Pulmonale Metastasektomie: Analyse technischer und onkologischer Ergebnisse bei 301 Patienten mit Fokus auf die Laserresektion

Osei-Agyemang, T; Palade, Emanuel; Haderthauer, J.; Ploenes, Till; Yaneva, V.; Passlick, Bernward

doi:10.1055/s-0033-1350873

Cited by 21 publications

(26 citation statements)

References 7 publications

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“…The mean disease-free interval for all patients was 12.9 months. After a median follow-up period of 27.2 months, 42.5% had experienced a recurrence and 29.2% had died [19]. In a clinical study by Vodicka et al [1] the 5-year survival rate for 87 patients was 38%.…”

Section: Complications and Results After Laser Surgerymentioning

confidence: 97%

“…In another paper, Rolle et al [18] reported that one case of postoperative haemothorax and one prolonged air leak occurred in 100 cases treated surgically. In a retrospective evaluation Osei-Agyemang et al [19] found that between a group treated with conventional surgery versus a group treated with laser surgery, only the rate of postoperatively-occurring pneumonia was markedly increased (11.3% as opposed to 2.9%) [19]. However, the use of lasers has made it possible to successfully treat patients with a large number of lung metastases.…”

Section: Complications and Results After Laser Surgerymentioning

confidence: 99%

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Nd:YAG Laser surgery of lung metastases

Kirschbaum¹

2015

Photonics &Amp; Lasers in Medicine

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Lung metastases occur during the course of the disease in many types of cancer. If the basic disorder is under control and there are no distant or mediastinal lymph node metastases, removal of the lung metastases can improve long-term survival. Lung metastases are nonanatomically removed from the healthy patient if they have not infiltrated any central bronchi or blood vessels. Nd:YAG lasers are particularly suitable for this. They cut the lung parenchyma and at the same time coagulate the resected surface. This means that large numbers of lung metastases can be removed with little bleeding. Modern Nd:YAG lasers (wavelength 1318 nm) are more efficient to use because the laser power is greater (80-100 W). This shortens the operation time and makes the resected surfaces more airtight. Consequently, resection zones on the surface need no longer to be sutured. The mortality and morbidity of the operations are low. Nd:YAG lasers are now indispensable in the surgical treatment of lung metastases. Zusammenfassung: Bei vielen Tumoren treten im Lauf der Erkrankung Lungenmetastasen auf. Ist das Grundleiden kontrolliert, d.h. liegen keine Fern-sowie mediastinale Lymphknotenmetastasen vor, kann durch eine Entfernung der Lungenmetastasen das Langzeitüberleben verbessert werden. Infiltrieren die Lungenmetastasen keine zentralen Bronchien oder Gefäße, so werden sie nichtanatomisch im Gesunden entfernt. Der Nd:YAG-Laser eignet sich dafür in besonderem Maße: er schneidet das Lungenparenchym und koaguliert gleichzeitig die Resektionsfläche. Dadurch können auch viele Lungenmetastasen blutungsarm entfernt werden. Die modernen Nd:YAGLaser (Wellenlänge: 1318 nm) werden durch die höhere Laserleistung (80-100 W) effizienter eingesetzt. Dies verkürzt die Operationszeiten und erhöht die Luftdichtigkeit der Resektionsflächen. Oberflächliche Resektionszonen müssen nicht mehr übernäht werden. Die Mortalität und Morbidität der Operationen ist gering. Auf den Nd:YAGLaser kann im Rahmen der Lungenmetastasenchirurgie nicht mehr verzichtet werden.

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Section: Complications and Results After Laser Surgerymentioning

confidence: 97%

Section: Complications and Results After Laser Surgerymentioning

confidence: 99%

Nd:YAG Laser surgery of lung metastases

Kirschbaum¹

2015

Photonics &Amp; Lasers in Medicine

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“…The Nd:YAG Laser has become indispensable in lung surgery procedures [1]. It is used mainly in the context of open surgical procedures for the resection of lung metastases.…”

Section: Introductionmentioning

confidence: 99%

“…The aim is to perform a non-anatomic resection of all palpable lung metastases in order to preserve the largest possible amount of lung parenchyma [2]. Anatomical lung resections are only carried out when the metastases are located more centrally or have reached a certain size [1]. If the branch of the lobar bronchus exhibits infiltration it even becomes necessary to perform sleeve lobectomy.…”

Section: Introductionmentioning

confidence: 99%

Local Effects on Lung Parenchyma Using a 600 µm Bare Fiber with the Diode-Pumped Nd:YAG Laser LIMAX® 120

2015

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Lung metastases are frequently removed with an Nd:YAG laser. The aim is to perform a non-anatomic resection of all intraoperatively palpable lung metastases completely in order to preserve the largest possible amount of healthy lung parenchyma. The surgeon can either work with a focusing handpiece or use a laser fiber of the so-called bare fiber with direct contact to the lung parenchyma. We currently use a 600 µm bare fiber for applications involving the lung parenchyma. Precise data on the local effect of the laser fiber on the lung parenchyma are not available, especially with regard to an increase in the laser energy. We want to study this question within the scope of an experimental model in pig lungs by means of systematic and reproducible tests. The lung lobes were removed from animals recently slaughtered in the abattoir and taken to the laboratory immediately, where the lobes were stored such that the surface of the lungs was parallel to the floor. A 600 µm bare fiber was attached to a mounting bracket vertically above the lung surface at a distance of either 0, 5, or 10 mm. This mounting bracket was in turn connected to a hydraulic feed motor. The feed motor is capable of moving the bare fiber forward across the lungs consistently at three different speeds (5 mm/s, 10 mm/s, or 20 mm/s). The bare fiber itself was connected to the diode-pumped Nd: YAG Laser LIMAX ® 120 (Gebrüder Martin GmbH & Co KG, Tuttlingen, Germany). We carried out the tests using three different laser powers: 20 W, 60 W, and 120 W. The lung lesions caused by the laser in each of the lungs were resected and sent in for histological analysis. The exact size of the vaporization and OPEN ACCESS

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“…In another retrospective study, Osei-Agyemang et al demonstrated that although a higher number of metastases was resected in the laser group, there was no significant benefit in the long-term survival (20).…”

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confidence: 97%