[Minimal invasive pediatric surgery: development and progress by innovative technology]

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.

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).

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.

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.

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.