Evolution of Surgical Staplers!

While the rules and concepts for successful surgical anastomosis were laid down by acclaimed surgeons such as Christian Albert Theodore Billroth and William Stewart Halstead, It wasn’t until the year 1908 that a surgical stapler was invented by surgeon Humor Hultl that weighed approximately 8 pounds. Withstanding the test of time, Hulltl's staplers provided several ideas that are still utilized in the modern-day surgical stapler. This includes a double staggered staple row that allows proper closing of the tissues and the “B shaped” staple that provides better control over tissue compression. Finally, Dr. Aladar Von Petz improved on this design and invented a new surgical stapler using the same concepts introduced by Hultl. This was eventually evolved to the modern-day stapler. Over the years, the surgical stapler has evolved to become better than the previous generations – easily loading, specialized, and more functional surgical staplers were created. Modern Day surgical staplers are efficient tools providing clinicians the ability to appose wounds and incisions with great precision. Staplers are available with compatible staples in variable sizes and heights. The surgeon chooses the staple height based on the requirement of the opposition.
  • In case a closed staple height is too high there are increased chances of insufficient apposition resulting in bleeding and leakage.
  • If a staple height is too low, the shearing can occur which leads to multiple complications.
The criterion for adequate tissue apposition include -
  • Minimization of trauma at the staple site
  • Maintenance of a good blood supply
  • Prevention of tension at the site of the staple
  • Leak-proof apposition to prevent further complications
  Today, there are various types of surgical staplers available - The linear cutter, the circular stapler, the linear stapler, and the disposable skin staplers are commonly used staplers by clinicians and have multiple applications. It has been observed that using the stapling technique for wound closure minimizes tissue healing time and is cosmetically at par with suturing. One of the most trusted staplers for skin stapling is the Covidien Appose Skin Stapler. This single-use skin stapler dispenses staples that first penetrate the skin and then form to oppose the tissue. The stapler comes with staples of two staple height and width options giving the surgeon more options to select from while making a decision for surgical staplers. Additionally, the Covidien Appose stapler can be fired at multiple angles due to its ejector spring mechanism that automatically unlocks the staple which facilitates the removal of the instrument in any direction. Although the choice of apposition device depends on the case requirement, surgical staplers have provided a great alternative to surgeons for faster wound apposition with minimal tissue reaction. While the medical industry is constantly looking for a better tissue apposition device to come as close as possible to the ideal device, the surgical staplers have filled multiple lacunae that the conventional wound closing devices left the void.