Question

Dr. William Halsted was a famous surgeon who was the professor of surgery at Johns Hopkins Hospital from 1893 to 1922. He contributed numerous ideas and concepts for Suturing Technique’s used today.

1. Identify his techniques and why they are so important when considering wound closure and wound healing. Your response for this question must be at least 150 words.
2. Identify at least 4 Surgical Staplers used in the past and/or still in use today. Identify when they were first used, why they are used and also a brief description of each stapler. Also include a brief paragraph why staplers are important for wound closure.

Answer 1

William Halsted, M.D. (1852-1922), was an innovative U.S. surgeon who introduced the fundamental surgical principles that bear his name. Halsted was fundamental in the formalization of a training system for surgeons in the United States. He also performed early biliary tract operations, introduced the plate and buried screw technique for long bone fractures and started the practice of operating with rubber gloves.

Halsted's principles, also known as Tenets of Halsted, are the basic principles of surgical technique regarding tissue handling.

• Gentle handling of tissue
• Meticulous haemostasis
• Preservation of blood supply
• Strict aseptic technique
• Minimum tension on tissues
• Accurate tissue apposition
• Obliteration of deadspace

The Halsted suture can be performed both as an interrupted and running inverting suture, which is placed through the subcutaneous fascia and runs parallel to the wound. This creates an inverted edge formation and the ends are tied together. Practically, it is a modification of the Lembert suture (bkz. Lembert suture), which continue to the next leap with an additional circumferential link that supports the suture parallel to the wound.The half-Halsted suturing technique is safe and effective for anastomoses of edematous or hypertrophic small and large bowel.

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, They can close large wounds or incisions more quickly and be less painful than stitches for patients. They are often used in minimally invasive surgery. They can also be used to close wounds in areas where skin is tight against bone, in operations to remove organs or to reconnect parts of internal organs.

HISTORY OF SURGICAL STAPLERS

1880s Reports of first stapler by Dr Henroz- everted bowel anastomosis in dogs.

1908 Professor Humer Hultl with Victor Fischer created a stapler with emphasis of following principles- Tissue compression B-shaped configuration of closed staples placement of staples in double staggered rows use of fine wire as the staple material. But it was heavy and its assembly was difficult and time-consuming.

1921 Aladar von Petz, another Hungarian surgeon, developed a light and easy-to-use version of stapler was more readily adopted.

1934 Dr. H. Friedrich of Germany introduced the first stapling instrument to feature a replaceable, preloaded staple cartridge

1976 Ethicon, Inc. introduces the first completely disposable, single patient use mechanical stapler  1980 The dawn of minimally invasive procedures (MIP). Surgeons request laparoscopic adaptation of Transecting Linear Cutter (TLC) device

1989 Titanium replaces stainless steel as the key component for staples

There are currently two major types of mechanical stapling devices in clinical use for open and laparoscopic surgery: linear and circular staplers.