A common task is the closure or anastomosis of hollow organs such as bowel or bladder requiring achievement of a reliable, strong, airtight and watertight seal without causing tissue ischemia (inadequate blood supply). In both techniques, connecting adjacent tissue intracorporeally (inside the body) is an important component of many procedures. Today, a growing percentage of surgical interventions are performed using standard minimally invasive surgery (MIS), or robot-assisted minimally invasive surgery (RAMIS). Adhesives also have their limitations – they may exhibit insufficient tensile strength, and may be toxic. Staples that are too small can lead to excessive tissue compression, which exceeds the tensile strength of the tissue, leading to tearing and perforation, whereas staples that are too large can fail to achieve a good seal. Stapling is appropriate in some cases, but it also relies on the original tissue strength, and may be limited by the shape and size of the specific stapler: a poorly adapted stapler may result in bonding failure. Sutured sites are at an increased risk for leaks, infections, and scarring. However, suturing is a delicate, demanding, and time-consuming procedure, requiring technical skill. In suturing, the surgeon passes the needle through the tissues close to their edge, pulling them together and relying on tissue and suture strength to hold them tight. Technologies such as sutures, staples, clips, and adhesives have been used for many years to close surgical incisions and wounds. Almost every surgical intervention requires some type of joining of adjacent sections of tissue.
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