By Dr. Vikas Gupta
Sutures are an often overlooked but essential component in the field of medical sciences. The art of stitching and its medical usage predates the modern era by several millennia with the first reported use unearthed in Ancient Egypt, around 5000 years ago. For centuries, plant and animal derivatives such as hemp, cotton, silk, tendon and arteries were used in the suturing process. It was only with the turn of the 20th century, that medical practitioners commenced using synthetic materials for stitching, with the constructed equipment being classified into two distinct categories: “absorbable” and “non-absorbable” depending upon their ability to be absorbed by the body during the healing process. And in surgery, sutures are indispensable.
In modern-day surgery, an important tool for performing sutures is the surgical stapler, used extensively to suture surgical cuts. Surgical staplers were developed in response to concerns about the sterility of traditional suture methods. Staplers generally ensure greater efficiency, are easy to use and significantly reduce the chances of infection. First developed in 1908 by Hungarian surgeon Hümér Hültl, the earliest archetype of the stapler weighed 3.6 kg and required 2 hours to assemble and load. Since then, the science of surgical staplers has come a long way, with subsequent refinement to the technology resulting in rapid, reusable models. According to a study published in the National Library of Medicine, It was concluded that skin staples are better alternatives to conventional sutures in head and neck cancer surgery as they offer ten times faster wound closure, cost-effectiveness, and similar results to sutures in terms of patient comfort, aesthetic outcome and complication rate.
The Soviet Union emerged as the leader in refining stapler technology, with the first commercially produced re-usable stapling device for the creation of vascular and bowel anastomoses sold there. The first commercial staplers were composed of stainless steel with titanium staples loaded into reloadable staple cartridges. While keeping the elementary principle intact, the stapler has evolved considerably. With the advent of minimally-invasive surgeries, linear and lightweight laparoscopic staplers were developed for narrow openings and could quickly cut and seal tissue and blood vessels. The modern-day staplers come with different height and weight options empowering surgeons with the ability to choose the stapler that is most suited to the Surgical Procedure. Modern surgical staplers are generally categorized into two divisions based on their reusability: single-use, disposable staplers made of plastic or reusable staplers made of stainless steel..
Modern specimens of the surgical stapler are equipped with various features serving particular purposes. The enhanced features include a better angle of articulation, ergonomic design, durability, and other functional features. These features are very significant in deciding the choice of staplers for a particular surgical procedure to minimize the complications like bleedings and leakage during anastomosis. It has been observed that using the correct stapling technique for anastomosis minimizes the tissue healing time and also has cosmetic benefits. Although most surgical staples are made of titanium, stainless steel is more often used in some skin staples and clips. Titanium produces less reaction with the immune system and, being non-ferrous, does not interfere significantly with MRI scanners. Synthetic absorbable (bio-absorbable) staples are also now becoming available, based on polyglycolic acid.
The latest developments in the field are the robotic staplers fitted with measuring software ensuring a greater uniformity in the staple line and increasing efficiency and ease of usage while simultaneously eliminating human error. The best surgical stapler outcomes are aimed at minimizing the trauma, maintaining adequate blood supply, and preventing tension while ensuring minimum tissue resection and leakage-free anastomosis.
Another modern development in the field is the usage of “bio-inspired technology.” As the term suggests, technology that is derivative from properties and characteristics of flora and fauna are being developed. According to a study conducted by bio-medical engineers from Harvard and MIT, the porcupine, a rodent with sharp spines (quills) on its back, has served as an inspiration for a new generation of surgical staplers. The quill has a unique structure which allows for easy penetration into the skin and beneath. And this particular attribute of the porcupine quill attracted bio-medical engineers Dr. Jeffrey Karp of Harvard and Robert Langer of MIT who went on to publish a paper highlighting this particular characteristic in Proceedings of the National Academy of Sciences (PNAS). The authors concluded that bio-inspired polymer patches drawing inspiration from the quill would be particularly useful for developing surgical staples among other medical products.
One of the major advantages of the Surgical stapler: Closing wounds with surgical staplers result in minimal scarring and is also the most sterile method of suturing. Being made of stainless steel, staples are biologically inert, thereby drastically reducing the possibility of an infection. Staples are also easier and quicker to apply and remove. And also, removal of staples are a relatively painless process.
Thus, Surgical staples have become of the essential components of modern day surgery and is generally preferred over other suture methods especially if the cut is wide and large.
(The author is Director – Orthopaedics and Head – Hand & Shoulder Surgery, Max Hospital, Gurgaon & Max Smart Super Specialty Hospital, Saket. Views expressed are personal and do not reflect the official position or policy of the FinancialExpress.com.)