Choosing the Right Surgical Stapler

Ethicon (Johnson & Johnson group) linear surgical stapler

There are four main types of sterile, disposable surgical staplers: skin closure, linear, laparoscopic, and circular.

• Skin closure staplers are designed to perform skin sutures and apply staples one by one.
• Linear staplers apply an entire line of staples in a single shot. Some linear staplers have a blade that cuts the tissue while the suture is made. Linear staplers are suited for thoracic, abdominal, and lung applications.
• Laparoscopic staplers also apply a line of staples with a single shot. They can be sharp or not, articulated or non-articulated. They are used in minimally invasive surgery, particularly for intestinal anastomoses and other gastrointestinal surgical interventions, but also in lung resections, etc.
• Circular staplers also apply a line of staples at once and are used to join tissues in minimally invasive surgeries, particularly resections. Surgeons often use circular staplers for procedures in the digestive tract, from the throat to the colon, gastrointestinal anastomoses, hemorrhoid surgeries, or circumcisions.

Covidien (Medtronic group) skin stapler

When choosing a surgical stapler, several criteria must be taken into account, such as the type of surgery, the ergonomics of the device, its dimensions, and whether or not it is electric.

• Application: The type of surgery in which the stapler will be used
• Ergonomics: Comfortable handling, ease of use, audible trigger click, etc.
• Diameter and length: Staplers of different diameters and lengths are available on the market
• Suture length: The length of the wound to be sutured
• Thickness of the staples
• Articulation angle: There are articulated staplers with a rotation mechanism to guide the load and make it easier to apply staples in hard-to-reach areas; the articulation angle is adjustable
• Number of staples in the cartridge
• Electric or mechanical stapler: See the section on electric staplers

Covidien (Medtronic group) electric articulated linear stapler

There are advantages and disadvantages to using surgical staplers compared to manual suturing with a needle and surgical thread. Here are the main ones below:

Advantages:

• Fast application and ease of use: Surgical staplers close large wounds or incisions faster. They are very useful in minimally invasive surgery as they only need a small opening and can quickly cut and join tissues and vessels.
• Lower risk of infection and less tissue reaction: staples offer faster healing.
• Resistant suture: Skin staplers are used to join skin with a strong tension, such as on the skull or torso.

Disadvantages:

• Less precision: Aligning the edges of the wound to be closed is less precise than when done manually.
• Higher cost: A surgical stapler and disposable staple cartridges cost more than a needle and surgical thread.

Electric staplers, or automatic staplers, run on batteries. They are still quite recent. According to a study funded by Ethicon (manufacturer of staplers, part of the Johnson & Johnson group) and published in the journal Advances in Therapy, compared to mechanical staplers, the use of electric staplers in a pulmonary lobectomy:

• Reduces the risk of complications (particularly bleeding)
• Shortens patients’ recovery time by at least one day
• Reduces the cost of these procedures for healthcare establishments by around 10%

However, the study does not explain why electric staplers produced better results than mechanical ones. It may have something to do with the tissue gripping mechanism of electric staplers, but no evidence is presented in this regard.

B. Braun circular stapler

The choice of staples for a surgical stapler is based on two main criteria: material and dimensions.

Material:

• Stainless steel and titanium: Most staples are made of stainless steel or titanium, two resistant and biocompatible metals. Metal staples do not dissolve, so special care is needed to avoid possible infections.
• Plastic: Plastic staples can be used for people who are allergic to metals or to minimize the size of the scar. Plastic staples, like metal ones, do not dissolve.
• Polymer poly (lactic-co-glycolic acid) (PLGA): PLGA staples are absorbable, which means they will be absorbed by the body. They are often used in cosmetic surgery because, like plastic staples, they leave more discreet scars.

Dimensions:

• Staples come in different lengths and widths. Your choice will depend on the type of tissue, and its thickness, to be sutured.