Minimally invasive pediatric surgery: Further advances through innovative technology. ATCS-Sealing

Minimally invasive pediatric surgery (MIPS) has a solid tradition in which technique and technology have made key contributions to an already broad ra nge of indications. This surgical method still has a deficiency with regard to tissue management of large-area defects, however. Sealing techniques ca n further expand the range of application. Method: Technological evaluation provided outstanding data of fleece-bound collagen- and fibrinogen-based s ealing systems (TachoComb(R)) on biodegradability, adhesive strength and pr acticability. A relevant instrument was developed for MIS application and w as introduced as the ATCS (AMISA-TachoComb(R)-System). Patients: From 1993- 2000, ATCS sealing was carried out in the scope of thoracoscopy (105 proced ures) and laparoscopy (53 procedures) and specifically for recurring pneumo thorax, traumatic chylothorax and splenic trauma. Results: Pneumothorax: 59 ACTS procedures in 49 patients (mean age: 11.4 yrs) with 6 reoperations (1 0.2%) 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 r elevant parameters were also reduced. Chylothorax: 3 ATCS procedures in 3 p atients (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 c ase and no significant drainage volumes. Conclusion: The ATCS is an innovat ive instrument for MIPS and ca be employed for efficient and socio-economic (e.g. DRGs) closure of large-area defects.