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Surgical staples are specialized staples used in surgery in place of sutures to close skin wounds, anastamose bowel or portions of lung. A more recent development, from the 1990s, uses clips instead of staples for some applications; this does not require the staple to penetrate.
Stapling is much faster than suturing by hand, and also more accurate and consistent. In bowel and lung surgery, staples are primarily used because staple lines are less likely to leak blood, air or bowel contents. In skin closure, skin glues are also an increaisngly common alternative.
The technique of stapling for surgery is said to have been influenced by the Roman use of ants for wound closure.
History
Staplers were originally developed to address the problem of patency (security against leaks of blood or bowel contents) in anastomoses in particular. Leaks from poor suturing of bowel anastomoses was at that time a significant cause of post-surgical mortality.
The technique was pioneered by a Hungarian surgeon, Humer Hultl, known as the "father of surgical stapling". Hultl's prototype stapler of 1908 weighed eight pounds (3.6kg), and required two hours to assemble and load. Many hours were spent trying to achieve a consistent staple line and reliably patent anastomoses.
The early instruments, by developers including Hultl, von Petz, Friedrich and Nakayama, were complex and cumbersome to use, but were refined over time. Experiments were informally reported abroad, and in 1964 entrepreneur Leon C. Hirsch founded the United States Surgical Corporation to manufacture surgical staplers under its Auto Suture brand. Initially this company had the market essentially to itself, but competitors soon arose and currently both USSC (now part of Tyco Healthcare) and Johnson & Johnson's Ethicon brand are widely used, along with competitors from the Far East.
Types of surgical staplers
The first commercial staplers were made of stainless steel with titanium staples loaded into reloadable staple cartridges.
Modern surgical staplers are either disposable, made of plastic, or reusable, made of stainless steel. Both types are generally loaded using disposable cartridges.
The staple line may be straight, curved or circular (for end-to-end bowel anastomosis in particular). 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.
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 staples are also now becoming available, based on the same principles as synthetic absorbable sutures.
See also
References
- Non-suture methods of vascular anastomosis, British Journal of Surgery, 19 Feb 2003: Volume 90, Issue 3, Pages 261 - 271
- Circular vascular stapling in coronary surgery, Konstantinov, Annals of Thoracic Surgery, 2004; 78: 369-373
- History of United States Surgical Corporation
External links
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