Surgeons from different departments contribute their expertise - as in the case of Niklas L., who had a rare malignant tumour
Professor Dr Dingemann examines patient Niklas L. Copyright: Karin Kaiser/MHH
There are eight sub-disciplines in surgery and numerous specialisations within these. ‘We are working in an increasingly differentiated way,’ says Professor Dr Jens Dingemann, Director of the Department of Paediatric Surgery at Hannover Medical School (MHH). This not only makes the individual surgical specialities more professional, but also opens up completely new opportunities for cooperation. ‘Together we are even better and can operate more successfully and safely,’ explains Professor Dingemann. In MHH paediatric surgery, surgeons from different specialist departments work together in interdisciplinary teams for complicated and risky operations. One example of this is the adolescent Niklas L. from near Nienburg. A large malignant tumour was removed from his chest by a ‘mixed’ surgical team.
Large tumour in a critical location
‘It all started when I felt a small lump on my left chest,’ recalls Niklas. After telling his parents about it, he was examined by his family doctor, pneumologist and radiologist as well as in the paediatric oncology department at Minden Hospital. Then the diagnosis was finalised: Niklas had cancer. A chondrosarcoma, a rare bone tumour, was located in his chest cavity. In November 2023, the then 17-year-old came to the MHH for treatment. Chondrosarcomas are normally removed surgically. However, Niklas' X-rays showed that the tumour, which looked like a small lump on the outside, was as big as an orange on the inside. ‘The position of the tumour was also extremely unfavourable.
It was located directly on the heart and on the aorta, the main artery,’ explains Professor Dingemann. An operation initially seemed impossible because it was too risky. There were no really good alternative treatment options: chemotherapy is generally not suitable for chondrosarcomas and radiotherapy was not particularly promising in Niklas' case.
Four highly specialised surgeons
An interdisciplinary team came together from the outset to assess the situation and the next steps. This included Dr Murat Avsar, Dr Patrick Zardo and Dr Alexander Horke from the Department of Cardiothoracic, Transplantation and Vascular Surgery as well as Professor Dingemann.This meant that four highly specialised experts were on board: Dr Avsar for cardiovascular surgery, Dr Zardo for thoracic and lung surgery, Dr Horke for paediatric cardiac surgery and Professor Dingemann for paediatric surgery. ‘We discussed the case in detail and considered whether we should go ahead with the operation. In the end, we were sure that together we could do it,’ explains Professor Dingemann. The surgeons were able to present the joint treatment plan to Niklas' parents.
Maximum preparation for the operating theatre
After further preliminary examinations, the team went into the operating theatre on 17 July this year fully prepared. ‘We were well prepared to be able to act appropriately even in an unexpected situation,’ says Professor Dingemann. This also included having a heart-lung machine on standby. Fortunately, this did not have to be used. During the three-hour operation, the interdisciplinary surgical team with colleagues from cardiotechnology, anaesthesia and nursing managed to completely remove the tumour despite its critical position. ‘This was mainly due to our good cooperation, in which everyone was able to contribute their special expertise and make the appropriate incisions,’ explains Professor Dingemann.
Surgery survived well
Niklas had only told a few people about his cancer before his operation.‘I didn't want it to be a constant topic,’ he reports. In hindsight, this proved to be the right strategy for him. ‘That way, I managed not to think about it all the time myself. ’He came through the procedure well. He is currently still coming to the paediatric clinic regularly for follow-up examinations - and has good prospects of making a full recovery.
More patient safety
Surgeons from different departments working at the same operating table is not normally the norm. ‘In the past, it was clear that one person did everything alone. Perhaps certain vanities also played a role,’ says Professor Dingemann. But the self-image is slowly changing. Today, there are always examples of surgical co-operation. Professor Dingemann would like to further strengthen the model at the paediatric clinic, because: ‘We are good on our own, but together we are even better.
As a team of specialists, we can complement each other perfectly in complicated procedures and learn from each other. And patients benefit from greater safety.’
Text: Tina Götting