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Surgical staples are specialized staples used in surgery in place of surgical suture to close skin or to resect and/or anastomosis parts of an organ (e.g. , stomach or ). The use of staples over sutures reduces local inflammation, the width of the wound, and the time it takes to close a defect.
A more recent development, from the 1990s, uses Surgical clip instead of staples for some applications; this does not require the staple to penetrate.
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 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. History of United States Surgical Corporation 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 Anastomosis has been widely studied. Studies generally show sutured anastomoses are comparable or less prone to leakage. It is possible that this is the result of recent advances in suture technology, along with the 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.
Patients undergoing pulmonary resections, where lung tissue is sealed with staplers, often experience postoperative air leakage. Alternative techniques for sealing lung tissue are currently being investigated.
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.
Staple lines may be: straight, curved or circular. Circular staplers are used for end-to-end anastomosis after bowel resection 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 (popularly known as "stomach stapling").
While devices for circular end-to-end anastomosis of digestive tract are widely used, in spite of intensive research Nazari S et al. A new vascular stapler for pulmonary artery anastomosis in experimental single lung transplantation.Video, Proceedings of the 4th Annual Meeting of The Association for Cardio-Thoracic Surgery, Naples, Sept 16-19, 1990 circular staplers for vascular anastomosis have not yet had a significant impact on the standard hand (Carrel) suture technique. Vascular staplers are less widely used than digestive staplers. One reason is that small blood vessels require high precision when positioning and activating any device. This level of precision is difficult to achieve, making traditional hand sutures more practical in most cases. 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 done to minimize the time the donor organ is exposed to warm ischemia, reducing risk during transplantation
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 (bioabsorbable) staples are also now becoming available, based on polyglycolic acid, as with many synthetic absorbable sutures .
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