Tissue Sealing Concept in Minimally Invasive Surgery in Children

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Abstract
Background: The Adjustable Minimally Invasive Surgery Applicator (AMISA) is an innovative instrument used for tissue gluing; e.g., for sealing larger defects in parenchymal organs. After the applicator is loaded with an approx. 5 × 10-cm self-adhesive collagen fleece (TachoCombv®), the AMISA can be introduced into the relevant body cavity with the aid of a conventional 10/12-mm trocar. The fleece roll is positioned over the tissue defect and rolled out like a carpet thanks to the rotary applicator head. Methods and Results: Preliminary studies of selective leak closure (SLC) demonstrated that fleece-bound tissue sealing with a ready-to-use collagen fleece coated with tissue glue is efficient. In vitro studies of SLC of porcine pleura demonstrated significantly higher adhesive stability than with liquid gluing methods employing various fleece materials. The main indications are larger-area leakages of parenchymal organs of various origins that cannot be controlled or cannot be taken care of quickly enough with conventional minimally invasive pediatric surgery (MIPS) devices (staplers, high-frequency energy, laser, piezoelectric). Conclusion: Sealing with AMISA expands the range of application for MIPS and simplifies complication management (bleeding, rupture, leakage, secretion). Further economic advantages (decrease in drainage time, reduction in treatment time) are consistent with the principles of minimally invasive therapy in pediatric surgery.