[Minimal invasive pediatric surgery: development and progress by innovative technology].
BACKGROUND
Minimally invasive pediatric surgery (MIPS) has a solid tradition in which technique and technology have made key contributions to an already broad range of indications. This surgical method still has a deficiency with regard to tissue management of large-area defects, however. Sealing techniques can further expand the range of application.


METHODS
Technological evaluation provided outstanding data of fleece-bound collagen- and fibrinogen-based sealing systems (TachoComb) on biodegradability, adhesive strength and practicability. A relevant instrument was developed for MIS application and was introduced as the ATCS (AMISA-TachoComb-System).


METHODS
From 1993-2000, ATCS sealing was carried out in the scope of thoracoscopy (105 procedures) and laparoscopy (53 procedures) and specifically for recurring pneumothorax, traumatic chylothorax and splenic trauma.


RESULTS
Pneumothorax: 59 ACTS procedures in 49 patients (mean age: 11.4 yrs) with 6 reoperations (10.2%) and one recurrence (1.7%). The drainage dwell time was reduced (p < 0.05) using a conventional comparison (31.9 hours vs. 17 days) and further relevant parameters were also reduced. Chylothorax: 3 ATCS procedures in 3 patients (mean age: 6.3 years) with reduction in the drainage dwell time (p < 0.05) based on a conventional comparison (35 hours vs. 18 days). Splenic trauma: 17 ATCS procedures in 16 patients (mean age: 8.9 years) with one re-operation (5.9%) for associated liver trauma, organ conservation in each case and no significant drainage volumes.


CONCLUSIONS
The ATCS is an innovative instrument for MIPS and ca be employed for efficient and socio-economic (e.g. DRGs) closure of large-area defects.
Carbon
R T
RT
Abteilung für Kinderchirurgie, Chirurgische Klinik und Poliklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg.
Baar
S
S
Waldschmidt
J
J
Hümmer
H P
HP
Simon
S
S
D000007:Abdominal Injuries / Q000209:etiology / Q000601:surgery; D002648:Child; D002916:Chylothorax / Q000209:etiology / Q000601:surgery; D004867:Equipment Design; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage; D006801:Humans; D020706:Laparoscopes; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D011030:Pneumothorax / Q000209:etiology / Q000601:surgery; D013161:Splenic Rupture / Q000209:etiology / Q000601:surgery; D013525:Surgical Instruments; D013536:Suture Techniques / Q000295:instrumentation; D020708:Thoracoscopes
D015718:Fibrin Tissue Adhesive