The new method with a laser scalpel involves the chest being opened with a lateral cut. The lung is then thoroughly palpated with the fingers in order to detect the conspicuous areas that will subsequently have to be removed. On average, 7.3 metastases (from solitary metastases up to 84 metastases) are removed during one laser intervention. “Removing just a small seam (only a few millimetres) of healthy tissue around the metastasis is sufficient,” said Dr. Thomas Kiefer explaining that a tube is inserted into the lung as drainage after the operation and the chest is closed again.

Depending on the number and size of the metastases that have to be removed, an intervention takes between 60 and 240 minutes. It is quite challenging, both for the surgery team and for the technology. “We have to use protective goggles for one to three hours, and an enormous amount of noise is generated after 45 minutes by the laser’s cooling system. This, along with the need to concentrate very hard on the work, makes the intervention a real challenge,” said Kiefer.

At the Offenburg Hospital and now also in Constance, Dr. Thomas Kiefer has already treated over 100 patients and has more than 15 years experience in thoracic surgery. In addition, he has long been acquainted with the use of laser technology. He is well prepared for using the new laser through his participation in trials and he has also been assisted by a colleague at another clinic who already had an excellent knowledge of the new laser. Kiefer had one patient who had over 30 metastases per lung lobe, all of which he managed to remove.

Kiefer is sure that the continued development of new technologies for the treatment of lung metastases and metastases in general is what makes his work possible. But he is also sure that all the opportunities are not yet being fully exploited as many of his colleagues lack specific knowledge in the use of the new technologies in clinical applications. “The German Society for Thoracic Surgery estimates that in our field of treatment in Germany about 10,000 operations, not exclusively relating to the removal of metastases, are not carried out although there is a clear indication of disease.” Many patients are not operated on because they do not have access to a specialist. “In addition, many laypeople and physicians unfortunately assume that the diagnosis of lung metastases or metastases in general is a catastrophe,” said Kiefer who is sure that it would be possible to help many patients, even older ones, if their doctors were better informed about the progress made in thoracic surgery. “We often see a kind of therapeutic nihilism, even though this is not at all justifiable,” said Kiefer.

In future, Dr. Kiefer hopes that further technical improvements will improve the removal of metastases with lasers. “The lasers have to become even more effective so that the preparation time can be reduced. In addition, it is of equal importance to make it clear to the public and in particular also to physicians that we are able to help patients with metastases,” said the thoracic surgery specialist.