WordNet

a medical instrument for dilating a bodily passage or cavity in order to examine the interior
a mirror (especially one made of polished metal) for use in an optical instrument
attach with a clip; "clip the papers together"
terminate or abbreviate before its intended or proper end or its full extent; "My speech was cut short"; "Personal freedom is curtailed in many countries" (同)curtail, cut_short
the act of clipping or snipping (同)clipping, snip
a sharp slanting blow; "he gave me a clip on the ear"
an article of jewelry that can be clipped onto a hat or dress
any of various small fasteners used to hold loose articles together
performed with great precision; "a surgical air strike"
relating to or requiring or amenable to treatment by surgery especially as opposed to medicine; "a surgical appendix"; "a surgical procedure"; "operative dentistry" (同)operative
of or relating to or involving or used in surgery; "surgical instruments"; "surgical intervention"

PrepTutorEJDIC

『紙ばさみ』,クリップ;留める物 / (機関銃の) 挿弾子｛そうだんし｝、弾倉｛だんそう｝　…'を'『はさむ』,はさんで留める
(はさんで)…'を'『切る』,切り取る / 〈羊毛・頭髪・庭木・芝など〉'を'刈り込む;〈ヒツジ・ウサギなど〉‘の'毛を刈る / …'を'短くする,切りつめる / 《話》…'を'バチンとひっぱたく / 切る;刈り込む / 《話》す早く進む,すっ飛ばす / (頭髪・羊毛などを)刈り込むこと,切り取ること;刈られた物,刈り取った羊毛 / 《複数形で》刈り込みばさみ / 《話》鋭い一撃 / 《話》速度 / 《米話》1回,1度
外科の;手術用の / 《名詞の前にのみ用いて》(衣服などが)整形用の
centiliter[s]

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/04/12 11:44:24」(JST)

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34 surgical staples due to Craniotomy

X-ray of surgical staples

Surgical staples are specialized staples used in surgery in place of sutures to close skin wounds, connect or remove parts of the bowels or lungs. A more recent development, from the 1990s, uses clips instead of staples for some applications; this does not require the staple to penetrate.

Stapling is much faster than suturing by hand, and also more accurate and consistent. In bowel and lung surgery, staples are primarily used because since staple lines are more consistent, they are less likely to leak blood, air or bowel contents, still, several randomized controlled trials have shown no significant difference in bowel leakage after anastomoses performed either manually with suture by experienced surgeons, or after mechanical anastomoses with staples. In skin closure, dermal adhesives (skin glues) are also an increasingly common alternative.

History

Staplers were originally developed to address the perceived problem of patency (security against leaks of blood or bowel contents) in anastomoses in particular. Leaks from poor suturing of bowel anastomoses was at that time a significant cause of post-surgical mortality. More recent studies have shown that with current suturing techniques there is no significant difference in outcome between hand sutured and mechanical anastomoses, but mechanical anastomoses are significantly quicker to perform.^[1]

The technique was pioneered by a Hungarian surgeon, Humer Hultl,^[2] known as the "father of surgical stapling".^[3] Hultl's prototype stapler of 1908 weighed eight pounds (3.6 kg), and required two hours to assemble and load. Many hours were spent trying to achieve a consistent staple line and reliably patent anastomoses.

The early instruments, by developers including Hultl, von Petz, Friedrich and Nakayama, were complex and cumbersome to use. The technology was refined in the 1950s in the former Soviet Union, allowing for the first commercially produced re-usable stapling devices for creation of bowel and vascular anastomoses.^[4] Mark M. Ravitch, brought a sample of stapling device after attending a surgical conference in USSR, and introduced it to entrepreneur Leon C. Hirsch, who founded the United States Surgical Corporation in 1964 to manufacture surgical staplers under its Auto Suture brand.^[5] Until the late 1970s USSC had the market essentially to itself, but in 1977 Johnson & Johnson's Ethicon brand entered the market and today both are widely used, along with competitors from the Far East. USSC was bought by Tyco Healthcare in 1998, which became Covidien on June 29, 2007.

Safety and patency of mechanical (stapled) bowel anastomoses has been widely studied. It is generally the case in such studies that sutured anastomoses are either comparable or less prone to leakage.^[6] It is possible that this is the result of recent advances in suture technology, along with increasingly risk-conscious surgical practice. Certainly modern synthetic sutures are more predictable and less prone to infection than catgut, silk and linen, which were the main suture materials used up to the 1990s.

One key feature of intestinal staplers is that the edges of the stapler act as a haemostat, compressing the edges of the wound and closing blood vessels during the stapling process.

Types and applications

Laparoscopic cholecystectomy.

Close-up demonstration of a surgical skin stapler.

The first commercial staplers were made of stainless steel with titanium staples loaded into reloadable staple cartridges.

Modern surgical staplers are either disposable and made of plastic, or reusable and made of stainless steel. Both types are generally loaded using disposable cartridges.

The staple line may be straight, curved or circular. Circular staplers are used for end-to-end anastomosis after bowel resection or, somewhat more controversially, in esophagogastric surgery.^[7] The instruments may be used in either open or laparoscopic surgery, different instruments are used for each application. Laparoscopic staplers are longer, thinner, and may be articulated to allow for access from a restricted number of trocar ports.

Some staplers incorporate a knife, to complete excision and anastomosis in a single operation. Staplers are used to close both internal and skin wounds. Skin staples are usually applied using a disposable stapler, and removed with a specialized staple remover. Staplers are also used in vertical banded gastroplasty surgery (popularly known as "stomach stapling").

Vascular stapler for reducing warm ischemia in organ transplantation. With this model each stapler end can be mounted on donor and recipient by independent surgical teams without care for reciprocal orientation, being the maximal possible vascular axis torsion ≤30°. Activating guide-wire is connected just immediately before firing (video)

In spite of intensive research ^[8]^[9]^[10] circular staplers for vascular anastomosis never had yet significant impact on standard hand (Carrel) suture technique.

Although most surgical staples are made of titanium, stainless steel is more often used in some skin staples and clips. Titanium produces less reaction with the immune system and, being non-ferrous, does not interfere significantly with MRI scanners, although some imaging artifacts may result. Synthetic absorbable (bioabsorbable) staples are also now becoming available, based on polyglycolic acid, as with many synthetic absorbable sutures.

Titanium staples are never solely titanium; they all have some amount of nickel content.

References

^ Suregery Today, Volume 34, Number 2 / February, 2004
^ Non-suture methods of vascular anastomosis, British Journal of Surgery, 19 Feb 2003: Volume 90, Issue 3, Pages 261 - 271
^ Circular vascular stapling in coronary surgery, Konstantinov, Annals of Thoracic Surgery, 2004; 78: 369-373
^ [1]
^ History of United States Surgical Corporation
^ e.g. Stapled versus Sutured Gastrointestinal Anastomoses in the Trauma Patient: A Multicenter Trial, Journal of Trauma-Injury Infection & Critical Care. 51(6):1054-1061, December 2001.
^ European Journal of Cardio-Thoracic Surgery, Volume 25, Issue 6, June 2004, Pages 1097-1101
^ Proceedings of the 4th Annual Meeting of The Association for Cardio-Thoracic Surgery, Naples, Sept 16-19, 1990
^ J Cardiovasc Surg (Torino). 2007 Oct;48(5):659-65.
^ Eur J Vasc Endovasc Surg. 2007 Apr;33(4):408-11. Epub 2006 Nov 28

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Japanese Journal

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リンク元	「止血鉗子」「speculum」「surgical equipment」「surgical instrument」「trocar」
関連記事	「clip」「CLIP」「surgical」