If you should happen to contract a serious disease requiring intestinal surgery, chances are the surgeons will fix you up using staples.

The technique of stapling was pioneered in Russia, and later spread to the West through 'informal' channels. The pioneers had huge instruments which took a long time to load - Humer Hultl's stapler of 1908 weighed eight pounds (3.6kg), and required two hours to assemble and load. In the earliest days almost everything was tried to get consistent staple lines, including the use of common office staples. Soon, though, titanium came to be accepted as the ideal staple material for surgery.

Early developers including Hultl, von Petz, Friedrich and Nakayama used considerable ingenuity in the designs of their instruments, but they were still hand crafted and required very considerable skill to load and use.

These days, however, surgical staplers are commercially manufactured either in stainless steel, to be cleaned and re-used, or in plastics for single use. The biggest improvement over the old hand-built staplers is in the staples themselves. Early staples were hand formed and inconsistent; these days they are supplied pre-loaded in cartridges, and the better staplers have features such as overlapping staple lines; B-shaped staples (which do not crush tissue); and optional knife blades, so that the blade which passes through contaminated and possibly cancerous tissue is used only once, then discarded.

The result is a tissue join¹ which is patent², consistent, and is stable over time. Benefits to the patient include dramatically reduced rates of infection, and faster recovery times.

Staples can also be used in minimally invasive or 'keyhole' surgery, where accurate suturing is very challenging, or even for simple skin repairs such as to deep scalp lacerations.

It's all come a long way from the Egyptian technique of pressing ant mandibles against a wound, then cutting the ant's head off so the mandibles contract and hold the wound edges together...