Zentralblatt fur Chirurgie最新文献

Pelvic intraoperative neuromonitoring (pIONM) is emerging as a key tool to enhance functional outcomes following rectal cancer surgery. This paper synthesizes current evidence on pIONM, including findings from the multicenter, randomized NEUROS trial, which demonstrated significant benefits for urinary, sexual, and ano-(neo-)rectal functions. Additionally, the role of telementoring as a catalyst for standardized robotic assisted pIONM adoption is explored. Three case studies illustrate the low cognitive burden on surgeons during telemedicine-assisted monitoring, assessed via the NASA-TLX questionnaire (TLX-score varied from 5.0 to 24.3). The results highlight pIONM's potential to prevent nerve damage and improve patient quality of life, with telementoring poised to facilitate broader implementation.

Pleural mesothelioma (PM) is a highly aggressive tumour, mainly associated with prior asbestos exposure. Symptoms typically do not manifest until 20 to 50 years after exposure. Depending on the histological subtype of PM, the prognosis varies, though the median survival time is only 12-18 months. Imaging plays a central role in the management of PM patients, particularly in assessing operability and treatment response. However, PM presents a unique challenge for radiology due to its rarity, complex morphology, and tendency to invade multiple tissue layers simultaneously. Contrast-enhanced computed tomography (CT) is the central imaging modality in the diagnosis, preoperative planning and therapy monitoring of pleural mesothelioma (PM). Ideally, CT should include both the thorax and abdomen to capture the entire pleural space. Tumour thickness and volume, as determined by CT, are important prognostic factors for patient survival in PM. In addition, PET/CT, using radioactively labelled fluorodeoxyglucose (¹⁸F-FDG), offers additional valuable insights into tumour metabolism. Since PM is typically metabolically active, PET/CT is particularly effective in detecting smaller lesions, occult metastases, and assessing morphologically ambiguous lesions. Magnetic resonance imaging (MRI), on the other hand, offers distinct advantages over CT, due to its superior soft tissue contrast, particularly in visualizing tumour extent and infiltration of adjacent structures. Dynamic contrast-enhanced imaging, diffusion-weighted imaging, and 4D sequences provide valuable additional information. On the basis of the "Best Practices" of the expert panel from the International Mesothelioma Interest Group (iMig), we provide an overview of the common imaging modalities, including conventional X-ray, CT, MRI, and PET/CT. Additionally, we discuss staging based on the TNM classification (Tumour, Node, Metastasis), which evaluates the local invasion of the tumour (T), lymph node involvement (N), and the presence of metastases (M). We also present examples of assessing treatment response and highlight recent developments in diagnostic imaging.

We report on an 70-year old male patient with progressive dyspnoea. For further differential diagnosis he underwent a CT thorax in the pulmonary arterial phase. This revealed a solid, pleural round lesion. The lesion was located paravertebrally in the area of the distal aortic arch. Initially the dignity of the round lesion was undetermined. A subsequent examination conducted three months later, utilising HRCT, revealed no alterations in the dimensions or configuration of the mass. A change in position was observed. In this case of idiopathic phrenic nerve paralysis with diaphragmatic atrophy, diaphragmatic elevation and chronic progressive exertional dyspnoea, the surgical intervention involved a diaphragmoplasty and the surgical removal of the voluminous thoracolith by means of a muscle-sparing limited lateral thoracotomy. The diagnosis of a thoracolith was confirmed on the basis of morphologic criteria and a change in position.

Postoperative wound infections are a serious complication in thoracic surgery. At the same time, excessive use of antibiotics poses the risk of multi-resistant pathogens. The article highlights evidence-based strategies for perioperative antibiotic prophylaxis (PAP) and provides specific recommendations for action.

CT-guided transthoracic lung biopsy (CT-TTNB) is an essential method for the diagnosis of pulmonary nodules and masses. With a sensitivity of 85-97% and a specificity of 85-100%, it offers high diagnostic accuracy. By using core-needle biopsies, high-quality tissue samples can be obtained that enable molecular analyses for personalised therapy.At the same time, lung ablation has established itself as a valuable minimally invasive therapy. Procedures such as radiofrequency ablation (RFA), microwave ablation (MWA) and cryoablation enable targeted tumour destruction, particularly in inoperable patients with NSCLC or lung metastases. Studies have shown a high level of local tumour control with acceptable complication rates. The combination of imaging and interventional technique significantly improves patient safety and treatment outcomes and offers good results with low complication rates.Overall, CT-guided puncture and ablation are integral components of modern lung cancer diagnostics for primary and secondary lung tumours, while offering a new treatment option and therapy. They offer precise, low-risk alternatives to invasive procedures and can therefore make a significant contribution to effective patient care.