Surgical staplers | PPT

Surgical staplers are medical devices that can be used instead of sutures to close wounds and incisions. They close large wounds or incisions more quickly than sutures and are less painful for patients. Surgical staplers come in reusable and disposable models and resemble construction staplers. They are used internally to seal tissue during surgery and are useful for minimally invasive procedures. Surgical staples are typically made of stainless steel or titanium and are designed to insert and close multiple staples at once to quickly seal wounds and prevent bleeding.

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History

The surgical stapler most likely has a European history. To prevent spillage of bowel contents during abdominal surgery, the Hungarian surgeon Hümer Hültl developed the first known surgical stapler together with the engineer Victor Fischer in (Fig. 1)1,2.

The stapler consisted of U-shaped steel wire staples. After stapling, the tissue had to be cut. The staples did not completely close to prevent tissue necrosis, but were left in a B shape after stapling to allow tissue perfusion. The Fischer&#;Hültl stapler took 2 h to reload with individual staples and weighed about 5 kg. The first operation using this stapler was a subtotal gastrectomy for gastric cancer. In , Aladar Petz, who was trained by Hültl, developed a lighter version that used nickel&#;silver alloy staples and weighed 1 kg (Fig. 2)3.

The Petz stapler gained in popularity and became the most used stapler for the next 40 years. An important modification was made by the German surgeon Friedrich, who developed replaceable cartridges preloaded with staples in . Here, an exchange system comparable to that of surgical blades developed by Morgan Parker, as described earlier in this series, was introduced4.

Vascular stapler

In World War II, Vasilii Kolesov worked as a military surgeon during the siege of Leningrad5. His hospital had a high caseload owing to the numerous war injuries, and was often confronted with vascular injury. To decrease procedure time, the engineer Vasilii Gudov developed a vessel stapler to anastomose blood vessels (Fig. 3)5,6.

Kolesov eventually used this device in coronary artery surgery. In addition, it was often used in animal experiments and laboratory settings. However, the vascular stapler was not practical to use and needed more vessel length in comparison to a sutured end-to-end anastomosis.

Intercontinental stapling

Staplers become more popular in the Soviet Union, and several models were developed for vascular anastomoses, parenchymal resection, and gastrointestinal anastomoses1.

It was Mark Ravitch who brought surgical stapling from the Soviet Union to the USA. Ravitch was a New York-born surgeon and son of Russian immigrants. In , a group of American surgeons, including Ravitch, visited Kiev to learn about Russian blood banking principles. Here, Ravitch met Nikolai Amosov, head of a thoracic surgery department. When shown movies of pulmonary resections, Ravitch saw stapled bronchus resections and metal staples on postoperative chest X-rays. Ravitch requested the staplers used, but was refused. Eventually he bought several models of surgical stapler in a store in Leningrad and started using them to close bronchial stumps2.

Becoming part of the armamentarium

In Leon Hirsch, a businessman who collaborated with Mark Ravitch, founded the United States Surgical Corporation. Based on the staplers from the Soviet Union, they added improvements such as linear cutting and circular stapling, and developed the thoracoabdominal (TA) stapler and gastrointestinal anastomosis (GIA) model under the brand name Auto Suture&#; (Fig. 4).

Fig. 4

Latest models of thoracoabdominal and gastrointestinal anastomosis staplers7

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These staplers gained in popularity and the company grew. Interchangeable cartridges with different sizes and heights of staple specifically for the tissue stapled were introduced. With the rise of laparoscopic surgery, stapling technology further developed, and automated firing and powered stapling was added (Fig. 5).

Fig. 5

Endostapler for use in tissue division and anastomoses in thoracolaparoscopic surgery.

The stapler is battery-powered and uses automated firing8.

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From an environmental perspective, staplers are made from disposable materials and equipped with single-use batteries. Recently, more attention has been given to the concept of reusing materials, and reusable staplers may possibly become more popular again. Several projects have been initiated to reuse individual components of staplers.

Funding

The author has no funding to declare.

Disclosure

The author declares no conflict of interest.

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Contact us to discuss your requirements of linear stapler surgery. Our experienced sales team can help you identify the options that best suit your needs.

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