Dr. Konstantinos M. Konstantinidis MD, PhD, FACSScientific Director of AMC.
The current trend for minimally invasive surgery is directed towards single incision surgery, as the most realistic approach of the so-called "Scarless surgery". The use of robotic technology simplifies single incision operations, by means of restoring the crossed hand-instrument coordination and offering a stable stereoscopic surgical field. The newly designed instruments and the cut-edge technology of these systems enhance the possibilities even more.
In 2011, the team of Robotic Surgery of Dr. K. M. Konstantinidis, from Athens Medical Center, was chosen, along with two other centers worldwide, one in Italy and one in Switzerland, to perform single-site robotic surgery for the first time worldwide. With this technique, the entire operation is performed robotically through a small incision of 1,5cm, at the lower border of the navel. The single-site surgery can be performed only with the robotic system da Vinci Si HD, which is available only at Athens Medical Center. The new platform initially applied for removing the gallbladder (cholecystectomy), however soon the method expanded and was applied for other types of surgery including, gastric fundoplication for restoration of gastroesophageal reflux disease, renal cysts, varicocele repair, ovarian cysts, pericardial cysts and recently for right hemicolectomy. These operations were carried out for the first time worldwide in Greece.
"For patients who desire minimal scarring, Robotic single-site surgery is the best option," says the Director of General Surgery and head of the Robotic Surgery Program at Athens Medical Center, Dr. K. M. Konstantinidis. The surgical team of Athens Medical pioneered in laparoendoscopic surgery, performing laparoscopic procedures since the early 90s’, thereby now having extensive experience in this field of surgery. During conventional laparosocopy, e.g for cholecystectomy, four incisions are necessary for the laparoscopic camera and the instruments needed inside the abdomen. Today, with single-site robotic surgery all instruments are inserted through only one small incision.
"Single-Site Surgery is not something new. With conventional laparoscopy single incision surgery can be of great technical difficulty, mainly because all instruments lie along the same plane. Thanks to Robotic technology, problems of angulation and instrument crowding are solved and the surgeon feels he operates normally"adds Dr.Konstantinidis.
The Dr.Konstantinidis surgical team started Robotic Surgery with the da Vinci system in September 2006. To date, more than 1500 robotic operations of general surgery, urology and gynecology, have been successfully performed. The spectrum of operations involves robotic esophagectomy, esophageal hernia repair for gastroesophageal reflux, esophageal cardiomyotomy for achalasia, total and subtotal gastrectomy, right or left colectomy, sigmoidectomy, low anterior resection and abdominoperineal resection for rectal pathology and for rectal prolapse. Also hepatectomy, biliary surgery, total or distal pancreatectomy and splenectomy and all types of surgery for abdominal wall hernia are regularly performed robotically. Several advantages are also seen in robotic adrenalectomy.
Particular important lately, is the application of robotic surgery in obese patients, in which the robotic arms can easily lift the weight of the enlarged abdominal wall for as long as needed. This is of particular interest in operations conducted for morbid obesity, such as in Roux-en Y and gastric by-pass.
The urology surgical team of Athens Medical Center, has equally perfomed multiple radical prostatectomies for prostatic cancer, as well as total and subtotal nephrectomies and radical cystectomies with neocyst formation. Furthermore, a number of gynecologic robotic procedures including removal of ovarian and pelvic masses, enucleation of fibroids (myomas), as well as total and subtotal hysterectomies with pelvic lymphadenectomy have been successfully performed.
In 2011 the dr. Konstantinidis surgical team was chosen by the manufacturer of the robotic surgical system for the first Single-Site robotic operations, and was recognized as a universal training center because of its extensive experience in this field of surgery. In Robotic Single-Site Cholecystectomy, the flexible robotic instruments cross each other at the point of entry into the abdomen and the system electronically reverses the arms (the right becomes left and vice versa) so that the surgeon’s console movements are comfortable and natural. The manufacturer recently presented (October 2014) the new, sophisticated robotic Single-Site platform, in which all instruments and the camera, which are all articulated, are inserted through a common cannula, only 2cm wide.
Dr.Konstantinidis explains: "The system requires special training for initiating the procedure and the docking (connection) of the robot. However with appropriate surgical experience and proper patient selection, the outcome is excellent. Minimizing trauma, eliminates postoperative discomfort and shortens recovery. "Using single incision surgery, significantly improves postoperative care, minimizes surgical wound complications and provides excellent cosmetic results"
But who really is candidate for this most recent development of surgery? Those patients considered suitable for conventional laparoscopic surgery, may equally undergo Robotic Single-Site surgery, according to Dr.Konstantinidis.
Single-Site robotic operations are performed only in Athens Medical Center in our country and Dr. Konstantinidis has presented the results of this technique as an invited speaker, in several international conventions in Europe (Sofia, Milan, Paris, Brussels, Moscow), Asia (Seoul , Beijing) and in the US (Chicago, San Francisco).
Konstantinos M Konstantinidis, MD, PhD, FACS
Adjunct Professor of Surgery, Ohio State University, USA.
Scientific Medical Director, Athens Medical & Pediatric Center
Chairman, Dept. of General, Bariatric, Laparoscopic & Robotic Surgery
President,Greek Chapter of American College of Surgeons
President of European Society of Robotic Surgery
President of Hellenic Scientific Society of Robotic Surgery