Athens Medical Group: International recognition for Dr. Konstantinos M. Konstantinidis

Athens, October 17th 2017 – Dr. Konstantinos Konstantinidis, MD, PhD, FACS, Scientific Director and Director of the General, Bariatric, Laparoscopic and Robotic Surgery Clinic of Athens Medical Center, was elected unanimously as Secretary General in the five-member Board of Directors of the Clinical Robotic Surgical Association. His election took place during the World Robotic Surgery Congress, held in Chicago, Illinois, USA (21-23 September 2017). Among things to be noted is that the Board of Directors consists of the most reputable and experienced surgeons from all over the world, who are recommended by the General Assembly.

During the congress, Dr. K. Konstantinidis was the chair-person of robotic surgeries – broadcasted live – such as, gastrectomy, hiatal hernia, myotomy in patients with esophageal achalasia, rehabilitation of inguinal and ventral hernia following open mesh, gastric bypass against overweight and diabetes, cholecystectomy and colectomy. He also gave a speech about the Single Site Robotic Cholecystectomy, that Mr. Konstantinidis was the first to perform world-wide in the Athens Medical Centre in 2011. 

Dr. K. Konstantinidis made the following statement:” It is a tremendous honor for me, indeed.  I am very proud that the most distinguished colleagues of mine rewarded my scientific and teaching endeavors. This distinction is a lifetime achievement. My participation in the evolution of robotic surgery and the ascertainment that our patients do not suffer due to long and difficult surgical operations gives me the strength to carry on, together with my colleagues, offering our services to the patient in need”.

Dr. Vassilis Apostolopoulos, CEO of Athens Medical Group (AMG) stated: This important distinction for one of the most renowned Greek doctors on an international level attributes credit to AMG for the endless effort we all make and for our strategic choice to provide the required infrastructure in terms of materials and equipment and, above all, to inspire well-reputable Greek doctors of the diaspora to return to Greece. The return of Dr. Konstantinidis from the USA to AMG, in the early 90s, is a typical example and a point of reference to our continuous “brain gain” against the “brain drain plague, which is now – more than ever - the most significant problem that our country has to deal with”.

Robotic departments of AMG constitute international excellence and reference centers that cooperate with University institutions in Greece and abroad. Pioneering surgeries, such as the single site robotic colectomy, cholecystectomy and the rehabilitation of hiatal hernia were performed for the 1st time – world-wide – in Athens Medical Group. It is worth mentioning that Dr. Konstantinidis has performed, in total, more than 1,800 robotic surgeries.

Athens Medical Center: The only private Greek Health provider in the European Program Horizon 2020

Athens, September 13th2017 - Athens Medical Group is the only private hospital provider in Europe, which, along with 12 university faculties, companies and several agencies from 8 countries, is participating in the European Research and Innovation ProjectEVOTION, and the only private Health provider in Greece participating in Horizon 2020.

The objective of this research project – fully funded by the European Union – is the Public Health Hearing Loss Policies decision-making based on the gathering and analysis of Big Data. This in turn will improve the prevention and treatment of hearing loss and its consequences in the life of thousands of people; it is anticipated that this project will contribute to hearing loss management methods by health specialists and organizations. Moreover, it forms part of Horizon 2020, the largest program in the history of the European Union for research, innovation and technology; the overall invested budget of the program is over 80 billion Euro for the period 2014 – 2020, in view of strengthening Europe's position as a global competitor.

For research purposes, hearing aids, noise reports, clinical, fiscal, financial and social related data, along with Big Data supporting public hearing health policies will be collected. In this way, the EVOTION platform will be created aiming at studying and identifying factors leading to total or partial hearing loss impairment, as well as at drawing the right conclusions for the development of public health policies based on this analysis.

1,750 European patients will participate in the research study, 250 of which will be patients of Athens Medical Group; it includes the use of hearing aids, clinical examinations (ENT) and observation of patients for one year. Apart from the Athens Medical Group, major companies and universities, such as Oticon A/S, the National and Kapodistrian University of Athens, City University of London, University College London, Nofer Institute of Occupational Medicine, the Institute of Public Health for the Osijek-Baranya County and the Università degli Studi di Milano (UNIMI) participate in the research study.

When announcing the composition of the scientific team, consisting of ENT doctors, audiologists, specialized nurses and administrative personnel, the head of the team of Athens Medical Center, Dr. George Gavalas, Director of the Division of Otology and Neurotology of the Athens Medical Group, stated: “We are especially content to participate in this pioneering project, aiming at effectively treating hearing loss, one of the most common chronic diseases and the 5th most common cause of disability and at improving the quality of life for thousands of people. The experience of Athens Medical Group in this sensitive field is undisputable and this was the basic criterion for our selection”.

Dr. Vassilis Apostolopoulos, CEO of Athens Medical Group, pointed out the following: «Honouring our commitment at Athens Medical Group to constantly invest in medical innovation, we are participating in EVOTION, a major European project for the advancement of medical science and the development of Public Hearing Loss Health Policies in the EU area.”

Press release 20 years dedicated to your health 20 years – 20 medical doctors – 20 free consultations*

Bucharest July 12th 2017. 2017 is an important milestone for Medsana Bucharest Medical Center, because it coincides with the anniversary of 20 years of operation. Serving 100.000 patients yearly in its 4 diagnostic centers, with a total of 340 employees and highly qualified physicians/ doctors and covering more than 11.000 corporate employees in capitation programmes, Medsana is a true synonym of Quality for the Romanian Healthcare sector. On the occasion of the 20 years of Medsana in Romania, 20 experts from Athens Medical Group, Medsana’s mother company, are visiting Romania to offer 20, 2nd opinion medical consultations, per doctor, to Medsana patients, free of charge (*a total of 400 free 2nd opinion medical consultations).

Furthermore, Athens Medical Group and Medsana, acknowledging their visitors / patients’ loyalty, presented the Health Passport, a benefit card which offers integrated healthcare services in the ultra modern Hospitals in Athens and Thessaloniki. Health Passport provides to its owners, two set of benefits, covering both emergency cases and scheduled visits or treatments in AMG hospitals 365 days per year. For more information please visit

Finally, a scientific collaboration was announced between Athens Medical Group and Center of General Services and Liver Transplantation, I.C. Fundeni in the areas of Oncology and Minimal invasive surgery – Robotic surgery, concerning future joint academic initiatives.

Professor Konstantinos Konstantinidis, MD,PhD,FACS, Scientific Director and Director of the General, Bariatric, Laparoscopic and Robotic Surgery Clinic of Athens Medical Center, representing AMG’s scientific team, on the occasion of 20 years of Medsana’s excellence, commented: “We are proud to present today the 20 | 20 | 20 initiative which coincides with the anniversary of 20 years of Medsana’s operation. It is a great honor to provide to every Romanian patient 2nd opinion medical consultations, as it depicts the Romanian and Greek long lasting scientific relationship. As a Greek surgeon, I feel proud that we can offer to our patients the best surgical techniques, bloodless, painless, with excellent results and international recognition, in areas such as: surgical Oncology, Hernias of all types, including Sports Hernias, surgical treatment of GERD (Gastro-Esophageal Reflux Disease) and Robotic assisted bariatrics operations, among other to cure type II diabetes. Regarding our collaboration with Professor Irinel Popescu, I am deeply honored that we are finally able to expand our academic relationship to the benefit of our two countries and Medical Tourism”.

Professor Irinel Popescu, Director, Center of General Services and Liver Transplantation I.C. Fundeni, commented: “I would like to welcome the collaboration with AMG and I.C. Fundeni, two prestigious academic organizations, in the areas of Oncology and Minimal Invasive surgery – Robotic surgery. Today, both parties have set the basic principles of cooperation, which we believe is a humble 1st step to a significant project. I would like to thank AMG for its willingness to work together in this strategic, academic initiative. I will personally oversee every part of it, so I am confident that together we can make it a major scientific success for the two organizations involved”.

Dr. Achilles Ploumidis, MD, BSc, MSc, PhD, FEBU, Surgeon Urologist, Athens Institute of Robotic & Endoscopic Urology, Athens Medical Center, on the occasion of the anniversary of 20 years of Medsana’s operation, commented: “My ties with the Romanian Academia given the extensive training schedule of the past five years, are very strong. I am deeply honored and pleased to see that this long-lasting relationship is officially given and academic and business prospective. Innovations such as single site urology operations, Robotic oncological and reconstructive procedures, Robotic prolapse procedures, as well as lithiasis treatment, are among the big number of specialty procedures the people of both countries can now benefit”.

Mr Nikolaos Moschos, Business Development Director, Athens Medical Group, commented: “Our objective is to establish a business collaboration in medical areas where Romania excels, between State Authorities in Romania and Athens Medical Group, so as to support Romania's effort to become a Center of Medical Tourism itself. As you already know, Athens Medical Group has been a pioneer in this field, as it is the main player in Greece who managed to reverse the trend of Greek people flying abroad to get treatment and today receives more than 40,000 international patients for primary and secondary treatment. At the same time, we want to offer medical services to all Romanian patients which are currently travelling abroad to seek treatment, due to the lack of equipment, or for other reasons, such as: complex oncology, neurosurgery and cardiology operations, radiotherapy, digital angiography, PET CT and other. These are areas where Athens Medical Group has superb results, with doctors who are among the global elite in their field of expertise”.

Mr. Vassilis Chaniotis, General Manager, Medsana Bucharest Medical Center , commented: “Truly, this is a great day for Medsana. Together with Athens Medical Group, we are not celebrating only our 20 years anniversary, but also our plans and commitment for extroversy and prosperity in the years to come”.

Athens Medical Group (AMG) is the leading healthcare provider in SE Europe, providing high-quality, internationally certified medical services for more than 33 years. AMG runs 8 state-of-the-art Hospitals with 1,200 patient beds, 3,000 full time employees and 2,800 highly qualified physicians. The AMG is a Centre of Excellence in Robotic Surgery, General Surgery, Bariatrics, Orthopedics-Microsurgery. It also performs cutting-edge Medical Procedures in Interventional Cardiology, Heart Surgery, Interventional Neuroradiology, Neurosurgery, Oncology, Plastic Surgery, IVF. Its highly qualified physicians who are certified with long working experience in Europe and the USA, offer patient-centered & top quality medical services abiding by the strictest international medical guidelines and certifications.­­­


For more information, please contact:

Anca Sert, Director Marketing, Member of Athens Medical Group, Medsana Bucharest Medical Center

Bucharest, Romania, T: (+4) 021 4087800, E-mail:


Savvas Karagiannis, Communications Manager, Business Development Division, Athens Medical Group, Τ.:+30 210 6862521, E-mail:

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.

Valve Replacement in the heart without a scalpel - New implantation method replacing open-heart surgery

Written by Dimitris Avgerinos, MD, PhD, Director of Cardiology of Athens Medical Center, Assistant Professor of Heart Surgery Department in the Cornell University of New York

One in 20 adults has a problem in one of the main valves of the heart, the aortic or mitral, which require surgical treatment. Until a few years ago, patients were undergone an open heart surgery, requiring a connection to an extracorporeal circulation device and interruption of the heart with strong drugs. Today, however, in selected patients a noninvasive percutaneous method is used.

As an individual gets older, calcium is deposited in the aortic valve, causing gradual narrowing, subsequently impeding the free flow of blood and developing symptoms such as chest pain, shortness of breath and fainting.

When should a surgery be performed?

When the patient develops symptoms (especially breathlessness, chest pain or loss of consciousness) or when a valve is very narrow or failure occurs.

How did the need for non-invasive treatment occur?

The open surgery has increased risks and complications for the high-risk patients: very elderly population, patients with previous history of open heart surgery, and patients with renal or hepatic impairment.

Actually, for these specific groups of patients a percutaneous aortic access technique has developed in recent years.

How is the surgery performed?

Through the femoral artery or a small incision in the chest. During surgery, usually no more than one-hour duration, although the patient is under anesthesia, his heart does not need to stop and he is not connected with extracorporeal circulation device.

What are the advantages of the method?

Short-duration surgery, relatively a non-invasive operation, without postoperative pain and complications of an open- heart operations and significantly reduced mortality compared to open heart surgery. The patient goes home in 3-4 days and is ready to return to daily activities.

The new method is now available for special patient groups who can not undergo the traditional surgery, while the patient selection is done under strict rules established by the American and European heart surgery and cardiology companies.


·       4-5% of the population will develop eventually valve disease requiring surgery

·       Patients aged50 years and more  require surgical reconstruction or replacement of the heart valve

·       The mean survival of patients treated without surgery is 2-3 years , when the aortic valve causes symptoms

Suspected signs of severe valvular heart disease

·       Dyspnea

·       Angina Pectoris

·       Loss of consciousness (fainting)

Eligible patients for percutaneous intervention

Those who can not undergo an open heart surgery because they:

·       Are old age

·       Have multiple health problems (especially respiratory problems, and hepatic or renal failure)

·       Previous history of open heart surgery

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.

In vitro fertilization today: Indications, methods, risks, complications

Written by Goutzioulis Fotios MD, DrMeDObstetrician Gynaecologist, ΙVF & Infertility Center, European Interbalkan Medical Center, Athens Medical Group

It is estimated that in Greece over 10.000 attempts - cycles of IVF are realized every year. The call of society for the use of this method is very strong.

The method of in vitro fertilization (IVF), since its establishment, has spread rapidly around the world and today, nearly four decades later, it is a routine method that has entered the everyday life of many couples. Today, in most Western countries, as in Greece, the application of the methods of in vitro fertilization is regulated by a special law - framework that have established benefits from insurance providers for interested couples.

Without doubt this is an effective method. Today, it is estimated that 80% of couples that will resort to IVF will eventually succeed in having a child, after one or more attempts. Research and development in this scientific field is continuous and intense, while there is a significant improvement in the success rate, compared to what it was two or three decades ago. By means of in vitro fertilization today problems that in the past were impossible to overcome can now be confronted.

In vitro fertilization methods are of a high technology. High scientific knowledge on the part of the specialized reproduction physician are required, but together with team work that combines the skills of the physician, specialized embryologists, specialized paramedical staff, geneticists, with the appropriate technical means such as ultrasounds, autoclaves, microscopes, nutrient mediums, cryopreservation methods. At the same time continual and timely integration of the latest technologies, that are constantly emerging from research is necessary.

It is not necessary for all couples to resort to in vitro fertilization. After trying naturally to conceive for a reasonable period of time, possible causes of reduced fertility of the couple should be sought.

by the physician and, where appropriate, put into practise, and initially exhaust, the most simple methods that could help natural conception, for example, treatment of endometriosis or insemination.

Nevertheless, the demand for in vitro fertilization today seems to be rising and a major reason for this is the postponement of having children and the older age of candidate mothers.

The usual indications for IVF today are:

• Blocked fallopian tubes

• Extensive endometriosis

• Anovulation - difficulty in successful ovulation that is not treatable by other methods

• Male causes - significantly reduced number and motility of sperm

• Unexplained Infertility - when all tests appear normal and simpler methods have not succeeded

• Advanced age of the woman, 40 years and above, where, it is recommended to resort to IVF much sooner

Smoking and lung cancer

Written by Dahabreh Jubrail MD,PhD Thoracic Surgeon, Director of Thoracic Surgery Department, Athens Medical Center

The relationship of smoking to lung cancer, just as with other fatal diseases, is a serious social and economic problem. 

It is estimated that 80% of deaths from lung cancer in women are due to smoking, while this percentage reaches 90% in men, and this relationship is linear with the number of smokable cigarettes and duration of smoking in years.

Besides smoking, the appearance of lung cancer may be attributed also to other factors such as radon, exposure to asbestos, uranium and coal, as well to contamination of the atmosphere.

Lung cancer is responsible for 28% of cancer deaths, and causes more deaths than the total of deaths caused by cancers of the colon, breast and pancreas.       

The effects of lung cancer concern the patient, their family members, society, personal finances as well as the national economy. As regards the patient this is related to the duration of hospitalization, high cost of diagnostic tests, and treatments, which are often done at regular intervals.

Equally important is the social cost that is unbearable, as patients often suffer dramatic consequences in their personal as well as family and professional lives. Many times, patients are treated with compassion, others suffer rejection, lose professional development opportunities and all these create an additional intolerable psychic load.

It is important to implement programs for the prevention and early diagnosis and treatment for people with a family history, those at a high risk due to smoking, profession and those suffering from pulmonary emphysema and chronic obstructive pulmonary disease.

At the Athens Medical Center in Maroussi, the Thoracic Surgery Department  operating since 2001 has treated a large number of patients suffering from lung cancer, many of whom underwent successful surgical treatment, with long-term survival. Patients undergo the required surgery after prior extensive clinical laboratory tests. The decision to carry out any treatment must be individualized and made once the perioperative risk is deemed acceptable, and in accordance with the guidelines of the European Society of Thoracic Surgeons (ESTS), European Society for Medical Oncology (ESMO), as well as the American Association for Thoracic Surgery (AATS) and American National Comprehensive Cancer network (NCCN).

It is worth mentioning that the decision to conduct the surgery is made after assessment of the whole of the patient by the responsible Thoracic Surgeon (Jubrail Dahabreh ), in collaboration with the Pulmonologist, Oncologist, Radiotherapist, Doctor of the CT and Cardiologist. Finally, the picture of the patient is also assessed by the Anesthesiologist, who has extensive experience in the administration of Anesthesia and in the treatment of postoperative pain. It must be noted that older age (80 and above), diabetes mellitus, renal failure, possible coronary heart disease, and prior Bypass surgery are not in themselves contraindications to perform the surgical treatment. An assessment of all these risk factors is done and based on the result, the final decision to perform or not the surgery is taken.

Patients with lung cancer comprise a specific group of thoracic surgery patients, that need proper evaluation by an experienced team of experts since surgical treatment is the treatment of choice offering long-term survival. It should be emphasized that major and specialized thoracic surgical procedures must only be performed by qualified, experienced Thoracic Surgeons and should be done in specialized Nursing Units. There are many patients who undergo successful surgical treatment after correct assessment by the specialized team of the Athens Medical Center in Maroussi,  though initially they had been excluded from surgical treatment when the assessment was done at non-specialized centers. Patients with limited respiratory reserve can undergo surgical treatment with the performance of specialized surgical techniques, such as bronchoplasty,  with or without angioplasty,  that aim at maintaining as much functional pulmonary tissue as possible. Likewise patients with locally advanced cancer may be subjected to surgical treatment after successful preoperative chemotherapy or chemo-radiotherapy. Furthermore, patients with advanced lung cancer that has spread to adjacent anatomical structures, such as the ribs, diaphragm, pericardium, or the superior vena cava, but also those with monera metastasis in the brain, can be treated surgically with a very low post-operative risk. The execution of this type of surgery is very demanding and requires skill and extensive experience.

Surgery in the above groups of patients not only increases survival but also offers a better quality of life. Thanks to the significant advances in surgical techniques, the use of more modern technical support measures, the progress of anesthesia and also the support of Intensive Care Units, perioperative risk has been significantly reduced, even for the most complicated surgeries.

Until we reach the point where we have the perfect therapy with the desired results, young people must be properly informed on the risks of smoking and the provision of this information is more effective when done at schools. Finally, an important role in early diagnosis of lung cancer is played by a CT scan of the chest, with a low radiation dose, which should be done annually, in heavy smokers, aged over 55 years and in those who have first-degree relatives who had lung cancer, but also to those exposed to various risk factors, such as exposure to asbestos and contamination of the atmosphere. 

The latest advances in the surgical treatment of Cardiovascular Disease (BYPASS)

Written by Vasilios N. Kotsis MD, Cardiothoracic Surgeon, Director of Cardiac Surgery Clinic and Beating- Heart Surgery Center in Athens Medical Center

In 2002-2012, there was a rapid spread of the use of stents to treat coronary heart disease, despite the improvement in mortality and morbidity of the surgical method, known as Bypass.

In the initial stages of implementation, there was enthusiasm for their prevailance in the treatment of coronary artery disease. The studies that followed demonstrated that despite the technological revolution in the manufacture of the stents, the results fell short of the surgery.

We had fewer deaths, fewer heart attacks, fewer strokes and less need for reoperation to surgical repair than with the stents, in the long run. In very severe cases, the difference was even greater for the surgical method.

The results of these studies were included in the guidelines for the treatment of coronary artery disease (instructions for myocardial reperfusion), issued in 2014 by the European Society of Cardiology and the European Association of Cardiothoracic Surgery (the largest scientific societies in Cardiology and Cardiac Surgery in Europe). In these instructions, surgery is recommended (known Bypass) as the most appropriate treatment in myocardial reperfusion, except for cases of one or two stenosed coronary vessels, which can be repaired by angioplasty.


It is even more interesting, however, that bypass surgery is performed in much the same way in the last thirty years. In various centers abroad, many innovative methods are applied but to be established, studies are required to prove their utility. In this context, approved and applied innovations refer to both how the surgery is performed and the implants used. Such development in the way the operation is performed, was the surgery of coronary arteries in beating heart. This is an important tool in the hands of the surgeon, improving morbidity and mortality of surgery. This technique does not use an extracorporeal circulation device replacing the heart and lungs during surgery. By using this device, the surgeon can perform his practice in unbeating heart and clean field. However, this device, while helping the surgeon, is the cause of complications such as strokes, bleeding, inflammation, etc., that increase the mortality of surgery.

The coronary artery surgery in beating heart allows us to avoid the complications arising from the use of extracorporeal circulation device in order to operate patients, for example, whose aorta has hardened over the years (porcelain aorta), patients over 80 years with fragile tissues, diabetics at higher risk of contamination, renal patients bleeding easily, patients with respiratory failure and COPD having an increased risk of infections, women who have sensitive tissues, patients receiving antiplatelet medications and must be operated immediately (less bleeding tendency), even patients who avoid blood sampling for religious reasons (minimize the need for blood). Patients with peripheral vascular disease (e.g., a carotid disease) can also be operated without the need for concomitant endarterectomy. Finally, this technique is important in patients with poor heart function, i.e., heart failure. In these cases, maintaining heart function, we can improve the blood circulation in the periphery of the vessel, without ischemia time, while maintaining heart function. In any case, a remarkable decrease in recovery time has been achieved, both in the ICU and the simple treatment room. The patient is mobilized quickly and leaves the hospital one to two days earlier.

In recent years, great change has been also seen in the grafts used. The new guidelines of the Society of Thoracic Surgeons (The Annals Of Thoracic Surgery, Volume 101, Number 2, February 2016) include the use of both mammary arteries (the arteries behind the breastbone) for anterior cation revascularization (the main vessel to the heart), instead of the left mammary artery alone and the use of 2 arterial grafts instead of one, which is generally used today. The second arterial graft may be either the right mammary artery or the radial artery. The guidelines state that age is not prohibitive for the use of arterial grafts and if they are placed with beating heart, the risk of stroke is reduced. Now, we do not see patients with large incisions on both feet for graft harvesting, since the use of venous grafts is reduced, which are inferior to the arterial ones. Of course, there are also major technological advances in surgery, such as the use of robot, automatic staplers, endoscopic graft harvesting, synthetic grafts, etc., which though are not widely used and we will have to deal with in the future.

In Athens Medical Center and specifically in the Beating- Heart Surgery Center, we follow these principles for many years, which now form the official guidelines of the Cardiothoracic community.

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.