Bariatric Surgery: From weight loss to curing Type 2 Diabetes

General Info: 

Recent studies show that obesity is turning into an epidemic. Throughout Europe there are over 135 million overweight and obese individuals, of which at least 6 million suffer from morbid obesity. In Greece, the relevant figures are equally worrying. The frequency of appearance of obesity is 26.0% for men and 18.2% for women, while the figures for children are 8.5% for those aged 7-12 years and 6% for teens.

Obesity is characterized as morbid when the body mass index (BMI=weight/height2) is equal to or higher than 40, or equal to or higher than 35 when concurrent diseases are present as a result of obesity. It is worth noting that the life expectancy for morbidly obese individuals is 20 years less than for non-obese individuals of the same age. Patients with a BMI>50 are characterized as hyper-morbidly obese. These patients require a more aggressive treatment approach.

Surgery for morbid obesity is the only treatment approach that can enable long-term weight loss maintenance, contribute to the treatment of diseases associated with obesity, and improve quality of life. Laparoscopic bariatric surgical procedures have distinct advantages over the corresponding open ones, including a shorter hospital stay, smaller chance of respiratory complications, minimization of the percentage of trauma purulence and post-surgical hernias, as well as the patients’ faster return to their daily activities and work.

The gastric band is considered today the safest bariatric surgical procedure, although its outcome depends greatly on the patient’s subsequent behavior and nutrition. A silicone band is placed around the stomach, creating two stomach chambers. The upperchamber has a capacity of 15-20ml, thus creating a feeling of early satiation after a meal. The band bears an internal sac that is connected to a valve, placed subcutaneously in the abdominal region. When this sac is distended by administering saline solution, it is possible to increase or decrease the width of the opening that connects the two chambers.

Sleeve gastrectomy (gastric sleeve) is a method that has been gaining ground lately, because it is fairly easy to execute laparoscopically. It consists of using automatic stapling machines to create a narrow tube along the minor curvature of the stomach, and removing the rest. The procedure has spectacular results in the first few months post-operatively. A recent German study (April 2011) posited questions about the procedure’s potential for severe complications, compared to other bariatric procedures.

Gastric plication (laparoscopic greater curvature plication – LGCP) is an alternative restrictive surgery where a narrow gastric tube is created by sewing folds externally onto the stomach. No long-term study outcomes are yet available to support this procedure.

The gastric bypass Roux-en-Y procedure is today the most frequently performed bariatric operation (65% of bariatric operations worldwide), due to its very good weight loss outcome. At 10-year follow-up, most patients retain at least 50% of the original excessive weight loss. It is performed laparoscopically. Approximately 30% of patients may present nutrition issues (iron and vitamin B12 deficiency). The great 

advantage of his method is that it can be applied to people who consume many sugars and also to hyper-morbidly obese individuals. The loss of excessive weight is more effective than with restrictive-type operations.

Bariatric surgery is an effective method for preventing or treating Type 2 diabetes mellitus (T2DM) however, the duration of the results over time differs for the different types of procedures. In a recent study in the USA (December 2012), a weight loss comparison was made between patients with gastric band and patients with gastric bypass, in regards to metabolic response to meals, sensitivity to insulin, and the function of the beta-cell in non-diabetic obese individuals. Metabolic response was significantly different following a gastric bypass compared to gastric banding, and was manifested in the quick transfer of glucose from the meal into the systematic circulation, an increase in the dynamic secretion of insulin, and early increase in plasma glucose, insulin, and Glucagon-like peptide-1 (GLP-1) for the gastric bypass group. However, the improvement in the glucose curve, sensitivity to insulin, and beta-cell function did not differ between the two groups following weight loss. Additionally, both procedures led to a decrease in the inflammation indexes of subcutaneous fat. According to the authors, weight loss is primarily responsible for the therapeutic effect of the gastric band and gastric bypass on sensitivity to insulin, beta-cell function, and glucose curves on non-diabetic obese adults.

The mini-gastric bypass is making a comeback in the laparoscopic and more dynamic version of the procedure, and its effectiveness and safety are under investigation. It is similar to the classic gastric bypass (Roux-en-Y) and has comparable weight loss results. A recent study in China (December 2012) that included 1,657 patients showed the same effectiveness for both procedures at 10-year follow-up. The technique is simpler than the gastric bypass: after separating the stomach and creating a small pouch, this pouch is then connected directly to the small intestine, bypassing a small section of it (200cm). The operation is considered permanent, but can be reversed in the event that excessive malabsorption problems arise.

According to the International Diabetes Federation, Bariatric Surgery is the appropriate treatment for obese individuals with Type 2 diabetes mellitus (IDF, March 28, 2011, New York). This is the first international acknowledgement of a new concept in surgery, of Type 2 Diabetes Mellitus Surgery or, in the term now being widely established, of Metabolic Surgery. The origins of this revolutionary term date back to 1978, when Buchwald and Varco presented their book entitled “Metabolic Surgery”. Today, the term is defined as: “the sum of surgical procedures that correct Type 2 diabetes mellitus and release the patient from the need to receive oral or hypodermal insulin treatment”.

At this point, it should be pointed out that weight loss does not necessarily require a “metabolic surgery”. Bariatric surgery has many beneficial metabolic effects however, if these are considered the result of the weight loss, then it cannot be called “metabolic surgery”. A purely metabolic surgical procedure should fix metabolic pathology regardless of any weight loss.

The bariatric procedures that today make up the sum of metabolic surgeries are focused on the substantial improvement, or even complete eradication, of Type 2 diabetes without significant weight loss. Procedures designed especially to cure Type 2 diabetes include the duodenal-jejunal bypass, the duodenal sleeve, and the ileal interposition surgery. However, these new procedures should only be performed within the framework of medical studies. A significant question that remains is whether these procedures should be performed on non-obese patients (BMI<35). In the first metabolic surgery consensus that took place in 2007, it was agreed that in those patients, the proper performance of surgical procedures on the gastrointestinal tube for the treatment of diabetes is a serious research priority. Although metabolic surgeries presented a positive cost-effectiveness ratio for this group of patients as well, in at least two reliable studies, further research is required before the indications can be extended for all patients with Type 2 diabetes.

There is great interest in the application of Robotic Surgery to procedures for morbid obesity. Specifically, the use of a robotic system provides a 3D imaging of the surgical field and seven degrees of freedom with surgical tools (movements identical to the human wrist). These capacities combined with the power of robotic arms greatly facilitate intra-abdominal suturing, which is necessary in surgical procedures for morbid obesity (constructing shunts, folds or pleats, securing the gastric band, etc.).

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Athens Medical Center

Dr. Konstantinos M. Konstantinidis MD, PhD, FACS

Scientific Director of AMC

  • Director of General, Bariatric, Laparoscopic & Robotic Surgery,
  • President of Greek Chapter of American College of Surgeons,
  • President & Founder of SEERSS

News By Page

Athens Medical Centre: For the first time worldwide successful robotic cholecystectomy through one micro-incision in an 8 month pregnant woman

For the first time worldwide, a cholecystectomy surgery was successfully performed through a micro-incision (Single Site Robotic Cholecystectomy)  in a woman being in her 31st week of gestation, i.e. the eighth month. The surgery was performed by Dr. Konstantinos Konstantinidis, Adjunct Professor of Surgery of the US Ohio State University, Scientific Director and Director of General, Laparoscopic and Robotic Surgery at Athens Medical Centre, and his team.

The 39-year old woman, who is pregnant with her first child, had frequent episodes of intolerable pain in the abdomen, which was the result of cholecystitis due to biliary sludge and microlithiasis, with a risk of presenting pancreatitis and jaundice. Waiting endangered both her life and the life of the foetus, and the medical team decided to proceed directly to the operation. The patient stayed in the clinic for only 24 hours and she did not show the slightest problem during her recovery.

The team chose the single-site robotics technique instead of the open or laparoscopic technique, as this method is perfectly safe for both the patient and for the smooth continuation of pregnancy. The advanced flexible robotic micro-tools and robotic camera are inserted from an incision with a length of 1.5 cm below the woman’s navel. Instruments insertion is conducted under direct three-dimensional vision, without anything touching the expanded pregnant uterus.

Single-site robotic surgical operation is at the forefront of developments in minimally traumatic surgery. Apart from the “disappearance” of surgical scars, it reduces postoperative pain and it enables faster recovery and discharge from the hospital.

Dr. Konstantinos Konstantinidis stated: “We have already operated on three other pregnant women with acute cholecystitis in the past with the same technique, while being at the 28th, 27th and 18th week of gestation. So far, our team is the only one that has described this technique in pregnant women worldwide, and for this last case we have many invitations to present the operation’s video in all the upcoming international robotic surgery conferences. Since March 2011, when the manufacturer of da Vinci, Intuitive Surgical, trusted us to initiate, first in the world, Single Site Robotic Surgery, we have performed more than 350 surgeries of this kind at Athens Medical Centre, four of which four were during pregnancy. It should be noted that in the past we have performed operations on several women in advanced pregnancy laparoscopically but with multiple incisions.”

“Athens Medical Centre provides the possibility to use this aerospace robotics technology, allowing us to innovate at international level and feel proud to offer the best to the patients who trust us. By now, my team’s experience exceeds 15,000 laparoscopic and 1,600 robotic operations. Many surgeons, as well as students and residents from Greece and abroad visit us to attend these techniques that we implement successfully. This is a great honour for me personally, but also for my partners”, added Dr. Konstantinidis.

Diaphragmatic hernia - Gastroesophageal Reflux Disease

Written by Konstantinos M. Konstantinidis, MD, PhD, FACS, Adjunct Professor of Surgery, Ohio State University, USA, President, Greek Chapter of American College of Surgeons, Scientific Director, Director of General, Bariatric, Laparoscopic and Robotic Surgery Department, Athens Medical Center, Athens Medical Group

What is a Diaphragmatic Hernia?

Diaphragmatic hernia is one of the causes of Gastroesophageal Reflux Disease or GERD.

At the lower part of the esophagus there is a circular muscular layer, called Lower Esophageal Sphincter (LES). In normal individuals, the diaphragm helps the Lower Esophageal Sphincter to remain constantly in contraction, preventing gastroesophageal reflux of the stomach’s liquids into the esophagus, and it only relaxes during swallowing. Indiaphragmatic hernia, the diaphragm’s esophageal chiasm is larger than normal, and it allows the displacement of the esophagus towards the chest, thus cancelling its sphincter mechanism and allowing gastroesophageal reflux of stomach fluids (GERD).

Gastroesophageal reflux disease (GERD) is the flow of stomach contents into the esophagus or pharynx. GER Disease is characterised by recurrent episodes of gastroesophageal reflux and it is a chronic disease. When it starts, it usually lasts forever. Therefore, treatment of Gastroesophageal reflux should be taken for long periods or continuously, according to some specialists.

People with more than 2-3 gastroesophageal reflux episodes per week are considered to suffer from Gastroesophageal Reflux Disease (GERD). Heartburn is the most common symptom of gastroesophageal reflux, characterised by burning or pressure sensation in the middle of the chest, often reflecting towards the pharynx. Other symptoms include:

  • Acidic taste sensation in the pharynx
  • Dysphagia (difficulty in swallowing)
  • Persistent laryngitis and hoarseness
  • Persistent sore throat
  • Chronic cough, especially at night
  • Asthma
  • Recurrent respiratory infections
  • Worsening of teeth conditions

What are the complications of Gastroesophageal Reflux?

Chronic gastroesophageal reflux of stomach acid towards lower esophagus may cause:

  • Esophagitis
  • Ulcers in the lower esophagus
  • Narrowing of the esophagus
  • Chronic bleeding
  • Laryngitis - Aspiration pneumonia
  • Metaplasia of the esophageal epithelium (Barrett's esophagus)
  • Carcinogenesis

Risk Factors for Gastroesophageal Reflux

  • Foods such as fried and fatty foods, spices, chocolate, soft drinks, coffee, alcohol, acidic juices
  • Smoking
  • Obesity
  • Chronic increased intra-abdominal pressure (chronic cough, constipation)
  • Stress, because it enhances gastric secretions’ acidity
  • Pregnancy

How is Gastroesophageal Reflux Disease treated?

Treatment of GERD includes three treatment phases:

1. Conservative treatment of GERD

A combination of changes in dietary habits, including the following:

Weight loss is recommended to ALL patients.

  • Avoid foods that aggravate gastroesophageal reflux.
  • Do not lie down immediately after taking the meal.
  • Raise the head during sleep.
  • Take small meals in the evening.
  • Avoid smoking and stress

2. Oral medication

If gastroesophageal reflux symptoms persist, despite changes in lifestyle, medication is required to neutralise stomach acid and reduce the amount of acid produced in the stomach. A series of formulations are effective in the treatment of gastric secretions’ acidity. Simple antacids, histamine receptor blockers (H2Blockers), and Proton Pump Inhibitors (PPIs) are the most popular medications.

3. Surgical operation (enhancement of the sphincter mechanism of the esophagus)

Surgical correction of diaphragmatic hernia is very effective in treating the symptoms of Gastroesophageal Reflux. Furthermore, it protects from GERD complications, and it is the only way of preventing cancer in the esophagus (adenocarcinoma).

The following are included among the advantages of surgical operation:

  • Eliminates the use of medications.
  • Stops gastroesophageal reflux and heartburn.
  • Stops chronic cough and chronic laryngitis.
  • Allows normal sleep.
  • Allows the consumption of “forbidden” foods and alcohol.
  • Allows physical exercise.

Which methods are used for diaphragmatic hernia repair?

1. Open Surgery

The open surgery for hernia repair is a very traumatic surgery, because the surgeon is forced to make a large cross section in the upper part abdomen in order to reach the diaphragm. Postoperative pain is managed with strong painkillers, which often keep the patient sedated. Therefore, the patient cannot be mobilised quickly and extension of the hospitalisation is required.

2. Laparoscopic Nissen fundoplication

Since 1991, our team in Athens Medical Centre performs the laparoscopic technique for diaphragmatic hernia repair, with better results and fewer complications. For the laparoscopic procedure 4-5 small incisions (5 mm) to the skin are required, with no muscle cross section. The advantages of laparoscopy are:

  • Less blood loss
  • Less postoperative pain
  • Faster return to solid diet
  • Shorter hospitalisation
  • Faster recovery
  • Minimisation of postoperative complications associated with trauma (suppuration, cleavage, hernia, chronic pain)
  • Elimination of postoperative adhesions
  • Optimal cosmetic outcome Studies, as well as our extensive experience with hundreds of patients, have shown that patients with gastroesophageal reflux are completely free, or show marked improvement, of gastroesophageal reflux symptoms, immediately after surgery.

3. Robotic Nissen Fundoplication

Robotic fundoplication is the most modern evolution of laparoscopy, and in Greece it is performed since 2006 by our team in cases of gastroesophageal reflux. With the robotic method, micro-incisions of 5-8 mm are again performed, but the surgical field is now stable and the surgeon has great freedom. The risk of converting a surger to an open surgery is less than 1%, while the procedure is performed with ease even in overweight patients and those with sizeable diaphragmatic hernias.  Nissen Robotic retains all the advantages of laparoscopic and additionally offers:

  • Three-dimensional colour and stable optical high-resolution image (HD 1080p), which gives a feeling as if the surgeon’s eyes and hands are within the patient's body.
  • Absolute instruments’ flexibility and precision of movements to the millimeter, and elimination of natural hand tremor through an electronic filter.
  • Minimisation of the surgeon’s physical fatigue (who performs the surgery sitting at the console) especially in long surgeries.
  • Conversion to open surgery is less likely.
  • Excellent recognition and conservation of very important vagal nerve (nerves paring technique) as well as their branches, the injury of which may cause normal food digestion disturbances.
  • Accurate identification and preparation of vessels towards the stomach, the liver or the spleen, which are at short distance from the surgical operation field.
  • Ability to easily operate even extremely obese persons (Body Mass Index > 60) due to robotic instruments’ stability against increased intra-abdominal and wall pressures.
  • Possibility of extensive lysis of adhesions. The accuracy of the surgeon’s movements with the aid of robotic instruments protects the integrity of the esophagus, which usually adheres to the liver and stomach.
  • Possibility to perform intra-abdominal suturing with great ergonomics.
  • Creation of a “loose” fundoplication. Excessive tension on the suture of the fundoplication of the stomach may cause postoperative complications such as vomiting and dysphagia.
  • Through the use of the sophisticated pneumoperitoneum system “Air-Seal” available from our team, the operation is performed at much lower intra-abdominal pressures (8-10 mmHg). This detail is substantial, because lower pressures minimise cardiopulmonary system distress, making surgery safer for patients with increased body weight, as well as those with cardiovascular diseases. Moreover, the lower the pressure within the abdomen during surgery, the lower the postoperative pain for the patient.
  • Specialised robotic instruments, such as “VesselSealer”, allow safe ligation of vessels, such as the short gastric arteries towards the spleen. Vesselsealer is an articulated robotic disposable instrument able to ligate and separate tissues and vessels with absolute precision, even in hard to reach spots.

How will I be after surgery?

Most patients feel well and they move out of bed within a few hours. Mobilisation reduces the risk of deep venous thrombosis, and it is thus pursued as soon as the patient feels that he can stand on his feet. Some common symptoms after surgery include dizziness, weakness, abdominal pain and neck discomfort, most of which recede within the first 12 hours. Hospitalisation with the robotic method is reduced to 24 hours. On leaving, the patient already feels comfortable, moves and eats safely. At the same time a prescription is also given, especially for a painkiller and dietary guidelines. No medications for gastroesophageal reflux are required, such antacids and PPIs. Return to daily activities, provided that weight lifting is avoided, is achieved in just a few days.

Laparoscopic Hernia Repair

Written by Konstantinos M. Konstantinidis, MD, PhD, FACS, Adjunct Professor of Surgery, Ohio State University, USA, President, Greek Chapter of American College of Surgeons, Scientific Director, Director of General, Bariatric, Laparoscopic and Robotic Surgery Department, Athens Medical Center, Athens Medical Group

What is a hernia?

A hernia is defined as a defect or opening in the abdominal wall. It may be congenital (i.e. birth defect) or acquired (develops due to weakness of the tissues or after injury). Hernias are quite common, affecting 10-15% of the population. Both men and women may suffer from hernias.

What are the symptoms of a hernia?

Most commonly hernias are associated with a visible protrusion or lump, which is the result of the projection of an intra-abdominal organ through the abdominal wall opening, resulting in a deformation of the skin’s surface.

Hernias may present with discomfort or even pain, often associated with exercise. However, no symptoms may be present. In worst cases, hernias may cause severe pain, damage to intra-abdominal organs, or even intestinal obstruction (incarcerated hernias).

In this case, the patient should undergo surgery within a maximum of six hours of the onset of symptoms, otherwise there is a risk of intestinal necrosis. Generally with time, hernias have the tendency to grow, while the symptoms may worsen. Surgical operation is the exclusive treatment for hernias.


What are the risk factors of a hernia?

Risk factors for the development of a hernia include the following:

  • Previous surgeries
  • Rapid increase in abdominal size
    • Sudden weight gain
    • Pregnancy
  • Chronic increase of intra-abdominal pressure
    • Weight lifting
    • Chronic cough
    • Constipation

Why should hernias be repaired?

Surgical repair is the only permanent method for the correction of a hernia. Patients with a hernia are at risk of developing serious complications, such as intestine entrapment in the hernia’s opening (incarceration), which may subsequently cause intestinal obstruction and ischaemia (impaired intestinal perfusion, which leads to gangrene). Both these conditions require urgent surgical treatment. Generally, the scheduled (non-urgent) correction of a hernia leads to better results, shorter recovery time and far fewer postoperative complications.

What are the treatment options for hernias?

  • Conservative treatment: The use of a truss should be avoided. May cause long-term injury to the intestine or multiple adhesions, which hinder greatly surgical repair.  
  • Surgical treatment:
  • Open - Repair through incision, with conventional equipment.
  • Laparoscopic - Performed through skin micro-incision with the use of a High Definition (1080p) video camera and special micro-laparoscopic equipment. 
  • Robotics - Robotics technology offers to the surgeon optimal image quality (3D High Definition 1080p image) and operating comfort in narrow spaces (Endowrist Instruments) and represents the ideal approach in the treatment of hernia.

Inguinal hernia

Inguinal hernia is the most common type of hernia, accounting for about 2/3 of all hernia cases. It occurs more often in men. When the hernia sac reaches the scrotum, the hernia is called Scrotal-inguinal hernia. Depending on hernia’s course in the inguinal canal, two types are distinguished, straight and oblique inguinal hernia. In all cases, treatment involves the surgical repair. During the past twenty years, laparoscopic hernia repair became more and more popular, due to its significant advantages:

  • Bloodless
  • Minimal postoperative pain
  • Swift recovery
  • Immediate return to daily activities and work
  • Excellent aesthetic result

For many surgeons, laparoscopic access has replaced the open one. The operation is performed through 3 micro-incisions, one of which is 8 mm under the umbilicus, from where the High Definition optic laparoscope is inserted, and two 5 mm, through which the laparoscopic instruments are inserted. The laparoscope, which is a long and thin telescope allowing surgeons to see that part of lapara (abdomen) that interests them, is connected to a high-definition monitor. With microsurgical technique the hernia is reduced and the weak abdominal wall is strengthened with a mesh. The mesh, with dimensions 10x16cm, is made of non-absorbable material and it is perfectly compatible with the body. It is prepared, folded, and placed in the body through the camera trocar with no additional incision required.

Which laparoscopic technique is better?

Two different techniques are widely used:

  1. TransAbdominal Properitoneal Procedure (TAPP): This technique requires entering the peritoneal cavity (where the organs are located), opening the peritoneum from inside the abdomen, preparation of hernia, placement of the mesh, and closing the peritoneum covering the mesh.
  2. Totally ExtraPeritoneal Procedure (TEP): This technique avoids entering the peritoneal cavity. Conversely, it is performed outside the peritoneal cavity, at an area just above the peritoneum. The hernia opening is detected and restored through the placement of a mesh. The extraperitoneal technique (TEP - Totally Extraperitoneal Repair) is considered the safest method of restoring inguinal hernia, with the least possible complications. This technique is performed in our clinic since 1991, with a recurrence rate of less than 0.5%. Our experience, considered among the largest worldwide, exceeds 3,000 operations of this type.

What are the advantages of laparoscopic method?

The laparoscopic technique requires smaller incisions and it does not cause muscle injury. This may result in less postoperative pain and faster recovery. Due to the great magnification, testicular vessels and nerves of men are recognised and injuries are prevented. The laparoscopic technique is ideal for the treatment of bilateral inguinal hernia, since both sides can be accessed, using the same three small incisions. Additionally, the laparoscopic repair is the method of choice in all cases of recurrent hernias after previous open surgical procedures.

What possible complications are related to laparoscopic inguinal hernia repair?

  • With the laparoscopic technique, bleeding, wound infection or even mesh infection may rarely occur.
  • Even less frequent complications include injuries to the organs of the region’s organs.
  • Hernia recurrence.

Is the conversion of laparoscopic to open surgery possible?

It is rather unlikely that this might be required. However, for some patients and for specific reasons it might be necessary to convert the surgery to open.

Furthermore, the conversion to the traditional open technique is sometimes required for technical reasons and it is not considered a surgical complication.

What is robotic inguinal hernia repair?

In recent years, there is great clinical interest in robotic inguinal hernia repair. The technique is safe and bloodless, while it uses the most modern technology with minimal intervention to the body. It allows optimum mesh positioning under three-dimensional stereoscopic vision and its fixing with sutures.

Postoperative complications are minimal and recovery is immediate. This technique is performed in our clinic with excellent results.

Athens Medical Centre: Important International scientific announcements from Dr. Konstantinos Konstantinidis

Dr. Konstantinos Konstantinidis, MD, PhD, FACS, Professor of the US Ohio State University, Director of General, Bariatric, Laparoscopic and Robotic Surgery at the Medical Centre of Athens  

Dr. Konstantinos Konstantinidis, MD, PhD, FACS, Professor of the US Ohio State University, Director of General, Bariatric, Laparoscopic and Robotic Surgery at the Medical Centre of Athens  participated in the 24th International Conference of the European Society of Endoscopic Surgery (EAES) with 4 innovative scientific studies on robotic surgery.

Dr. Konstantinidis and his colleagues (S. Hirides, P. Chrysocheris, Ph. Antonakopoulos, P. Hirides, Ch. Charitopoulo and P. Fereto) attracted participants’ interest with their projects, presented as videos. Their projects were based on their large experience in laparoscopic surgery, with more than 15,000 operations, and in robotic surgery, which exceeds 1500 operations, with excellent results.

The first project involved his technique for the use of robotic surgery, as an evolution of laparoscopic, in the management, with a mesh, of inguinal hernias and sports hernias. The technique shows excellent results, especially in difficult cases, as well as in recurrences after open surgery. Dr. Konstantinidis has performed over 4000 laparoscopic and robotic surgeries of inguinal hernias (TEP but also TAPP techniques), more than 800 surgeries of post-operational hernias, umbilical hernias and abdominal wall hernias, and more than 650 surgeries of sports hernias (Sportsman's hernia, abdominal adductor syndrome), with a recurrence rate of less than 1%.

The second project involved robotic surgery through one incision, and its excellent results. The team of Dr. Konstantinidis has the greatest experience in this technique at worldwide level (Single Site Robotic Surgery), with more than 350 operations, mainly cholecystectomies. It is noted that Dr. Konstantinidis was the first worldwide to perform the technique in 2011.

The third project concerned the first robotic gastric Bypass repair “ROUX EN O” in a patient with ongoing alkaline reflux performed at worldwide level. It was the first time internationally that the da Vinci SI HD system and the robotic technique to repair this problem and convert the operation to the correct gastric bypass were used successfully. The video of this operation was considered among the top videos of the conference and received warm reviews and distinction by the participants.

The fourth project presented the team’s ten-year experience in robotic surgery for benign gastric disorders and stomach cancer. The team of Dr. Konstantinidis has the greatest experience in this field in Europe, with almost 1000 laparoscopic and robotic surgery operations for diaphragmatic hernia and gastroesophageal reflux repair, with excellent results. Robotic gastrectomy and lymph node dissection for gastric and lower oesophagus cancer without incision in the upper abdomen, leading to minimisation of intraoperative and postoperative complications, such as infections, bleeding, and reoperations, as well as quick and painless recovery.

Dr. Konstantinos Konstantinidis stated: “The opportunity given to us to be at the forefront of aerospace robotic technology developments and applications in surgery is exciting. Athens Medical Centre, with the full support of the visionary President Dr. George Apostolopoulos, is at the top of robotic surgery, among the best hospitals of the world. As a Greek physician and surgeon, I feel proud that together with my colleagues we can offer our patients, both from Greece and from abroad, the best surgical technique with excellent results and international recognition. Our educational work on new techniques and technologies, has become internationally known, and we often have surgeons from abroad, attending to learn our techniques. A great number of Greek medical students as well as residents and young surgeons participate in the educational work we offer, with love and respect for their own future, but also for patients' health.

New International Recognition of Dr. Konstantinos Konstantinidis

Dr. Konstantinidis, chaired and spoke at a roundtable entitled “Single Site Robotic Surgery” (Robotic surgery through one incision) in which surgical professors from America and Europe, presented the results of the implementation of the new robotics technique to date, who was firstly performed by Dr. Konstantinidis at Athens Medical Centre in March 2011.

At the same time, Dr. Konstantinidis was rewarded for his techniques in robotic splenectomy, partial splenectomy and surgical operation of diaphragmatic hernia. 

On the occasion of his award, Dr. Konstantinidis said: “The opportunity given to us to be at the forefront of the latest technological developments and ultramodern robotic applications in surgery is exciting. Our team at the Athens Medical Centre, which is at the top of robotic surgery, is among the best and most experienced of the world.  We already have great experience in robotic treatment of diaphragmatic hernia, stomach cancer, morbid obesity, ventral hernia, inguinal hernia, colectomy, cholecystectomy, splenectomy, adrenalectomy, pancreatectomy, adhesions, hysterectomy. As a Greek surgeon I feel proud that we can offer our patients the best surgical technique, bloodless, painless, with excellent results and international recognition”.

To date, Dr. Konstantinidis and his highly trained team have performed, at international level, the greatest number and type of robotic surgical operations through an incision (300 procedures). It is worth mentioning that Dr. Konstantinidis has performed in total more than 15,000 operations in laparoscopic surgery and 1,200 in robotic surgery.