Thoraxchirurgie: Das Zeitalter der minimalinvasiven Lobektomie

In den letzten Jahren haben die minimalinvasiven bzw. videothorakoskopischen (VATS) Resektionen das operative Spektrum in der Thoraxchirurgie revolutioniert. Dieser Beitrag soll zeigen, warum die VATS-Lobektomie für Patienten mit der Diagnose eines operablen Lungenkarzinoms Vorteile bringt, welchen Stellenwert sie innerhalb der Thoraxchirurgie bekommen hat, was bezüglich Indikationen und Komplikationen zu beachten ist und wohin die Zukunft der minimalinvasiven Thoraxchirurgie weist.

Abstract

The contingent of VATS (video assistend thoracic surgery) lobectomies will continue to increase in the time to come. Thoracic surgery departments that do not integrate this procedure into their routine spectrum will have to justify themselves to referrers and clinic administrations and will have problems with the recruitment of training assistants as well. The advantages of minimally invasive lobectomy are impressive and the long-term oncological results are equivalent to open lobectomy. VATS lobectomies in non-intubated patients will increase significantly in the next few years and further reduce the invasiveness of the operation. The number of clinics that offer RATS (roboter assistend thoracic surgery) lobectomies will also increase as more companies bring robot systems onto the market, making them significantly cheaper. Better screening programs for risk patients for lung cancer, rapid advances in thoracic oncology and further minimization of surgical trauma in lung resections will significantly improve the overall therapy and prognosis for lung cancer patients in the years to come.

Kernaussagen

• Die VATS-Lobektomie (VATS = Video-assistierte Thorakoskopie) ist ein technisch anspruchsvolles Operationsverfahren, das nur von erfahrenen thorakoskopischen Chirurgen mit ausreichender jährlicher Fallzahl an Operationen durchgeführt werden kann und soll.

• Mit zunehmender Erfahrung des OP-Teams und durch die Verbesserung der Operationsinstrumente, Kamerasysteme und Stapler in den letzten Jahren können heutzutage auch fortgeschrittene und zentral gelegene Lungenkarzinome von entsprechenden Expertenteams per VATS operiert werden.

• Das deutlich reduzierte Schmerzniveau nach VATS-Lobektomien führt zu einer schnelleren Mobilisation und kürzeren Krankenhausverweildauer, was besonders in der Gruppe der über 80-jährigen Patienten mit einer geringeren Morbidität und Mortalität einhergeht und bei sorgfältiger Selektion somit mehr Operationen in diesem Kollektiv ermöglicht.

• Die onkologischen Langzeitergebnisse nach VATS-Lobektomie sind gleichwertig zur offenen Lobektomie.

• RATS-Operationen (Roboter-assistierte Thorakoskopie) und NI-VATS-Lobektomien (nicht-intubierte VATS) werden helfen, das operative Trauma für die Patienten zu reduzieren und das perioperative Setting weniger invasiv zu gestalten.

Schlüsselwörter

Thoraxchirurgie - Lobektomie - Lungenkrebs - Bronchialkarzinom - minimalinvasive Chirurgie

Keywords

thoracic surgery - lobectomy - lung cancer - minimally invasive surgery

Publikationsverlauf

Artikel online veröffentlicht:
15. Oktober 2020

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