Yes the Biohole was started in Japan in 2003 and Europe about 6 to 7 years ago that is when I heard about. Canada about two years ago.From what I have heard talking to my Europe and Canada friends in dialysis it is the way to go. Cannualtion is done with a 15g needle after treatment is stopped the needle is pulled and after the bleeding has stopped the device is placed and left in for two weeks. during the two weeks cannualtion is performed in the rope ladder cannulation. After two Weeks the biohole is pulled and you have have a perfect buttonhole it is great.The problem with Canada, two are three Providences there has been a problem with infections, have said that at the end of Feb 2014 we have 52,214 buttonhole cannualtion with one infection using the scrubber technique. they cost around 80.00 to 100.00 dollors to me as a caulator they are wort it, Just a note use "touch Cannualtion "