations wordwide/year FUTURE MARKET: - only 1.5 billion out of 6 billion people have access to modern medicine - vascular disease is n° 1 mortality cause - life expectancy in industrialised world is much longer POTENTIAL SALES: for bypass operations: 2 million operations x 2 ( at least 2 sutures needed) x cost price material MANUFACTURABILITY the device is very easy to manufacture and can be made in different materials TECHNIQUE: very easy to learn for the surgeons DEVICE: very easy to apply COMPETITION: New-to-the world product and technique: no compettion SYNERGY: can be combined with existing techniques and devices, thereby creating new inventions. APPROPRIATE for any medical company dealing with vascular surgery, suture materials, artificial vessels, etc. A new revolutionary Sutureless Technique & Device, developed by Dr. Erwin De Winter © 2008 all rights reserved