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| {{Short description|Staples used in surgery in place of sutures}} | |||
| ⚫ | ]]] | ||
| {{more footnotes|date=April 2016}} | |||
| ⚫ | ] | ||
| ⚫ | ]]] | ||
| ⚫ | ] of surgical staples]] | ||
| '''Surgical staples''' are specialized ]s used in ] in place of ]s to close ] wounds |
'''Surgical staples''' are specialized ]s used in ] in place of ]s to close ] wounds or ] or remove parts of the ]s or ]s. The use of staples over sutures reduces the local inflammatory response, width of the wound, and time it takes to close.<ref>{{Cite journal|last1=Iavazzo|first1=Christos|last2=Gkegkes|first2=Ioannis D.|last3=Vouloumanou|first3=Evridiki K.|last4=Mamais|first4=Ioannis|last5=Peppas|first5=George|last6=Falagas|first6=Matthew E.|date=September 2011|title=Sutures versus staples for the management of surgical wounds: a meta-analysis of randomized controlled trials|journal=The American Surgeon|volume=77|issue=9|pages=1206–1221|doi=10.1177/000313481107700935|issn=1555-9823|pmid=21944632|s2cid=40578006|doi-access=free}}</ref> | ||
| A more recent development, from the 1990s, uses clips instead of staples for some applications; this does not require the staple to penetrate.<ref name=":0">{{Cite journal|last1=Chughtai|first1=T.|last2=Chen|first2=L. Q.|last3=Salasidis|first3=G.|last4=Nguyen|first4=D.|last5=Tchervenkov|first5=C.|last6=Morin|first6=J. F.|date=November 2000|title=Clips versus suture technique: is there a difference?|journal=The Canadian Journal of Cardiology|volume=16|issue=11|pages=1403–1407|issn=0828-282X|pmid=11109037}}</ref> | |||
| Stapling is much faster than ] by hand, and also more accurate and consistent. In bowel and lung surgery, staples are primarily used because since staple lines are more consistent, they are less likely to leak blood, air or bowel contents. Still, several randomized controlled trials have shown no significant difference in bowel leakage after anastomoses performed either manually with suture by experienced surgeons, or after mechanical anastomoses with staples. In skin closure, ]s (skin glues) are also an increasingly common alternative. | |||
| ==History== | ==History== | ||
| The technique was pioneered by "father of surgical stapling", Hungarian surgeon ].<ref>''Non-suture methods of vascular anastomosis'', British Journal of Surgery, 19 Feb 2003: Volume 90, Issue 3, Pages 261 - 271</ref><ref name="Konstantinov">{{cite journal |last1=Konstantinov |first1=Igor E |title=Circular vascular stapling in coronary surgery |journal=The Annals of Thoracic Surgery |date=July 2004 |volume=78 |issue=1 |pages=369–373 |doi=10.1016/j.athoracsur.2003.11.050 |pmid=15223474 |url=https://www.annalsthoracicsurgery.org/article/S0003-4975(04)00214-0/fulltext|doi-access=free }}</ref> Hultl's prototype stapler of 1908 weighed {{Convert|8|lb|}}, and required two hours to assemble and load. | |||
| Staplers were originally developed to address the perceived problem of ''patency'' (security against leaks of blood or bowel contents) in ] in particular. Leaks from poor suturing of bowel anastomoses was at that time a significant cause of post-surgical mortality. More recent studies have shown that with current suturing techniques there is no significant difference in outcome between hand sutured and mechanical anastomoses, but mechanical anastomoses are significantly quicker to perform.<ref></ref> | |||
| ⚫ | The technology was refined in the 1950s in the Soviet Union, allowing for the first commercially produced re-usable stapling devices for creation of bowel and ].<ref name="Konstantinov" /> ] brought a sample of stapling device after attending a surgical conference in USSR, and introduced it to entrepreneur ], who founded the ] in 1964 to manufacture surgical staplers under its Auto Suture brand.<ref></ref> Until the late 1970s USSC had the market essentially to itself, but in 1977 ]'s ] brand entered the market and today both are widely used, along with competitors from the Far East. USSC was bought by ] in 1998, which became ] on June 29, 2007. | ||
| The technique was pioneered by a Hungarian surgeon, Humor Hultl,<ref>''Non-suture methods of vascular anastomosis'', British Journal of Surgery, 19 Feb 2003: Volume 90, Issue 3, Pages 261 - 271</ref> known as the "father of surgical stapling".<ref>''Circular vascular stapling in coronary surgery'', | |||
| Konstantinov, Annals of Thoracic Surgery, 2004; 78: 369-373</ref> Hultl's prototype stapler of 1908 weighed eight pounds (3.6 kg), and required two hours to assemble and load. Many hours were spent trying to achieve a consistent staple line and reliably patent anastomoses. | |||
| ⚫ | Safety and patency of mechanical (stapled) bowel ] has been widely studied. It is generally the case in such studies that sutured anastomoses are either comparable or less prone to leakage.<ref>{{cite journal | author = Brundage Susan I| year = 2001 | title = Stapled versus Sutured Gastrointestinal Anastomoses in the Trauma Patient: A Multicenter Trial | url = http://www.jtrauma.com/pt/re/jtrauma/abstract.00005373-200112000-00005.htm;jsessionid=HGcPqDY6ny12TtcpJwhGzx4hymlFGkJn1hpPvntqS1J2C1GLL2w3!1458925248!181195629!8091!-1 | journal = Journal of Trauma-Injury Infection & Critical Care | volume = 51 | issue = 6| pages = 1054–1061 | doi=10.1097/00005373-200112000-00005| pmid = 11740250 }}</ref> It is possible that this is the result of recent advances in suture technology, along with increasingly risk-conscious surgical practice. Certainly modern synthetic sutures are more predictable and less prone to infection than ], ] and ], which were the main suture materials used up to the 1990s. | ||
| ⚫ | |||
| One key feature of intestinal staplers is that the edges of the stapler act as a ], compressing the edges of the wound and closing blood vessels during the stapling process. Recent studies have shown that with current suturing techniques there is no significant difference in outcome between hand sutured and mechanical anastomoses (including clips), but mechanical anastomoses are significantly quicker to perform.<ref>{{cite journal | url=https://doi.org/10.1007%2Fs00595-003-2678-0 | doi=10.1007/s00595-003-2678-0 | title=Stapled Versus Hand-Sewn Anastomoses in Emergency Intestinal Surgery: Results of a Prospective Randomized Study | year=2004 | last1=Catena | first1=Fausto | last2=Donna | first2=Michele La | last3=Gagliardi | first3=Stefano | last4=Avanzolini | first4=Andrea | last5=Taffurelli | first5=Mario | journal=Surgery Today | volume=34 | issue=2 | pages=123–126 | pmid=14745611 | s2cid=6386495 }}</ref><ref name=":0" /> | |||
| ⚫ | Safety and patency of mechanical (stapled) bowel anastomoses has been widely studied. It is generally the case in such studies that sutured anastomoses are either comparable or less prone to leakage.<ref> |
||
| In patients that are subjected to pulmonary resections where lung tissue is sealed with staplers, there is often postoperative air leakage.<ref>{{cite journal|last1=Venuta|first1=F|last2=Rendina|first2=EA|last3=De Giacomo|first3=T|last4=Flaishman|first4=I|last5=Guarino|first5=E|last6=Ciccone|first6=AM|last7=Ricci|first7=C|title=Technique to reduce air leaks after pulmonary lobectomy.|journal=European Journal of Cardio-Thoracic Surgery|date=April 1998|volume=13|issue=4|pages=361–4|pmid=9641332|doi=10.1016/S1010-7940(98)00038-4|doi-access=free}}</ref> Alternative techniques to seal lung tissue are currently investigated.<ref>{{cite journal|last1=Guedes|first1=Rogério Luizari|last2=Höglund|first2=Odd Viking|last3=Brum|first3=Juliana Sperotto|last4=Borg|first4=Niklas|last5=Dornbusch|first5=Peterson Triches|title=Resorbable Self-Locking Implant for Lung Lobectomy Through Video-Assisted Thoracoscopic Surgery: First Live Animal Application|journal=Surgical Innovation|date=3 January 2018|volume=25|issue=2|pages=158–164|doi=10.1177/1553350617751293|pmid=29298608|s2cid=4965005}}</ref> | |||
| One key feature of intestinal staplers is that the edges of the stapler act as a ], compressing the edges of the wound and closing blood vessels during the stapling process. | |||
| ==Types and applications== | ==Types and applications== | ||
| Line 23: | Line 24: | ||
| The first commercial staplers were made of ] with titanium staples loaded into reloadable staple cartridges. | The first commercial staplers were made of ] with titanium staples loaded into reloadable staple cartridges. | ||
| Modern surgical staplers are either disposable and made of plastic, or reusable and made of stainless steel. Both types are generally loaded using disposable cartridges. |
Modern surgical staplers are either disposable and made of plastic, or reusable and made of stainless steel. Both types are generally loaded using disposable cartridges. | ||
| The staple line may be straight, curved or circular. Circular staplers are used for end-to-end ] after ] or, somewhat more controversially, in esophagogastric ].<ref> |
The staple line may be straight, curved or circular. Circular staplers are used for end-to-end ]{{Broken anchor|date=2024-06-17|bot=User:Cewbot/log/20201008/configuration|target_link=Anastomosis#Medicine|reason=Anchor "Anastomosis#Medicine" links to a specific web page: "Medicine". The anchor (Medicine) ].}} after ] or, somewhat more controversially, in esophagogastric ].<ref>{{cite journal | first1=Hsao-Hsun | last1=Hsu | first2=Jin-Shing | last2=Chen | first3=Pei-Ming | last3=Huang | first4=Jang-Ming | last4=Lee | first5=Yung-Chie | last5=Lee | title=Comparison of manual and mechanical cervical esophagogastric anastomosis after esophageal resection for squamous cell carcinoma: a prospective randomized controlled trial | url=https://academic.oup.com/ejcts/article/25/6/1097/380193 | journal=European Journal of Cardio-Thoracic Surgery | volume=25 | issue=6 | date=June 2004 | pages=1097-1101 | doi=10.1016/j.ejcts.2004.02.026 | doi-access=free }}</ref> The instruments may be used in either open or ], different instruments are used for each application. Laparoscopic staplers are longer, thinner, and may be articulated to allow for access from a restricted number of ] ports. | ||
| Some staplers incorporate a knife, to complete ] and anastomosis in a single operation. | Some staplers incorporate a knife, to complete ] and anastomosis in a single operation. | ||
| Line 31: | Line 32: | ||
| ]] | ]] | ||
| While devices for circular end-to-end anastomosis of digestive tract are widely used, in spite of intensive research <ref>{{cite journal | vauthors = Kolesov VI, Kolesov EV, Gurevich IY, Leosko VA | year = 1970 | title = Vasosuturing apparatuses in surgery of coronary arteries | journal = Med Tekhnika | volume = 6 | pages = 24–8 }}</ref><ref>{{Cite journal |vauthors=Kolesov VI, Kolesov EV |year=1991 |title=Twenty years' results with internal thoracic artery-coronary artery anastomosis |department=Letter |journal=The Journal of Thoracic and Cardiovascular Surgery | volume=101 |issue=2 |pages=360–361 |pmid=1992247}}</ref><ref>Nazari S et al. A new vascular stapler for pulmonary artery anastomosis in experimental single lung trasnplantation.Video, Proceedings of the 4th Annual Meeting of The Association for Cardio-Thoracic Surgery, Naples, Sept 16-19, 1990</ref><ref>{{cite journal|date=Oct 2007|title=Evaluation of an aortic stapler for an open aortic anastomosis|url=http://www.minervamedica.it/en/journals/cardiovascular-surgery/article.php?cod=R37Y2007N05A0659|journal=The Journal of Cardiovascular Surgery (Torino).|volume=48|issue=5|pages=659–65|via=Minerva Medica}}</ref><ref>{{cite journal|date=Apr 2007|title=Intravascular Stapler for "Open" Aortic Surgery: Preliminary Results|journal=European Journal of Vascular and Endovascular Surgery|volume=33|issue=4|pages=408–11|doi=10.1016/j.ejvs.2006.10.019|pmid=17137806|last1=Shifrin|first1=E.G.|last2=Moore|first2=W.S.|last3=Bell|first3=P.R.F.|last4=Kolvenbach|first4=R.|last5=Daniline|first5=E.I.|doi-access=free}}</ref> circular staplers for vascular anastomosis never had yet significant impact on standard hand (Carrel) suture technique. Apart from the different modality of coupling of vascular (everted) in respect to digestive (inverted) stumps, the main basic reason could be that, particularly for small vessels, the manuality and precision required just for positioning on vascular stumps and actioning any device cannot be significantly inferior to that required to carry out the standard hand suture, then making of little utility the use of any device. An exception to that however could be organ transplantation where these two phases, i.e.device positioning at the vascular stumps and device actioning, can be carried out in different time, by different surgical team, in safe conditions when the time required does not influence donor organ preservation, i.e. at the back table in cold ischemia condition for the donor organ and after native organ removal in the recipient. This is finalized to make as brief as possible the donor organ dangerous warm ischemia phase that can be contained in the couple of minutes or less necessary just to connect the device's ends and actioning the stapler. | |||
| In spite of intensive research <ref>Nazari S et al,118. A new vascular stapler for pulmonary artery anastomosis in experimental single lung trasnplantation. | |||
| Video, ,Proceedings of the 4th Annual Meeting of The Association for Cardio-Thoracic Surgery, Naples, Sept 16-19, 1990</ref><ref>J Cardiovasc Surg (Torino). 2007 Oct;48(5):659-65.</ref><ref>Eur J Vasc Endovasc Surg. 2007 Apr;33(4):408-11. Epub 2006 Nov 28</ref> circular staplers for vascular anastomosis never had yet significant impact on standard hand (Carrel) suture technique. The basic reason may be that, particularly for small vessels, the manuality required just for positioning any device cannot be inferior to that required to carry out the standard suture. | |||
| Although most surgical staples are made of ], ] is more often used in some skin staples and clips. Titanium produces less reaction with the ] system and, being non-ferrous, does not interfere significantly with ] scanners, although some imaging artifacts may result. Synthetic absorbable (bioabsorbable) staples are also now becoming available, based on ], as with many synthetic absorbable sutures. | Although most surgical staples are made of ], ] is more often used in some skin staples and clips. Titanium produces less reaction with the ] system and, being non-ferrous, does not interfere significantly with ] scanners, although some imaging artifacts may result. Synthetic absorbable (bioabsorbable) staples are also now becoming available, based on ], as with many synthetic absorbable sutures. | ||
| ==Removal of skin staples== | |||
| Titanium staples are never solely titanium; they all have some amount of ] content. | |||
| Where skin staples are used to seal a skin wound it will be necessary to remove the staples after an appropriate healing period, usually between 5 and 10 days, depending on the location of the wound and other factors. The skin staple remover is a small manual device which consists of a shoe or plate that is sufficiently narrow and thin to insert under the skin staple. The active part is a small blade that, when hand-pressure is exerted, pushes the staple down through a slot in the shoe, deforming the staple into an 'M' shape to facilitate its removal. In an emergency it is possible to remove staples with a pair of artery forceps.<ref>{{Citation | |||
| | last1 = Teoh | |||
| | first1 = MK | |||
| | last2 = Bird | |||
| | first2 = DA | |||
| | title = Removal of skin staples in an emergency | |||
| | date = 1 September 1987 | |||
| | pmc=2498551 | |||
| | pmid=3314634 | |||
| | volume=69 | |||
| | issue = 5 | |||
| | journal=Ann R Coll Surg Engl | |||
| | pages=222–4}}</ref> | |||
| Skin staple removers are manufactured in many shapes and forms, some disposable and some reusable. | |||
| ==See also== | ==See also== | ||
| *] | *] | ||
| ==References== | ==References== | ||
| {{reflist|2}} | {{reflist|2}} | ||
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| ] | ] | ||
| ] | ] | ||
| ] | |||
| ] | |||
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Latest revision as of 02:46, 9 September 2024
Staples used in surgery in place of sutures | This article includes a list of general references, but it lacks sufficient corresponding inline citations. Please help to improve this article by introducing more precise citations. (April 2016) (Learn how and when to remove this message) |
Surgical staples are specialized staples used in surgery in place of sutures to close skin wounds or connect or remove parts of the bowels or lungs. The use of staples over sutures reduces the local inflammatory response, width of the wound, and time it takes to close.
A more recent development, from the 1990s, uses clips instead of staples for some applications; this does not require the staple to penetrate.
History
The technique was pioneered by "father of surgical stapling", Hungarian surgeon Hümér Hültl. Hultl's prototype stapler of 1908 weighed 8 pounds (3.6 kg), and required two hours to assemble and load.
The technology was refined in the 1950s in the Soviet Union, allowing for the first commercially produced re-usable stapling devices for creation of bowel and anastomeses. Mark M. Ravitch brought a sample of stapling device after attending a surgical conference in USSR, and introduced it to entrepreneur Leon C. Hirsch, who founded the United States Surgical Corporation in 1964 to manufacture surgical staplers under its Auto Suture brand. Until the late 1970s USSC had the market essentially to itself, but in 1977 Johnson & Johnson's Ethicon brand entered the market and today both are widely used, along with competitors from the Far East. USSC was bought by Tyco Healthcare in 1998, which became Covidien on June 29, 2007.
Safety and patency of mechanical (stapled) bowel anastomoses has been widely studied. It is generally the case in such studies that sutured anastomoses are either comparable or less prone to leakage. It is possible that this is the result of recent advances in suture technology, along with increasingly risk-conscious surgical practice. Certainly modern synthetic sutures are more predictable and less prone to infection than catgut, silk and linen, which were the main suture materials used up to the 1990s.
One key feature of intestinal staplers is that the edges of the stapler act as a haemostat, compressing the edges of the wound and closing blood vessels during the stapling process. Recent studies have shown that with current suturing techniques there is no significant difference in outcome between hand sutured and mechanical anastomoses (including clips), but mechanical anastomoses are significantly quicker to perform.
In patients that are subjected to pulmonary resections where lung tissue is sealed with staplers, there is often postoperative air leakage. Alternative techniques to seal lung tissue are currently investigated.
Types and applications
The first commercial staplers were made of stainless steel with titanium staples loaded into reloadable staple cartridges.
Modern surgical staplers are either disposable and made of plastic, or reusable and made of stainless steel. Both types are generally loaded using disposable cartridges.
The staple line may be straight, curved or circular. Circular staplers are used for end-to-end anastomosis after bowel resection or, somewhat more controversially, in esophagogastric surgery. The instruments may be used in either open or laparoscopic surgery, different instruments are used for each application. Laparoscopic staplers are longer, thinner, and may be articulated to allow for access from a restricted number of trocar ports.
Some staplers incorporate a knife, to complete excision and anastomosis in a single operation. Staplers are used to close both internal and skin wounds. Skin staples are usually applied using a disposable stapler, and removed with a specialized staple remover. Staplers are also used in vertical banded gastroplasty surgery (popularly known as "stomach stapling").
While devices for circular end-to-end anastomosis of digestive tract are widely used, in spite of intensive research circular staplers for vascular anastomosis never had yet significant impact on standard hand (Carrel) suture technique. Apart from the different modality of coupling of vascular (everted) in respect to digestive (inverted) stumps, the main basic reason could be that, particularly for small vessels, the manuality and precision required just for positioning on vascular stumps and actioning any device cannot be significantly inferior to that required to carry out the standard hand suture, then making of little utility the use of any device. An exception to that however could be organ transplantation where these two phases, i.e.device positioning at the vascular stumps and device actioning, can be carried out in different time, by different surgical team, in safe conditions when the time required does not influence donor organ preservation, i.e. at the back table in cold ischemia condition for the donor organ and after native organ removal in the recipient. This is finalized to make as brief as possible the donor organ dangerous warm ischemia phase that can be contained in the couple of minutes or less necessary just to connect the device's ends and actioning the stapler.
Although most surgical staples are made of titanium, stainless steel is more often used in some skin staples and clips. Titanium produces less reaction with the immune system and, being non-ferrous, does not interfere significantly with MRI scanners, although some imaging artifacts may result. Synthetic absorbable (bioabsorbable) staples are also now becoming available, based on polyglycolic acid, as with many synthetic absorbable sutures.
Removal of skin staples
Where skin staples are used to seal a skin wound it will be necessary to remove the staples after an appropriate healing period, usually between 5 and 10 days, depending on the location of the wound and other factors. The skin staple remover is a small manual device which consists of a shoe or plate that is sufficiently narrow and thin to insert under the skin staple. The active part is a small blade that, when hand-pressure is exerted, pushes the staple down through a slot in the shoe, deforming the staple into an 'M' shape to facilitate its removal. In an emergency it is possible to remove staples with a pair of artery forceps. Skin staple removers are manufactured in many shapes and forms, some disposable and some reusable.
See also
References
- Iavazzo, Christos; Gkegkes, Ioannis D.; Vouloumanou, Evridiki K.; Mamais, Ioannis; Peppas, George; Falagas, Matthew E. (September 2011). "Sutures versus staples for the management of surgical wounds: a meta-analysis of randomized controlled trials". The American Surgeon. 77 (9): 1206–1221. doi:10.1177/000313481107700935. ISSN 1555-9823. PMID 21944632. S2CID 40578006.
- ^ Chughtai, T.; Chen, L. Q.; Salasidis, G.; Nguyen, D.; Tchervenkov, C.; Morin, J. F. (November 2000). "Clips versus suture technique: is there a difference?". The Canadian Journal of Cardiology. 16 (11): 1403–1407. ISSN 0828-282X. PMID 11109037.
- Non-suture methods of vascular anastomosis, British Journal of Surgery, 19 Feb 2003: Volume 90, Issue 3, Pages 261 - 271
- ^ Konstantinov, Igor E (July 2004). "Circular vascular stapling in coronary surgery". The Annals of Thoracic Surgery. 78 (1): 369–373. doi:10.1016/j.athoracsur.2003.11.050. PMID 15223474.
- History of United States Surgical Corporation
- Brundage Susan I (2001). "Stapled versus Sutured Gastrointestinal Anastomoses in the Trauma Patient: A Multicenter Trial". Journal of Trauma-Injury Infection & Critical Care. 51 (6): 1054–1061. doi:10.1097/00005373-200112000-00005. PMID 11740250.
- Catena, Fausto; Donna, Michele La; Gagliardi, Stefano; Avanzolini, Andrea; Taffurelli, Mario (2004). "Stapled Versus Hand-Sewn Anastomoses in Emergency Intestinal Surgery: Results of a Prospective Randomized Study". Surgery Today. 34 (2): 123–126. doi:10.1007/s00595-003-2678-0. PMID 14745611. S2CID 6386495.
- Venuta, F; Rendina, EA; De Giacomo, T; Flaishman, I; Guarino, E; Ciccone, AM; Ricci, C (April 1998). "Technique to reduce air leaks after pulmonary lobectomy". European Journal of Cardio-Thoracic Surgery. 13 (4): 361–4. doi:10.1016/S1010-7940(98)00038-4. PMID 9641332.
- Guedes, Rogério Luizari; Höglund, Odd Viking; Brum, Juliana Sperotto; Borg, Niklas; Dornbusch, Peterson Triches (3 January 2018). "Resorbable Self-Locking Implant for Lung Lobectomy Through Video-Assisted Thoracoscopic Surgery: First Live Animal Application". Surgical Innovation. 25 (2): 158–164. doi:10.1177/1553350617751293. PMID 29298608. S2CID 4965005.
- Hsu, Hsao-Hsun; Chen, Jin-Shing; Huang, Pei-Ming; Lee, Jang-Ming; Lee, Yung-Chie (June 2004). "Comparison of manual and mechanical cervical esophagogastric anastomosis after esophageal resection for squamous cell carcinoma: a prospective randomized controlled trial". European Journal of Cardio-Thoracic Surgery. 25 (6): 1097–1101. doi:10.1016/j.ejcts.2004.02.026.
- Kolesov VI, Kolesov EV, Gurevich IY, Leosko VA (1970). "Vasosuturing apparatuses in surgery of coronary arteries". Med Tekhnika. 6: 24–8.
- Kolesov VI, Kolesov EV (1991). "Twenty years' results with internal thoracic artery-coronary artery anastomosis". Letter. The Journal of Thoracic and Cardiovascular Surgery. 101 (2): 360–361. PMID 1992247.
- Nazari S et al. A new vascular stapler for pulmonary artery anastomosis in experimental single lung trasnplantation.Video, Proceedings of the 4th Annual Meeting of The Association for Cardio-Thoracic Surgery, Naples, Sept 16-19, 1990
- "Evaluation of an aortic stapler for an open aortic anastomosis". The Journal of Cardiovascular Surgery (Torino). 48 (5): 659–65. Oct 2007 – via Minerva Medica.
- Shifrin, E.G.; Moore, W.S.; Bell, P.R.F.; Kolvenbach, R.; Daniline, E.I. (Apr 2007). "Intravascular Stapler for "Open" Aortic Surgery: Preliminary Results". European Journal of Vascular and Endovascular Surgery. 33 (4): 408–11. doi:10.1016/j.ejvs.2006.10.019. PMID 17137806.
- Teoh, MK; Bird, DA (1 September 1987), "Removal of skin staples in an emergency", Ann R Coll Surg Engl, 69 (5): 222–4, PMC 2498551, PMID 3314634
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