A more recent development, from the 1990s, uses clips instead of staples for some applications; this does not require the staple to penetrate.[2]
History[edit]
The technique was pioneered by "father of surgical stapling", Hungarian surgeon Hümér Hültl.[3][4] 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.[4] 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.[5] 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.[6] 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.[7][2]
In patients that are subjected to pulmonary resections where lung tissue is sealed with staplers, there is often postoperative air leakage.[8] Alternative techniques to seal lung tissue are currently investigated.[9]
Removal of skin staples[edit]
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.[16] Skin staple removers are manufactured in many shapes and forms, some disposable and some reusable.