Surgical Staplers

Article Overview

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. 

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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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