History of Surgical Stapling (3)

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A Moment in History

William S. Halsted, MD
(1852 – 1922)

American anatomist, teacher, and surgeon, William Stewart Halsted was born in New York City, USA to a wealthy family of English origin. His father was involved in charitable work and Governor and trustee to a city hospital. Not a brilliant student initially, Halsted took an undergraduate in Liberal Arts in Yale, CT., after which he entered the Medical College of Physicians at the Columbia College, where he excelled.

As a second-year medical student Halsted applied and obtained a position in surgery at a local hospital. In here he learned about Lister’s antiseptic technique and became an adamant proponent of it to reduce infection. In 1877 Halsted obtained his MD. After a short time as House Physician at the New York Hospital, Halsted traveled to Europe to further his education studying for two years at the Universities of Vienna, Leipzig, and W?rzburg.

Besides being at the forefront of surgical and antiseptic techniques (introducing the use of rubber gloves in surgery), Halsted was extremely concerned with the way medical students were taught in the US. He pioneered bedside clinical round discussions with the medical students after two years of basic sciences studies. Halsted developed the idea of a patient chart; he also developed the residency program for medical students in use today.

Halsted is probably the most influential researcher and surgeon at the turn of the century. He dedicated time to the study of intestinal anastomoses and the use of silk as a suture material. His experimental work in 1887 proved that the inclusion of the submucosa layer in an anastomosis was mandatory, as well that a single layered anastomosis was enough to attain closure. Perhaps Halsted’s most important contribution was the application and use of the scientific method to surgical questions. Halsted’s principles set the standards used today in surgical suturing and surgical stapling.

He also pioneered the development and surgical techniques for radical mastectomy as a treatment for breast cancer.

As a side effect of this studied in anesthesia and the use of cocaine for anesthesia, Halsted became addicted to this substance, a problem that followed him through the years. Without impairing his capacity as a researcher and a surgeon, Halsted eventually recovered. He died in Baltimore in 1922 as a complication to surgery.

Sources:
1. Dubay, A. D., & Franz, G. M. (2003). Acute Wound Healing: The Biology of Acute Wound Failure. Surg Clin NA, 83, 463-481.
2. Halsted, W. S. (1887). Circular Suture of the Intestine - An Experimental Study. Am J Med Sci, 436-461.
3. “William Stewart Halsted: his life and contributions to surgery” Osborne, P. Lancet Oncol 2007; 8: 256–65
4. “William Stewart Halsted: Surgical pioneer” Burress, P Endoc Today (2010), 8: (2) 22
5. “William Stewart Halsted (1852–1922) Neurological stamp” Haas, LF J Neurol Neurosurg Psych 2000;69:641
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Details: Published: May 01, 2015

This article is part of the series "A Moment in History" where we honor those who have contributed to the growth of medical knowledge in the areas of anatomy, medicine, surgery, and medical research.

History of Surgical Stapling
Surgical staplers through history

In the mid 1900’s the Soviet Ministry of Health established in Moscow the Scientific Research Institute for Experimental Surgical Apparatus and Instruments. This was forced by the need to train surgeons to perform complex operations at long distances from the capital cities. The Institute developed an incredible array of instruments including single line, linear cutter, and circular staplers which had applications such as gastrointestinal stapling, bone staplers, skin staplers, cornea and vascular staplers. etc. One of the problems of these instruments was that since they were hand-made, the parts from different staplers were not necessarily interchangeable.

The Moscow Thoracic Surgical Institute had very good results with the bronchial stapler, and it was here that in 1958, almost by chance, Dr. Mark M. Ravitch (1910 – 1989) and three other American physicians had the opportunity to evaluate patients that had been operated with this instrument, as well as seeing it in use.

Again, totally by chance, Dr. Ravitch happened to find a store that carried this instrument and as he tells “…quite unnecessarily I am sure, I identified myself plainly as an American. The only instrument they had in stock that day was the bronchial stapler…” He brought the instrument to the Thoracic Institute where the personnel calibrated it. This instrument came back to the USA with him to start a revolution in surgery.

Back in the USA, Dr. Ravitch started research with this and other instruments he procured in later trips. He recruited Dr. Felicien Steichen (1926 – 2011) to work with him, starting a friendship and collaboration that would last until his death. Both Drs. Ravitch and Steichen helped perfect and develop the modern instruments we use today: The linear stapler, the linear cutter, and the circular stapler.

Once these instruments were introduced, the development and advancement of the technology was pioneered by medical industry in the USA. First with Mr. Leon Hirsch, founder of the U.S. Surgical Corporation (today Covidien Surgical Devices), and later by Johnson and Johnson’s Ethicon Endo-Surgery (today Ethicon). These companies developed first the reloadable reusable surgical staplers and later the disposable reloadable surgical staplers.

Minimally invasive surgery (MIS) was common with gynecologist, but not used by general surgeons. Dr. Erich Muhe (1938 – 2005) was the first to perform a laparoscopic cholecystectomy in 1985, followed by many others. With the advent of MIS, these companies launched the development of laparoscopic surgical staplers, quite common today.

What about the future? First is the development of newer stapling technologies that take into account the viscoelastic behavior of tissues under rapid compression, multiple height staple lines, microstaplers, etc. Then, the advent of NOTES (Natural Orifice Transluminal Endoscopic Surgery) needs the development of smaller and smaller surgical staplers that can be used through a natural orifice and delivered through a flexible endoscope. That is, for now, the new frontier of surgical stapling.

The history of surgical stapling [1] ; [2]; [3]; [Video]

Sources
1. "Surgical stapling" Mallina, R F 1962 Scientific American 207, 48
2. “Science of Stapling: Urban Legend and Fact” Pfiedler & Ethicon EndoSurgery
3. “Cholecystointestinal, gastrointestinal, enterintestinal anastomosis, and approximation without sutures” Murphy JB. Med Rec (1892) 42: 665
4. “Study of Tissue Compression Processes in Suturing Devices” Astafiev, G. (1967 (USSR Ministry of Health, Ed.)
5. “Rese?as Hist?ricas: John Benjamin Murphy” Parquet, R.A. Acta Gastroenterol Latinoam 2010;40:97br />6. “The Science of Stapling and Leaks” Baker, R. S., & et al. (2004) Obesity Surgery, 14, 1290-1298.
7. “John Benjamin Murphy – Pioneer of gastrointestinal anastomosis”Bhattacharya, K., & Bhattacharya, N. (2008). Indian J. Surg., 70, 330-333.
8. “The Story of Surgery” Graham, H. (1939) New York: Doubleday, Doran & Co.. Inc.
9. “Compression Anastomosis: History and Clinical Considerations”Kaidar-Person, O, et al, e. (2008) Am J Surg, 818-826.
10. “Current Practice of Surgical Stapling”Ravitch, M. M., Steichen, F. M., & Welter, R. (1991) Philadelphia: Lea& Febiger.
11. “Aladar Petz (1888-1956) and his world-renowned invention: The gastric stapler” Olah, A. Dig Surg 2002: 19; 393-399
NOTE: The copyright notice for the images in this article can be found in the series "The History of Surgical Stapling" in this website

History of Surgical Stapling (3)

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