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Surgical staples are specialized staples used in surgery in place of
suture Suture, literally meaning "seam", may refer to: Arts, entertainment, and media * ''Suture'' (album), a 2000 album by American Industrial rock band Chemlab * ''Suture'' (film), a 1993 film directed by Scott McGehee and David Siegel * Suture (ban ...
s to close skin wounds or
connect Connect may refer to: Music Albums * ''Connect'' (album), an album by Australian rock band Sick Puppies *''Connect'', album by Mark Farina *'' Tha Connect'', a 2009 album by Willy Northpole *''Connect'', a 2009 album by Dave Schulz (musician) * ...
or remove parts of the
bowel The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The GI tract contains all the major organs of the digestive system, in humans and ...
s 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 , 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 vascular anastomoses. 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 Johnson & Johnson (J&J) is an American multinational corporation founded in 1886 that develops medical devices, pharmaceuticals, and consumer packaged goods. Its common stock is a component of the Dow Jones Industrial Average and the company ...
's
Ethicon Ethicon, Inc. is a subsidiary of Johnson & Johnson. It was incorporated as a separate company under the Johnson & Johnson umbrella in 1949 to expand and diversify the Johnson & Johnson product line. Ethicon has manufactured surgical sutures and ...
brand entered the market and today both are widely used, along with competitors from the Far East. USSC was bought by
Tyco Healthcare Covidien was an Irish-headquartered global health care products company and manufacturer of medical devices and supplies. Covidien became an independent publicly traded company after being spun off from Tyco International in 2007. It was purcha ...
in 1998, which became
Covidien Covidien was an Irish-headquartered global health care products company and manufacturer of medical devices and supplies. Covidien became an independent publicly traded company after being spun off from Tyco International in 2007. It was purcha ...
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 Catgut (also known as gut) is a type of cord that is prepared from the natural fiber found in the walls of animal intestines. Catgut makers usually use sheep or goat intestines, but occasionally use the intestines of cattle, hogs, horses, mules, ...
, 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 An anastomosis (, plural anastomoses) is a connection or opening between two things (especially cavities or passages) that are normally diverging or branching, such as between blood vessels, leaf veins, or streams. Such a connection may be norma ...
after
bowel resection A bowel resection or enterectomy ('' enter-'' + '' -ectomy'') is a surgical procedure in which a part of an intestine (bowel) is removed, from either the small intestine or large intestine. Often the word ''enterectomy'' is reserved for the sense ...
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 Vertical banded gastroplasty (VBG), also known as stomach stapling, is a form of bariatric surgery for weight control. The VBG procedure involves using a band and staples to create a small stomach pouch. In the bottom of the pouch is an approxim ...
(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 Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio waves ...
scanners, although some imaging artifacts may result. Synthetic absorbable (bioabsorbable) staples are also now becoming available, based on
polyglycolic acid Polyglycolide or poly(glycolic acid) (PGA), also spelled as polyglycolic acid, is a biodegradable, thermoplastic polymer and the simplest linear, aliphatic polyester. It can be prepared starting from glycolic acid by means of polycondensation or r ...
, 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

* Instruments used in general surgery


References

{{DEFAULTSORT:Surgical Staple Surgical instruments Fasteners