title: Innovative minimally invasive pediatric surgery is of therapeutic value for splenic injury.
abstract: OBJECTIVE
  Until now, minimally invasive surgery (MIS) has not had any therapeutic status for operable splenic trauma, because reliable sealing of larger defects is not possible with general techniques.
  
  
  METHODS
  Fleece-bound sealing allows rapid, large-area sealing of erosions and defects, so that with the aid of an MIS applicator system (AMISA), this method of tissue management can be transferred to MIS.
  
  
  RESULTS
  An in vitro evaluation showed that liquid fibrin sealing (FS) exhibits incomplete selective leak closure and low adhesive strength (4.1 hPa) and is not suitable for challenging surfaces. Fleece-bound sealing (ready-to-use v. prepare-to-use) showed reliable sealing and higher adhesive strength for collagen fleeces that are ready coated with fibrinogen-based sealant (TachoComb H; Nycomed, Linz, Austria) compared with various carrier systems that had to be impregnated on the spot (prepare-to-use; 50.2 v 23 hPa; P <.0001). Between October 1993 and October 2001, 19 of 87 children with splenic rupture were treated with the AMISA system (AMISA + TachoComb H) (21.8%), and 3 of these children had multiple trauma. The operation was indicated because of circulatory instability despite adequate volume replacement therapy. Splenic repair always was possible with the AMISA system, a changeover and splenectomy was not necessary, and the postoperative course was complication free. The mean stay in the hospital was 9.2 days.
  
  
  CONCLUSIONS
  The AMISA system efficiently expands the indications for emergency laparoscopy and can be used successfully in emergency laparoscopy for splenic rupture management.
authors.affiliation: Department of Pediatric Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Germany.
authors.forename: Roman Th
authors.initials: RT
authors.lastname: Carbon
authors.forename: Sibylle
authors.initials: S
authors.lastname: Baar
authors.forename: Juergen
authors.initials: J
authors.lastname: Waldschmidt
authors.forename: Hans Peter
authors.initials: HP
authors.lastname: Huemmer
authors.forename: Stefanie-Isabell
authors.initials: SI
authors.lastname: Simon
mesh_terms: D000293:Adolescent; D007611:Aprotinin; D002648:Child; D002675:Child, Preschool; D004322:Drainage / Q000379:methods; D004338:Drug Combinations; D005260:Female; D015718:Fibrin Tissue Adhesive; D005340:Fibrinogen; D006488:Hemostasis, Surgical; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011182:Postoperative Care; D013161:Splenic Rupture / Q000601:surgery*; D013917:Thrombin; D016896:Treatment Outcome
chemical_list: D004338:Drug Combinations; D015718:Fibrin Tissue Adhesive; C093991:tachocomb; D005340:Fibrinogen; D007611:Aprotinin; D013917:Thrombin