Surgery: A Stitch to Save Nine

Suturing, which is the surgical task of sewing together what has been sliced apart, has long required the patient skill of a seamstress. The North American Indians used bone needles and sutures made of sinews. And even today, when surgery is marked by devices as dramatic as mechanical hearts, sewing and tying sutures by hand take up most of the time that a patient is on the operating table.

Moscow’s Research Institute of Experimental Surgical Apparatus and Instruments went to work in the 1950s and devised 20-odd mechanical staplers to suture internal tissues together with stainless steel wires. But few surgeons were ready to drop their deft fingerwork and give the experimental devices a try. Now, almost a decade later, American improvements on Russian designs are beginning to bring automatic suturing into the operating room.

Blood Through Bs. Unlike the Russian inventions, in which staples must be loaded one by one with tweezers, U.S. Surgical Corp.’s more advanced instruments use throwaway, presterilized cartridges. The carefully engineered instruments are lighter and remarkably versatile. They can fire as many as four different sizes of sutures in as many different patterns. The stapler itself looks like a stainless steel monkey wrench with a pistol grip. Setting its minuscule metal staples in suture lines that are doubled for safety, it can clamp together as much as 3½ inches of tissue with a single squeeze of the surgeon’s hand. It can save upwards of half an hour for complicated stomach or lung operations.

Doctors who have worked with the staplers are impressed with their uniform precision and safety even more than their time-saving abilities. The staples are bent by the instrument’s grooved anvil at tolerances of two-thousandths of an inch; their tops are rounded like the letter B so that blood can continue to circulate through the two arches and the sutured tissue will not be squeezed to death. Unlike silk or catgut sutures, which can harbor infection, the stainless steel staples are virtually nonreactive and do not hinder healing.

Filter in the Vein. The possibilities of surgical staplers are not limited to sealing off tissue. One instrument is capable of joining two hollow organs such as the stomach and small intestine, simultaneously cutting the necessary opening between them and stapling them together, in a 5-minute procedure that usually requires 20 minutes or more of scalpel work and stitching. One experimenter with the staplers, Dr. Mark Ravitch of the University of Chicago School of Medicine, has worked out a new way to prevent emboli (traveling blood clots) from passing into the lungs through the vena cava, the body’s largest vein. He simply has the staples turned at right angles to form a filter which can be implanted in the vein swiftly and easily. Used in this manner, the new machines have already graduated from stitchwork repairs to performing some of the most important stages of surgery.