SURGICAL STAPLERS

SURGICAL STAPLERS
Kelley Thieman DVM, MS, DACVS-SA
Texas A&M University, College Station, Texas
Key Points:
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Stapler types
Stapler details
Stapler sizes
Surgical stapling devices are available for many applications in veterinary medicine.
Types of surgical staplers available include the thoracoabdominal stapler, gastrointestinal
staplers, circular staplers, ligating dividing stapler, vascular clips and skin staples (pictured
below). These devices can be used for various procedures and are available in multiple sizes.
Thoracoabdominal staplers are available in three different widths to accommodate the
width of tissue being resected. These widths are 30, 55, or 90mm. In addition to width, the
staple size varies. The staple size will be selected based on the size of the vessels and tissues that
the surgeon wishes to occlude. The white cartridge fires three rows of staples that close to
1.0mm. This white cartridge is only available in a 30mm width and is considered to be a
vascular cartridge (V3). The blue cartridge fires two rows of staples that close to a height of
1.5mm and is available in all three widths (30, 55 and 90mm). The green stapler is the largest
with staples that close to a height of 2.0mm and is available in all three widths (30, 55 and
90mm).
Several types of gastrointestinal (GI) staplers are available. Two main GI staplers
include the gastrointestinal anastomosis stapler (GIA) and the intestinal linear anastomosis
stapler (ILA). GIA and ILA staplers are made of two limbs that lock together prior to deploying
the staples. In order to use these staplers for anastomosing intestine, each limb of the stapler is
placed into the lumen of the intestine to be anastomosed together. The limbs of the stapler and
staple cartridge are available in different lengths. The GIA stapler comes in 50mm and 90mm
lengths. The staples close to a height of 1.5mm. The ILA stapler comes in 52mm and 100mm
lengths. The staples close to a height of 1.5mm. The 100mm length of the ILA is also available
with staples that close to a height of 2.0mm. The length of the stapler determines how far into
the intestinal lumen the instrument will extend, and how long the resulting anastomosis will be.
If the 50mm stapler length is chosen, each limb of the stapler cartridge will extend approximately
5cm into the lumen. The stapling surface of the instrument is positioned against the
antimesenteric border of the intestine and then the two limbs of the stapler are locked together.
Often, two or more stay sutures placed at the intestinal resection site will facilitate introduction
of the limbs of the stapler into the lumen. Once the stapler is correctly positioned, the stapler is
fired. This stapler fires four rows of staples and cuts down the middle resulting on two rows on
each side. The top of the newly formed anastomosis can be closed with a second GIA stapler or
a TA stapler. These instruments are also available in a version to be used endoscopically.
Circular stapling devices are also used in the GI tract. They are available as a reusable
end to end anastomosis (EEA) or a single use curved end to end anastomosis (CEEA). Both
devices contain staples that close to a height of 2.0mm. The outside diameters available for EEA
are 25, 28.6, and 31.6mm. The CEEA comes in outside diameters of 21.3, 25, 28.7, 21.6, and
34.1mm. Measurements can be made using sizers that can be inserted into the lumen of the
intestine in order to determine the diameter of stapler required. Once the size is determined, the
stapler can be inserted into the lumen through an incision or through a natural orifice (such as the
anus). The ends to be anastomosed are secured to the center rod of the stapling device with full
thickness purse string sutures. The instrument is closed and the stapler is fired to release a
circumferential double row of staples to form a two layer inverting anastomosis. A blade is also
fired to trim redundant tissue from the lumen. If an incision was made for introduction of the
instrument, the defect is closed using a TA stapler or hand suturing.
The ligating dividing stapler (LDS) is used mainly for fast ligation and division of
vessels. The LDS is available in two staple sizes regular and tall. Regular staples close to a
width of 5.33mm and tall staples close to a final closure width of 7.33mm. The LDS only
provides a single staple per side and divides between. If multiple ligatures are required, they
should be placed prior to division with the LDS. Vascular clips are similar to the LDS.
However, the vascular clips are placed one at a time manually and the instrument does not divide
between the two clips. Vascular clips are typically metal clips used for routine vessel occlusion.
Skin staples are possibly the most commonly used stapling devices in veterinary
medicine. Skin staples are available in regular and wide widths. Depending on the
manufacturer, the regular staple widths range from 4.8 to 6.1 and the wide width ranges from
6.5mm to 7.0mm. Skin staples are fast and easy to place.
GastrointestinalAnastomosisStapler(GIA)
ThoracoabdominalStapler(TA)
LigatingDividingStapler(LDS)
EndtoEndAnastomosisStapler(EEA)
photoscourtesyofDr.LauraPeycke
REFERENCES:
Tobias KM. Surgical Stapling Devices in Veterinary Medicine: A Review. Vet Surg 2007; 36:
341-349.

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