Surgical staple

Staples used in surgical procedures as an alternative to sutures

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34 surgical staples closing scalp following craniotomy Projectional radiograph of surgical staples

Surgical staples are specialized fastening devices employed in surgical procedures to close skin wounds, or to connect or excise portions of the intestines or lungs. Opting for staples instead of traditional sutures can minimize local inflammation, shorten wound width, and expedite the closure process.[1]

An innovative method that emerged in the 1990s utilizes clips rather than staples for certain applications, which eliminates the need for the staple to penetrate the tissue.[2]

Background and Development

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The concept was introduced by Hungarian surgeon Hümér Hültl, often referred to as the "father of surgical stapling".[3][4] In 1908, Hültl's initial stapler prototype weighed 8 pounds (3.6 kg) and took two hours to assemble and load.

The technology saw significant improvements in the Soviet Union during the 1950s, leading to the first commercially available reusable surgical staplers for bowel and anastomoses procedures.[4] Dr. Mark M. Ravitch attended a surgical conference in the USSR and brought back a sample device, introducing it to entrepreneur Leon C. Hirsch. Hirsch subsequently founded the United States Surgical Corporation in 1964, which began manufacturing surgical staplers under the Auto Suture brand. Up until the late 1970s, USSC dominated the market until Ethicon, a Johnson & Johnson brand, entered the scene in 1977. Both brands are now widely utilized alongside competitors from East Asia. Ultimately, USSC was acquired by Tyco Healthcare in 1998, which rebranded as Covidien in 2007.

Considerable research has examined the safety and functionality of stapled versus sutured bowel anastomoses. Studies generally find that sutured connections are on par with, or even less likely to leak than, stapled ones.[6] This trend is likely due to advancements in suture materials and a growing emphasis on surgical risks. Modern synthetic sutures offer more reliability and lower infection rates compared to older materials like catgut, silk, and linen.

One standout feature of intestinal staplers is their ability to function as a haemostat by compressing wound edges and sealing blood vessels during the stapling process. Recent findings indicate no significant difference in outcomes between manually sutured and mechanically joined anastomoses, including those using clips, but mechanical methods are considerably faster.[7][2]

In pulmonary resections where lung tissue is sealed using staplers, patients often experience postoperative air leakage.[8] As a result, alternative lung sealing techniques are currently under investigation.[9]

Different Types and Uses of Surgical Staplers

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A close-up view of a surgical skin stapler.

Early commercial staplers were crafted from stainless steel and featured titanium staples loaded into refillable cartridges.

Contemporary surgical staplers are either disposable, made from plastic, or reusable, composed of stainless steel. Both types typically utilize disposable cartridges.

The staple lines can be straight, curved, or circular. Circular staplers are frequently employed for end-to-end anastomosis post-bowel resection or, more controversially, in esophagogastric surgeries.[10] These instruments can be used in both open and laparoscopic surgeries, the latter requiring longer, thinner, and more articulated tools for limited access points.

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Some staplers come with an integrated knife, allowing for simultaneous excision and anastomosis in one operation. Staplers are suitable for both internal and external skin wounds. Skin staples are typically applied with a disposable stapler and removed using a specialized removal tool. Additionally, staplers are instrumental in vertical banded gastroplasty, commonly known as "stomach stapling."

Vascular stapler for reducing warm ischemia in organ transplantation. With this model each stapler end can be mounted on donor and recipient by independent surgical teams without care for reciprocal orientation, being the maximal possible vascular axis torsion ≤30°. Activating guide-wire is connected just immediately before firing (video)

Although devices for circular end-to-end anastomosis of the digestive tract are widely used, circular staplers for vascular anastomosis have yet to significantly impact traditional hand-suturing techniques. The primary reason is that for small vessels, the skill and precision needed to position the device are nearly comparable to those required for manual suturing, making the use of such devices minimally advantageous. However, organ transplantation might be an exception, as the device positioning and actioning phases can be performed separately by different surgical teams. This approach can minimize the dangerous warm ischemia time to merely minutes by connecting the device ends and deploying the stapler quickly.

While most surgical staples are made from titanium, stainless steel is also commonly used for skin staples and clips. Titanium elicits less of an immune response and, being non-ferrous, doesn't interfere significantly with MRI scans, although some imaging artifacts may occur. Bioabsorbable (synthetic absorbable) staples made from polyglycolic acid are also becoming more prevalent, akin to many modern synthetic sutures.

How to Remove Skin Staples

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When skin staples are used to seal a wound, their removal is necessary after a suitable healing period, usually between 5 and 10 days, based on wound location and other factors. The skin staple remover is a small manual device featuring a narrow, thin plate inserted beneath the staple. Pressure on the device pushes a small blade through a slot in the plate, deforming the staple into an 'M' shape to facilitate its removal. In emergencies, staples can be removed using artery forceps.[16] Skin staple removers come in various shapes and designs, with both disposable and reusable options available.[17]

Additional Resources

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References

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