Thoraxsurgery

In the surgical department of the Martha-Maria Hospital in Munich, all interventions in the area of the chest and lungs are regularly performed. These include first and foremost tumor diseases, which have increased dramatically in our society over the last decades.

A major advance for patients is the introduction of minimally invasive lung surgery, which is also performed in its entirety at our hospital. On the one hand, these minimally invasive interventions serve to further clarify unclear findings in the area of the lung and the chest wall. However, resection procedures can also be performed thoracoscopically. A frequent problem is recurrent pleural effusions, which can be treated very well by minimally invasive means.

In addition, other lung diseases are also treated, such as the so-called spontaneous pneumothorax or inflammatory diseases. 

Surgical methods
Tumors of the lung

Tumors of the lung are usually discovered in the X-ray image. They are often circular, which is why they are also called "round foci".

Each round foci must be further clarified. For this purpose, a computer tomogram of the thorax is absolutely necessary, which usually already allows a decision to be made as to which further steps are necessary. Round foci can be both benign and malignant.

The bronchial carcinoma

Lung cancer is the most common tumor disease in men and - together with breast cancer - also in women. It is crucial for patients to detect and treat this disease as early as possible, which means that a cure can be achieved here too. Therefore all "shadows in the lungs", or "round foci", should be further clarified! In case of doubt, these round foci must be surgically removed and examined. If adequate surgery is performed in an early tumor stage, patients with lung cancer can also be cured.

Metastases in the lung    

Other lung tumors that should often be treated surgically are metastases from other tumors. If these metastases, which also look like round foci on an X-ray, can be completely removed, the patient often has a good chance of being cured.

Video-assisted thorascopy

Minimally invasive lung surgery

In recent years, minimally invasive surgery has also become increasingly established in thoracic surgery (as was the case in visceral surgery before), by means of which a wide range of different diseases can be treated. In addition, minimally invasive surgery can also be performed for purely diagnostic purposes, e.g. to take a tissue sample from the lung, pleura, mediastinum or lymph nodes.

In specialist circles, this is known as "Video-Assisted Thoracic Surgery" or "VATS" for short. In contrast to the open surgical method, VATS requires only three skin incisions of a few centimeters in size. The ribs are not spread. This means that the patient recovers much more quickly, as the trauma for the patient is much less severe.

Surgery with the latest technical equipment

By using modern technical equipment we guarantee a high degree of safety for the patient

  • Use of the latest imaging platform with high quality HD imaging especially for minimally invasive, video-assisted surgery
  • Instruments specially developed for minimally invasive lung surgery

Operating with the smallest incisions

  • 2 incisions, approx. 1cm small: once at the lower end of the rib cage in a line through the front edge of the armpit, as well as at the lower edge of the rib arch in extension of the upper hip scoop
  • an approx. 4 cm long incision at the lower edge of the armpit to remove diseased lung tissue. In order to prevent the spread of tumor cells, the lung tissue is always removed with a recovery bag
  • the blood vessels of the lungs and bronchial tubes are cut through with small titanium clamps (staplers) and sealed blood-dry and airtight
  • cosmetic intradermal suture of the skin
  • the thoracic drainage is usually removed after about 2-4 days VATS lobectomy
Surgery of the trachea

Disease of the windpipe (= trachea) is usually associated with severe limitations and suffering for those affected. Usually this is respiratory distress, which leads to a considerable reduction in performance and also to immobilization.
The following diseases can lead to a narrowing of the trachea:

  1. Enlargement of the thyroid gland - especially when the thyroid gland moves into the thorax - can lead to compression of the trachea and thus to stridor and shortness of breath.
  2. Narrowing of the windpipe due to both benign and malignant tumors.
  3. Narrowing of the windpipe due to stenoses after tracheotomy. 
  4. Idiopathic unification of the trachea.
  5. Tracheomalacia (= instability of the trachea)

The treatment of these diseases depends on the type of constriction, but also on the location of the constriction. For example, a compression of the windpipe due to thyroid enlargement can usually be eliminated and thus cured by a thyroid resection.
Several options are available for the treatment of tracheal stenosis of other causes:

  1. Interventional, endoscopic ablation by the pulmonology department in our hospital. These include the insertion of stents (tubes made of silicone and/or metal) to bridge constrictions as well as the removal of foreign tissue by means of laser and/or cryogenic (= icing) technology
  2. Tracheal resection. The trachea can be resected up to a length of 4-6 cm. Continuity is restored by anastomosis. This is a relatively minor operation, after which the patient remains in hospital for about 1 week. These operations are performed in the surgical clinic of our hospital.

Interventional, endoscopic ablations can be used, for example, for idiopathic and tumor-related stenoses. The interventional insertion of tracheal stents also makes it possible to keep the airways open. These stents also stabilize the trachea, so that this procedure can also be used for tracheomalacia.
The localization of the lesion in the trachea is important for this option. If the lesion in the trachea is too close to the larynx, these stents cannot be inserted because they cannot be placed or anchored.

Tracheal resection is a very good therapeutic option for all lesions of the trachea. A classic indication is tracheal stenosis after tracheotomy, even the already mentioned idiopathic stenosis can be treated in this way.
The advantage of the operation is the fact that a permanent freedom from symptoms can be achieved.
But the localization of the stenosis or tumor is also important for tracheal resection. Lesions that lie directly under the larynx or involve the larynx represent a particular challenge (high tracheal stenosis). In this case, good preoperative diagnostics is required, which is carried out by our pulmonological, - and ENT medical department.

The decision to operate is made in an interdisciplinary consultation. Operations involving the larynx are performed in cooperation with the head physician of our ENT department.

Treatment spectrum

In our clinic we offer you all modern therapy methods

  • surgical treatment of lung cancer and lung metastases as well as malignant diseases of the mediastinum, thoracic wall and pleura
  • diseases of the mediastinum (e.g. thymomas, lymphomas, germ cell tumors)
  • Thoracic wall tumors
  • palliative interventions (e.g. pleurodesis, permanent pleural drainage)
  • Infections (e.g. pleural empyema, lung abscess, chronic infections with destruction of lung tissue)
  • benign diseases of the lung, mediastinum and chest wall (e.g. hamartomas, bronchiectasis, cysts, sequestered tissue)
  • Thoracic injuries (e.g. hematothorax, rib fractures, including their late effects)
  • Pneumothorax
  • Hyperhidrosis
  • Trachea surgery with a high degree of specialization for the surgical treatment of diseases of the trachea (e.g. stenoses, tumors)
  • Lung Volume Reduction Surgery (LVRS) as palliative surgical therapy for carefully selected patients with advanced emphysema as part of an interdisciplinary treatment concept in close cooperation with the Pneumology Department on our Emphysema Board

All patients with oncological diseases of the thoracic organs are discussed in the biweekly interdisciplinary tumor conference, which is attended by pneumologists, radiologists, radiotherapists, oncologists and thoracic surgeons.
For general as well as specific questions, patients and general practitioners have access to a special consultation hour for thoracic surgery (appointments by appointment only).
All therapeutic measures are always carried out in consultation with the treating pneumologists.

Minimally invasive lung surgery or VATS

In recent years, minimally invasive surgery has also become increasingly established in thoracic surgery (as was the case in visceral surgery before), by means of which a wide range of different diseases can be treated. In addition, minimally invasive surgery can also be performed for purely diagnostic purposes, e.g. to take a tissue sample from the lung, pleura, mediastinum or lymph nodes.

In specialist circles, this is known as "Video-Assisted Thoracic Surgery" or "VATS" for short. In contrast to the open surgical method, VATS requires only three skin incisions of a few centimeters in size. The ribs are not spread. This means that the patient recovers much more quickly, as the trauma for the patient is much less severe.

Operating with the latest technical equipment

By using modern technical equipment we guarantee a high degree of safety for the patient

  • Use of the latest imaging platform with high quality HD imaging especially for minimally invasive, video-assisted surgery
  • Instruments specially developed for minimally invasive lung surgery
Operating with the smallest incisions
  • 2 incisions, approx. 1cm small: once at the lower end of the rib cage in a line through the front edge of the armpit, as well as at the lower edge of the rib arch in extension of the upper hip scoop 
  • an approx. 4 cm long incision at the lower edge of the armpit to remove diseased lung tissue. In order to prevent the spread of tumor cells, the lung tissue is always removed with a recovery bag
  • the blood vessels of the lungs and bronchial tubes are cut through with small titanium clamps (staplers) and sealed blood-dry and airtight
  • cosmetic intradermal suture of the skin
  • the thoracic drainage is usually removed after about 2-4 days

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