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Editorial

Staplers and endomechanical devices have represented arevolution in surgical technology and operative tech-nique. Their acceptance, use, and technical developmenthave been a study in evolution, however.

During their early introduction using such instrumentswere thought to be inferior to hand sewn methods of anasto-mosis and tissue reconstruction. After many years and manystudies, thesafety of mechanical stapling devices were shown

to be comparable to more conventional surgical techniques.Subsequently, open surgical staplers started to gain a notori-ety and respect of their own. Some instruments allowed theperformance of certain maneuvers or procedures that wouldotherwise be very difficult or impossible using conventionalhand sewn methods. Sphincter sparing surgery for low rectalcancers clearly was facilitated and made safer using the vari-ous versions of the circular stapler, for example. Without adoubt, procedures requiring extensive suturing (eg, the cre-ation of an ileal reservoir) were facilitated by the easy andrapid single fire placement of many staples, decreasing oper-ative time, and minimizing associated hypothermia andblood loss. Staplers were not only making surgery easier, butalso safer.

Then came laparoscopic surgery and staplers were re-de-signed to accommodate to such small orifice surgery. In fact,without the prior ‘stapling revolution,’ the ‘laparoscopic rev-olution’ would have been near impossible. It has been theengineering and technical wizardry of small caliber endome-chanical devices that has facilitated andpromoted thegrowthand now widespread use of minimally invasive surgery ingeneral surgery. The demands and parameters defined bylaparoscopic surgery are now fostering the development of newer energy delivery devices, newer techniques of anasto-motic creation and newer methods of intracorporeal organevaluation and surgical care.

In keeping with this evolution of stapler design anduse has

been the discovery of unusual associated complications orunique applications that were not originally anticipated. Thishas led to the use of surgical staplers in different ways, toovercome unforeseen difficulties or to take advantage of themin special circumstances. This is the purpose of the presentissue of  Operative Techniques in General Surgery, namely to

describe unique and unusual applications or variations onthe use of surgical stapling devices, both open and endome-chanical. Thus, anastomotic stricture after the use of the cir-cular stapler has led to a method of transanal revision thatavoids laparotomy, using the very same circular stapling de-vice, as described by Dr. McKenna. The same propensity of the circular stapler to create such a stricture however, canminimize subsequent hernia development after stoma cre-

ation, as described by Dr. Stewart. Similarly, the laparoscopicstapler has been discovered to be a very effective tool in openliver resection as described by Dr. Kimchi. This issue is filledwith such “tricks and techniques” that allow the surgeon totake full advantage of the various staplers’ unique designfeatures to overcome several problems in general surgery.

This issue also marks the final installment of  OTIGS in itspresent form under my editorship. Much like surgery, thepublication industry is changing and the provision of infor-mation, especially one that is dependant on visual illustra-tion, is redefining and reformulating itself. Without a doubt,there will always be the continued need for rapid, accurate,and authoritative delivery of new information, especially insuch a profession as surgery where frequently only the best is

good enough. The general surgeon will always need to main-tain the highest standards of technical expertise and knowl-edge and I feel that OTIGS has doneits best to provide such toits readership. I thank Elsevier Publishers and especiallyHerb Niemirow andJournal Manager Marla Kipp andall theirstaff for allowing me to help in that endeavor over the pastseveral years. This has been a unique and valuable opportu-nity to help serve my surgical colleagues and would havebeen impossible without their patient and experienced assis-tance.

 Walter A. Koltun, MDProfessor of Surgery

Peter and Marshia CarlinoProfessor of Inflammatory Bowel DiseaseChief, Section of Colon and Rectal Surgery

Penn State College of MedicineMilton S. Hershey Medical Center 

Editor-in-Chief 

Volume 10, Number 4 December 2008

1651524-153X/08/$-see front matter © 2008 Elsevier Inc. All rights reserved.

doi:10.1053/j.optechgensurg.2008.10.003