Dr. Preissler, the thoracic surgery department at the RBK Lung Center Stuttgart has been recognized as a center of excellence. What does that mean?
The certification recognizes highly specialized thoracic surgery centers that carry out a particularly large number of operations – so-called high-volume centers – and meet strict quality criteria. Scientific performance and activity as a training center are also evaluated. There are currently only 13 such certified centers across Germany, and in southern Germany – including us – only two.
What exactly is the thorax?
The thorax is the ribcage, with ribs, sternum, thoracic spine as well as the surrounding muscles and the soft tissue layer. It protects the lungs and heart and, together with the diaphragm, enables breathing.
For which complaints or illnesses should you contact a thoracic surgeon?
Thoracic surgeons are specialists in all operations on the chest, lungs and mediastinal space. The spectrum ranges from rib and sternum fractures to lung collapse, pleural effusion, suppuration of the pleural space, congenital malformations of the chest and tumor diseases of the organs in the chest.
Tumor surgery in particular is very important in our field. These include operations for lung cancer or rarer tumors such as thymomas. The thoracic surgeon also removes secondary tumors from other types of cancer, so-called metastases, from the lungs.
Sarcomas of the chest – malignant tumors of the ribs or muscles and connective tissue – are also treated by the thoracic surgeon.
You have already mentioned tumor surgery, particularly for lung cancer. How does such an operation typically work?
Smaller lung cancers can now usually be operated on minimally invasively. A video camera and instruments are inserted through small incisions on the side of the chest. The surgeon then sees the inside of the chest on a monitor during the procedure.
In order to keep the risk of a relapse as low as possible, a so-called oncologically radical operation is always carried out when operating on lung cancer. This includes systematically removing the affected lung lobe and the neighboring lymph nodes.
In the case of very small tumors, only a so-called lung segment is often removed instead of the entire lung lobe. This protects healthy lung tissue and improves subsequent respiratory function. However, these procedures are technically very demanding, as you need to know exactly the fine branches of vessels and bronchi within the lung lobe in order to completely and radically remove the tumor.
Surgical robots are on the rise in many areas. Do you also use surgical robots at the RBK?
Yes, at the RBK we use the “DaVinci-Xi” surgical robot for many minimally invasive procedures. It supports the surgeon with four gripping arms. One of these gripping arms guides the camera, the surgeon uses the others to operate the finest pliers and other instruments. This allows you to work with the highest precision and a fantastic three-dimensional camera image. We are particularly able to carry out lung cancer operations so well.
They also treat diaphragmatic paralysis at the RBK. How do these paralysis occur and what consequences do they have?
Diaphragmatic paralysis occurs when the phrenic nerves are damaged, for example by nerve inflammation or injury during surgery. The diaphragm plays a very important role in breathing. Its nerves run from the cervical spine down through the chest to the diaphragm muscle. If one of these nerves is damaged, the diaphragm can no longer move properly and remains paralyzed: it bulges far into the chest, presses on the lungs and makes breathing significantly more difficult.
And what exactly does the treatment look like in such cases?
The surgeon can create space for the lungs again by performing a minimally invasive diaphragm lift. The paralyzed diaphragm is sutured so that it remains stretched tightly. A plastic mesh on the surface of the diaphragm provides stability.
We also carry out this operation at the RBK with the “DaVinci” surgical robot.
Rib fractures are one of the more common injuries in the chest area and are often treated conservatively. Can a surgical procedure still make sense?
Often several ribs break at the same time and in different places, so that the chest is dented and sharp fragments can injure the lungs and diaphragm. This can lead to internal bleeding and permanent breathing problems.
With surgery, the broken ribs can be restored to their normal shape and fixed with metal plates. The healing process is significantly less painful and the ribs do not heal together crookedly.
What is the pectus excavatum all about – and why can it be problematic?
A pectus excavatum is a congenital bend in the sternum. The bulge at the lower end of the sternum usually appears in childhood. As the child grows, this can increase and lead to symptoms such as a feeling of pressure in the chest and shortness of breath. A pronounced funnel reduces the space for the lungs and heart; The right half of the heart in particular has significantly less space and cannot fill with blood as well when stressed. This also increases the risk of heart disease in the long term.
How can a pectus excavatum be corrected surgically?
As a rule, we treat the pectus excavatum with the so-called “NUSS” operation, a minimally invasive method that goes back to the surgeon Donald Nuss. Using the keyhole technique, we insert one or two metal brackets behind the breastbone through small incisions. These straps push the sunken breastbone forward and straighten it. They remain in the body for around three years so that the sternum can permanently stabilize in the new position.
Info: Find out more about thoracic surgery on the Robert Bosch Hospital website.
