For nearly two centuries, surgeons have been using mechanical devices to approximate tissues and facilitate their healing process. Currently, surgical staplers are widely used and have become essential tools in surgery. Staples facilitate rapid wound closure, hence shortening the duration of the surgical procedure. In comparison to intradermal sutures, stapling is associated with better cosmetic outcomes.1 However, stapling results in more complications and prolongs hospital stay.2 3
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Staplers are classified into five categories: circular, linear, linear cutting, ligating, and skin staplers. Furthermore, contemporary variations have emerged to accommodate minimally invasive surgery.4 Every category includes a variety of commercial models, each characterized by distinct features. With distinct names, color-coded features, and variations in length and tissue thickness, each stapler serves a specific purpose in the surgical setting. The distinct characteristics of various tissue types in the human body significantly influence the selection of staples. To achieve the best stapling results for any type of tissue, it is important to have a sufficient amount of time for the tissue to be compressed to allow elongation of the tissue being compressed, while preventing the possible risk of tearing.5
This video aims to provide a comprehensive overview of stapling instruments and their associated use. The skin staplers, presented first, are typically crafted from a titanium alloy with minimal reactivity with tissues. The sizing of skin staples, such as 35R for regular or 35W for wide, is crucial, and their deployment aims to approximate rather than strangulate the tissue. The intraoperative staplers are presented next. Inside the human body, clips are often used on structures such as the cystic duct and the homonymous artery during gallbladder surgery. Laparoscopically, clip appliers with digital readouts are employed. For gastrointestinal side-to-side anastomoses or partial lung and liver resections, surgeons may use stapling devices such as the gastrointestinal anastomosis (GIA) stapler, which lays down two rows of staples and cuts in between.
Linear staplers are reusable. There are linear staplers with and without cutting functions. The latter may have different surgical uses than those that have cutting properties (e.g. digestive tract reconstruction or incisions during liver resection). Linear staplers contain a handle at the opposite end of the jaw. The surgeon manipulates the jaw using its handle to apply staples to the incision. Every time the surgeon fires a staple, a row of staples is ejected and applied to the tissue. The reloads for linear staplers are color-coded based on their intended use: white for vascular, blue for regular tissue, and green for thicker tissues.
The end-to-end anastomosis (EEA) circular stapler serves specific purposes such as end-to-end anastomoses. Unlike reusable staplers, the EEA stapler is a one-time-use item and is discarded after use. The stapler joins two hollow organs, creating a stapled anastomosis. For endoscopic procedures, Endo GIA staplers provide versatility. They are available in various lengths, and their disposable units are color-coded as well. The staplers allow surgeons to manipulate and fire the device through trocars, being incredibly useful in the context of minimally invasive surgery (MIS).
Surgical staplers are a wide range of instruments that have distinct uses in surgical practice. From skin closure to gastrointestinal anastomosis, each stapler is designed to meet the unique demands of a given surgical intervention. The operative staff should understand the features and uses of staplers to effectively handle the complexity of these devices.
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A linear cutting and stapling device includes a handle body, a pusher, a nail cartridge holder, and a staple holder. A push button for controlling the pusher is provided on the handle body. A cam with a hook portion is rotationally connected to the handle body. The cam's side is equipped with a safety mechanism. When the safety mechanism is in the locked state, the hook portion hooks on the push button, and the cam is fixed relative to the handle body. When the safety mechanism is in the unlocked state, the hook portion releases the push button.
The endoscopic linear cutter stapler is now widely used in anal and rectal surgeries and has significant advantages over manual anastomosis.
The device can complete some anastomoses that are difficult to accomplish manually, as well as anastomoses for low rectal cancer.
It shortens operation time, reduces trauma from long-term surgery and anesthesia, reduces the impact on organs such as the heart, lungs, liver, and kidneys, and increases operative safety.
The quality of the anastomosis produced by the device is high, with a smooth and neat inner wall, tightly and reliably stapled rows on both sides of the anastomosis, better blood supply to the anastomosis, and lower complications than the traditional double-line suturing method.
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This type of medical stapler is suitable for both open and laparoscopic surgery.
The anastomotic material used by the device is metal staples, which are tissue-compatible and cause less inflammation than foreign body stimulation, making it easier for the anastomosis to heal. Selecting the appropriate height of the nail cartridge and the diameter of the anastomotic tube according to the thickness of the tissue and the diameter of the anastomosis, mastering the characteristics of the tissue and the principles of anastomosis, and grasping the key points of anastomosis are critical to successful anastomosis. The endoscopic linear cutter stapler can be used in open or laparoscopic surgery.
Although the linear cutter price may be high compared to other surgical tools, its advantages make it a cost-effective option in the long run, as it reduces the need for blood transfusions and compensatory interventions. In summary, the endoscopic linear cutter stapler is a valuable surgical tool that offers numerous benefits to patients and surgeons alike.
Select and use a nail cartridge that matches the thickness of the tissue.
Effective pre-compression. Clamp and wait for 15 seconds, then tap the instrument to remove tissue fluid and reduce tissue thickness, while fully protecting the mucosa and submucosa of the anastomotic tissue.
The tapping should be stable, ensuring the stability of the endoscopic linear cutter stapler during tapping and preventing traction.
When there is bleeding or oozing from the anastomosis, the energy device should be used cautiously to prevent additional damage.
Precautionary reinforcement. After tapping, observe the condition of the anastomotic line, especially where the suture lines overlap. If necessary, use a suture to reinforce the full muscle layer or multi-layer suture.
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