Thoracic Surgery

With 37 beds and a further five beds in the intensive ward, our Thoracic Surgery Clinic is one of Germany’s large specialized chest units. Since 2008, we have been certified as a ‘Thoracic Center’ by the German Thoracic Surgery Association and since 2009 as a ‘Lung Cancer Center’ by the German Cancer Society. The Clinic is able to offer highly qualified treatment thanks to close collaboration and cooperation with other specialist areas such as thoracic anesthesia, intensive medicine, pneumology, radiology, radiation therapy, psychooncology, physiotherapy, patient welfare and our oncology outpatient service. Interdisciplinary meetings and tumor conferences are held on a daily basis.

The main focus of the 900-plus interventions performed each year is on tumor diseases. Within our oncological thoracic surgery unit, we specialize in minimally invasive (e.g. VATS lobectomy), parenchyma-saving (e.g. tracheal and broncheal sleeve resection, segmental resection of the lung) and extended interventions (e.g. vascular sleeve resection, partial resection of atrium, chest wall resection).

However, we also perform the entire range of thoracic surgical interventions in response to benign diseases of the respiratory tract (trachea and bronchia), lungs, mediastinum, pleura, diaphragm and chest wall.

As well as malignant and benign conditions, we treat infectious diseases of the chest area such as tuberculosis and septic diseases.We also conduct outpatient operations, e.g. port implantation where chemotherapy or lymph node removal is required.

Selected thoracic diseases:

• Bronchiectasis (abnormal widening of the bronchia)
• Hematothorax (collection of blood in the pleural space)
• Hyperhidrosis (excessive sweating of the head, hands and arms)
• Pigeon chest
• Lung carcinoma (lung cancer)
• Lung emphysema (volume reduction surgery in case of over-inflated lungs)
• Lung metastases (spreading of tumors from outside the lungs)
• Pulmonary nodules
• Mediastinitis
• Metastases or local recurrence in the chest area, e.g. in cases of breast carcinoma.
• Myasthenia with thymic hyperplasia
• Osteomyelitis (discharge from bone region, e.g. ribs, sternum)
• Fungal diseases of the lung (e.g. aspergillus)
• Pleural effusion (collection of fluid in the chest cavity)
• Pleural carcinosis (migration of tumor cells in the pleura)
• Pleural empyema (pleural effusion)
• Pleural mesothelioma (malignant pleural disease, e.g. after exposure to asbestos)
• Pneumothorax (collapsed lung)
• Sternal dehiscence (e.g. after heart OP)
• Thymoma (tumor of the thymus)
• Tracheal stenoses (narrowing of the windpipes)
• Tracheomalacia (‘floppiness’ of the windpipes)
• Funnel chest
• Tuberculosis (e.g. caverns, pleural TB)
• Tumor of uncertain origin (e.g. benign tumors of the lung, mediastinum of chest wall)
• Diaphragm (e.g. plication in case of weakening of tissue)
• Cysts (bronchia or pericardium)

Oncological thoracic surgery
In lung carcinoma interventions, it is important to have an experienced team in place right at the preparatory stage, since the indications for the operation and in some cases the need for a combined form of treatment as well as the potential scope of the operation all need to be assessed.

As a rule, the pulmonary lobe affected by the tumor will need to be removed (lobectomy), although in rarer cases an entire lung may have to be taken out (pneumonectomy). In order to protect as much healthy lung tissue as possible, we conduct parenchyma-saving operations (sleeve resection) to the bronchia or vessels; in the case of large tumors, however, more extensive resection may be necessary involving the atrium, the vena cava, neighbouring organs, the thoracic wall or the trachea (sleeve pneumonectomy). Segmental resection may be indicated for patients with impaired lung function. Patients with early-stage lung carcinoma can be operated on using minimally invasive techniques.
Pleural mesothelioma is treated by means of pleural pneumonectomy (3PD operation) or palliative decortication.

Minimally invasive thoracic surgery
Many interventions in the chest or lung area are now possible using minimally invasive techniques (keyhole surgery). This allows surgeons to examine and treat chest diseases less invasively without the need for a large incision. The operation is conducted by means of two or three small incisions using a video camera and extremely delicate instruments. We have been employing this modern technology since 1991 and have made constant improvements.
Minimally invasive techniques can be used to treat many of the diseases listed above. Over 40 percent of our operations are carried out in this way, for example using VAMLA (video-assisted mediastinal lymphadenectomy) and VATS lobectomy (video-assisted thoracoscopic surgery) in early-stage lung cancer, VATS decortication for pleural empyema and correction of funnel chest using the Nuss method.

Laser metastasis surgery
In 2004, we acquired a special laser (lung laser) for operations to remove metastases (migrated tumor cells) in the lungs, which can form in cases of intestinal cancer, kidney cancer, chest cancer and other types of cancer. This laser allows us to remove metastases with minimal damage to the neighbouring healthy lung tissue. By targeting and removing individual metastases, it is possible to significantly improve the patient’s chances of survival. Complete removal is possible even where there are several metastases. In the event that new metastases form at a later stage of the disease, the operation can be repeated.
Thanks to a special computer-assisted program (CAD), it is possible to detect even very tiny metastases using computed tomography of the thorax. We collaborate with an number of institutions including the Berlin Brandenburg Sarcoma Center. In the case of this particular condition, residual surgery is performed on completion of chemotherapy. As part of the Berlin-Buch Tumor Center, we have also established a partnership with the clinics at the center.

Video mediastinoscopy
Video-mediastinoscopy is part of our standard repertoire of diagnostic and therapeutic procedures and is used to clarify diseases of the mediastinal area or to conduct accurate staging in cases of lung carcinoma. Since 2001, we have also employed the extended technique of VAMLA (video-assisted mediastinal lymphadenectomy). This allows us not only to take biopsies from the lymph glands but also to remove the glands completely. This is important in the preparation of a VATS lobectomy and in cases of mediastinal metastases from other tumors.
In certain cases, it is possible to conduct extended mediastinoscopic mediastinal surgery, e.g. a second bronchial resection following pneumonectomy in cases of pneumonectomy cavity empyema.

Correction of funnel and pigeon chest
For many years the Clinic has also specialized in operations to correct malformations of the chest wall known as funnel chest and pigeon chest. These abnormalities appear in children and adolescents, although it is sometimes necessary to undertake corrective surgery in adults in cases where the malformation leads to the impairment of bodily functions, e.g. breathing difficulty.
Here too, as well as the open method, minimally invasive surgery using the Nuss procedure is becoming more widespread.

Tracheal surgery
Assessing the indications for operations to the windpipe requires tremendous expertise on the part of the medical staff (thoracic surgeon, anesthetist, bronchologist), as success depends on the right procedure. Effective intraoperative cooperation with the anesthetists is crucial.
The Clinic can also perform resection in the case of stenosis (narrowing), e.g. following long-term ventilation or as a result of tumors, as well as reinforcement operations to rectify tracheomalacia (floppiness of the tracheal wall).

Volume reduction surgery
One of the most common lung diseases is lung emphysema, which can lead to over-inflation of the entire thorax, thus inhibiting the function of the musculature of the airways, and to aggravation of the breathing difficulties experienced by the patient. Resection (removal) of the most severely over-inflated sections of the lung (lung volume reduction) can restore the physiological function of the respiratory musculature.
Providing the indications are correctly identified, this minimally invasive intervention can produce a significant improvement in the patient’s quality of life.