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Time savings potential for stapler device is technique- and patient-dependent

Article-Time savings potential for stapler device is technique- and patient-dependent

Key iconKey Points

  • The Insorb Stapler is a single-use, disposable device.
  • There is a learning curve for the stapler device and the technique itself, as well as for selecting ideal candidates and surgical procedures.

The single-use, disposable Insorb Subcuticular Stapler is used to close an abdominoplasty (left); same-day results shown (middle) and results 10 days post-op (right). (Photos courtesy of Incisive Surgical, Plymouth, Minn.)
NATIONAL REPORT—Surgical tools that could minimize anesthesia time, help improve aesthetic appearance of scars, and possibly reduce potential intra-operative sequelae would be attractive to many physicians, and the Insorb Subcuticular Skin Stapler (Incisive Surgical, Plymouth, Minn.) may provide these benefits, when used appropriately.

The Insorb Stapler is a single-use, disposable device. The staples are composed of a poly-lactic acid/poly-glycolic acid (PLA/PGA) copolymer; staples are delivered via the Insorb Stapler using forceps. The staples, placed through a tissue path created by two surgically sharpened needles, securely fasten the approximated edges of tissue. Over the course of a few months, the body absorbs them via a process of hydrolysis.

Peter A. Vogt, M.D., F.R.C.S., in private practice at Plastic Surgery Center, Wayzata, Minn., has been using the subcuticular stapler for about two years. "I have found it to be a real benefit for specific types of cases," he says, explaining that the thicker the skin, and the thicker the subcuticular layer and the fat underneath it, the better the surgical candidate. "I use the subcuticular staples primarily on abdominoplasties, abdominal contouring, and mastopexies. I'm very careful only to use it on those cases where the available tissue is thick." BENEFITS & CAUTIONS

Robert T. Stroup, M.D., F.A.C.S., chief of plastic surgery at Hillcrest Hospital, Cleveland, Ohio, and private practitioner at Advanced Concepts in Plastic Surgery in South Euclid, Ohio, says he sees both potential pros and cons to the new device.

"The main advantage to using this device would be a significant time savings," he says. "There is less anesthesia time and, therefore, this is safer and less costly for the patient."

Dr. Vogt
At the same time, however, Dr. Stroup points out several device- and technique-related areas of possible concerns, including "the learning curve with the technique of using the device, 'lumpiness' of the staples under the skin [like we see with Lacti-sorb bone screws], long-term outcomes [only short-term results available so far], and limited use in areas where there is a scar, or in complex wounds such as z-plasties, w-plasties [and] 'T'-shaped incisions."

Dr. Vogt agrees and says that, not only is there a learning curve for the stapler device and the technique itself, but also for selecting ideal candidates and surgical procedures.

"Initially, it was a little bit like if you have a hammer in your hand," he explains, then "the whole world looks like a nail." But his two years of experience have provided valuable insights with regard to technique and candidate selection. "Because of the nature of the staple," he points out, "I think the better use for it is in the thicker subdermal and fatty layer. Very lean patients with low body mass indexes or post-bariatric patients, for example, generally are not good candidates."

In very thin patients, Dr. Vogt says, "The staples may protrude against the skin and possibly erode through the skin before they have a chance to absorb," not only opening an avenue for infection, but causing the patient considerable discomfort as well.

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