The Telegraph
Since 1st March, 1999
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Staplers, not sutures, in bypass success

Doctors in Calcutta took the initial step towards making robotic surgery a reality, when they successfully used staplers, instead of conventional stitches, for the first time in a bypass grafting surgery case a few days ago.

This is the first successful bypass surgery in eastern India without using the usual suture and needle, and only the second such case in India. The first was conducted in a Hyderabad hospital a few weeks ago.

Normally, it takes eight to 10 minutes to stitch a graft through the conventional procedure, but with the staplers — or automatic anastomotic devices — the stitching time has come down to a minute. So, the duration of a bypass surgery, too, has come down from four hours to an hour and a half, with greater accuracy.

These surgeries are particularly advisable for elderly patients, who tend to have high calcium deposits in the body and are prone to strokes, paralysis and lung complications, which can be further aggravated from errors in stitching during the bypass surgery.

The stapler, or the aortic connector, is a mechanical anastomotic device that allows cardiac surgeons to attach vein grafts from the leg to the aorta without sutures. The device is simple to use and is complete in seconds. It also provides surgeons with a precise and reproducible stitching device without any cross-clamping or side-biting, say doctors.

The inferior-quality staplers of earlier times made watertight stitches impossible, which delayed their entry in cardiac surgery. Recently, the Food and Drug Administration of the US approved the use of staplers in cardiac surgery. There have been reports of excessive bleeding, paralysis and stroke, along with lung complications, in conventional stitching in bypass grafting at times.

“The use of staplers standardises the quality of stitches. Everything falls into place automatically and there are no complaints. There are chances that bits of calcium deposit may enter the blood vessels, which increases chances of brain complications in conventional stitching, but with staplers being used, one can eliminate errors and complications to a great extent,” says cardiac surgeon Ajay Kaul, who performed the first surgery of this type with his team on a patient at B.M. Birla Heart Research Centre a few days ago.

The patient, Lt-Colonel S.N. Ghosh, did not have a clue that his name would be written in the record books, when the medical board at the heart research centre decided to use staplers for the first time, instead of sutures.

“His was a perfect case, as he had associated brain complications too. The surgery was completed in an hour and a half, surprising many,” added Kaul. Earlier, doctors tried out the stapler for tests on an animal aorta to make sure that it worked perfectly.

Abhijit Banerjee, sales and marketing manager of St Jude Medical (Hong Kong), which markets these special staplers in India, at an estimated cost of Rs 22,000, feels that staplers would be used in almost all heart surgeries in the next five years. “This is the second case in India, but we feel that people are, slowly but surely, looking at error-free quality surgery in less time, which can be now possible,” Banerjee said.

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