The Learning Curve of an Absorbable Subcuticular Stapling Device in Plastic and Reconstructive Surgery

Abstract

Bloom, MBBS (Hons), FRACS (Plas)* Background: Learning curves can reflect a surgical trainee's rate of progress and competence in acquiring new skills. The INSORB subdermal staple device has been well established to facilitate decreased closure time across various surgical procedures, with similar cosmesis, healing, and consistency as those of standard subdermal sutures. This study is unique, as it demonstrated an observable learning curve with this device when used by a junior surgeon. Methods: Sixty-six patients underwent a cosmetic procedure during the second half of 2019 under the care of a single plastic surgeon in Melbourne, Australia. This corresponded to 254 unique linear incisions. Subdermal closure was done either with interrupted 3-0 Monocryl sutures or with the INSORB device. The consultant closed the incisions on one side, with the contralateral incision closed by the assistant using the same closure method. Data were then compared retrospectively, and closure times were compared over the ensuing 6 months. Results: Overall, consultant closure speed is 25% faster than assistant speed. When using 3-0 Monocryl, the difference is 33%, whereas the difference is reduced to 21% when using the INSORB. Furthermore, a mild learning curve could be appreciated with the assistant's use of the INSORB over the comparatively short 6-month study period. Conclusions: In addition to improved speed, cost, outcome, and ergonomics, subdermal absorbable staples may also garner a faster learning curve than standard closure with 3-0 Monocryl. This study supported the learning curve of a surgical device as another innovative benefit and an important aspect of developing surgical technology.

Use of Absorbable Dermal Staples in Bilateral Breast Reduction Surgery

“…25 Deep dermal stapler usage may also be less effective for thinner skin that may present with factors such as chronic corticosteroid use. 25,26 Some users have felt that absorbable staples may result in dermal scarring, particularly in skin with darker pigmentation; however, scars from incisions closed with absorbable staples have been shown to be similar to scars from incisions closed by sutures in several studies, and no notable differences in scars were visually observed in this study cohort. 11,17 This study is subject to several limitations.…”

“…Despite the associated benefits in operation efficiency, the nuances of such usage must also be considered. For example, Singhal et al detected a notable learning curve in closure speed with application of absorbable subcuticular staples over 6 months when compared with traditional 3-0 Monocryl sutures, which suggests that surgeons who have never used the deep dermal stapler will need to invest some time to become proficient in its use 25 . Deep dermal stapler usage may also be less effective for thinner skin that may present with factors such as chronic corticosteroid use 25,26 .…”

“…For example, Singhal et al detected a notable learning curve in closure speed with application of absorbable subcuticular staples over 6 months when compared with traditional 3-0 Monocryl sutures, which suggests that surgeons who have never used the deep dermal stapler will need to invest some time to become proficient in its use 25 . Deep dermal stapler usage may also be less effective for thinner skin that may present with factors such as chronic corticosteroid use 25,26 . Some users have felt that absorbable staples may result in dermal scarring, particularly in skin with darker pigmentation; however, scars from incisions closed with absorbable staples have been shown to be similar to scars from incisions closed by sutures in several studies, and no notable differences in scars were visually observed in this study cohort 11,17 …”