When engineer Victor Fischer and surgeon Hümér Hültl introduced the first surgical stapler in 1908, it took a whopping two hours to assemble and load the 100-part device. It also weighed a hefty 8 pounds and couldn’t be placed into a wound at an angle, making it particularly tricky to wield.1
Despite those shortcomings, the device—which was designed to be an efficient alternative to suturing—opened the path to safer, shorter surgeries. Revolutionary (and popular) for the time, it was used in 21 surgeries the following year.1
Fast-forward more than a century later: Though tissue staplers have become much less bulky and far easier to maneuver, the need for them remains as strong as it was in 1908.
Within the past year, roughly 1 in 9 American adults had surgery, according to 2024 research from The Annals of Open Surgery.2 Plus, the population of adults over 65—a group that faces health issues requiring surgical intervention more often than younger folks3—is growing, alongside obesity and other disease rates. That requires both surgical stapler engineers and surgeons to continuously tweak, refine and build upon their approach to tissue management, says Jason Harris, R&D Engineering Fellow at Johnson & Johnson MedTech.
And that’s an area where Johnson & Johnson MedTech has long been innovating. In the 1970s, the company introduced the PROXIMATE™ Disposable Skin Stapler, which was designed to close wounds faster than traditional sutures and minimize scarring in some situations. Today, the company’s tissue-specific advanced stapling portfolio is designed to enable clinically differentiated access, precision and control in challenging anatomy through innovations like 3D stapling and Gripping Surface Technology.
“As the landscape of patient profiles is rapidly changing, medtech innovation must play a leading role in solving for tissue variability, limited access to targeted anatomy and surgical variability,” says Sandeep Makkar, Global President, Endomechanical and Energy, Johnson & Johnson MedTech.
The company’s deep understanding of the scientific properties of living tissue and its partnership with healthcare providers throughout its device design process informs its creation of surgical staplers that meet the changing needs of today’s patients—and enables clinicians to improve patient outcomes.
Modern-day population demographics are changing the surgical landscape
Similar to how World War II drove the need for more advanced tissue management back in the early 20th century, today, surgeons are facing a different (but similarly pressing) issue: a generally older, sicker population, Harris explains.
According to the World Health Organization, global life expectancy increased by more than six years between 2000 and 2019—from 66.8 years in 2000 to 73.1 years in 2019.4 Rising obesity rates also factor in, Harris explains: Global estimates suggest that nearly 3.3 billion adults, or a little over half of the world population, will be obese by 2035—a sharp uptick from 2.2 billion in 2020. For young people between ages 5 and 19, the figure rises from 430 million obese individuals in 2020 to more than 770 million by 2035.5
“Comorbidities linked to obesity—including heart disease, high blood pressure and chronic inflammation—can put patients at a higher risk during surgery.6 Age also affects the likelihood of surgical complications due to bodily changes such as a weakened immune system, decreased organ function and reduced tissue elasticity,” says Makkar.7
As today’s patient enters the OR with comorbidities that increase their surgical risk, having stapling technology that accounts for both challenging anatomy and complex procedures is critical.
A spike in diseases that more commonly require staplers to perform surgery might also factor into the changing surgical landscape, including those related to the colon. In the case of colon cancer, for instance, cancerous tissue is removed and healthy tissue is rejoined using surgical staplers. Each year, more than 600,000 surgical procedures are performed in the U.S. to treat a number of colon diseases, including colorectal cancer.8 At the same time, Harris adds, screening technologies have improved with time, so surgeons are detecting (and ultimately operating on) diseases like colon cancer much sooner than before.
And there are specific challenges associated with these kinds of surgeries. As Makkar explains, “While neoadjuvant regimens in cancer management, including chemotherapy, radiotherapy and immunotherapy are proven to improve surgical outcomes by shrinking the tumor size, they can leave the tissue inflamed and fibrotic, making it difficult for surgeons to identify tissue planes and precisely dissect tissue, which increases the risk of intraoperative bleeding.”
Why an efficient, well-crafted surgical stapler matters
To be sure, the variables described above are “pushing medtech companies to consider how they’re designing, developing, testing and connecting new surgical technologies to achieve desired patient outcomes while reducing the cognitive burden on operating teams,” says Makkar.
Surgical staplers are a necessity in the OR—as Harris puts it, “without them, you just can’t do certain procedures.” But as with any medical device, there’s a chance for adverse outcomes, like when a lack of staple-line integrity causes leaks, which can then lead to severe postoperative complications. According to a study from The Journal of The Society of Laparoscopic & Robotic Surgeons, these most often arise from failures at the staple line, like when the tissue doesn’t heal properly.9
Complications during surgery can also stem from difficult-to-access anatomy, Harris explains. Compromised tissue, associated with patients who are older, obese and/or diagnosed with cancer, can also cause issues.
While addressing these obstacles is a complicated task, there have been a handful of technological advancements to make procedures as safe as possible. One major breakthrough was the ability to articulate staplers, introduced in the 1990s, which paved the way for single-port surgery—something virtually impossible with straight staplers. “The availability of a stapler that articulates expands the ability to access difficult anatomy through a reduced number of incisions, or ports,” Gianluca Casali, M.D., Senior Director of Global Medical Affairs for Johnson & Johnson MedTech, explains. That’s a major advancement from when staple devices were designed to simply fire straight, he notes.
Indeed, surgical instruments have seen tremendous improvements in adaptability. “Surgical staplers also feature customizable reload designs and firing speeds that optimize staple formation in various tissue conditions to reduce leak pathways,” says Makkar.
The importance of having options in the operating room
As Casali and Harris note, robotic and powered stapling have also been major wins for surgical procedures in terms of providing enhanced precision and dexterity, plus a greater range of motion for the surgeon.
Still, in complex and high-risk procedures in which the quality of the tissue is compromised, the use of handheld staplers might offer advantages because they allow surgeons to manipulate, maneuver and articulate the instrument in a specific, tailored way. Indeed, hybrid surgery (robotic surgery enhanced by the use of handheld devices) is gaining traction to more efficiently respond to the evolution of patients' needs, says Casali.10
Plus, as Harris points out, the goal of any surgery, but particularly oncologic surgery, is to completely remove the diseased area and the least amount of healthy tissue possible. A hybrid robotic-manual stapling approach might help give way to that.
A hybrid approach can also be especially helpful in revisional bariatric surgeries. In these situations, the additional scarring secondary to the primary surgery increases the thickness and stiffness of the stomach tissue and creates a situation that may be handled more efficiently by handheld staplers, Casali says.11
What’s next in stapling?
As today’s patient enters the OR with comorbidities that increase their surgical risk, having stapling technology that accounts for both challenging anatomy and complex procedures is critical. J&J MedTech is continuing to advance options that will provide access and control across a variety of tissue types in both open and minimally invasive surgical procedures.
These kinds of advances serve as a continuation in tissue stapling’s long history of innovation, both in general and at Johnson & Johnson.
“With adaptability comes increased ease of access to targeted anatomy and, when coupled with connectivity, surgical devices can better anticipate and respond to the surgical team’s needs, minimizing disruptions and improving intraoperative workflow,” says Makkar. “Rather than adding to the complexity, surgical instruments and systems should be adaptable, more connected and more human to create efficiency and help mitigate the challenges surgical teams encounter in the operating room,” says Makkar.
In other words, all these advancements have the potential to improve the way patients are cared for around the world—and advance the options that clinicians have for treating them.
Learn more about the science of stapling
Understand specific tissue properties and challenges, as well as how to optimize stapler use, through the J&J Institute Stapling Academy course.
© Johnson & Johnson and its affiliates 2025 | US_SRG_STAP_403136
References:
1 Surgical Staplers: The History of Conception and Adoption, The Annals of Thoracic Surgery, Volume 112, Issue 5, p1716-1721, November 2021
2 Bicket MC, Chua KP, Lagisetty P, Li Y, Waljee JF, Brummett CM, Nguyen TD. Prevalence of Surgery Among Individuals in the United States. Ann Surg Open. 2024 Apr 11
3 Unique Aspects of the Elderly Surgical Population, Geriatric Orthopaedic Surgery & Rehabilitation, March 2011
4World Health Organization. GHE: Life expectancy and healthy life expectancy. www.who.int. Published 2019. https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-life-expectancy-and-healthy-life-expectancy
5Lobstein T, Powis J, Jackson-Leach R. World Obesity Atlas 2024. March 2024. https://data.worldobesity.org/publications/WOF-Obesity-Atlas-v7
6Rivero-Moreno Y, Garcia A, Rivas-Perez M, et al. Effect of Obesity on Surgical Outcomes and Complication Rates in Pediatric Patients: A Comprehensive Systematic Review and Meta-Analysis. Cureus. Published online February 19, 2024. doi:https://doi.org/10.7759/cureus.54470
7How Does My Age Affect My Outcome from Surgery? Anesthesia Patient Safety Foundation. https://www.apsf.org/patient-guide/how-does-my-age-affect-my-outcome-from-surgery/
8Facts and Statistics. Colorectal Cancer Alliance. Published January 17, 2025. Accessed July 2, 2025. https://colorectalcancer.org/basics/facts-and-statistics?gad_source=1&gclid=CjwKCAjwwLO_BhB2EiwAx2e-38Gub0vvA4RqdRG6Zoo_X6GMHItiBmidrpISEEtc2IC4Hw0YFWL9QRoCIOgQAvD_BwE
9Parmer M, Wang YHW, Hersh EH, Zhang L, Chin E, Nguyen SQ. Management of Staple Line Leaks after Laparoscopic Sleeve Gastrectomy. JSLS. 2022 Jul-Sep;26(3):e2022.00029. doi: 10.4293/JSLS.2022.00029. PMID: 36071996; PMCID: PMC9439287.
10 Hafermann JO, Phelps JD, Tayash MFE. Comparing the effect of laparoscopic and robotic stapling on clinical outcomes, efficiency, and costs of robot-assisted Roux-en-Y gastric bypass. J Robot Surg. 2025 Feb 8;19(1):65. doi: 10.1007/s11701-025-02223-6. PMID: 39921831; PMCID: PMC11807049.
11Clapp BL, Billy H, Lutfi RE, Pan IW. Effectiveness of bedside staplers in bariatric robotic procedures. Surg Endosc. 2024 Sep;38(9):5310-5318. doi: 10.1007/s00464-024-11045-w. Epub 2024 Jul 17. PMID: 39020121; PMCID: PMC11362250.