News

23.09.15
Athens Medical Centre: Urologic robotic surgeries in patients who have lost part or all of the lung

Athens, September 23, 2015 - During the past six months, a significant number of robotic radical prostatectomies and robotic partial nephrectomy robotic surgical operations were performed successfully at Athens Medical Centre, in patients who had lost part or all of their lung due to cancer. It is worth noting that such surgeries are rare in Europe, since integrity, scientific training and coordination of a team of doctors of various specialties is required. 

Patients recovered very quickly without complications, and they were discharged from the hospital just 2-3 days after surgery.

In recent years, there has been significant progress in prostate cancer and tumour-like kidney lesions surgeries. Now, thanks to the daVinci robotic system, available at Athens Medical Centre, the results recorded both in oncology and in operational parameters (urinary continence and preservation of erectile function) of radical prostatectomy are excellent. The same surgical method has contributed extremely in the surgical treatment of kidney tumours, through their selective ablation instead of the whole kidney (partial nephrectomy). Furthermore, a great number of good results have been recorded in the eradication of up to 7 cm long tumours, while the function of the remaining kidney is very good, with the lowest possible ischaemic renal stress.

Dr. George Kyriakou, Director of the Centre of Minimally Invasive Urology at Athens Medical Centre, stated: “In Europe, prostate cancer is the most common type of tumor and 2nd most common cause of death due to cancer in the male population, while renal cell cancer is the most common renal epithelial malignant neoplasia, and it is responsible for over 90% of all renal malignancies. Nevertheless, at European level, robotic surgeries are rare in patients who have already lost part or all of their lung due to cancer.  We are proud at Athens Medical Centre, since we have succeeded in making these successful operations, actively demonstrating our commitment to continuous leadership.”

It is worth noting that the robotic surgery constitutes a minimally invasive surgical operation without incisions, with no or minimal postoperative pain, faster recovery and return to everyday life for the patient. Due to the fact that no incision exists on the abdominal walls and minimum trauma, metabolic stress is lower than an open surgery. 

16.09.15
Athens Medical Centre: The first implantation of a totally subcutaneous defibrillator in a patient with an inherited disease in Greece

The first implantation of the novel, totally subcutaneous defibrillator system in patient with inherited disease was performed in Greece in Athens Medical Center by the Electrophysiologists of the Athens Heart Center, Dimitrios Tsiachris and Sotiria Stambola.

The surgery was performed in a 16- years-old patient and for the first time, total subcutaneous defibrillator was used to treat a congenital disease. The patient suffered from the gene-inherited “long QT syndrome”(electrical heart rhythm disorder) and had recovered from sudden cardiac death.

The defibrillation generator is placed on the distal left axillary region and the subcutaneous defibrillation electrode, on the sternum. This prevents direct contact of the total subcutaneous defibrillator with the circulatory system and the heart and reduces the severe complications of typical transvenous systems, thus ensuring faster recovery.

Sudden cardiac death is the most negative outcome of congenital cardiovascular diseases and is mainly responsible for the death of young and otherwise healthy people. Since the overall control of the population is not possible, the specialized team of the Cardiomyopathy Unit of Athens Heart Center, under the direction of Mr. Ari Anastasaki, focuses on a thorough testing of high-risk groups, which consist of:

  • Individuals who develop cardiac symptoms
  • Families affected by sudden cardiac death of their members
  • Families who have members diagnosed with hereditary cardiovascular disease
  • Athletes at high-level competitive sports diagnosed with cardiomyopathy

"Sudden cardiac death manifests by a sudden loss of consciousness and occurs within one hour of the onset of symptoms in individuals with or without known cardiovascular disease. According to the American Heart Association, it is estimated that 1,000 people/day die from sudden cardiac death worldwide, making prevention and early diagnosis of cardiovascular disease, particularly in people at high risk, the best treatment approach of syndrome. The totally subcutaneous defibrillator is our most important ally in cases such as the 16-year -old patient, giving patients a better quality of life, "said Professor Christodoulos Stefanadis, Professor of Cardiology, Director of the Athens Heart Center.

19.08.15
Athens Heart Center

Written by Christodoulos Stefanadis, Professor of Cardiology University of Athens, Professor of Cardiology Yale School of Medicine, Director of Athens Heart Center, Athens Medical Center

Cardiology is a modern specialty rapidly developed and shifted regarding its methods and scope. Standard "Athens Heart Center" in Athens Medical Center aims at covering the entire spectrum of modern developments in cardiology while aiming at producing and promoting research and educational work.

The main features of Athens Heart Center is the Department of Cardiology, the Catheterization Laboratory, The Electrophysiology Laboratory - Pacing and the improved innovative Diagnostic Laboratories and Units, which cover the entire spectrum of cardiology with the most modern approach.

The Interventional Cardiology Laboratory has two modern rooms of Catheterization Laboratory. The contemporary approach to invasive treatment of coronary artery disease requires performing both angiography and angioplasty with stent placement, by accessing the arm and the radial artery, achieving patient’s mobilization and discharge on the same day.The Cardiology Clinic is a fully equipped and organized cardiology clinic, with excellent medical and nursing personnel, who are at the disposal of patients at any time, ready to manage any acute or chronic cardiac incident. The excellent patient monitoring is facilitated by the telemetry systems and the ongoing education of nursing staff.

Main commitment and mission of the Laboratory is to conduct primary angioplasty any time and day, ie, direct stenting of the occluded artery in case of acute myocardial infarction with excellent results. The method is internationally established as the best treatment of acute myocardial infarction, it requires readiness and experienced staff and is carried out in very few centers in our country in a 24-hour basis.

High priority is to promote the transcatheter aortic valve implantation program (TAVI), where recent studies demonstrate the efficacy of percutaneous approach of structural heart disease, often superior to the open-heart surgical approach. In the Laboratory of Electrophysiology and Pacing of Athens Heart Center,

entire range of electrophysiology and pacing procedures is performed. The laboratory is available all days and hours of the week, throughout the year, for permanent pacemaker implantation systems in patients, where the pacemaker implantation is urgent.

Since October 2015, Athens Heart Center is the first center in Attica, and Athens Medical Center the only private hospital, where implants without leads of the most advanced pacing technology of Micra pacemakers will be performed, in the largest international clinical study. The innovative device is implanted through the femoral vein, it is 93% smaller than existing pacemakers and minimizes complications as it has no leads or does not require the creation of a "pocket" on the chest, making it the epitome of nanotechnology.

The implanted defibrillator is now an established treatment that prevents sudden death in patients with heart failure and in patients with myocardial infarction, dilated cardiomyopathy, hypertrophic cardiomyopathy and electrical heart diseases. At the same time, one in three patients with heart failure also require biventricular implant systems with the defibrillator. The defibrillator prevents the occurrence of sudden cardiac death, while the biventricular pacemaker, to appropriately selected patients, re- synchronizes significantly the cardiac contraction, improving cardiac function and the clinical condition of the patient.

Atrial fibrillation that needs a holistic medical approach with a proper selection of anticoagulation, antiarrhythmic and invasive treatment and management of comorbidities in conjunction with the relevant specialties. The selection of patients for atrial fibrillation ablation is performed by the first in Greece Special Unit for Atrial Fibrillation.

The AF ablation procedures are performed both with the current method of cryoablation and with the help of the latest electroanatomical mapping systems, which also provide an objective assessment of each cauterization (CARTO 3, Smart-touch). In the Laboratory of Electrophysiology and Pacing of Athens Heart Center, the efficacy of these operations exceeds 80%.

Experience and special interest in the management of patients with ventricular arrhythmias within the Arrhythmia Unit is also adequate. Patients are selected based on the appropriate clinical- laboratory examinations and they will undergo safe and effective endocardial and epicardial ablations of ventricular tachycardias. Arrhythmia unit aims at the selection of patients with supraventricular arrhythmias and bundles for ablation procedures, often achieving final cure and free of any medication.An innovation of Athens Heart Center is the improved, innovative Diagnostic Laboratories and Units. In the Echocardiology Laboratory a three-dimensional echocardiography using modern techniques and transesophageal echocardiography are performed at any time, while Dobutamine Stress Echocardiography for the diagnosis of coronary heart disease and Stress echo using a bicycle ergometer for valvular heart disease investigation and assessment of myocardial viability are of unique experience.

In the Laboratory of Fatigue, Arrhythmias Control and Pressure Measurements of Athens Heart Center, we conduct fatigue test, cardiopulmonary exercise test on bicycle ergometer, a tilt-table test to investigate syncope, Holter rhythm with the possibility of sudden death risk assessment in patients with structural heart disease, and a 24- hour blood pressure monitor (pressure Holter) in connection with the Hypertension Unit. It is also possible to carry out tests and adjustment of pacing and defibrillation systems.

The Units of "Athens Heart Center" are designed for the systemic, holistic and contemporary management of the entire range of cardiovascular diseases, staffed by the most specialized cardiologists.

In the Hypertension Unit, a full diagnostic and laboratory testing (pressure Holter, heart triplex, albuminuria measurement, assessment of peripheral vessels) is performed. Emphasis is given to the investigation of secondary hypertension and in selecting patients for renal artery angioplasty, removal of endocrine tumors and sleep apnea treatment. At the same time, refractory hypertension cases are thoroughly investigated and patients are selected for renal artery denervation .

In the Cardiomyopathy and Congenital Disorders Unit patients and families with diagnosis of congenital cardiovascular disease are monitored, while pre-activity and pre-sport activity control is also carried out.

In the Coronary Disease Unit, an appropriate diagnostic disease approach is performed in cooperation with the specialized Echocardiology Laboratory and performing stress echo, while a relevant optimal invasive and non-invasive treatment is applied.

In the Syncope Unit, an appropriate diagnostic approach is done using rhythm Holter, heart triplex, tilt-table test and implantation of loop recorders, prognosis of patients is assessed and patients suitable for implantation of pacemaker and defibrillator systems are selected.

In the Pregnancy Heart Disease Unit, pregnant women who develop gestational hypertension are monitored in cooperation with gynecologists, as well as pregnant women with preexisting heart problems.

In Metabolic Disease and Pathological Condition Unit, patients with diabetes mellitus, metabolic syndrome, morbid obesity and special pathological metabolic diseases are monitored and their cardiac risk is assessed.

The Units and the Laboratories of the Standard Athens Heart Center, in addition to the best and innovative health services provided at clinical level, aims at providing both research results by the internationally recognized scientific personnel and educational work, either at undergraduate level on student education or providing high quality clinical training to cardiology residents. The ultimate goal is to help Athens Heart Center to develop in a special education center for cardiologists across Europe in specific innovative techniques ensuring its autonomy.

23.07.15
Robotic Urogynacological Surgery: The permanent treatment of pelvic floor prolapse while the uterus is preserved

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

What is pelvic floor prolapse?

This is the projection of one or more organs of lesser pelvis through the vagina, which end up extending beyond the labia. These organs may be: the uterus, the vaginal cuff (in case of preceding hysterectomy), the bladder, the intestine strands, or even the rectum. This prolapse occurs during intra-abdominal pressure increase (sneezing, coughing, weight lifting), and it is due to the relaxation of ligaments, fascias and the peritoneal muscle wall, all of which form a complex network of dynamic and static support of the pelvic organs.

What are the symptoms of pelvic floor prolapse?

  • Permanent feeling of heaviness in the perineum or vagina, which is often also transfered to the lumb (waist).
  • Displacement (descent) of the uterus or a soft organ in various movements, which can project outside the vagina.
  • Lower urinary tract symptoms, such as: weak urination, difficulty in urination, feeling of obstruction during urination, feeling of incomplete bladder emptying, frequent urination, urgency, urinary incontinence.
  • Gastrointestinal system symptoms, such as constipation, feeling of incomplete emptying during defecation.
  • Discomfort during sexual intercourse.
A. Normal anatomy of the female pelvis. II. Various types of pelvic floor prolapse: prolapse of the anterior compartment (cystocele), prolapse of the central compartment (uterine prolapse) and prolapse of the posterior compartment (rectocele). III. The correction of pelvic floor prolapse is achieved robotically through the suspension of the vagina to the sacrum

How common is pelvic floor prolapse?

Pelvic floor prolapse is one of the most common urogynaecological problems that adult women face. The impact increases with age and, in fact, one in three women over 50 will seek medical attention due to the symptoms. Unfortunately, many women are overwhelmed by shame, reduced sexuality and as a result, self-esteem, leading to the disease often remaining in a latent state, with serious impact on quality of life.

Types of pelvic floor prolapse:

When prolapse occurs in the anterior wall of the vagina, then it is called anterior compartment prolapse. Since the organs projecting from the anterior compartment are the bladder and/ or urethra, it is often called cystocele or urethrocystocele, respectively. This type of prolapse is the most common and affects, in most cases, urination function (obstructive symptoms). Correspondingly, when the prolapse concerns the posterior wall of the vagina, then it is called prolapse of the posterior compartment. In this case, the organ projecting is the rectum, which is why the prolapse is called rectocele.

However, part of the small intestine may be also projecting from the upper part of the posterior vaginal wall, known as enterocele. Finally, when the uterus or vaginal cuff projects (in case of hysterectomy), it is a prolapse of the central compartment. Uterus or vaginal cuff prolapse is the second most common type of pelvic floor prolapse. It should be emphasised that the separation of the condition into three compartments (anterior, central and posterior) is of particular diagnostic and therapeutic importance, although a woman may have a combination of the above: i.e. she may have a cystocele with vaginal cuff prolapse, especially following hysterectomy surgery. For this reason, the condition should be treated as a single disease.

The causes of pelvic floor prolapse:

Pelvic floor prolapse is mainly due to the relaxation of muscles, ligaments and fascias supporting the pelvic organs. This, in turn, is caused by the following conditions:

  • Pregnancy and childbirth are considered among the most important factors. In fact, one in three women who have given birth will ultimately suffer from the disease, which may even occur some years after pregnancy. However, it is important to note that only 1 in 9 women will need surgery.
  • Increased age and menopause are among the factors that cause pelvic floor ligaments relaxation.
  • Most of the times chronic increase of intra-abdominal pressure is released on the pelvic floor, resulting eventually in its downwards displacement. Conditions that increase intra-abdominal pressure include: obesity, chronic cough, constipation and weight lifting.
  • There are women who are prone to pelvic floor prolapse, while there are also some connective tissue disorders, which affect ligaments’ strength.

Treatment of pelvic floor prolapse:

Pelvic floor prolapse is not a life-threatening condition, while some women actually have minimal symptoms, and their daily lives are not affected. Therefore, depending on the degree of prolapse, the woman's age and the symptoms, the physician can recommend the corresponding treatment. Treatments are mainly divided into conservative (non-surgical) and surgical.

Conservative Treatments:

  • Behavioural change: Body weight reduction (in case of overweight women), avoiding weight lifting and avoiding any cause of intra-abdominal pressure increase, such as chronic constipation and chronic cough (frequent in smokers).
  • Transvaginal pessary placement: The pessary is a device (usually silicon) placed by the physician into the vagina, with the aim to mechanically support the prolapsing organs. Therefore, the woman feels released of the symptoms to some extent, while the main advantage is the avoidance of surgery. It is not recommended for young women as it complicates intercourse and frequent changes are needed.
  • Exercises for the strengthening of the pelvic floor (Kegel exercises): Since perineal muscle relaxation is one of the factors of pelvic floor prolapse, strengthening these muscles through appropriate exercises, which will be recommended by the physician, can improve symptoms and prevent further relaxation at that area. These are the first treatments to be applied, especially in cases of small prolapse.

Surgical Treatments:

With robotic surgery, the large incisions of classic open surgery are replaced by 4 small openings on the abdominal wall.

Surgical treatment is recommended in cases where conservative measures have failed, to young women as well as in moderate and high degree of prolapse. There are several techniques applied, and they are classified mainly as: transvaginal procedures (through the vagina) and transabdominal procedures (through the abdomen). Surgical repair may be performed with or without the use of a mesh. It is important to note that, according to international literature, the use of a mesh provides a permanent solution to the problem with lower chances of relapse. Current concerns over the use of the mesh relate mainly to its use in transvaginal (through the vagina) repair operations. As is known, the vagina has a normal microbial flora, which may subsequently contaminate the mesh. The operations performed transabdominally are free from such risks, since the abdominal cavity has bacteria. Besides, transabdominal use of a mesh is the gold standard in other general surgical operations with similar aetiolopathology, such as restoring hernias of the abdominal wall and the inguinal region.

Robotic Sacrocolpopexy & Robotic Hysteropexy:

Sacrocolpopexy is an operation aiming at restoring normal anatomical position and function of the vagina (in women who have undergone hysterectomy), and in preventing pelvic organs descent. This is achieved with the placement of a mesh in the anterior wall of the vagina, i.e. between the vagina and bladder (thus repairing any cystocele), as well as in the posterior wall of the vagina, i.e. between the vagina and rectum (thus repairing any rectocele and enterocele). These two meshes are placed on the sacrum, thus providing strong support to the vaginal cuff (and thus repairing vaginal prolapse). It is proven (CochraneReview) that the above procedure has the fewer relapses. However, the disadvantage of the above operation (so far) in relation to transvaginal operations, is that it requires open abdominal incision and it is more time consuming. Today, however, with the application of robotic surgery, which is the method of choice for pelvic operations in particular, the above procedure (robotic sacrocolpopexy) can be performed in a minimally invasive manner. This way, low recurrence rate of a transabdominal surgery are combined with minimal complications and inconvenience of a transvaginal operation.

With the robotic platform the surgeon’s moves are transferred to the robotic instruments to a scale (Downscaling), providing accuracy in tissue preparation

Furthermore, with robotic surgery women can undergo uterus and cystocele proptosis repair operation, while their uterus is preserved with minimally invasive manner (robotic hysteropexy).

The long-held view that in cases of uterus prolapse the uterus should be removed has been revised, and today it has been proven that uterus drop is the result and not the cause of the disease.

05.07.15
Intra-arterial Therapy in acute ischemic stroke incidents the department of invasive Neuroradiography of the Athens Medical Center pioneer in Greece, successfully implementing modern endarterial techniques

Written by Karygiannis Michail MD, Interventional Radiologist - Neuroradiologist, Director of Interventional Neuroradiology Department,  Athens Medical Center, Athens Medical Group

Introduction

Worldwide, over the last 5 years, special centers and medical units for the treatment of patients with acute ischemic stroke have been organized. This is because the contribution of intra-arterial interventions to address those with acute ischemic strokes is continuously enhanced and developed. The Interventional Neuroradiology department of the Athens Medical Center has performed the largest number of surgeries in Greece, with results corresponding to those of major European centers.

Strokes are the most important cause of disability in adults and one of the leading causes of death worldwide. In our country it is estimated that each year there are 30 to35 thousand new strokes, while total hospital admissions due to strokes exceeds 40 thousand annually. Strokes, beyond the urgency of the situation that must be handled, have serious physical, mental, social and economic consequences not only for patients but also their families.

Strokes are distinguished in ischemic strokes, which are more frequent and are 85% of total strokes, and hemorrhagic strokes (15%).

Ischemic strokes (IAEE) occurs when the arterial blood supply is interrupted in a portion of the brain. This is due to obstruction of large arteries in the brain or of small arteries within the brain. The obstruction is caused by either creation of a clot in an artery stenosis (thrombosis), or a clot formed normally in the heart that moved in the brain arteries by blood flow (embolism).

However, the functioning of brain cells requires a continuous supply of oxygen and glucose in the bloodstream. When the blood supply to part of the brain is interrupted by a stroke, a disturbance in the functioning of brain cells is caused and then these cells die.

In acute ischemic stroke, immediate treatment is necessary to prevent the spread of damage to a larger area of the brain, where the blood supply is reduced but has not stopped.

Symptoms of ischemic stroke

When brain cells do not have sufficient oxygen, they cease to perform their usual “duties”, in other words their functions. Symptoms following a stroke depend on the area of ​​the brain that is affected and the extent of the damage. When any of the following stroke symptoms appear suddenly, medical assistance should be immediately requested.

  • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
  • Sudden confusion or difficulty in speaking or understanding
  • Sudden difficulty in sight of one or both eyes
  • Sudden dizziness, loss of balance or coordination of movements

It is important that if any of these symptoms of stroke occur, to visit a doctor as soon as possible. This is because the possibility of therapeutic intervention in patients with acute ischemic stroke is directly dependent on the time between the onset of symptoms and the start of treatment.

Treatment

The restoration of blood flow in the occluded cerebral artery, especially within the first 6 hours, results in an increase (4-5 times) of functional recovery and a reduction of the risk of death (up to 5 times). 

Patients who manage to go to an organized stroke center that and are subjected to the necessary laboratory and imaging tests for up to 4,5 hours after the onset of symptoms, are able to receive intravenous thrombolytic therapy (administration of a substance that dissolves the clot).

The time window of 4,5 hours is very limited and most times patients with stroke do not arrive at the hospital in time or have contraindications for the use of this medicine.

40% of ischemic strokes involve a large degree of occlusion of the cerebral vessel (such as the internal carotid artery, the main artery, the middle cerebral artery) with mortality rates between 30% and 90%. In these patients the response to intravenous administration of thrombolytics is unfortunately very small.

The need to extend the therapeutic time window from the onset of stroke and the treatment of patients with occlusion of the large blood vessels, led to the development of intra-arterial therapy, which includes intra-arterial thrombolysis and intra-arterial thrombectomy or mechanical thrombolysis.

Intra-arterial thrombolysis (effusion of thrombolytic substance directly into an occluded artery) can be applied for up to 6 hours after the onset of the symptoms of stroke, providing a 60% chance of opening of the occluded artery.

Intra-arterial thrombectomy or mechanical thrombolysis (clot removal) can be applied for up to eight hours (up to 12 hours in the posterior circulation) after the onset of stroke symptoms, offering a 80% probability of opening of the occluded artery.

Intra-Arterial therapy

Indications

  • Patients who completed their laboratory examinations (neurologic assessment, blood tests and imaging) after 4,5 hours and before 8 hours from the onset of stroke symptoms
  • Patients administered intravenous thrombolytic substance within 4,5 hours and showed no improvement
  • Patients with a contraindication to administration of thrombolytic substance
  • Patients with occlusion of a large artery and imaging indicating enhancement of a region of the brain with no necrosis, but at risk

Technique

Intra-arterial thrombolysis is performed under fluoroscopic monitoring (Digital Angiography) after puncture of the femoral artery, as is diagnostic digital angiography. Then, a guiding catheter (thin tube with a diameter of 2 mm) is advance to the carotid artery or vertebral artery (central arteries of the brain located in the neck) that supply the occluded cerebral artery. Through the guiding catheter, a microcatheter is advanced up the artery with the clot and the thrombolytic substance (r-tPA) is thereby effused directly to the thrombus.

In intra-arterial thrombectomy, the procedure followed for placement of the guiding catheter is the same as that of intra-arterial thrombolysis described above, but, with the guiding catheter an apparatus is advanced, which captures the thrombus, and then device and thrombus are removed from the artery.

The intra-arterial therapy surgery is usually performed under general anesthesia. Many times a combination of intra-arterial thrombolysis and thrombectomy is performed. Thus, depending on the artery blocked, thrombectomy is done when thrombolysis is not efficient or thrombolysis is done after thrombectomy so as to dissolve small clots in thin peripheral arterial branches.

The department of Interventional Neuroradiology at the Athens Medical Center has been in operation since 2001, having performed more than 1.500 surgeries. It has a digital angiogram of modern technology, is staffed by specialized and experienced personnel (doctors, radiology technologists, nurses) and covers emergencies 24 hours a day.    

Michael Karygiannis, Interventional Radiologist - Neuroradiologist Sci. Head of Interventional Neuroradiology Athens Medical Center.

30.06.15
The First Single Site Robotic Pyeloplasty in Southeastern Europe was performed at Athens Medical Centre

Athens, July 30, 2015 - The first single site robotic urological surgery in Southeast Europe was performed successfully at Athens Medical Centre by Surgeon Urologist - Andrologist, Dr. Achilles Ploumidis. Single site robotic pyeloplasty was recently performed with the modern da Vinci Si HD system, in a young patient with chronic kidney obstruction, where the constriction of the renal pelvis was repaired with ipsilateral ureter, preserving good renal function.

The operation was performed entirely by a single 2 cm incision through the umbilicus and the patient was discharged from hospital in less than 24 hours, with minimal postoperative pain.

Modern surgery is no longer performed with large incisions, as in the past. In robotic surgery, the actual three-dimensional vision, articulated instruments, as well as the ergonomic console give a significant advantage to the surgeon in terms of tissue preparation and accuracy during surgery. In addition, robotic surgery can be performed by a 2 cm incision through the umbilicus, achieving minimal blood loss, less postoperative pain and faster recovery, while at the same time the cosmetic result is excellent and they leave abdominal wall intact.

“Athens Medical Centre has pioneered internationally, since from 2011 single site robotic surgeries are systematically performed safely and successfully in general and gynaecological surgical operations. Now, recent technological advantages in robotic instruments construction and in the overall single site robotic platform allow the use of this technology in urology operations of the kidney. It is worth noting that single site robotic surgery is a rapid advancement and it is expected to be applied to further urology operations” said Dr. Achilles Ploumidis.

The urology clinic of Athens Medical Centre, with Director Dr. Anthony Ploumidis, has now extensive experience in robotic surgeries, which were initiated in 2006 when the first in Greece da Vinci robotic system was installed. Today, a large number of oncological surgeries for prostate, kidney and bladder, as well as urinary system repair surgeries, and urogynaecological operations have been performed successfully. Moreover, the role of urology clinic’s executive members is also important (Director: A. Ploumidis) in training young European urologists, in writing articles for recognised scientific journals and in lectures in European conferences. 

17.06.15
Interbalkan Medical Center: The first, second generation bioabsorbable stent for artery stenosis

The first second generation bioabsorbable stent in Greece- the most modern worldwide in interventional cardiology - was successfully implanted in the 42-year-old patient in the Interbalkan Medical Center of Thessaloniki by the invasive cardiologist, Dr. Lambros Karagounis, Director of the Laboratory of Cardiac Catheterization and Interventional Cardiology. 

The new bioresorbable stent is indicated for patients with elongated stenoses of coronary arteries mainly in the anterior central artery. It is a promising development especially for young people who will need several re-operations in the vessels due to coronary disease progression. Indicatively, the patient received the first second-generation stent in the Interbalkan Medical Center, experiencing coronary heart disease problem since he was 35 years old. 

As noted by Dr. L. Karagounis, "the comparative advantage of second-generation stents, is that the degree of difficulty of implantation is lower and the rate of absorption by the body, faster. This is a breakthrough in interventional cardiology. The earlier metal stents, since they remain permanently implanted in the vessel wall, limit significantly the future treatment options, such as coronary artery bypass grafting in the implantation area. In addition, a scar due to inflammatory reaction in the presence of the metal stent may be created on the vessel wall».

The novel bioabsorbable stent after implantation release local drug that inhibits restenosis. In two years, they restore vascular function and are fully degraded. The safety and efficacy has been demonstrated in large randomized trials.

25.05.15
Athens Medical Centre: Model Centre for Greece and Europe in the innovative total hip arthroplasty technique ASI

More than 200 operations with innovative minimally invasive ASI method for Total Hip Arthroplasty, have been performed at Athens Medical Centre by Mr. Ioannis Tsarouchas, Director of Major Joints Clinic and his team, highlighting the clinic as a model centre for Greece and all Europe.

Through the ASI method, impressive patient recovery, immediate mobilisation, and reduction of frequency of complications are achieved. The innovative element of the technique lies in the way the surgeon reaches the joint. In particular, through an anterior intersection with a length of only 6-7 cm, it is ascertained that soft tissues are not injured, while preventing muscle and tendon intersection. It is important to note that the operation lasts approximately 1.5 hours, while postoperative pain is minimal. The duration of hospitalisation is limited to three to four days and very soon the patient is returns to daily activities and normal life.

At the same time, dislocation risk is almost eliminated since no muscles are injured, while rapid mobilisation reduces the risk of complications, such as thrombosis. Of particular interest is the fact that the ASI technique is suitable for overweight patients, who face major problems with all other existing techniques.

The ASI technique is the most recent development in minimally invasive methods, and it offers solutions to problems that occurred with the previous ones.  Thus, for example, it poses no injury risk for the nerves or other joints of the lower limb, while it allows accurate control of limbs balancing.

“With this technique, we consider that a major step forward has been made towards the full relie of the patient from the postoperative discomfort of an operation, which is necessary for good quality of life. This is an innovative method, demonstrating in practice the commitment of Athens Medical Group to constantly stay one step ahead” stated Mr. Ioannis Tsarouchas, Director of Large Joints Clinic of Athens Medical Centre.

05.05.15
Atrial Fibrillation

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

Atrial fibrillation (AF) is a disease and not just a cardiac arrhythmia, which needs a holistic medical approach using a proper selection of anticoagulation, antiarrhythmic and invasive treatment and management of comorbidities in conjunction with the relevant specialties.

The Atrial Fibrillation Unit of Athens Heart Center is the first standard unit in Greece, which aims at the holistic management of the disease, covering the entire range of pharmaceutical and interventional methods.

Prevalence of Atrial Fibrillation

AF is detected in a surface ECG (electrocardiogram) by an irregular ventricular rhythm and loss of compatible P waves with the QRS. Continuous ECG recordings of patients with AF, have shown that more than half of AF episodes are not detected by conventional ECG recordings, even in symptomatic patients, increasing the actual prevalence of AF in 2% of the population.

Types of Atrial fibrillation

An AF episode is defined as an AF recorded in ECG lasting at least 30 seconds. The presence of subsequent episodes of AF requires the presence of sinus rhythm in ECG recordings between AF episodes. Paroxysmal AF is defined as the presence of recurrent AF (.2 episodes), which terminate spontaneously within 7 days. AF episodes lasting less than 48 hours and require electrical or pharmacological cardioversion for termination are also classified as paroxysmal AF episodes.

  • Persistent AF is defined as AF that lasts longer than 7 days. AF episodes, which are determined to terminate under electrical or pharmacological cardioversion after 48 hours and prior to 7 days, are also classified as episodes of persistent AF.
  • Long-standing AF is defined as AF lasting over a 12-month period.
  • Permanent or chronic AF is defined as AF, which is determined by both patient and physician not to persue cardioversion to sinus rhythm, regardless of its duration. If decision has been changed to perform cardioversion of AF, then it should be reclassified as persistent or long-standing AF, depending on its duration.

Classification of atrial fibrillation symptoms

The asymptomatic episodes increase in frequency with age. Asymptomatic patients are classified in EHRA (European Heart Rhythm Association) Phase I. Patients whose daily activity is not affected by the perceived presence of arrhythmia are classified in Phase II, while patients with serious symptoms and negative impact of AF on a person's daily activity are classified in EHRA (European Heart Rhythm Association) phase III. Phase IV symptoms, where the patient cannot perform any activity due to the onset of AF, occur less often.

Predisposing factors Can AF be prevented?

Some factors involved in the onset of AF may be controlled or modified, such as the treatment of high blood pressure (hypertension) and reducing alcohol consumption. Some risk factors are not controlled, such as the advanced age and family history.

 

Modifiable risk factors:

  • Hypertension
  • Heart Failure
  • Valvular Disorders
  • Cardiomyopathies and Primary electrical heart diseases
  • Stress
  • Alcohol abuse
  • Lack of exercise
  • Sleep Apnea
  • Thyroid disorders
  • Obesity
  • Diabetes Mellitus
  • Metabolic syndrome

Non-modifiable risk factors:

  • Family history
  • Advanced age
  • Congenital heart disorders
  • Gender - Men have a higher incidence of AF

Complications of Atrial Fibrillation

KM has an impact on people’s health by increasing mortality rate, stroke and thromboembolism, while reducing the ability for exercise and left ventricular function. The presence of MS doubles the mortality rate independently of other known risk factors. Patients without structural heart disease (lone AF), especially those who are younger than 60 years old show similar mortality rate to the general population. Stroke is the most serious complication of AF. 1 out of 5 strokes is due to AF. It must be noted that strokes occurring due to AF are accompanied by increased mortality rate and permanent disability and recur more often. A significant proportion of cryptogenic strokes (in which the cause has not been identified at the initial investigation) is also attributed to AF.

Management of patients with atrial fibrillation

The management of patients with atrial fibrillation aims at reducing symptoms, if any, and preventing severe complications associated with AF. Complications are prevented by anticoagulation, heart rate control and adequate treatment of concomitant risk factors and cardiovascular diseases. Symptoms relief, on the other hand, often requires controlling the rate that can be achieved by either cardioversion, or antiarrhythmic therapy, or ablation procedures.

For patients at high thromboembolic risk of stroke and high hemorrhagic risk, it is possible to perform percutaneous closure of the flap of the left atrium and consequent discontinuation of anticoagulants, by an operation performed percutaneously through the femoral vein.

Ablation of atrial fibrillation

AF ablation, which has just started being used in the last 15 years, it is more effective in the long-term maintenance of sinus rhythm compared to antiarrhythmic drugs. In any case, the way arrhythmia occurs, the chronicity of arrhythmia, the presence and severity of cardiovascular diseases and the size of the left atrium must be taken into account. AF ablation is recommended in symptomatic patients with paroxysmal AF after failure of antiarrhythmic treatment: Indication I AF ablation is recommended in symptomatic patients with paroxysmal AF before the administration of antiarrhythmic treatment: Indication IIa AF ablation is recommended in symptomatic patients with Persistent AF after failure of antiarrhythmic treatment: indication IIa

Recommendations on the strategy for AF ablation

  • The main objective of all strategies is the electrical isolation of the pulmonary veins with ablation preferably in their antrum.
  • Confirmation of the electrical isolation to achieve bidirectional block, namely blocking electrical signals imput from the atrium into the veins and output with pacing failure of the pulmonary veins is required (Figure 1).
  • RF ablation is the standard technique to accomplish point-by- point transmural lesions in the ostium or in the antrum of pulmonary veins.
  • The use of electroanatomical mapping system creating a 3D anatomy of cardiac structures (CARTO system) helps reduce the radiation and improve safety.
  • Balloon cryoablation blocking pulmonary veins achieves isolation by one homogeneous transmural lesion (one shot) and reduces the operation time, while it requires less learning time.

The AF ablation procedures are performed both with the current method of cryoablation and with the help of the latest electroanatomical mapping systems, which also provide an objective assessment of each cauterization (CARTO 3, Smart-touch). The efficacy of these operations exceeds 80% in the Interventional Electrophysiology laboratory of Athens Heart Center, while the atrial flutter ablation is performed using electroanatomical mapping systems (CARTO 3, Smart-touch), increasing by far both efficacy (> 95 %) and safety.

04.04.15
Genital Prolapse: Causes, Symptoms, Treatment

Written by Dr. George Kyriakou, Urologist, Faculty Member, IRCAD/EITS, Strasbourg, Director of Minimally Invasive Urology Department,  Athens Medical Center, Athens Medical Group

Some medical problems of women, such as urinary incontinence and genital prolapse, are still a taboo in 2015, causing social isolation.

A passive attitude towards prolapse and incontinence is considered absolutely wrong, since that woman's pathology is now treated by urology with excellent room for improvement and rehabilitation.

Pelvic organ prolapse is the descent of urogenital organs in the pelvis of the woman, due to vaginal wall degeneration and collagen damage. It may relate to a hernia of any combination, such as bladder (cystocele)cervix, or intestine and rectum (rectocele).

Over 50% of women who have had children show some degree of genital prolapse. Many are asymptomatic, and thus they do not want or require treatment. 38% of women with genital prolapse mention annoying symptoms and 25% of them has problems in quality of life. More than 200,000 prolapse operations are performed annually, while the possibility of prolapse and incontinence for a woman-mother in her life reaches 11.1%.

Prolapse causes:

  • Pregnancy with large fetus, childbirth
  • Obesity
  • Frequent weight lifting
  • Hormonal environment
  • Smoking
  • Previous pelvic operations
  • Constipation
  • Chronic cough (bronchial asthma, emphysema)

Prolapse symptoms

  • Frequent cystitis
  • Urine loss and pain during intercourse
  • Difficulty urinating - “stuffiness”
  • Frequent urination and urgency
  • Disturbances in defecation (rectocele)

Hysterectomy favours prolapse, because the bladder “loses its support”, while the percentage of women requiring correction of prolapse after hysterectomy is around 6 - 8%

PROLAPSE TREATMENT: Surgical repair is the appropriate treatment for genital prolapse. The golden rule is to repair from the abdomen with suspension (lifting) of the organs with a mesh, as well as the laparoscopic and robotic method with the daVinci system, specialised and performed by very few centres in Greece, due to the high level of surgeons’ training, constitutes significant offer of our Hospital, as it is successfully performed over the last 8 years from our urological team. This technique repairs automatically all 3 types of prolapse (cystocele, uterine prolapse, rectocele). The three-dimensional image of the surgical field, the perfectly coordinated, accurate and steady movements of robotic arms that replicate the surgeon’s movements, and the greater ease provided by the robot for multiple sutures and mesh support, render the success of this operation excellent, with the following advantages:

  • Minimal blood loss
  • Short hospitalisation (1-2 days)
  • Minimal postoperative pain
  • Fewer relapses
  • Preservation of the outcome in time
  • Less pain on contact
  • Very small percentages of INFECTION AND MESH REJECTION 

The experience of the Athens Medical Centre urology team makes it a pioneer in Europe, as the European Association of Urology has posted on its site a video showing a robotic prolapse surgery performed at the surgery unit and by the team of Athens Medical Centre as an exemplar video, due to the integrity and accuracy of this surgical operation.

26.03.15
Athens Medical Centre: For the first time in Greece a robotic surgery for radical prostatectomy in a patient with colostomy and previous abdominoperineal resection of the rectum

Athens, March 26, 2015 - For the first time in Greece, the team of Dr. Nick Pardalidis, Athens Medical Centre, performed a robotic radical prostatectomy surgery in a patient with colostomy and previous abdominoperineal resection of the rectum.

The high level of difficulty of radical prostatectomy surgery, which was due to the heavy medical history of the patient, lasted 3 hours, while the patient recovered fully on the same day and was discharged from the hospital on the following day.

“Robotic surgery, which is the method of choice in the treatment of localised prostate cancer, can now be applied safely and effectively in difficult cases such as this one, allowing the patient to leave the hospital immediately,” said Dr. Nick Pardalidis, Director of the Urology Department of Athens Medical Centre. 

It is worth noting that robotic radical prostatectomy method was firstly applied in Greece by the team of Dr. Nick Pardalidis nearly 10 years ago, when the 1st Robotic system arrived in the country, at Athens Medical Centre.