Treatment of pleural empyema (abscess) with pleurectomy and lung decortication in Catholic Clinic Koblenz-Montabaur

About the department

The Department of Thoracic Surgery at the Catholic Clinic Koblenz-Montabaur offers the full range of surgical treatment for patients with benign and malignant diseases of the lungs, pleural cavities, and mediastinum. The department is part of the Lung Cancer Center certified in accordance with the standards of the German Cancer Society (DKG), and therefore it provides high-quality treatment for lung malignancies. The team of the department's thoracic surgeons also has vast experience in the surgical treatment of benign respiratory system diseases, including pleurisy, lung abscesses, emphysema, pneumothorax, and other pathologies. The department's surgeons are internationally recognized experts in the field of minimally invasive operations, namely video-assisted thoracoscopic surgery (VATS). The first minimally invasive lung lobe removal in Rhineland-Palatinate was performed in this department. Such operations are done through small incisions between the ribs, due to which the patient experiences minimal pain, can breathe better, and recovers faster in the postoperative period. The department's specialists cooperate closely with pulmonologists and radiologists, thanks to which patients receive comprehensive medical care. The focus of doctors is always on the patient and his individual wishes and needs.

The department is headed by PD Dr. med. Martin Hürtgen who, together with the medical team, has developed the following innovative surgical procedures: video-assisted mediastinoscopic lymphadenectomy and mediastinoscopic sonography. The specialists, not only from Germany and Europe but also from Japan, strive to master these newly developed techniques, for which they come to the medical facility on their own or invite surgeons from the department to exchange their experience.

Lung cancer is one of the most frequently diagnosed and dangerous types of cancer. The first-line treatment for lung cancer is usually surgical resection of the tumor, a lung segment with a tumor, or a lung lobe, depending on the spread of the cancer process. The choice of the optimal operation and the development of a concomitant conservative treatment scheme take place at an interdisciplinary tumor board with the participation of thoracic surgeons, pulmonologists, oncologists, radiologists, radiation therapists, psycho-oncologists, and other specialists. With appropriate clinical indications, the department's thoracic surgeons perform the operation using low-traumatic video-assisted thoracoscopic surgical techniques (VATS): through small incisions and without opening the chest. If the stage of oncopathology does not allow for minimally invasive treatment, the department's specialists resort to open surgery. The success rates for open lung cancer interventions performed in the department are also at their highest level. In most cases, in addition to the resection of the malignant neoplasm, the patient is prescribed chemotherapy and/or radiation therapy.

The department's thoracic surgeons can also be proud of their exceptional success in the surgical treatment of lung, mediastinal, and chest wall metastases. The specialists mostly operate on patients with lung metastases due to breast, colon, kidney, prostate, stomach, and other types of cancer. Metastases can affect any area of the lung. These can be single or multiple. If a patient has single lung metastases, the department's surgeons will remove them using minimally invasive techniques. The medical facility uses advanced laser technologies to remove multiple metastatic foci. During such interventions, a special laser is used, with which surgeons make bloodless tissue incisions. Thoracoscopic imaging is used to determine the exact location of the tumor and direct the laser beam to it. The therapeutic effect is achieved due to the impact of laser beams on the metastatic focus, which results in the heating and destruction of cancer cells in the lungs. Laser metastasis removal is of particular value in the treatment of secondary lung tumors causing tracheal or airway obstruction.

The department's team of surgeons performs operations for a variety of benign pathologies of the respiratory system, including pneumothorax, pulmonary emphysema, pleural effusion, pleural empyema, solitary pulmonary nodules, and other diseases. Surgical interventions for the above pathologies are always performed using minimally invasive techniques. When performing operations, the department's surgeons make 2-3 skin incisions several centimeters long, after which a miniature camera and special surgical instruments are delivered to the pathological focus. The camera ensures the transfer of images of the operated field to the screen, and multiple zooming of images allows the surgeon to perform manipulations with pinpoint precision. Minimally invasive surgical procedures are performed under general anesthesia. Following the operation, the patient is under medical supervision for 1-3 days, after which they are given recommendations for follow-up treatment and discharged from the hospital.

The department's range of surgical services includes the following options:

• Surgical treatment for lung cancer
  • Sparing treatment using minimally invasive surgical techniques at early stages
    • Video-assisted mediastinoscopic lymphadenectomy
    • Thoracoscopic lobectomy
  • Combination treatment for advanced stages of lung cancer
    • Preoperative chemotherapy or radiation therapy
    • Extensive lung tumor resection along with part of the chest wall or other chest organs
    • Postoperative treatment with chemotherapy or radiotherapy
• Surgical treatment for lung, chest wall, and mediastinal metastases 
  • Lung metastases
    • Minimally invasive thoracoscopic resection of single metastases
    • Laser removal of multiple metastases
  • Chest wall metastases
    • Minimally invasive palliative removal of individual ribs
    • Chest wall extensive resections and chest wall radiation necrosis with subsequent plastic repair (in cooperation with plastic surgeons)
  • Mediastinal metastases
    • Videomediastinoscopic diagnosis and palliative resection of lymph node metastases
• Tracheal surgery
  • Resection of the tracheal segment with end-to-end anastomosis
  • Surgical correction of tracheal and laryngeal stenosis (in cooperation with the Department of Otolaryngology)
  • Palliative endobronchial recanalization and stent implantation
• Surgical treatment of chest wall and mediastinal tumors
  • Surgery for primary chest wall tumors
  • Extensive therapeutic resection of mediastinal tumors using sternotomy or thoracoscopic thymectomy (depending on the results of a histological examination and the stage of cancer)
  • Minimally invasive sampling for a histological examination before chemotherapy or radiotherapy
• Lung, chest wall, and tracheal laser surgery
• Video-assisted thoracoscopic surgery
  • Surgery for pneumothorax
  • Surgery for hyperhidrosis
  • Surgery for diaphragmatic paralysis
  • Surgery for pulmonary emphysema
  • Surgery for solitary pulmonary nodules
  • Surgery for pleural effusion and pleural empyema
  • Video-assisted mediastinoscopic lymphadenectomy
  • Thoracoscopic lobectomy
• Bronchoscopic interventions
  • Tracheal stent implantation
  • Recanalization for stenosing tumors
  • Bronchoscopy under general anesthesia (if necessary, with foreign body removal)
• Other medical services