Heavy surgery spared

Innsbruck University Hospital: Unique procedure worldwide

Alexander Loizides and Gerlig Widmann with the robot.

(Bild: Innsbrucker Univ.-Klinik für Radiologie)

Innsbruck University Hospital reports a "worldwide unique procedure": for the first time, a leak in the largest lymph vessel of a patient's body has been treated with a micro-robot-assisted puncture and vascular closure. The patient concerned (63) was able to be discharged just 48 hours after the procedure.

The conventional, normal way would have been to subject the patient to a major operation, during which the chest might have had to be opened to close the leak.

Minimally invasive access instead of major surgery
The 63-year-old, who had to have most of his oesophagus removed due to cancer, was still recovering from a first major operation, so two experts from the University Department of Radiology wanted to spare him another operation and opted for a "globally unique, robot-assisted and minimally invasive approach".

The challenge here is to avoid damaging any sensitive vessels or organs on the way to the center of the body and to successfully hit the very narrow target.

Gerlig Widmann, Geschäftsführender Oberarzt der Klinik für Radiologie

Life-threatening leak in a vessel
Due to a leak in the body's largest lymphatic vessel (thoracic duct), around one liter of lymph fluid had accumulated in the chest cavity every day, which would have been life-threatening in the long term, the difficult initial situation was described. "We first punctured a lymph node in both groins in order to apply contrast medium to the patient's lymphatic system," explained senior physician Alexander Loizides.

This made it possible to visualize the lymph vessel and the leak in the chest cavity. The patient was then turned onto their stomach so that a long needle could be advanced into the large lymph vessel via the back using robot-assisted navigation.

Image a: Depiction of the leak in the central lymph vessel. Images b and c: Robot-assisted puncture of the lymph vessel, image d: Closure using coils.

(Bild: Innsbrucker Univ.-Klinik für Radiologie)

Obviously not an easy undertaking, as no sensitive vessels or organs had to be damaged on the way to the center of the body and the very narrow target had to be successfully hit, as Gerlig Widmann, Managing Senior Physician at the University Department of Radiology, explained: "And we used a microrobot for the first time in the world to support us in this task."

"Very impressive"
A hollow guide catheter was then inserted via the needle and maneuvered into the leaking lymph vessel. Eleven "coils" (a type of metal spiral, note) were inserted and the lymph vessel was completely sealed from the inside. "It was very impressive to see how no new fluid came in within 24 hours, the patient was able to breathe normally again and was discharged after just 48 hours," Widmann and Loizides were delighted to report.