Kenneth S Danielson, MD1, Charles Rogers2. 1Androscoggin Valley Hospital, 2Opus KSD, Inc.
Objective: Develop a skin stapler suitable for closing short laparoscopic incisions using a technique comparable to the “Set-back Buried Dermal Suture”.
Description: The Set-back Buried Dermal Suture (SBDS), first published in 2010 , is an interrupted vertically applied suture that captures the dermal tissue on the deep surface away from the cut edge. It has been shown to provide superior wound eversion and better cosmetic outcomes with fewer spitting sutures compared to the more common Buried Vertical Mattress Suture (BVMS) technique that is placed at the cut edge . I have used this technique in hundreds of surgeries, both laparoscopic and open incisions, and find that it combines two courses of sutures (subcutaneous followed by subcuticular sutures).
The SBDS technique is time consuming and requires a higher level of skill to be done correctly. Because of these limitations, I set out to develop a skin stapler, now called SubQ It!, capable of incorporating the SBDS technique. We first developed a flexible bioabsorbable fastener in the shape of a horse-shoe that is mounted on specially designed needles. The fastener is then deployed simultaneously on both sides of the incision to be closed. This is accomplished by everting the skin edges with forceps exposing the “set back” position of the dermis. The forceps are placed in indentations to precisely position the tissue so that the needles enter the dermis in the “set back” position reproducing the SBDS technique.
Preliminary Results: My colleagues and I have had excellent results (photographs and data to be presented) on both laparoscopic and longer incisions. Because the SubQ It! fastener is inserted from above, it can be used in very short incisions. The visibility of placement is excellent and skin edge alignment is precise. Each fastener provides approximately 10 Newtons (1Kg force) of holding strength so one fastener in a 5mm trocar incision or two fasteners in a 10mm trocar incision provide secure apposition.
Conclusions / Future Directions: The SubQ It! Bioabsorbable Skin Stapler provides rapid secure apposition of incisions and excellent cosmetic results. Future efforts are directed at producing a body of data confirming the preliminary observations of our current work and the work of others:
1 – Reduced infection rates compared to metal staples or continuous subcuticular sutures. 
2 – Reduced rates of suture “spitting” due to the increased distance the suture material is from the surface. 
3 – Reduced rates of reactive responses due to minimal tissue damage from clamping, cauterizing or crushing leading to better cosmesis. 
4 – Improved scar appearance by not penetrating the external skin (compared to metal staplers) and applying the closing forces away from the incised edge creating the eversion of skin edges (compared to skin adhesives). 
5 – Reduced rates of wound separation due to the strength of the fastener and capture of deep dermal tissue so the pulling forces are away from the incised edge. 
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 98801
Program Number: ETP731
Presentation Session: Emerging Technology Poster Session (Non CME)
Presentation Type: Poster