From Big Medical Encyclopedia

STAPLERS — devices for mechanical connection of bodies and fabrics at surgeries.

The earliest data on the devices allowing to mechanize process of imposing of surgical seams belong to the end 19 — the beginning is 20 century old. The first stapler was offered by Zhannel (M. to Jeannel) in 1904. Afterwards Hyultl (H. Hultl, 1908) created the device, to-ry sewed fabrics brackets from a German silver, and Gunn (F. Hahn, 1911) — the device stitching fabrics a chain of silk seams. In Russia N. Stakhovsky in 1907 described a method and special tools for sewing together of fabrics the P-shaped metal brackets offered by the fr. surgeon P. Michel and emphasized prospects of this method. Attempts to develop and apply more perfect S. and., with use of a soft suture material, were not crowned with success whereas the devices for stitching by means of metal brackets differing in relative simplicity of a design and comparative reliability of formation of a seam gained further development. But also they did not find broad application, except for Pets's device (A. Petz, 1924) and its modifications.

The new stage in development sewing technicians was marked by opening of a way and creation of the device for sewing together of blood vessels. In 1945 the Soviet engineer V. F. Gudov with group of doctors and engineers: P. I. Androsov, M. G. Akhalaya, H. N. Kapitanov, L. I. Kukushkin, N. P. Petrova, A. A. Strekopytov, etc. for the first time in the world designed and used the angiorrhaphy device in clinic, for creation to-rogo his authors awards were conferred in 1951 State. Further in scientific research institute of the experimental surgical equipment and tools (nowadays All-Union research and test the in-t of the medical USSR M3 equipment) developed a row C. and., original on a design and a technique of use: for sewing together of vessels to dia. from 1,5 to 20 mm (ASTs), for the sewing together of bronchial tubes (STBT), the closure of a bronchial stump (CBS), a root of easy (UKL), fabric of easy (UTL), a stump of a stomach (UKZh), for the suturing intestines (SI), for the imposing went.-kish. anastomosis (IW.K.A), etc. S. I. Babkin, B. S. Bobrov, Yu. Ya. Gritsman, T. V. Kalinina, V. S. Kasulin, etc. are developed devices for imposing of an anastomosis went to surgeries. - kish. a path, gained recognition at us and abroad. Achievements of the Soviet science in S.'s creation and. promoted development of these devices and pix to production in other countries (the USA, Japan, etc.). Amer. by firms in the USSR licenses for production of a number C.

of ampere-second purchased. and. happen single-staple and mnogoskobochny; for imposing of linear, circular, oval and other seams with a longitudinal, transversal and inclined run of stitches concerning a suture line; for imposing of one-storey and two-storeyed submersible seams; single-step, section or consecutive sewing together; with a knife for a section of fabrics, with the fixing device for connection of the device with fabric or walls of body for the period of stitching and other auxiliary devices; with lever, screw, maple and other drives of the sewing mechanism. The listed types C. and. do not exhaust possible design, functional and operational features of the devices caused by abundance of techniques of imposing of surgical seams and a variety of conditions of carrying out operations.

S. are most widespread and., the connecting fabrics by means of P-shaped brackets. Originally applied tantalic brackets; then brackets began to make from alloy 40 KXHM (40% of cobalt, 20% of chrome, 16% of nickel, 7% of molybdenum, etc.).

Fig. 1. Scheme of sewing together of fabrics metal brackets: and — the sewed fabrics are compressed between shop and a matrix; — the bracket is pushed out by a pusher from shop, puncturing fabrics; in — a bracket, having got the ends of legs to holes of a matrix, it is deformed and sews fabrics; 1 — a matrix; 2 — holes; 3 — the sewed fabrics; 4 — shop; 5 — a bracket; 6 — a groove; 7 — a pusher (the arrow showed the direction of its movement).
Fig. 2. Options of mechanical sewing together of fabrics brackets: and — during the imposing of the covering blooming stitches; — at sewing together of fabrics end-to-end; in — during the imposing of stitches with introduction to fabrics of needle matrixes; — during the imposing of stitches by deformation of a back of a bracket (the dotted line designated the initial position of a pusher and bracket): 1 — a matrix; 2 — a vessel; 3 — a flute; 4 — shop; 5 — a pusher (the arrow showed the direction of its movement); 6 — a bracket (stitch); 7 — the sewed sites; 8 — needle matrixes; 9 — legs of a bracket; 10 — a back of a bracket; 11 — a basic pad.

The scheme of imposing of the elementary seam by means of brackets is submitted in fig. 1. The majority used for this S. and. consist of a matrix with two holes, shop with a groove for installation and the direction of a bracket and a pusher. The sewed fabrics which are previously compressed between shop and a matrix are punctured legs of a bracket, to-rye, having got the ends to holes, are deformed and, forming a stitch, connect fabrics. The form of a stitch along with other factors depends on distance between shop and a matrix (a gap of the sewing together) established according to thickness of the sewed fabrics and the size of a bracket (height of a bracket of the majority of devices from 1,3 to 20 mm, width from 1 to 25 mm; to dia. wire from 0,1 to 1,5 mm). At the maximum gap of sewing together apply so-called. An au-about-different form of a stitch, on the minimum gap — In-shaped or with a ring-shaped bend of legs. Various options of mechanical sewing together of fabrics are presented by brackets in fig. 2. Applied the covering blooming stitches to sewing up of vessels (fig. 2, a).

Edges, a breast, etc. are sewed end-to-end (fig. 2. б). For this purpose the sewed sites press to each other cuts and squeeze between shop and a matrix so that the surface of contact of cuts was located between holes of a matrix. At sewing together of bone fragments of various thickness and a difficult profile use a combination of replaceable straight lines and inclined matrixes (device SRKCh-22). For sewing together of fabrics use also matrixes in the form of the pair getting divorced curved needles (SB-2 device) with flutes for the direction and deformation of legs of a bracket (fig. 2, c). Feature of a way is that at sewing together of a needle can be entered directly into fabrics, providing their fixing and a possibility of approach to them only on the one hand.

In zaruzhebny devices for sewing together of skin and a fascia, napr, in the device SFS (USA), sewing together by brackets is carried out without matrix by deformation of a back of a bracket (fig. 2, d) that provides a possibility of approach to fabrics on the one hand; however the additional fixing tool is necessary for rapprochement of the sewed sites.

Also ways of mechanical compound of fabrics and bodies are known for clip-on earrings, rings (see. Cliping of vessels ) etc.

Fig. 3. Types of the mechanical seams applied at sewing up of bodies (a, c) and during the imposing of an anastomosis (d, e, g): and — two-row with a longitudinal arrangement of stitches; — single-row with the transversal run of stitches; in — two-storeyed submersible; — circular turned out; d — linear screwed; e — circular screwed; — linear turned out; shooters specified seams.

Techniques of imposing of surgical seams by means of S. and. are various. At sewing up of tissues of lung, vessels, guts, a stomach and other bodies apply the two-row seam with a longitudinal arrangement of stitches (fig. 3, a) which is carried out by U 0-60, MOUSTACHE-CRAW, U G-70 devices; at sewing up of bronchial tubes — the one-row suture with the transversal run of stitches concerning a suture line (fig. 3,6) which is carried out by the UB-40 device. For a gastrorrhaphy a linear two-storeyed submersible seam (fig. 3, c) S. and. the UKZh-8, UTO-70 type are supplied with the fixing adaptation and a pogruzhatel, with the help to-rykh make invagination of the first floor of a seam, and then put the serous and muscular immersing stitch. Sewing together of vessels the end in the end is carried out the circular seam which is turned out in the form of a cuff (fig. 3, d). For imposing of such seam shops and matrixes of angiorrhaphy ASTs-4 devices have demountable plugs according to diameter of the sewed vessels. There are devices for sewing together of vessels the end sideways, a vshivaniye of «patch» in defect of a vascular wall, etc. During the imposing went. - kish. and an interintestinal anastomosis of a wall of bodies sew a side sideways the linear screwed seams (fig. 3, e). Imposing of two rows of skobochny seams is carried out after introduction of the sewing part of the device NZhKA-60 to a cavity of bodies, and a section of walls between ranks from within make for formation of an anastomosis by means of the knife which is built in the sewing part. Bodies went. - kish. a path sew also circular screwed seams (fig. 3, e), to-rye carry out by means of SPTU, SK-28 devices. For imposing of an intestinal anastomosis also S. use and. SK-60 type. Imposing of the linear turned-out seam (fig. 3, g) is made without disclosure of a cavity of the connected bodies in the course of operation and without introduction to their cavity of the sewing part C. and., what raises an aseptichnost of operation.

Broad use of S. and., especially in chest surgery and in surgery of a digestive tract, is a consequence of a number of advantages of a mechanical seam before traditional manual with use of silk, a catgut and other threads. Brackets from tantalum and alloy 40KXHM cause the minimum fabric reaction, have no absorbenc. At a mechanical seam in comparison with manual smaller traumatization of the sewed fabrics is noted; this seam provides uniformity of an arrangement of stitches and compression of fabrics on all suture line, a possibility of regulation of extent of compression of fabrics in stitches and achievements thanks to it to the necessary density of compound of fabrics, and also good blood supply in a zone of a seam. Mechanical seams allow to compare precisely edges of the sewed bodies and provide uniform optimum distance from the line of a cut of fabrics to a seam thanks to what favorable conditions for an angenesis are created. Are important a possibility of reduction of a loss of blood at S.'s use and., increase in an aseptichnost of operation, considerable reduction of time of stitching and carrying out operation in general.

By 1983 the medical industry of the USSR released St. 40 samples of staplers; nek-ry of them are provided in the table.


Bibliography: E. M. entrenchments and P about with t of au l about in P. M. Staplers for imposing of an anastomosis in gastrointestinal surgery, the Medical equipment, No. 5, page 24, 1981, bibliogr.; E. M. entrenchments, Captains of H. N and Streko-pytov A. A. Design and functional features of an ushivatel of UG-70, in the same place, page 48, bibliogr.; And N d r au-au about in P. I. Surgical staplers and their clinical use, M., 1971, bibliogr.; B about at sh JI. To. and d river the Device for mechanical sewing together of a bone tissue, the Medical technician, No. 4, page 52, 1974; Danilov M. V., etc. A stapling machine for a papillosfinkteroplasti-ka, in the same place, No. 5, page 51, 1981; Kalinin T. V. ikasulin B.C. Use of the devices PKS-25 and KTs-28 in surgical practice, M., 1968; Captains of H. N and Petrova N. P. New generation of staplers, Medical technician, No. 5, page 20, 1981; M and I am V. S. t and d river. Resection of a stomach and gastrectomy, page 160, M., 1975; Mechanical seam in surgeries, the Index of literature in Russian (1950 — 1979), sost. A. A. Krapivkin pi other, Kharkiv, 1981; Piruzyanl. And., etc. About some patterns of processes of squeezing and an angenesis during the formation of a «seamless» anastomosis of hollow bodies of a digestive tract, Izv. Academy of Sciences of the USSR, it is gray. biol., No. 1, page 13, 1979; Revelries M. M. Apparat for sewing together of blood vessels, Surgery, No. 12, page 93, 1978; Stakhov-with to and y N. Metal seam and Ligature, Doctor, gas., No. 33, page 907, 1907; Surgical staplers, under the editorship of Yu. Ya. Gritsmana, M., 1967, bliogr.; Inokuchi K. Kusaba A. Alternative device for vascular stapling anastomosis, J. cardiovasc. Surg., v. 15, p. 458, 1974; J e a n n e 1, Des ligatures et sutures metalligues perdues, Arch. prov. Chir. (Paris), t. 13, p. 385, 1904; R a-v i t with h M. M. a. S t e i with h e n F. M. Technics of staple suturing in the gastrointestinal tract, Ann. Surg., v. 17 5, p. 815, 1972; they are e, A stapling instrument for end-to-end inverting anastomoses in the gastrointestinal tract, ibid., v. 189, p. 791, 1979; Rubio P. A. a. Farrell E. M. Pulmonary resections with staplers, Int.Surg., v. 64, p. 13, 1979, bibliogr.

E. M. Akopov.