News

26.07.16
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.

22.07.16
Revision of total hip arthroplasty: Now also with the minimally invasive ASI technique

Written by Dr. Ioannis Tsarouchas, MD, PhD,  Orthopaedic Surgeon,  Director of Joint Implant Orthopaedics Department, Athens Medical Center, Athens Medical Group

Total hip arthroplasty is one of the most successful surgical operations in orthopaedics. Nevertheless, a significant number of patients undergoes revision (second surgery/ reoperation/ revision).

Proper material placement during the initial operation, so that the patient surgical outcome to be perfect, requires significant surgical experience. In case of poor prosthesis positioning, mechanical problems arise, which together with the loosening or wear of the prosthesis, microbial infection and fractures around it, are the most common causes of revision. Regular postoperative monitoring is particularly important for the prevention and early treatment of these problems.

The main symptom of patients with problematic total hip arthroplasty is pain in the inguinal region and/ or thigh, so in case something like this is observed, it is necessary to visit the orthopaedic on time. The faster assessment and treatment of problematic arthroplasty is of particular importance, as it usually leads to avoidance of worst bone deterioration around the prosthesis, making its revision (revision) easier.

Total hip arthroplasty revision is a difficult and demanding procedure. Its success requires special knowledge and techniques, as well as great surgical experience, so it is better to be performed by experienced and fully trained surgeons in large centres.

Traditionally, hip revision surgeries require extensive accesses (large incisions, significant soft tissue injuries, great blood loss) accompanied by a higher rate of complications as compared to the first surgery. In cases where only one part of the prosthesis has a problem, individual replacement is preferrable, making the revision less time-consuming, with less need for blood and quicker recovery.

The minimally invasive ASI technique (Anterior Supine Intermuscular), apart from its great success in the initial total hip arthroplasty, is also used with excellent results in cases necessitating revision of the acetabular component, ensuring maximum advantages of old prosthesis’ partial repair. With the ASI method, needs for transfusion are practically minimised, recovery time is dramatically reduced, and complications accompanying the long recovery period following extensive access to the hip are avoided. The advantages of this method are due to minimal injury of soft tissue around the artificial joint (which is already injured by the previous operation) and the surgeon’s good visibility during the operation.

In the Major Joints Clinic of Athens Medical Centre, we have performed a large number of revisions with the ASI method combined, where appropriate, with the reliable acetabuloplasty techniques and the insertion of grafts in bone defects regions (impaction grafting, strut grafts, etc).

Acetabuloplasty, in particular, is a tested method for the management of incomplete acetabulum formation and great bone defects of the pelvic bones.

The selection of patients who may undergo revision surgery with the ASI method is made after a detailed preoperational check, to exclude the case of great damage of the femoral prosthesis. Furthermore, it is also necessary to exclude the case that the bone defects of the acetabulum are that large to require more extensive access.

Through the revision of the problematic total hip arthroplasty, patients ensure the multi-annual smooth functioning of their intention and maintain their quality of life high.

12.07.16
Shoulder Arthroscopy: When is it necessary?

Written by Nikolaos Piskopakis, MD, PhD Orthopaedic, ex President of Hellenic Arthroscopic Society, Director of Sports Medicine Department, Athens Medical Center, Athens Medical Group

Shoulder arthroscopy may be used to treat the following:

Subacromial impingement syndrome - (Acromioplasty)

It is a pathology of the rotators’ tendon, and mainly the supraspinatus, which may involve both young athletes and older people. The tendon of the rotors protects the head of humerus and it is located just below the acromion, creating the subacromial space, which is protected by a popliteal bursa.

When lifting the hand upwards the subacromial space is reduced and consequently the rotors’ tendon is injured. This may get worst as time goes by, creating a painful inflammation, which may even lead to rotors’ rupture. The causes that may lead to this is the form of the acromion, mainly its front surface, the presence of osteophytes, and any muscular atrophy that may occur after injury, leading to continuous impingement of the tendon to the subacromial space. Subacromial impingement syndrome treatment may be conservative and, if the symptoms persist, surgical - arthroscopic.

Acromioclavicular joint arthritis (Shoulder Arthritis)

Shoulder arthritis causes intense pain and shoulder motion weakness, and it should be managed.

The acromioclavicular joint is the contact point between the clavicle and the front inner part of the acromion. This area is normally characterised by a small space, which allows the clavicle’s micromotion and contributes to the composite motion of the shoulder.

As time goes by, in young athletes, but especially at more advanced ages, acromioclavicular degeneration - arthritis with presence of osteophytes may occur due to the repeated impingement of the area. This arthritis causes intense pain and shoulder motion weakness, and it should be managed. Shoulder arthritis surgical treatment comes after conservative treatment failure, and the arthroscopic technique can give excellent results.

Shoulder instability repair (Bankart lesion) - Shoulder Dislocation

Glenohumental joint is an unstable in nature joint. Both dynamic and static factors contribute to the stability and great range of motion that characterise it. These are the shoulder girdle muscles and the ligaments of the shoulder region. During possible injuries with the hand usually in abduction and external rotation, a displacement of the humeral head and its sliding out of the glenoid is usually caused. More often, this may occur in a forward direction (anterior dislocation), and less frequently in backward direction. In some young people it may contribute to more frequent presence of dislocations, an idiopathic relaxation of the shoulder’s joint. Shoulder instability is a pathology which definitely requires surgical treatment in young people. Today, it has been demonstrated that results are better when shoulder instability is treated in a timely manner, and arthroscopic treatment comes first. In some special cases open surgical repair is also indicated.

Long head of biceps repair (slap lesion)

The long head of the biceps tendon is a very strong tendon and is one of the two brachial biceps muscle’s tendons. The long head of the biceps tendon contributes to the humeral head stability relative to the glenoid. The long head of the biceps tendon is in contact with the rotors’ tendon, and anatomically it is attached to the humerus on the groove of the biceps. It adheres to the glenoid, at its top part, and it is in direct contact with the labrum. After long-term use and repeated micro-injuries inflammation may occur, with intense symptoms of pain both during movement and at rest. At more advanced ages in particular, degeneration of the tendon fibers is also present, which can be easily and with very good results managed arthroscopically through the biceps tenotomy method. In cases of damage coexisting in the rotors’ cuff, it is possible to perform, always arthroscopically, tenodesis of the long head of the biceps and repair together with the rotors’ damage. In young athletes of throwing sports mainly, a pathology of long head of the biceps tendon detachment from the glenoid may occur (SLAP LESION), which is only arthroscopically treated with good results and athletes’ rehabilitation.

Calcific tendinitis

The deposition of calcium salts - calcific (shoulder tendinitis) is a very painful shoulder pathology. Shoulder tendinitis mimics the symptoms of subacromial impingement, with severe pain that does not resolve easily with conservative treatment. The symptoms of shoulder tendinitis may last from 1 week to over a month. Calcium salts deposition in the mass of the rotors’ cuff and concomitant bursitis of the subacromial bursa cause the above symptoms.

After conservative treatment (anti-inflammatory – physiotherapy – local cortisone injection) symptoms resolve, without requiring radiological disappearance of calcification. In persistent cases that do not respond to conservative treatment arthroscopic treatment of the syndrome has excellent results in shoulder tendinitis.

12.07.16
Athens Medical Group: Signature of Memorandum of Collaboration with the MD Anderson Cancer Center

The Athens Medical Group, faithful to its commitment of always being a step ahead in the provision of high quality medical services, signed a Memorandum of Collaboration with the internationally renowned University Cancer Center of America MD Anderson Cancer Center.

The Athens Medical Group shows once again its commitment to developing partnerships with leading scientific, research and educational centers of the world, contributing in this way to the improvement of the provision of medical services in Greece.

The aim of this collaboration includes the development of joint actions, which will contribute to a better understanding of cancer and improvement of cancer patient care with actions that include issues such as the exchange of medical knowledge on cancer treatment, conduction of research programs and the development of educational programs.

Through this cooperation Greek oncologists will be able to pioneer enriching their knowledge and experience in treating cancer, using advanced international protocols with their participation in joint conferences, workshops and training programs to be organized between the Athens Medical Center and MD Anderson.

“Our goal is not simply to monitor medical developments but to always be one step ahead. This new collaboration of the Athens Medical Group is for us a crucial alliance, since it allows us the ability to acquire greater knowledge about cancer and equips us for to confront it” stated Mr. said. Christos G. Apostolopoulos, Vice President of the Athens Medical Group.

05.07.16
Prostate Cancer: The role of robotic-assisted surgery

Writen by Apostle Lampanaris,MD, PhD Urologist-Surgeon, Certified in Robotic Surgery at the Medical Balkan Thessaloniki

And George Lampanaris, MD, PhD  Urologist-Surgeon, Certified in Robotic Surgery at the Inter-balkan Medical Centre of Thessaloniki

Today, in almost all developed Western societies, prostate cancer is the most common malignant disease in men and the second leading cause of death from cancer in men, after lung cancer.

More commonly it occurs in people over 60 years old. Annually, in Greece approximately 4,500 men are suffering from prostate cancer; however, early diagnosis increases greatly the chances of complete cure.

Prostate - prostate cancer diagnosis - treatment

Prostate is a gland of the male reproductive system. It has the shape and size of a chestnut.

It is located behind the pubic symphysis, just below the urinary bladder and surrounds the initial part of the urethra. Its function is related to fertility.

Prostate specific antigen (PSA), is a special protein produced in the prostate gland, and it is essential for the sperm liquefaction. When the gland’s architecture is disturbed (such as cancer), small amounts escape into the circulation and can be measured in the blood. Small or moderate increases often accompany benign conditions, too, such as benign prostatic hyperplasia or prostatitis. Thus, PSA increase does not always mean that the man has prostate cancer, but he should certainly consult a urologist.

Normally, there is an ongoing renewal process of the body’s old cells with new ones. Cancer is nothing more than a disturbance of this normal process, resulting in the production of more new cells, without completing old cells’ life cycle. Malignant tumours arising in the prostate, due to this irregular cell reproduction, constitute prostate cancer, and the main feature of cancer cells is that they can metastasise to other organs.

At an early state, prostate cancer may not cause any symptoms, making its course even more insidious. As the disease progresses and the tumour size increases, it may push the urethra and prevent urine flow during urination.

What does treatment include?

  1. Careful monitoring and awaiting.
  2. External radiation and brachytherapy.
  3. Radical prostatectomy (open - laparoscopic - robotic)

What is robotic-assisted surgery?

By “robotic assisted surgery”, we mean the use of robotic systems in surgical practice, aiming at facilitating and perfecting the surgical operation for the benefit of the surgeon and the patient. “Robotic surgery” as it is simply called, is a development of laparoscopic and endoscopic surgery. It is actually a laparoscopic surgery, performed with the assistance of a robot.

I.e. it is a minimally traumatic and invasive surgical method, during which surgical operations are performed with great accuracy, with the aid of very thin and flexible instruments, which are inserted inside the patient's body through tiny holes in the skin, thus avoiding large incisions and painful. The term robot should not be confused: the surgeon performs the surgery through the use of a robot, which is fully controlled by the surgeon.

Robot-assisted radical prostatectomy

Radical prostatectomy is the complete removal of the prostate, together with its capsule and surrounding tissues, including the seminal vesicles. Pelvic lymphadenectomy is performed depending on the stage and degree of aggressiveness in specific cases. Robot-assisted radical prostatectomy is performed through a minimally traumatic surgery. Oncological outcomes, published worldwide for robotic prostatectomy, show excellent cancer control, with faster return of urinary continence and sexual function.

Advantages

Due to both the three-dimensional and magnified vision and the accuracy and freedom of motion, which allow us to perform the surgery as if the surgeon's hands were inside the patient's body, the possibilities of urinary continence and erectile function preservation are significantly greater, as compared to those after simple laparoscopic or open surgery.

It provides better opportunity for radical removal of the prostate and nearby lymph nodes, where required, resulting in fewer relapse problems and longer survival, without signs of cell disease, which constitute prostate cancer and may metastasise to other organs.

26.06.16
FIMS and the Interbalkan Medical Center of Thessaloniki inaugurate their collaboration for international athletes

“I am very happy that in Thessaloniki there is now a Center for the World Confederation of Sports for our athletes”, said the president of FIMS, prof. Fabio Pigozzi, at the ceremony designating the Interbalkan Medical Center of Thessaloniki as a collaborating Centre. FIMS (International Federation of Sports Medicine), based in Geneva, is the official consultant of the International Olympic Committee.

The importance of an organized Sports Center for an athlete, was described from experience at the event, by the two-time Olympic champion, Alexandros Nikolaidis: “Without the help offered to me by the Interbalkan Medical Center and personally the President of the Athens Medical Group, Dr. C. Apostolopoulos and the sports medicine physician S. Galitsanos, I would not have participated four times at the Olympic Games”, he said. He added, addressing the president of the FIMS: “In my view, the FIMS made the best choice with the Interbalkan Medical Center. This will save many careers at the games.”

This opinion was also adopted in his description from experience by veteran footballer Petros Passalis: “After a very serious injury, thanks to the recovery I made at the Interbalkan Medical Center I managed to continue for another 6 years at a high level, to have my feet strong and to exercise until today”.

At the proclamation event of the Interbalkan Medical Center of Thessaloníki as a partner to the World Confederation of Sports, the FIMS was represented by its chairman, Fabio Pigozzi, the board members, Tzouaou Paulo Di Almeida and Constantinos Natsis as well as the scientific manager and head of the Reference Centre for Anti-Doping research of FIMS, prof. John Pitsiladis.  

The official guests were welcomed by the Chief Operating Officer of Athens Medical Group and General Manager of the Medical Interbalkan Mr.. Basil Bardis, stressed that the largest private Group of healthcare provision in Greece, “is the largest medical sponsor of sports associations in the country”. He welcomed the cooperation with FIMS, stressing that the World Confederation chose one of the best hospitals, the Interbalkan Medical Center, to represent it in Southeast Europe.

In his reply, the president of FIMS, professor Fabio Pigozzi, underlined that the goal for the creation of 22 cooperating Sports Centers on four continents and the specialized Anti - Doping Center in Great Britain, is to ensure the health of international athletes, with emphasis on providing training for the young, so they remain “clean”. Also, Mr.  Pigozzi announced that the Thessaloniki member of the Board of the FIMS, prof. AUTH Constantinos Natsis, was selected by the FIMS as head of it’s world congress, which will be held in 2020 in Athens.

Welcoming the event, Professor of Brighton, John Pitsililadis, expressed his joy for the genuine emotions shown by the athletes at the event and stressed that the major issue to be addressed, is the difficult problem of doping that destroys sport.

The head of the Sports Center at the Interbalkan Medical Center and president of the Sports Medicine Association of Greece, doctor Simos Galitsanos, held a guided tour for all of the facilities of the Center which has been trusted for 20 years by Olympic champions, athletes and teams, and also “fanatic” groups from throughout N. Greece. 

The event was honored by the leaders of many football, basketball and volleyball clubs in Thessaloniki and Macedonia.

14.06.16
Athens Medical Center: The "hand and upper extremities surgery seminar” was successfully held for the 10th consecutive year

Upper Extremity Surgeons Adamantios Misitzis (right) and Panagiotis Giannakopoulos (left) with the Managing Director of the Group, Dr. Vasilis Apostolopoulos.

With great success the 10th anniversary of the “Hand and Upper Extremities Surgery Seminar” organized by the Department of Hand - Upper Extremities Surgery and Reconstructive Microsurgery of the Athens Medical Center came to a close. This is an educational activity that brings together participants from Greece and abroad and is organized consistently in recent years. The Department is a center for treatment of traumas of the hand recognized by the Federation of European Societies for Surgery of the Hand (FESSH).

In recent years, a large number of the nation’s Upper Extremity surgeons have been trained at the seminar. Specifically, through the modules of the seminar, participants had the opportunity to attend ten surgical incidents in real time (live surgery) lasting eight and a half hours, to participate in an eight hour exercise in cadaveric preparations and to listen to 38 lectures by distinguished speakers.

The opening speech of the Seminar was made by the Managing Director of the Athens Medical Group, Dr. Vasilis Apostolopoulos, who emphasized the extensive experience and significant expertise of the Department in the field of Microsurgery and in Surgery of the Upper Extremities.

"The large attendance of experienced and trainee Upper Extremity surgeons and especially the praise received are a great honor for us”, stated the Upper Extremities surgeon Panagiotis Giannakopoulos. “All participants, including the renowned orthopedic surgeons Bruno Battiston from Italy and Philip Roure from France, concluded by common consent that the seminar was a particularly valuable learning experience, which proves in practice the commitment of the Athens Medical Group to invest in continuous scientific training” , added the Upper Extremities surgeon, Diamantis Misitzis.

The Seminar was held under the Auspices of the Hellenic College of Orthopaedic Surgeons, the Hellenic Society of Reconstructive Microsurgery, the Hellenic Society for Hand - Upper Extremity Surgery and the Scientific Association of Athens Medical Center.

19.04.16
Athens Medical Centre: The first operation of robotic radical prostatectomy with the neurosafe technique in Greece

Athens, April 19, 2016 - The pioneering NeuroSAFE technique was performed for the first time in Greece in radical prostatectomy robotic surgery, by the Surgeon – Urologist Dr. Stavros I. Tyritzis, at the Minimally Invasive Urologic Surgery Department of the Athens Medical Centre. Robotic radical prostatectomy with the “NeuroSAFE” technique was conducted with the ultramodern da Vinci Si HD device, in a 50 year old patient with aggressive extraprostatic disease, with excellent oncological and functional outcomes.

Robotic radical prostatectomy using the DaVinci SI system, available at Athens Medical Centre, is the golden treatment option for the management of localised and locally advanced prostate cancer. Its superiority lies in the better maintenance of erection, urinary continence, reduction to elimination of postoperative complications and, of course, in the oncological outcome.

In this context and according to the European guidelines, the surgeon, with the robotic system’s aid is now able to proceed with aggressive preservation of the neurovascular bundle, ensuring the complete disappearance of the disease.  In the past this was not possible in patients with extensive or aggressive disease, and the surgeon was obliged not to proceed to neuroprotective radical prostatectomy, sacrificing the nerves and blood vessels of erection and continence, which are in direct contact with the prostate.

Furthermore, the innovative NeuroSAFE technique allows the “introduction” of the microscope in surgery, so that the surgeon can decide before the completion of the operation if nerves should be preserved, as they may have been affected by the disease at the microscopic level. The surgeon removes the prostate through a specially shaped hole, with no need to remove the robot system from the patient. Then, in collaboration with the pathologist, he examines the prostate regions where bundle of erection has been detached and fully preserved, so that to ensure the ideal oncological outcome.

“With NeuroSAFE technique, firstly performed by us at Athens Medical Centre, we managed to raise the level of the offered surgical service, with great benefits for patients, who will probably avoid radiation and hormonal therapy after surgery,” said Dr. Stavros I. Tyritzis, Surgeon - Urologist, Centre for Minimally Invasive Urologic Surgery, Athens Medical Centre, Assistant Professor of Oncology and Urogenital Robotics, Karolinska University Sweden and Doctor of Medicine of the University of Athens.

The Centre for Minimally Invasive Urologic Surgery of the Athens Medical Centre, with Director Dr. George Kyriakou, has a specialised multidisciplinary team of Surgeons-Urologists, Radiologists, Pathologists, Oncologists and Radiotherapists (MultiDisciplinary Team) for the comprehensive treatment of urological cases, through the most modern methods. As part of research protocols, the Centre cooperates with the world's leading cancer centre MD Anderson Cancer Centre.

22.02.16
Significant award opens the way for the surgical treatment of Peyronie's Disease

During the conference of ESSM (European Society for Sexual Medicine), recently held in Madrid, Konstantinos Konstantinidis, Surgeon, Urologist -Andrologist, Head of the Department of Sexology-Andrology at the Athens Medical Center, was rewarded for the work presented related to the geometrical surgical procedure and treatment of Peyronie's Disease. The work was rewarded for the quality of the surgical technique and the large number of cases studied.

Peyronie's Disease is a peculiar condition which has no clear causes nor pharmaceutical solution to date, while the medical community as a whole has not fully adopted one of the available surgical techniques. As a result, there is confusion as to what is the appropriate method to address this particular condition.

The work of Mr. Konstantinides, due to the large volume of cases studied, convinced that the technique with a mathematical geometric model for selection of graft, can be the golden rule in the surgical solution. Throughout the duration of the conference, Mr. Konstantinidis and his team presented in detail the method focusing on the extensive postoperative monitoring period that exceeds five years.

“The new award comes to warrant the rich experience that our team holds in surgery of the genital organs, both in Greece and abroad. In recent years we have operated on more than 5.000 cases relating to specific diseases, managing to improve the quality of life of our patients. We are optimistic that our work has paved the way for the effective treatment of Peyronie's Disease, demonstrating in practice the commitment of the Athens Medical Group to always stay one step ahead”, stated Mr. Konstantinides.

05.01.16
Robotic Radical Prostatectomy

The operation that combines the accuracy of a robot with the surgeon’s medical judgment

Written by Achilles Ploumidis, MD, BSc, MSc, PhD, FEBU, Surgeon Urologist - Urogynacologist, Centre of Robotic & Laparoscopic Surgical Urology - Andrology in Athens Medical Centre

Prostate cancer is the most common type of cancer among Europe’s elderly men, as well as the second cause of death from neoplasia after lung cancer. It is characterised by great heterogeneity both in terms of occurence and progress. More specifically, it may have an asymptomatic course, especially in the early stages, while other times the patient has clinical symptoms, with obstructive or irritative symptoms during urination. Furthermore, haematospermia or perineal pain may also occur frequently.

However, early diagnosis, and thus treatment of the disease is possible. Prevention plays a primary role. Thus, men over 50, or over 45 years in case of family history of prostate cancer, should undergo a special blood test (PSA - prostate specific antigen) and the necessary clinical assessment by their urologist.

Radical prostatectomy is an effective treatment for localised prostate cancer, among others. This operation involves total removal of the prostate and seminal vesicles with simultaneous bilateral pelvic lymph node cleaning according to the indications.

In 2006 the first robotic system in Greece was installed at Athens Medical Centre. Following the European and American standards, since then more and more robotic-assisted surgical operations are performed, both for malignant and for benign urinary tract diseases.

Robotic radical prostatectomy is a minimally invasive surgical method, in which all surgical operations are performed with the aid of a robot, which is controlled by the surgeon through a special console. Special handles on the console allow the transmission of the surgeon’s moves to the robot’s arms with much greater flexibility and stability than that of the human wrist. The tiny tools that are adjusted to the surgical arms, and the high-definition magnified and three-dimensional imaging of the organs of the human body allow difficult surgical manipulations with expertise and precision. During surgery, 5 small holes are created (less than 1 cm) at the lower abdomen, from which miniature instruments are inserted. Prostate removal is performed bloodlessly and with absolute optical precision, while maintaining the integrity of neurovascular bundles and creating a water-tight vesicoureteral anastomosis that will ensure good erectile function and continence postoperatively.

Benefits of Robotic Prostatectomy

  • Less blood loss - lower chance of transfusion
  • Direct urinary continence
  • Better erectile function
  • Faster recovery and quicker mobilisation of patients
  • Faster return to daily- professional activities
  • Shorter hospitalisation and therefore quicker exit from hospital
  • Better aesthetic result
  • Quick catheter removal
  • Minimisation of postoperative pain, less use of analgesics and fewer postoperative complications.

26.12.15
Syncope: What you should know and how to manage it

Written by Tsiachris Dimitrios MD, PhD Cardiologist - Electrophysiologist,  Director of Pacing and Electrophysiology Lab, Athens Medical Center , Athens Medical Group

Syncope is a medical term used to describe what is commonly called fainting. It refers to the sudden transient loss of consciousness of a person due to decreased blood supply to the brain.

Before syncope or a fainting episode, there are often the so-called "prodromal" symptoms, such as dizziness, nausea, pale and cold skin and what makes it different from a stroke, seizures and coma is the immediate recovery of consciousness without confusion or other recessive disorders

How common is syncope and how is classified?

Syncope is a common medical problem which accounts for 3% of patient visits to emergency rooms. The syncopal episodes are classified in:

  • vasovagal (vagotonic) syncope (after emotional stress, trauma, pain, prolonged standing or blood view)
  • Hypersensitive carotid sinus syncope
  • situational syncope (urination, defecation or severe cough)
  • Cardiac syncope (due to bradyarrhythmia or tachyarrhythmia or structural heart defect such as aortic valve stenosis)
  • postural syncope when standing.

What is the prognosis of patients with syncope? 

Cases of situational or vasovagal syncope have very good prognosis, whereas cardiac syncope can be life-threatening.

How we investigate patients with syncope

As in any patient who has suffered syncope, a targeted full history is received, we examine the heart, measure the blood pressure in supine and upright position and perform electrocardiogram and echocardiogram, thus achieving a diagnosis in half the cases. In patients aged more than 40 years with syncope, we will also massage the carotid sinus. Trying to correlate symptoms with the underlying heart rate, we will place a 24-hour or 48-hour Holter. If we suspect situational or vagotonic syncope, our patient will undergo a tilt-table test while in the case of underlying brady- or tachyarrhythmia, the value of electrophysiological study is prominent. Finally, continuous monitoring of heart rate with implantable Holter is beneficial in patients with arrhythmic syncope, often as a last step in the diagnostic algorithm.

Treating people with syncope

The treatment of patients who have suffered syncope is personalized based on the underlying disorder. In case of bradycardia or hypersensitive carotid sinus, pacemaker is implanted. In case of tachycardia and structural heart disease, we place a defibrillator and perform ablation in cases of idiopathic tachycardias.

In case of vasovagal, situational or postural syncope, which are the most common causes of syncope, we reassure patients (often of young age) for benign prognosis and train them to apply simple methods to prevent recurrent episodes.