Respiratory medicine and infectious diseases in cooperation with thoracic surgery

Internal respiratory medicine and thoracic surgery complement one another in various ways.

• Performances of internal respiratory medicine
• Performances of thoracic surgery

Performances of internal respiratory medicine

Internal respiratory medicine includes the complete spectrum of bronchial diagnostics in cases of unclear pulmonary processes. Noninvasive procedures assure minimal discofort and risk at a maximum of diagnostic reliability. Thus, thoracic surgical interventions can often be avoided. Nevertheless, if these interventions are indicated, risks can be reduced due to an extensive functional testing regarding the cardiopulmonary excerise capacity. In some cases, it is possible to optimize preoperatively the cardiopulmonary capacity by an accurately defined treatment and excercise program. Regarding oncological diseases of the bronchi and the lung, internal respiratory medicine cares for treatment planing as well as for the application of chemotherapy or chemo-radiotherapy - no matter if pre- or post-operatively or as part of palliative treatment in case of a nonresectable tumour. Centrally placed airway stenoses, if necessary, can be reopened and kept open by means of laser- or cryotherapy, with or without the implantation of stents. The postoperative management of patients with surgically resected tumours is of particular importance. In this context, respiratory medicine contributes to strategies of ventilatory support, weaning as well as infection control and management.

Performances of thoracic surgery

Thoracic surgery complements the spectrum of diagnostics and therapy of patients with respiratory diseases in an essential way. Particularly the minimum invasive intervention of the so-called video assisted thoracoscopic surgery (VATS) offers a big advantage in terms of safety and tolerability. It facilitates a diagnistic investigation of all diseases of the pleural space (space between pulmonary pleura and the costal pleura). In case of unclear diseases of the pulmonary tissue or unclear peripheral densities or nodes, VATS offers the possibility to gain representative tissue for examination (and thus, for a better way of planing focussed treatment). Sometimes the pre-operative examination of lymph nodes that are situated inside the thorax of patients who suffer from thoracic tumours is mandatory. In this case, mediastinoscopy (operative sampling of lymph nodes situated aside the trachea and the central bronchi) is used. The curative treatment of the so-called non-small cell lung cancer (NSCLC) as well as in early stages of small cell lung cancer (SCLC) - frequently the only treatment that offers the prospect of cure - is a clear domain of thoracic surgery. Some patients benefit from the extirpation of singular metastases. Finally, for some patients suffering from a serious pulmonary emphysema, the lung volume reduction surgery (LVRS) offers additional options. Within the scope of a LVRS, inactive pulmonary alveoli are excised to enable the expansion of still functioning pulmonary space and thus, and thereby to facilitate a better gas exchange.