Experience with a New Absorbable Subcuticular Skin Stapler Designed For Short Incisions in Anterior Lumbar Interbody Fusion Surgery
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Experience with a New Absorbable Subcuticular Skin Stapler Designed For Short Incisions in Anterior Lumbar Interbody Fusion Surgery Jonathan E. Schoeff, M.D., F.A.C.S. In this day and age, healthcare is increasingly patient-centric and driven by their options and choices. Our goal is to educate our patients and empower them to participate in decisions about their care. Every aspect of our practice is focused on optimizing clinical outcomes & managing economic challenges associated with an ever-evolving healthcare system. Patient satisfaction remains central to this effort. To ensure that we are successful in achieving these objectives, we have placed substantial emphasis in our surgical practice on utilizing the latest techniques and technology to perform the majority of procedures through smaller incisions, using special instrumentation. This lessinvasive or minimally invasive approach has been proven to dramatically decrease recovery time after surgery and overall need for narcotic pain medication, and to reduce the time to return to full activity and work with an overall improvement in quality of life. We understand that, while the choice of skin closure modality is typically surgeon driven, patient’s still view incisional closure as a reflection of procedural quality and attention to detail. Surgeon’s choice of modality has an important effect on the clinical and economic outcome of a surgical procedure. In this regard, we evaluated a new version of an absorbable subcuticular stapler to determine its clinical performance in terms of safety, efficacy, outcomes, cosmesis and patient-satisfaction in skin closure of anterior lumbar interbody fusion surgical incisions. In our clinical experience of over 250 patients, the absorbable subcuticular staples demonstrated equivalent efficacy compared to percutaneous metal staples and subcuticular suturing. Typical closures were closely approximated with good eversion and no apparent inflammatory or erythemic reaction. We found the use of the device to be simple and time-effective, and a truly single-operator closure technique. In addition, absorbable subcuticular skin staples were more comfortable and acceptable in appearance to the patients than percutaneous metal staples, while also eliminating the inconvenience, cost, anxiety and discomfort of staple removal. We have been especially pleased with the speed, cosmetic outcome and reduced complications of these closures, and our patients have expressed a high degree of satisfaction with the absorbable staple closures. INSORB Absorbable Staple INSORB|Shorty Subcuticular Stapler Introduction The objectives of surgical wound closure are safe, effective healing with good cosmesis. Effective time utilization of health care professionals in the surgical suite and postoperatively can be a determining factor in the selection of a closure modality. Prior to the absorbable subcuticular staple, our only choices for dermal closure were either subcuticular suturing or percutaneous metal skin staples. Initially, our goal was to reduce operative time and eliminate sharps injuries with a rapid closure modality that would not create additional, unnecessary trauma and pain for our patients. Materials and Methods We utilized a new version of the INSORB Subcuticular Skin Stapler designed for closure of shorter incisions (INSORB®|Shorty Absorbable Subcuticular Skin Stapler, Incisive Surgical, Inc., Plymouth, MN) to close anterior interbody fusion incisions at Sky Ridge Medical (Lone Tree, CO). The novel INSORB Subcuticular Skin Closure Modality has been commercially available for over 10 years in a version with 30 Absorbable Staples. The INSORB|30 Absorbable Subcuticular Skin Stapler is a sterile, single patient use device designed to close incisions up to 21-cm in length. The INSORB|Shorty Subcuticular Stapler is a sterile, single patient use device that contains 8 absorbable staples, sufficient to close up to an 8-cm incision. The device utilizes a novel method which precisely presents the dermis to surgically-sharpened needles, and then places an absorbable staple in a horizontal, subcuticular fashion to provide a secure, well-approximated, interrupted and everted closure. The absorbable staples are made of a benign polylactide-polyglycolide co-polymer with an established history in wound closure. The staple design features a U-shaped curvature with hooks at the two distal ends to secure the dermi

Results The device is ergonomically-designed and simple to use. We found that, with experience, closure times with the subcuticular skin stapler closely approximated closure times with a metal skin stapler, and was significantly faster than subcuticular suture closures. The use of the absorbable subcuticular skin staples resulted in a uniform, symmetric, everted interrupted skin closure without percutaneous tissue insult. Natural physiologic drainage is permitted with the absorbable staple closure, which may be seen as slightly wetter dressings at the first dressing change which may...