Treatments

"Simple" thoracoscopy

Thoracoscopy is often the first step in obtaining tissue (biopsy) from unclear processes in the pleural space (the space around the lung in which fluid and/or air can accumulate) or from lung lesions ('unclear nodules') in the lung itself. An endoscope (usually an approx. 5mm thick camera) is inserted into the chest cavity via one or two small incisions between the ribs and a tissue sample is taken from the lung and/or pleura using biopsy forceps. This type of procedure is typically referred to as "video-assisted thoracoscopic surgery", or VATS for short.

However, thoracoscopy is not only used to make a diagnosis, but in many cases also to treat diseases of the lungs or pleura. For example, to treat a pneumothorax (collapsed lung) or a pleural effusion (accumulation of fluid around the lung) or pleural empyema (accumulation of pus in the pleural cavity (outside the lung)).

Minimally invasive, by means of segmentectomy or lobectomy or also sleeve resection or pneumonectomy

Such diseases are also treated minimally invasively whenever possible (possible in 80 to 90 percent of cases with the appropriate expertise).

A camera with a diameter of 5 mm is inserted into the chest cavity via a single incision about 3 cm long, along with other fine instruments. A lung segment (for malignant lung tumors with a size of <2cm) or a lung lobe together with the tumor is removed.

As a rule, an "open procedure" is only necessary for very large tumors that grow into the pericardium or the chest wall, whereby a longer incision and spreading the ribs apart (thoracotomy) are required to safely remove the tumor.

Preferably minimally invasive, robot-assisted

Cysts or tumors (benign or malignant) can also occur in the soft tissue outside the lungs, which can preferably be removed surgically in a minimally invasive procedure. Examples include tumors of the thymus gland (so-called thymomas), nerve or nerve sheath tumors (gangliomas, schwannomas, neurinomas), cysts (thymus cysts, bronchogenic cysts, duplication cysts of the esophagus, etc.). A disease that predominantly affects younger women is myasthenia gravis (severe muscle weakness - caused by autoantibodies against the transmission of nerve impulses to the muscles), in which the surgical removal of the thymus / thymus gland has a positive effect on the course of the disease.

Pleurectomy/decortication

Malignant pleural mesothelioma is a rather rare but very aggressive disease with a poor prognosis. It is a malignant tumor of the pleura, which lines the inside of the chest and also covers the surface of the lungs. The main trigger is usually occupational exposure to asbestos, although the disease typically only occurs 30 to 40 years after exposure to asbestos (recognized occupational disease).

Treatment usually involves the surgical removal of all tumor tissue while sparing/preserving the lungs, followed by chemotherapy +/- immunotherapy.

Minimally invasive technique

If the diaphragm muscle is paralyzed - this usually occurs after cardiac surgery, due to an accident or sometimes without an explainable cause - the diaphragm rises upwards in the chest over time and compresses the lungs (takes space away from the lungs), causing breathing difficulties. By means of minimally invasive surgery, the diaphragm can be returned to its original position, eliminating the patient's breathing difficulties.

Preferably minimally invasive

Congenital chest deformities are rather rare, with funnel chest (sunken sternum) being the most common in our latitudes. The change in the chest wall is usually already visible in childhood and can usually be treated well at this stage using a self-applicable suction cup. During puberty, the deformity usually increases significantly and from then on can usually only be corrected by surgery due to the increasing firmness of the chest.

A metal rod is inserted behind the sternum through 2 small incisions on the side of the ribcage and the sternum is lifted. The metal bar must usually be left in place for approx. 2 years so that the deformity is optimally corrected and retains its new shape even after the bar has been removed.

With a keel chest, the breastbone protrudes forwards in contrast to a funnel chest. Here too, correction with a compression corset can be started in childhood. In severe forms, minimally invasive correction is also possible here, whereby the metal stirrup is placed under the skin and in front of the breastbone. The ends of the metal brace are then fixed to the ribs via two small incisions on the side.

Thoracic outlet syndrome, also known as "upper thoracic aperture constriction syndrome" / "shoulder girdle compression syndrome", is a constriction of the vascular nerve bundle to the upper extremities (i.e. to the arms). Both the vessels (vein and/or artery) and the nerve plexus to the arm between the collarbone and the upper rib can become trapped. This is particularly pronounced when the arms are raised and can manifest itself as

Obstruction or even thrombosis of the large arm vein with corresponding swelling of the arm (mainly vein affected)

Loss of strength and pulse in the arm after a short time as soon as the arm is raised above the horizontal (mainly artery affected)

Tingling paraesthesia or sensory disturbance with radiation to the hand (mainly nerves affected)

The diagnosis is usually made using computer tomography or MRI. The examination is carried out with the arms hanging downwards and raised, whereby the "pinching" of the vessels and nerves is usually clearly visible.

As a treatment, the uppermost rib can be precisely removed in a minimally invasive procedure with the help of the surgical robot, without damaging the vessels or nerves. This is in contrast to other techniques such as an incision in the armpit (trans axillary) or an incision above or below along the collarbone (supra- or infraclavicular approach) - in which case the entire rib cannot usually be removed and pressure damage to the nerves occurs much more frequently in the postoperative course).

Uncontrolled blushing in the facial area)

In the case of excessive sweating in the area of the hands (+/- armpits) and or uncontrolled flushing in the facial area, blocking the excessive stimulus conduction of the sympathetic nerve fibers using metal clips via thoracoscopy through 2 small incisions in the armpit can alleviate the symptoms.

In the case of an unclear enlargement of the lymph nodes in the neck area or behind the collarbone - if a needle biopsy alone is not sufficient or possible - it may be necessary to take a biopsy (tissue sample) via a short incision in the skin. This is usually carried out under a short anesthetic.

To administer chemotherapy or other "venotoxic" substances that need to be administered at regular intervals as part of medical treatment, a reservoir with a thin plastic catheter is placed in the vein under the collarbone.

The procedure is usually performed under local anesthesia and takes about 20 to 30 minutes. The reservoir is then located directly under the skin and can easily be pierced from the outside with a thin needle to draw blood and administer medication.