Surgical staples

Surgical staples are specialized staples used in surgery in place of sutures to close skin wounds, connect or remove parts of the bowels or lungs. 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. Staples are primarily used in bowel and lung surgery, because staple lines are more consistent and therefore less likely to leak blood, air or bowel contents. Still, several randomized controlled trials have shown no significant difference in bowel leakage after anastomoses performed either manually with suture by experienced surgeons, or after mechanical anastomoses with staples. In skin closure, dermal adhesives (skin glues) are also an increasingly common alternative.

Staplers were originally developed to address the perceived problem of patency (security against stenosis or occlusion of the lumen) and tightness (security against leaks of blood or bowel contents) as well as easiness and quickness in performing the anastomosis. 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, Humor 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. 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'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.

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