Surgical staples are specialized
stapleA staple is a type of two-pronged fastener, usually metal, used for joining or binding materials together. Large staples might be used with a hammer or staple gun for masonry, roofing, corrugated boxes and other heavy-duty uses...
s used in
surgerySurgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
in place of sutures to close
skin-Dermis:The dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain. The dermis is tightly connected to the epidermis by a basement membrane. It also harbors many Mechanoreceptors that provide the sense of touch and heat...
wounds,
connectAn anastomosis is the reconnection of two streams that previously branched out, such as blood vessels or leaf veins. The term is used in medicine, biology, mycology and geology....
or remove parts of the bowels or
lungThe lung is the essential respiration organ in many air-breathing animals, including most tetrapods, a few fish and a few snails. In mammals and the more complex life forms, the two lungs are located near the backbone on either side of the heart...
s. 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,
dermal adhesiveA dermal adhesive is a glue used to close wounds in the skin, as an alternative to sutures, staples or clips. GluStitch Inc., manufactures and distributes high purity, medical grade cyanoacrylate wound closure products...
s (skin glues) are also an increasingly common alternative.
History
Staplers were originally developed to address the perceived 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. 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.
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 (3.6 kg), and required two hours to assemble and load. Many hours were spent trying to achieve a consistent staple line and reliably patent anastomoses.
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. Until the late 1970s USSC had the market essentially to itself, but in 1977
Johnson & JohnsonJohnson & Johnson is an American multinational pharmaceutical, medical devices and consumer packaged goods manufacturer founded in 1886. Its common stock is a component of the Dow Jones Industrial Average and the company is listed among the Fortune 500....
's
EthiconEthicon can refer to two distinct subsidiares of Johnson & Johnson:* Ethicon Inc., a manufacturer of surgical sutures and wound closure devices that was founded in 1949...
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
CovidienCovidien , formerly Tyco Healthcare, is a healthcare device and supply company, incorporated in Dublin, Ireland, although its corporate offices are located in Mansfield, Massachusetts. On June 29, 2007, Covidien became an independent publicly traded company after being spun off from Tyco...
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
catgutCatgut is a type of cord that is prepared from the natural fibre found in the walls of animal intestines. Usually sheep or goat intestines are used, but it is occasionally made from the intestines of cattle, hogs, horses, mules, or donkeys.-Etymology:...
,
silkSilk is a natural protein fiber, some forms of which can be woven into textiles. The best-known type of silk is obtained from the cocoons of the larvae of the mulberry silkworm Bombyx mori reared in captivity...
and
linenLinen is a textile made from the fibers of the flax plant, Linum usitatissimum. Linen is labor-intensive to manufacture, but when it is made into garments, it is valued for its exceptional coolness and freshness in hot weather....
, 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.
Types and applications
The first commercial staplers were made of
stainless steelIn metallurgy, stainless steel, also known as inox steel or inox from French "inoxydable", is defined as a steel alloy with a minimum of 10.5 or 11% chromium content by mass....
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. Circular staplers are used for end-to-end anastomosis after
bowel resectionA bowel resection is a surgical procedure in which a part of the large or small intestine is removed. It may be performed due to cancer, necrosis, enteritis, diverticular disease, or a block in the intestine due to scar tissue...
or, somewhat more controversially, in esophagogastric
surgerySurgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
. The instruments may be used in either open or
laparoscopic surgeryLaparoscopic surgery, also called minimally invasive surgery , bandaid surgery, or keyhole surgery, is a modern surgical technique in which operations in the abdomen are performed through small incisions as opposed to the larger incisions needed in laparotomy.Keyhole surgery makes use of images...
, 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
trocarA trocar is a medical instrument with a sharply pointed end, often three-sided, that is used inside a hollow cylinder to introduce this into blood vessels or body cavities...
ports.
Some staplers incorporate a knife, to complete
excisionExcision is the alias of Jeff Abel, a dubstep DJ and music boss from British Columbia, Canada. He frequently works with fellow Canadian dubstep producers Datsik and Downlink. As one of the first dubstep producers and DJs in North America, he has played a significant role in the genre's growth in...
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 surgeryVertical banded gastroplasty , also known as stomach stapling, is a restrictive operation for weight control. Both a band and staples are used to create a small stomach pouch...
(popularly known as "stomach stapling").
In spite of intensive research (video)
http://www.fondazionecarrel.org/carrel/vasc/files/stapler/stapler.htm circular staplers for vascular anastomosis never had yet significant impact on standard hand (Carrel) suture technique.
Although most surgical staples are made of
titaniumTitanium is a chemical element with the symbol Ti and atomic number 22. It has a low density and is a strong, lustrous, corrosion-resistant transition metal with a silver color....
,
stainless steelIn metallurgy, stainless steel, also known as inox steel or inox from French "inoxydable", is defined as a steel alloy with a minimum of 10.5 or 11% chromium content by mass....
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
MRIMagnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...
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.
Titanium staples are never solely titanium; they all have some amount of
nickelNickel is a chemical element with the chemical symbol Ni and atomic number 28. It is a silvery-white lustrous metal with a slight golden tinge. Nickel belongs to the transition metals and is hard and ductile...
content.