Zentralblatt fur Chirurgie最新文献

Preoperative localization of small, non-subpleural pulmonary nodules is a challenge in minimally invasive segmentectomy. Bronchoscopic placement of indocyanine green (ICG)-soaked microcoils enables intraoperative detection via near-infrared fluorescence (NIR), improving the precision and safety of resection. We report three patients with CT-suspected solid pulmonary nodules who underwent bronchoscopic ICG-coil placement. The interval between localization and surgery ranged from 1 to 7 days. All patients underwent uni- or biportal video-assisted thoracoscopic segmentectomy. The ICG coil was clearly visible intraoperatively, and the resections were completed without complications. Histology revealed squamous cell carcinoma, typical carcinoid tumor, and a metastasis from sigmoid colon carcinoma. Postoperative recovery was uneventful in all patients. Bronchoscopic ICG-coil localization is an effective method for preoperative identification of small pulmonary nodules, enabling precise segmentectomy with high intraoperative accuracy.

This case report shows a robotic assisted resection and repair of the pars mebranacea of the trachea with a bovine patch plastic.During a robotic assisted McKeown oesophagectomy of a 36-year-old patient with a squamous cell carcinoma after neoadjuvant radiochemotherapy the resection of the pars membranacea was necessary to achieve a R0 resection margin.The preparation, the resection and the repair were conducted completely with robotic assistance.Because of the close relation between oesophagus and trachea, in large T4-carcinomas partial resection of the trachea is not uncommon. Also, tracheobronchial injuries are a rare but dreaded complication during an oesophagectomy with potentially lethal consequences. Even though numbers of thoracoscopic and robotic assisted oesophagectomies are rising, the repair of a tracheobronchial injury usually makes a conversion to open thoracotomy necessary. This case report shows that a completely robotic assisted resection and reconstruction of the pars membranacea is safe and feasible.

As lung cancer screening is now covered by statutory health insurance and with the goal of early cancer detection, the number of diagnostic and interventional bronchoscopic procedures is expected to increase substantially - in order to facilitate timely treatment and improve patient survival. This trend underscores the growing importance of evidence-based anaesthesiological management in interventional bronchoscopy.This review summarises current anaesthetic strategies, oxygenation and ventilation techniques, and the monitoring modalities used in interventional bronchoscopy. The review critically appraises the available evidence regarding safety, risk profiles, and procedural outcomes.While diagnostic bronchoscopy is commonly performed under local anaesthesia, with or without moderate sedation to improve patient comfort, modern interventional bronchoscopy imposes significantly higher demands on anaesthetic care. Increasingly complex and invasive procedures, such as transbronchial cryobiopsy, airway stent implantation, and endobronchial tumour ablation, require tailored approaches to analgesia, anaesthesia, airway management, and respiratory support, in order to ensure procedural success and patient safety. The shared airway necessitates close interdisciplinary collaboration and the continuous maintenance of adequate oxygenation and ventilation throughout the intervention.Anaesthetic strategies range from various levels of procedural sedation to general anaesthesia with neuromuscular blockade. Airway management options include augmented spontaneous breathing, supraglottic airway devices, infraglottic techniques such as rigid bronchoscopy, endotracheal tubes, and specialised catheters for jet ventilation. In addition to conventional oxygen supplementation, established respiratory support modalities include high-flow nasal oxygen therapy, controlled mechanical ventilation, and jet ventilation, which may be selected or combined - depending on procedural and patient-specific requirements.Individually adapted anaesthetic concepts are essential for minimising procedural complications and optimising outcomes. This requires structured pre-interventional interdisciplinary evaluation and the implementation of standardised peri-interventional strategies. The choice of anaesthetic technique should be individualised, considering patient-related risk factors, comorbidities, underlying pulmonary pathology, and the type and invasiveness of the bronchoscopic procedure.

The Thoracoflo hybridgraft was developed for treatment of thoracoabdominal aortic pathologies in selective patients, avoiding thoracotomy, thoracic cross-clamping, and extracorporeal circulation (ECC). In the following manuscript, criteria for patient selection as well as pitfalls and bailouts after first clinical experience are summarised.Since September 2021, worldwide a total of 50 Thoracoflo implantations have been performed in centres with high experience in open and endovascular treatment of thoracoabdominal aortic pathologies. All patients were selected by interdisciplinary board decision. Conventional open or solely endovascular repair was not feasible or at high risk due to comorbidities or for anatomical reasons. Simulator team training was performed prior to surgery and the procedure was supervised by a proctor. All procedures were evaluated postoperatively for technical and surgical pitfalls, and consecutive bailouts were elaborated and summarised.Requirements for graft implantation are a safe landing zone in the descending thoracic aorta, which can also be created by TEVAR implantation, and possibility for retrograde visceral perfusion (access to visceral arteries in dissection, low thrombus load). The Thoracoflo hybridgraft was successfully implanted in 49 out of 50 patients, but in one procedure intraoperative conversion with thoracotomy and extracorporeal circulation was necessary. During debriefing pitfalls and bailouts were summarised.The Thoracoflo hybridgraft offers an alternative treatment option for complex aortic pathologies, if perioperative requirements are followed. Accurate patient selection and verification of treatment indication are mandatory.

Minimally invasive (MIS) and robot-assisted surgery (RAS) have revolutionised surgical practice and place high demands on knowledge and technical skills as well as structured training concepts. Currently, there is no comprehensive curriculum in Germany, which leads to insufficient quality of training, with corresponding consequences.The GeRMIQ curriculum (German Robotic and Minimally Invasive Surgery Qualification) was developed to close this gap and create a national, standardised, and forward-looking program for basic surgical training.The12-month program is divided into two parallel strands, laparoscopy and robotics, and is based on a "proficiency-based progression" model. It comprises three central phases: a cloud-based theory section, step-by-step dry lab training, and a clinical phase. Before implementing GeRMIQ in a clinic, a needs and capacity analysis is carried out to evaluate site-specific requirements and draw up a plan. The theory phase teaches the basics of MIS and RAS. The dry lab phase focuses on technical skills, including exercises on realistic models. The clinical phase focuses on surgical assistance on the one hand and the performance of sub-steps and initial minor surgeries under supervision on the other, accompanied by assessments of the number of cases completed, surgical performance, and team competence. The curriculum is industry-neutral and uses standardised materials based on scientific evaluations and didactic requirements.The GeRMIQ curriculum represents a much-needed solution for surgical training in MIS and RAS in Germany. It integrates proven and modern teaching methods and practical components, setting new national standards for comprehensive, standardised training. The introduction and future viability of the concept require constructive cooperation between all parties involved and the provision of the necessary resources.

Colorectal cancer (CRC) is among the most common malignancies worldwide. Approximately 10% of all CRCs are caused by monogenic hereditary tumour syndromes, collectively referred to as hereditary colorectal cancers (hCRC). The increasing use of molecular diagnostics - such as microsatellite instability (MSI) testing - is expected to significantly raise the detection rate in the coming years. hCRC can be broadly divided into polyposis syndromes (e.g. FAP, MAP) and non-polyposis syndromes (primarily Lynch syndrome). Surgical management must be tailored to the specific syndrome, and must balance oncological safety with long-term functional outcomes. In FAP, timely prophylactic colectomy is essential, whereas in MAP, the surgical strategy depends on polyp burden and tumour location. For rare polyposis syndromes such as NTHL1-, POLE-, or POLD1-associated syndromes, evidence-based recommendations are lacking, and treatment should follow FAP/aFAP protocols. Lynch syndrome is associated with a significantly increased risk of metachronous tumours. In this case, surgical strategies must be re-evaluated that consider emerging immuno-oncologic therapies, such as checkpoint inhibition in MSI-positive tumours. Surgical care for patients with hCRC should be provided at specialised centres, including genetic counselling, and be guided by interdisciplinary tumour board discussions.

The video vignette will provide a structured guide to laparoscopic distal pancreatectomy using the Warshaw technique.Spleen-preserving laparoscopic distal pancreatectomy is considered the established standard for benign or low-grade malignant tumours and can be performed with or without preservation of the splenic vessels. Preservation of the splenic vessels is generally recommended, but the Warshaw technique, which involves routine division of the splenic vessels, is an option in selected cases.This video demonstrates the surgical procedure on an 84-year-old patient with a cystic lesion in the pancreatic tail. The central key points of the operation are demonstrated.Spleen-preserving laparoscopic distal pancreatectomy with division of the splenic vessels is an established procedure that can be performed in a highly standardised manner.

Hereditary diffuse gastric cancer (HDGC) caused by disease-causing variant in CDH1 or CTNNA1 and familial adenomatous polyposis (FAP, disease-causing variants in APC) require individualised cancer prevention strategies. In HDGC, prophylactic total gastrectomy is often recommended, whereas in FAP, endoscopic surveillance with interventions plays a central role. The choice of reconstruction (Roux-en-Y, jejunal interposition, double-tract) affects both duodenal accessibility and quality of life. Decisions between surveillance and surgery should be made individually, balancing cancer risk and postoperative quality of life.