AMISA: Innovative tissue management in MIS

SummaryAdjustable minimally-invasive surgery applicator (AMISA) is an innovative, reusable instrument developed for tissue gluing, e.g. for sealing large defects on parenchymal organs. The device AMISA is loaded with TachoCombr`, a commercially-available, ready-to-use dry collagen fleece, coated with tissue glue. After loading the adjustable applicator head with the 5 x10 cm, self-adhesive collagen fleece, the AMISA can be introduced into the body through a conventional 10/12 mm trocar. The fleece roll is positioned over the tissue defect and can be rolled-out (‘carpeting’) utilising the rotary positioning of the applicator head. Preliminary technological studies of selective leak closure (SLC) have demonstrated the efficiency of fleece-bound tissue gluing with a ready-to-use collagen fleece, coated with tissue glue. In vitro studies of SLC of porcine pleura have demonstrated significantly higher adhesive stability compared with liquid gluing methods employing various fleece materials. AMISA can be used in both thoracoscopy and laparoscopy.The main indications are large-area leakages on parenchymal organs of differing aetiology that cannot be controlled speedily and efficiently with conventional minimally-invasive technology (mechanical, thermal, piezoelectric). The AMISA system expands the range of applications of minimally-invasive surgery and simplifies complication management (bleeding, rupture, leakage, secretion). Other advantages of the system are decrease in drainage time and reduction in treatment time.