This is a medical suction device for improving pectus excavatum. The size is for those with a height of 140-170cm (see photo 5). All accessories are included (see photo 6). I purchased it used, but it came with patient information and instructions, so the usage was easy to understand. Regarding the pump, there is a notch (see photo 11), but it appears to be part of the structure (it was there when I purchased it, and there were no problems using it). * Please note that I am not accepting price negotiations.