Skin staplers have gained increasing acceptance in veterinary surgery over the past decade. Their popularity is due to several factors, including:
Link to lookmed
There are a number of companies currently marketing skin staplers for human and veterinary use. There are two basic stainless steel staple sizes that can be purchased: the regular staple (width range from 4.8 to 6.1mm) and the wide staple (width range from 6.5mm to 7.0mm). The length of staple legs varies with individual manufacturers.
Photo 1: Various stapler designs, including fixed and rotating head units. The fixed-head skin staplers are more economical and quite suitable for veterinary use. Note the various grips available.
Most companies sell disposable staplers containing 35 staplers per unit. Although there are several designs on the market, many units have a clear plastic window to visualize the number of staples remaining. A compressible palm grip is more popular than a finger "trigger" to apply the staples into the tissue (Photo 1). All units have a simple arrow or pointer at the tip of the stapler, allowing the clinician to center the stapler directly over the apposed skin margins (Photo 2). Today, most skin staples are extruded in a rectangular shape. As the staple wire is bent against the central anvil, the chisel-pointed tips are directly aligned as they pass through the dermis (Photos 3A and B).
Photo 2: Stapler with a clear plastic window to assess the number of staples remaining in the unit. Note the black guide arrow for alignment over the skin incision.
In skin closure, it is my opinion that the wide staple is the best size to use in the dog and cat. Skin staplers are purchased in sterile pouches for immediate use; incompletely used staplers can be resterilized either with ethylene oxide or the Sterrad Sterilizer (Advanced Sterilization Products, Inc.). The current plastic components in these devices generally cannot tolerate the extreme temperatures generated in the autoclave.
Photo 3A: Staple undergoing deformation as it is forced against the central "anvil"
Many surgeons commonly apply skin staples after an incision is apposed with an intradermal suture pattern. In cases where an intradermal pattern is not necessary or advisable, standard thumb forceps can be used to align, grasp, and slightly elevate the apposed skin borders during application of the staples.
Most veterinary practices used fixed-head staplers based on their significantly lower cost, in comparison to staplers with a rotating head for easier positioning in contoured areas of the body. Several factors are considered prior to the purchase of a stapler, including the cost, overall handling properties, and staple security in the skin. A paper, reviewing various stapler features, outlined the various advantages and disadvantages of six staple models in . Currently, I favor the Davis and Geck Appose ULC 35W. This is the standard skin stapler currently used at the Angell Memorial Animal Hospital.
Photo 3B: Upon competion of the application, the staple disengages from the stapler as the plunger retracts. Again, note the black guide arrow used for alignment of the skin incision.
The "learning curve" for the application and removal of staples is low. The primary problem initially faced by the veterinarian is how much pressure to apply for proper engagement of the staple. Insufficient pressure will result in a staple that stands above the skin without substantial engagement of the dermis. Excessive downward pressure can embed the staple. With tissue swelling, the embedded staple can cut into the skin and make removal difficult and painful to the patient. Because various staplers have different handling features, veterinarians need to adjust the amount of pressure to apply for a given model.
Photo 4A: Example of a skin staple remover. All skin staple removers have a similar design.
Improper alignment of the stapler with the apposed skin margins will result in a staple which does not properly engage one cutaneous border, necessitating its removal. Proper alignment of the "arrow or pointer guide" with the incision line can minimize this problem. These "guide arrows" and their visualization during application differ between manufacturers.
Most staples are extracted with the staple removers provided by the manufacturer. Staple removers grasp and crimp the external staple bar outwards, as the scissors-like handle is closed. The staple remover is lifted to free the staple from the skin surface(Photos 4A and 4B. For removal of one or two aberrant staples, mosquito hemostats can be inserted beneath a skin staple; gently opening the hemostat will spread the staple points apart and the staple can be lifted from the skin.
Photo 4B: The lower "double bar" jaw is slipped beneath the body of the skin staple. Closure of the handles compresses the upper bar against the staple, splaying the staple ends. The closed staple remover is immediately lifted to extract the staple.
Skin staples generally do not engage thin skin particularly well. The thin dermis creates staple instability, thereby allowing the staples to tilt and pivot perpendicular to the skin surface. As a result, the staples do not properly align the skin and their subsequent removal can be difficult. Oftentimes, a mosquito hemostat must be used to grasp the displaced staple. The veterinarian then must elevate and rotate the staple so that a remover or second hemostat can be used to free it from the skin. A second problem has been noted with stapling thin skin (eg, lower abdominal skin in cats, small dogs): rotation of the staple can enable the thin skin to stretch through a gap present between the chisel points of the staple. Dehiscence can be rather immediate (and dramatic) when this occurs along a major segment of a stapled incision. Veterinarians should examine the staples of a given manufacturer closely, to determine the staple shape is uniform and a significant gap is not present in the bent staple (Photo 5).
Photo 5: Close up view of a wide staple. Surgeons should examine the staple gap located between the chisel points. Large gaps increase the likelihood of wound dehiscence, primarily when staples are used on thin skin.
The author has noted that application of a surgical cyanoacrylate glue, over the length of a stapled incision, is very effective in improving the stability and security of skin staples. The glue forms a rigid bond to the staple and outer skin surface, thereby minimizing staple movement. In about one week, the glue has largely fragmented and does not impair the subsequent removal of the staples. The glue also adds an additional "footprint" of security to the stapled incision, further reducing the likelihood of dehiscence.
It is the author's experience that skin staples are not particularly reliable for closing wounds under mild to moderate incisional tension, compared to hand-sutured wounds. Under this situation, a vertical mattress suture pattern, alternated with a simple interrupted suture pattern is preferred. An intradermal suture pattern can give additional support to these problematic wounds. Surgical (cyanoacrylate) glues also can be used in conjunction with conventional suture patterns for additional security.
Photo 6A: Graft application to the inner thigh of a cat. Skin staples greatly facilitated graft alignment and security to the recipient bed.
Skin staples can be used to reinforce a conventional wound closure in danger of dehiscence, or incisions where small gaps are noted. In those cases in which the patient has removed skin sutures, the wound can be lightly prepared with an antiseptic solution, followed by the immediate application of skin staples. In many cases, little or no sedation is required to apply a few supportive staples to the "incision at risk."
Skin staples are a simple and effective method of securing sheet or meshed skin grafts to wounds, especially defects involving the extremities. The prepared graft is applied to the wound, with the graft overlapping the skin bordering the defect by about 1 cm. Graft tension is adjusted as opposing sides of the wound are stapled in an alternate fashion (Photo 6A).
Photo 6B: Staple application to the nonadherent dressing. The dressing was stapled over the graft, thereby preventing its displacement postoperatively. This entire area was then covered with a heavily padded bandage and external aluminum bar (Spica Bandage) to prevent graft motion.
Dressings applied to wounds are occasionally displaced as a result of motion. Ointments or discharge from the wound also can serve as a lubricant, facilitating movement of the contact dressing. Medicated or protective dressings can be effectively secured to a problematic area with skin staples. The author has found this technique particularly useful for coverage of skin grafts. Staples also can be used to secure individual (secondary bandage) bandage layers together for stronger, more cohesive coverage of a given body region (Photo 6B).
Are you interested in learning more about Disposable Skin Staplers? Contact us today to secure an expert consultation!
Closed vacuum drainage systems are comprised of a reservoir to collect body fluids by means of a fenestrated tube placed into the wound or body cavity prior to skin closure. The external tube (nonfenestrated) segment in turn is connected to the reservoir. Strips of surgical tape, applied as small "butterfly" bands to the external tubing, can support its span between the wound and collection reservoir. Skin staples are a simple method of securing the tape strips to the external skin (Photo 7).
Photo 7: Closed vacuum drainage system was inserted into a surgical wound after removal of a vaginal leiomyoma. The external drainage tube was secured to the side of the patient with tape bands and skin staples. The free end of the tube was then attached to the reservoir, secured to the trunk of the patient with adhesive tape.
After removal of a malignant tumor scheduled for future radiation therapy, metallic vascular clips or stainless steel sutures can be applied to the musculofascial tissues surrounding the surgical site. After skin closure, these retained radiopaque markers enable the radiation therapist to better determine the area requiring adjunctive radiation treatment. The author has found that stainless steel skin staples are easier to apply and attached securely to the musculofascial tissues for this purpose. Their biocompatible stainless steel composition permits their burial beneath the skin with minimal risk of tissue reaction.
The use of the smaller, regular-sized staple has been advocated for small intestinal anastomosis. The author has no experience with this specific technique, and cannot comment on its reliability. However, there are other surgical stapling devices, and technique variations that have been proven to be effective both in human and veterinary surgery.
Advances in the surgical staplers market remain significant as continuous technological innovations are intended to improve surgical precision, safety, and outcomes. There is intense competition among the leading manufacturers attempting to outdo one another by introducing electronic, powered, and smart staplers that raise the bar in surgical performance and operational efficiency.
Electronic Staplers are epitomes of precision and automation in a surgical setting. They obviate manual effort in staple placement and cope with differential tissue thickness very adaptively, reducing effort and ensuring consistency in the procedure. They prove very efficient, especially in surgeries where attention to tissue integrity is required since anything other than perfection will indirectly impact the recovery curve for the patient involved. The introduction of smart technology into staplers has been the newest phenomenon of data use in the surgery field. By equipping sensors, staplers allow immediate real-time feedback on tissue properties and force. At the same time, stapling, which can be immediately adjusted during stapling, proves essential in minimizing staple line failures, particularly in the riskiest procedures such as gastrointestinal resections.
Powered staplers mitigate ergonomics issues effectively in surgical processes. These eliminate the physical strain and discomfort of the surgeons, mainly during lengthy technical procedures. This improves the surgeon's performance and reduces the duration and time spent in operation since fatigue-related errors may occur.
The high price, the requirement for high-tech, substantial R&D investments, and the need for advanced materials restrain the market growth. Adding characteristics such as robotic compatibility, intelligent sensors, and advanced precision mechanisms increases manufacturing complexities that carry their price over to the end product. Such a high cost is a significant barrier for most health service providers, especially in highly cost-sensitive markets, including smaller hospitals, clinics, and regions with small healthcare budgets. It is excessively costly for emerging economies, where affordability is critical for any product to become famous. Even in developed markets, cost pressures within healthcare systems and continuous efforts to reduce operational expenditures prevent the adoption of high-cost devices. Although advanced staplers confer clinical benefits, some end users would perceive them as more of a luxury than a necessity, especially when such traditional suturing or simple stapling could be done at much lower rates. Hospital reimbursement policies also hamper the cost-effectiveness of these devices. Many healthcare insurers do not fully reimburse advanced staplers, so the hospital pays for the differential; this insufficient reimbursement is disincentive enough for healthcare facilities to further invest in such devices, limiting their market penetration.
The surgical staplers market ecosystem consists of key manufacturers such as Johnson & Johnson Services, Inc. (Ethicon, Inc.), Medtronic, Lepu Medical Technology (Beijing) Co. Ltd., Intuitive Surgical Operations, Inc., and 3M, driving innovation in surgical solutions. These companies manufacture surgical staplers used in wound closure and complex surgical procedures. Suppliers who support this supply chain include raw material suppliers such as Thermo Fisher Scientific, BASF, Thyssenkrupp, and Avion Alloys, which provide necessary materials needed in the composition of manufacturing materials, including metals and polymers. The end users are leading healthcare providers such as Mayo Clinic, Cleveland Clinic, Massachusetts General Hospital, Fortis, Apollo Hospitals, and Johns Hopkins Medicine. This interconnected network fosters efficiency and growth within the surgical staplers market.
In the Asia Pacific region, the market for surgical staplers is likely to grow at the highest CAGR during the forecast period; this growth can be primarily linked to establishing developed healthcare facilities, which governments in such emerging economies often facilitate. Such developments have made these surgical staplers widely available in hospitals and surgical centers and have thus increased their adoption rates. Local manufacturing ability in China and India has also helped build the market further by giving a cost advantage. Medical devices are manufactured in these nations at cheaper rates, thus making surgical staplers available at comparatively lower prices and more accessible to healthcare providers. Given this scenario of low prices and increasing healthcare infrastructure, surgical staplers have become widely used across the region. Increased awareness among the medical fraternity on the benefits of surgical staplers, such as faster procedure times and reduced risk of complications, led to rising adoption. The increased awareness among healthcare professionals regarding the advantages of surgical staplers and enhanced training programs drive the adoption of advanced surgical staplers in the region. Collectively, these factors broaden the scope of the surgical staplers market in the Asia Pacific and make it a focus of growth for the global market during the coming years.
HIGHEST CAGR MARKET IN - CHINA FASTEST GROWING MARKET IN THE REGIONThis research study involved the extensive use of both primary and secondary sources. It involved the study of various factors affecting the industry to identify the segmentation types, industry trends, key players, the competitive landscape of market players, and key market dynamics such as drivers, opportunities, challenges, restraints, and key player strategies.
This research study involved the wide use of secondary sources, directories, databases such as Dun & Bradstreet, Bloomberg Businessweek, and Factiva, white papers, and companies’ house documents. Secondary research was undertaken to identify and collect information for this extensive, technical, market-oriented, and commercial study of the surgical staplers market. It was also used to obtain important information about the top players, market classification, and segmentation according to industry trends to the bottom-most level, geographic markets, and key developments related to the market. A database of the key industry leaders was also prepared using secondary research.
In the primary research process, various supply side and demand side sources were interviewed to obtain qualitative and quantitative information for this report. Primary sources from the supply side included industry experts such as CEOs, vice presidents, marketing and sales directors, technology & innovation directors, engineers, and related key executives from various companies and organizations operating in the surgical staplers market. Primary sources from the demand side included hospitals, clinics, researchers, lab technicians, purchase managers etc, and stakeholders in corporate & government bodies.
A breakdown of the primary respondents for surgical staplers market (supply side) market is provided below:
Note 1: Companies are classified into tiers based on their total revenue. As of : Tier 1 = >USD 1 billion, Tier 2 = USD 500 million to USD 1 billion, and Tier 3 = < USD 500 million.
Note 2: C-level executives include CEOs, COOs, CTOs, and VPs.
Note 3: Other primaries include sales managers, marketing managers, and product managers.
To know about the assumptions considered for the study, download the pdf brochure
The market size for surgical staplers market was calculated using data from four different sources, as will be discussed below. Each technique concluded and a weighted average of the four ways was calculated based on the number of assumptions each approach made. The market size for surgical staplers market was calculated using data from three distinct sources, as will be discussed below:
The entire market was split up into four segments when the market size was determined. Data triangulation and market breakdown processes were used where necessary to complete the entire market engineering process and arrive at the precise statistics for all segments.
Approach to derive the market size and estimate market growth.
Using secondary data from both paid and unpaid sources, the market rankings for the major players were determined following a thorough analysis of their sales of surgical staplers. Due to data restrictions, the revenue share in certain cases was determined after a thorough analysis of the product portfolio of big corporations and their individual sales performance. This information was verified at each stage by in-depth interviews with professionals in the field.
Surgical staplers are a type of specialized medical device that could be used during surgery to close wounds or to remove or separate tissues. Stapling is generally faster and more accurate than suturing because staple lines are both more uniform and less likely to bleed or experience air leaks. These devices can either be hand-powered or battery-powered.
If you want to learn more, please visit our website Surgical Instruments Wholesale.