Staple line leaks are often deadly. Literature shows leak rate ranges between 1% to 5% depending on specialty, centre and surgeon. But the real number, I suspect, is way higher than that across the general population of patients, specialties and surgeons. In fact there is lots of data and clinical trials that support this. A simple review of the FDA Maude database some years ago resulted in a reclassification of surgical staplers. Why - Because the impact of a leak can be fatal, with a Clavien-Dindo grade II or higher complication attributed to stapler issues.
One of the challenges with stapler leakage is that the root cause of any individual’s leak can be varied and often multi factorial. From user technical errors to underpinning biological factors of the patient.
We also have to consider the usage of the stapler (Transection vs anastomosis) the procedure the stapler is being used in (Thoracic is very different to bariatric is very different to colorectal) plus the co morbidities of the patient, and of course the general use of good surgical technique that sets the surgeon up for good stapler use.
In the early 90’s I spent much of my time helping run stapling courses with some of legends of "good surgical technique" - and we diligently followed the principals of Halsted. “In 1887, Halsted stated the basis for a safe anastomosis: gentle handling of tissues, meticulous hemostasis, preservation of blood supply, strict aseptic technique, minimum tension on tissues, accurate tissue apposition, and obliteration of dead space.(NIH).”
Still today these sound principals hold true. Yet I see that many surgeons (seems to be more nowadays) do not adhere to all of these principals. Instead many (especially younger surgeons) seem to have a false belief that it is all in the stapler… so therefore “Fire and forget.” That can be a fatal assumption.
In my mind there has been too much attention on “automation” of the firing cycle and a loss of the “art” of stapling. In a great part I do feel this is down to a commoditisation of staplers, poor marketing messages, the withdrawal of support of stapling workshops and many great surgeons hitting retirement and so that tribal knowledge is being diluted or lost.
But as with most modern surgery - technology actually can play a part in ensuing that the “art” can be assisted by “The science”. So today I’m not going to go too deep into good surgical technique and review what anyone with Google or Chat GPT could research in ten minutes. Instead I’m going to talk emerging tech that is here, and coming, to assist surgeons in achieving better stapling in both transection and anastomosis.
I want to move the thinking away from "the stapler" in itself and propose a discussion about my concept of 360' technological support around stapling: that I believe is the future of stapling. A move from "surgical staplers" to a holistic "Stapling support architecture."