Surgical Staplers: The History of Conception and Adoption.

The paper explores not well-known aspects of the development of surgical staplers. It is based on the review of the selected literature. It covers the novel idea of using metal staples that was successfully executed in 1908 by the Hungarian surgeon Hültl, and acknowledges contribution of Soviet specialists to the development of the mechanical suturing devices for many thoracic, abdominal, and vascular procedures. The paper also reflects on an almost detective story of how Ravitch, an American surgeon visiting the USSR in 1957, managed to bring to the United States a Russian stapler, which became a prototype for modern devices.

Mark M. Ravitch: A Staple in Surgical History and Innovation.

Mark M. Ravitch is a surgeon worth acknowledging. He is credited for revolutionizing pediatric surgery as a subspecialty, mastering chest wall deformities and introducing the surgical stapler to the United States, to name a few. Above all, he was a notable leader, teacher, and author. This historical vingette is a brief snapshot of his biography and various achievements.

The History of Surgical Staplers: A Combination of Hungarian, Russian, and American Innovation.

Since their development in 1908, surgical staplers have been used as a method of "mechanical suturing" in efforts to divide hollow viscera and create anastomoses in an efficient and sterile manner. The concept for the surgical stapler was first developed by Humér Hultl, a Hungarian professor and surgeon, and designed by Victor Fischer, a Hungarian businessman and designer of surgical instruments. The design was highly acclaimed; however, it was bulky, cumbersome, and expensive to manufacture. In 1920, Aladár Petz, a student of Hultl, incorporated two innovations to the Fischer-Hultl stapler to create a more lightweight model, which was named the Petz clamp. In 1934, Friedrich of Ulm designed what would be the predecessor to the modern-day linear stapler. In the 1950s, Russian and American staplers began to emerge. Throughout the 1960s, a variety of stapling instruments were developed in the United States, manufactured by the United States Surgical Corporation. In the 1970s, Johnson & Johnson Ethicon brand joined the market. The United States Surgical Corporation was later bought by Tyco Healthcare and became Covidien in 2007. Through the collaboration of Felicien Steichen, Mark Ravitch, and Leon Hirsch, surgical staplers were further modified to incorporate interchangeable cartridges with various designs. With the advent of minimally invasive surgery began production of laparoscopic surgical staplers. Since its inception, the surgical stapler has provided a means to efficiently create safe and effective visceral and vascular anastomoses. The surgical stapler design continues to evolve while still maintaining the basic principles that were implemented in the original design.

Vasilii I Kolesov: a surgeon to remember.

Vasilii I. Kolesov (1904-1992) was one of the pioneers of cardiovascular surgery. He is often referred to as the surgeon who performed the first successful coronary artery bypass operation. Kolesov was the first to successfully apply the suture technique to clinical coronary artery bypass surgery. He was also the first--and remains the only--surgeon to use coronary stapling clinically. Recent rapid development in robotic and video-assisted coronary surgery has revived interest in Kolesov's original work on coronary stapling and off-pump coronary surgery. However, little is known about the personality of Dr. Kolesov, his early work that led to his pioneering effort, and the circumstances under which his work was done.

[History of mechanical sutures in digestive system surgery]. / Storia della sutura con dispositivi meccanici nella chirurgia dell'apparato digerente.

The attempts to suture wounds with mechanical device are very old, and their history is lost in the night of times. But more recently--that means less than two century ago--already before the true initial beginning of the modern surgery, after the birth of anaesthesiology with the "ether day--16 october 1846" there have been many efforts to develop new methods to join the tissue of the gut avoiding the danger of peritoneal contamination. The primitive tools of these ancient stapler were founded on the principle to compress with mechanical devices the two sides of the tissue to join. Very early in the past century, well before the appearance of the antibiotics, in the heart of the old Europe were developed and perfectionated devices able to join the intestinal tissue with metallic stitches: the primitive staplers. But after the end of the second world war the development has become bursting, with the progress of the Sovietic Institute of experimental research on surgical tools of Moscow and then with the mighty initiatives of the industrial power in the USA. The more important progress in this field was founded on the standardization of tools designed to fix metallic stitches on the gut, but very recently there are new attempts to use the more old principle of compression-suture on new basis. The results of this development, essential for modern surgery, are the standardization of the surgical technique, the shortening of operative times, and an important support to the new mininvasive approach to digestive surgery.

[History of healing; wound suturing]. / Geschiedenis van het genezen; de wondhechting.

The history of wound suturing reflects that of surgery itself. In wound treatment, which encloses the technique of suturing as well as suturing materials, wound suturing plays a prominent role. In ancient India, Egypt and the Greek and Roman societies wound treatments as well as suturing techniques and instruments were developed that strongly resemble those in our days. Catgut and silk are known since antiquity. Hardly any progress is noted up to the nineteenth century. The debate on closed or open wound treatment has never stopped. The improvement of catgut by Lister started in 1860. In the 19th century prototypes of mechanical suturing instruments (staplers) were developed. They were introduced into clinical practice in the early decades of the 20th century. The greatest progress in wound suturing started after World War II with the introduction of advanced semiautomatic stapler machinery and with the manufacture of synthetic non-resorbable and resorbable fibres. They have revolutionized surgery and were instrumental in developing new fields (microsurgery).

Review of facilitated approaches to vascular anastomosis surgery.

BACKGROUND: There is an increasing demand for an easier, quicker, less damaging, but reliable procedure to create a vascular anastomosis. This demand is not new but is revitalized by the movement of vascular procedures in various specialties, including cardiac surgery, toward minimally invasive procedures. This article reviews the most important representatives of devices or methods that have been developed in the last two centuries. METHODS: A thorough literature search was performed. The outcome is presented and discussed in four parts: (1) stapling and clipping devices, (2) coupling devices, (3) glues, and (4) laser welding. RESULTS: Stapling devices have not become the standard fashion to create an anastomosis because they are too complicated to use. In selected cases clips have potential in vascular surgery. There is a ring-pin coupling system available that is easy to use and especially suitable for creating an end-to-end anastomosis. The ideal glue is yet to be developed, and the currently available laser welding techniques have to become refined. CONCLUSIONS: It is anticipated that the future lies in hybrid techniques that combine sutures or clips with glues or laser-welding techniques.

Surgical staplers: a review.

For almost two centuries, surgeons have been using mechanical devices to join tissue. One of the most successful methods is that of stapling, which has become very common in more recent times. The range of staplers consists of five established stapler categories (circular, linear, linear cutting, ligating and skin staplers), along with recent variations which lend themselves to minimally invasive surgery. Within each category, several commercial models are available, many of which have their own unique features. The procedures which are enhanced by these instruments are many and varied. Applications have been further expanded and improved by the instrument design developments seen in recent years. This review attempts to present a rationalized overview of the array of stapling instruments, with relevant procedures. The authors believe that surgical stapling may be greatly enhanced by further research and development, taking the instrument designs and procedures further into the realm of minimally invasive surgery.

Stapling instruments for intestinal anastomosis in colorectal surgery.

The circular stapling instrument has had a major impact in the practice of colorectal surgery. Stapling technology was pioneered in the early part of this century and subsequently modified. Russian initiatives led to development of the original circular stapling instrument and further progress has resulted in instruments that are widely available, reliable and totally disposable. Mechanical failure is now rare and malfunction is generally due to operator error. Complications related to the stapling technique are uncommon, although anastomotic stricture may be more frequent than when handsewn anastomosis is performed. A stapling instrument facilitates and may expedite a surgical procedure but it is an adjunct to, and not a substitute for, meticulous surgical technique.

Emprego de grampeadores para anastomose intestinal em cirurgia colorretal / Employment of intestinal staplers in colorrectal surgery

Grampeadores sao instrumentos utilizados na pratica cirurgica, onde grampos colocados em cartuchos sao forcados mecanicamente a assumir a conformacao em B, unindo duas estruturas. Depois de experimentos na Europa Oriental, houve um grande desenvolvimento na Russia, onde nasceram os principais grampeadores que ate hoje utilizamos. Coube aos americanos a divulgacao e padronizacao das tecnicas. O uso dos grampeadores deve obedecer as mesmas premissas empregadas nas suturas manuais. A anastomose deve ser confeccionada com tecnica adequada, sem tensao e tecidos desvitalizados e com boa irrigacao das bordas a serem anastomosadas. Diversos procedimentos cirurgicos em coloproctologia sao descritos com a utilizacao dos grampeadores, sendo que as resseccoes anteriores do reto e as anastomoses ileo-retais com reservatorio ileal sao para nos as indicacoes mais apropriadas. Os diversos estudos realizados mostram que nao ha diferenca entre os indices de complicacao das suturas mecanicas e os das suturas manuais...