Editor's note: In the history of surgical development, the invention of surgical staplers has a milestone significance. It not only makes the wound suture change from manual to mechanization, simplifies the surgical operation, significantly shortens the operation time, and significantly reduces the chance of tissue damage, bleeding and infection during the operation, but also makes some previously impossible surgical operations possible. , Which brings huge benefits to both doctors and patients. The author of this article summarized and summarized the evolution of surgical stapler products and the research and development progress in related fields, which will help readers understand the development history of surgical stapler products, as well as some trends in surgical clinical technology and materials science.
　　 From prototype to mature
　　 Market growth is considerable
The prototype of 　　 surgical stapler appeared in the 14th century BC. The Arab doctor Albaucasis placed the giant ant on the edge of the aligned wound, causing the giant ant to bite the wound, and then removed the giant ant's body, leaving the giant ant's head to join the wound.
　　 At the beginning of the 20th century, Humer Hultl, a brain-conscious surgeon in Europe, was inspired by a stapler and boldly imagined: Can a surgical stapler similar to a stapler be developed to reduce the time for doctors to stitch wounds? Hultl put this idea into practice, and in 1908 took the lead in developing a medical stapler similar to the working principle of a stapler, and successfully completed the first mechanized surgical operation in medical history in Budapest. Hultl is therefore known as the "father of surgical staplers." According to reports in the literature, the double-row staple B-shaped suture principle followed by this stapler is the same as that of modern surgical staplers. However, it is assembled from a variety of metal parts, has a complex design, weighs up to 8 pounds, and takes more than two hours to install. It is not convenient to use, and it is difficult to promote clinically.
　　 In 1934, Fredrich of Germany developed a surgical stapler with removable and preloaded staples based on the Hultl double-row B-shaped suture principle.
In the 1940s, the former Soviet Union in the war-torn era formulated a plan to solve the shortage of surgeons in the former Soviet Union through the development of surgical staplers, use mechanical stapling devices to quickly shorten the operation time, and use automated operations to ensure surgical results. Not affected by surgeon fatigue. Scientists from the Institute of Experimental Surgical Instruments of the former Soviet Union conducted a systematic study on surgical staplers. In 1951, the institute developed the first vascular stapler. Subsequently, they introduced various surgical staplers such as bronchial staplers and gastrointestinal staplers. Although these products have achieved good results in clinical applications, they still do not get rid of the problems of bulky appearance and time-consuming assembly of staples.
　　 In 1958, the American scholar Ravitch was keenly aware of the prospects for the development of surgical staplers after an investigation at the Institute of Experimental Surgical Instruments in the former Soviet Union, introduced the stapler technology to the United States, and devoted his life to the research and commercialization of surgical staplers. From the 1960s to the 1970s, the research and development of surgical staplers in the United States developed rapidly. The American Surgical Company introduced an automatic suture device. This product introduces a "nail box". Before use, the doctor puts the staples in the staple box and sterilizes them, and only needs to insert the staple box into the stapler during use. The product successfully solved the complicated and time-consuming nailing process, and was quickly approved by the US Food and Drug Administration (FDA), and then quickly occupied the Western market. If the previous stapler is likened to a rifle that needs to be pressed into the bullets before firing, this new type of stapler is like a machine gun that can load the bullets together in the magazine and implement bursts. Its invention has greatly promoted the commercial mass production and widespread use of surgical staplers, and is a milestone product in the history of mechanical suture technology. Later, American medical device manufacturers introduced surgical staplers with double sets of double rows of staples and blades, surgical staplers with double rows of circular staples and blades, and second-use surgical staplers.
　　 It is worth noting that in 1987, Dr. Phililpe Mouret of Lyon, France successfully completed the world's first laparoscopic cholecystectomy, opening a new chapter in minimally invasive surgery. Since then, many stapler manufacturers in the world have devoted themselves to the research and development of minimally invasive surgical instruments. In the 1990s, new instruments such as titanium clamps and various staplers for endoscopic surgery changed the difficult and complicated suture and ligation methods originally used in endoscopic surgery, greatly improving the efficiency of the operation and reducing the difficulty of the operation.
　　 Market growth is considerable
　　 Today, surgical staplers have become quite popular. In general surgery, laryngology, thoracic surgery, plastic surgery and other departments of surgery, doctors can choose mechanical suture instead of manual suture according to the surgical situation.
　 　 The European Association of Physicians recently summarized the main advantages of surgical staplers (compared to manual suturing): First, it is convenient and easy to use, reduces wound suturing time, and greatly reduces the work intensity of doctors. Second, for operations on special organs and locations (such as resection of large intestine lesions, hernia surgery, and inguinal surgery, etc.), surgical staplers can be used to perform accurate, firm and reliable wound joints (these surgical sites are often affected by sports. Conventional catgut suture, the wound is easy to crack). The third is that the joints of mechanical sutures are very tight, which can effectively prevent the leakage of blood and intestinal tissues and other tissues, thereby avoiding accidents such as abdominal organ contamination and inflammation.
　　 The growth rate of the surgical stapler market is also considerable. A report published by the famous American consulting company Frost & Sullivan disclosed that: In recent years, the annual sales of surgical stapler products (including sutures, etc.) in the United States have reached 2 billion US dollars, and it is expected to reach 2.28 billion US dollars in 2011. Although the sales of surgical stapler products in Europe are not as good as those in the United States, they are also around one billion euros.
At present, the surgical staplers on the market mainly include: linear stapler (linear suture of tissue); circular stapler (applicable to cavity surgery); linear cutting stapler; purse-string stapler; skin fascia stapler; larynx Section suture device; special suture device for thoracoscopy; other special suture devices.
　　 Suture nail materials continue to innovate
　　In clinical use, doctors will choose to use different specifications of suture nails according to the patient's surgical site, such as bent nails, round nails, and long and thin special nails for laryngo surgery.
　　 is distinguished from the material of the suture nails. In the 1990s, steel metal nails were commonly used. However, after the wound has healed, the patient has to undergo the pain of a second operation to remove the steel nail. Later, foreign manufacturers developed titanium nails, plastic nails made of inert polymer materials, and wound suture buckles made of highly flexible metals (this kind of suture buckle is also classified as surgical suture nails abroad).
　 　 Among them, the absorbable plastic nail is made of polyethylene glycol acid polymer material, and its rigidity and softness meet the medical regulations. This plastic nail will degrade after being implanted in the human body for a certain period of time, so secondary operations can be avoided. However, the most clinically used surgical staples are still titanium steel nails. Titanium suture nails have high strength and small size, which are inert to the human body and are not easy to cause infection. In addition, when performing CT, MRI and other imaging examinations, doctors can clearly observe the degree of healing around the titanium steel nails, which helps doctors make accurate judgments, which is difficult to achieve with plastic nails. The only disadvantage of titanium steel nails is that a small number of patients will develop allergies. The reason is that trace nickel is mixed in titanium steel, which may cause symptoms such as itching and macula, while titanium itself does not cause allergic symptoms. In recent years, new material science technologies such as nanotechnology have also been used in the development of suture nails.
　　The prospect of independent research and development is broad
　 　 my country began to develop surgical staplers in 1976. Surgical staplers developed in the early stage have disadvantages such as complicated use and maintenance, which limits their large-scale promotion. In 1978, Shanghai Sixth Surgical Instrument Factory successfully developed the first domestic surgical stapler "GF-1 Tubular Digestive Tract Stapler", which was popularized and applied in clinical practice. In the following decades, with the rapid development of my country's national economy, a large number of imported surgical staplers with advanced technology were introduced into the clinic, including surgical staplers of special specifications such as thoracoscopic staplers and laryngeal staplers. Stimulated by imported products, coupled with the huge demand in the domestic market, the development of domestic surgical suture devices has continued to accelerate. At present, domestic research institutions have developed GW series tubular stapler series products suitable for clinical use in my country. These products have reasonable structure and good performance. Compared with a complete set of foreign disposable surgical instruments, some domestic surgical staplers only have the staples as disposable products, and the main body of the instrument can be sterilized and used repeatedly, so the use cost is lower, and it is affected by surgery. Doctor welcome. For the majority of primary medical and health institutions in my country, suture products that are convenient to operate, easy to maintain, and affordable will have a very broad market prospect.
  Key words
　　 surgical stapler
The working principle of the 　　 surgical stapler is somewhat similar to that of a stapler, that is, two rows of interlaced suture nails are fired into the tissue to carry out double-row cross-stitching to the tissue. The suture is tight to prevent leakage. Since small blood vessels can pass through the gaps of the B-type staples, it does not affect the blood supply of the suture and its distal end. Because the suture nails are arranged neatly and spaced equally, the tightness of the suture is controlled by the ruler, thereby avoiding the uneven density and tightness of the manual suture, and ensuring the healing of the tissue.
　 　 The main components of modern surgical staplers include nail drill, nail cartridge, nail cartridge, suture driver, firing handle, positioning needle, knob and marker ruler. In order to remove excess tissue and create round end-to-end anastomosis and side-to-side anastomosis, some surgical staplers are also equipped with various knives, such as ring knives, push knives, etc. The surgeon must use these components according to certain operating procedures to ensure that the tissue suture is completed quickly and accurately