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need is accurate deployment of the staple," says Nancy Burden, RN,
manager of ASC quality and education at the BayCare Health System
in South Florida. "When a staple becomes lodged in the gun with a
misfire, the physician wastes time and can become frustrated when
his attention must be directed to the instrument."
As a general rule, to prevent blood leakage in vascular tissue, you
want to use "real small, real tight" staples, says Dr. Renton. For abdom-
inal and bowel stapling, you'll want to use larger staplers so that they
form and meet on the other side of the tissue. "It all depends on how
thick the tissue is that you want to staple," says Ms. Frank. Dr. Renton
prefers to use staplers with different tiers of staple sizes: larger on the
outer edge and smaller on the insider edge. "With tiered staple height,"
he says, "you'll reach the cut end and seal it so it doesn't leak."
Advances in technology
Today's staplers offer greater access to the surgical cavity and let sur-
geons perform more abdominal cases laparoscopically. Ergonomically
designed staplers not only let surgeons reach deeper, but also get better
margins and better anastamosis. "Con-sidering the larger size of the popu-
lation, a stapler of this sort will allow more patients a chance at minimal-
ly invasive surgery," says a nurse manager at a government facility.
Applying mesh to an abdominal defect during an open hernia repair
has been compared to trying to wallpaper your ceiling. Dr. Renton
recently trialed a new stapler that he says improves open hernia repairs.
He says the ergonomically designed stapler lets surgeons reach deeper
into the abdominal cavity to apply tacks uniquely designed to take a bite
of mesh when fired at any angle.
Laparoscopic staplers need to be able to reach and approximate the
tissue intended to be stapled, says Ms. Brunswick. "To get there, the
device needs to be the right length — from pediatric length to
S U R G I C A L S T A P L I N G
