(About Staplers and Clips)
Instrument usage: Surgical staplers are used to resect part of an organ, transect tissue, and anastomose structures.1 Surgical staplers can be reusable, partially reusable, or disposable. The staples are commonly made of titanium, stainless steel, or absorbable material.2 The staples are nonreactive and permanently remain in the body.1 The stapler can place one or multiple rows of staples in a straight or circular pattern, and can cut and anastomose.1 The use of staplers significantly decreases operating time and can shorten length of stay for the patient.1 Surgical staplers are used in gastrointestinal, gynecologic, and thoracic procedures, and many other surgical specialties.1
Clips are used to occlude blood vessels, nerves, and other small structures, or to mark tissue.1,2 Clips are single staples that can be placed using a preloaded multiple clip applier or a single clip applier.2 Clips are small V-shaped staples made of stainless steel, titanium, or synthetic absorbable suture material.1
Key differences:
Staplers can be circular, curved, endo-GIA, end-to-end anastomosis, linear, open, or laparoscopic stapler.1
Terminal end staplers are L-shaped and are made to be positioned across the end of a hollow organ, such as bowel or stomach. Some can have ends that articulate to get into a specific area.1
Internal anastomosis staplers are straight, with two parts that are made to connect segments of a hollow organ to make a pouch or reservoir.1 The two tube-shaped organs are aligned next to each other and one side of the stapler is positioned in each opening. When the instrument is fired, the tubes are stapled along the adjoining lengths and an internal knife blade cuts between the two sets of double staple lines, which creates a longitudinal opening on the inside of the anastomosed organ segments.1
End-to-end circular staplers are long and are designed to staple two hollow, tubular organs to each other to create a continuous circuit.1 The ends of the tubular organs are positioned over the distal and proximal tips of the stapler and are secured with a suture, then the end of the stapler is closed, with the tissue of the tied ends completely in the stapler, a double row of staples is fired in a circle, and a circular knife trims the excess rim of tissue from the ends of the tubular organs.1
Clips can be manual or powered and are available in multiple sizes.2
Safety on the sterile field:
Reusable staplers have many moving parts that must be assembled prior to use on the sterile field.2 It is important for the scrub personnel to know how to proficiently assemble the reusable stapler so that it works properly.
Disposable staplers come completely assembled2 and only need to have the staple cartridge replaced for multiple uses.
The cartridge for both reusable and disposable staplers are disposable. It is important to keep track of how many times the disposable stapler is fired, since the device has a limit set by the manufacturer. The cartridges should be a counted item when doing surgical counts.
After a stapler or clip applier is used, the surgeon will most likely ask for a scissor or a cautery, if the stapler or clip does not have a cutting component within the device.
When using an end-to-end circular stapler, it is important to retrieve the tissue that is left in the stapler for pathology.1
It is important to pass the correct stapler with the correct staples or clip depending on the tissue that is being stapled or clipped.
Instrument names:
The stapler or clip is most often simply called “stapler” or “clip.” They may also be called by their style or by the manufacturer’s name.
References:
1. Rothrock, Jane C. Alexander's Care of the Patient in Surgery-E-Book. Elsevier Health Sciences, 2018.
2. Phillips, Nancymarie. Berry & Kohn's Operating Room Technique. Elsevier Health Sciences, 2016.