By Dr. Konstantinos Konstantinidis, MD, PhD, FACS, Adjunct Professor of Surgery, Ohio State University, USA, Honorary President of the Hellenic Department of the American College of Surgeons, Scientific Director, Director of General, Bariatric, Laparoscopic and Robotic Surgery Clinic, Athens Medical Center
One of the greatest achievements in medical technology of the 20th century is the development of minimally traumatic surgery. Undoubtedly, laparoscopic surgery has had a significant effect on the surgical treatment of most diseases over the last twenty years.
Laparoscopic surgery has proven to be safe, effective, technically feasible and well tolerated by patients. Its main advantages include shorter hospital stay, less pain, speedy return home and better cosmetic result when compared to the open (classic) surgery techniques. For the patient, this translates into less anxiety and hassle as well as a quick return to day-to-day activities.
Despite its advantages, conventional laparoscopy is limited by a high degree of difficulty, due to the limited space for maneuvering, the two-dimensional view, the opposite view of movement, and biotechnological parameters such as the natural trembling of the surgeon's hands through the long, rigid tools, especially when they have to remain unmoving for a long time.
These disadvantages have come to be eliminated by robotic surgery with its appearance at the dawn of the 21st century. It was born as an idea for medical assistance in the field of battle, but it quickly became part of the clinical applications of modern surgery.
Since 2006, the most modern robotic surgery system, Da Vinci, is available at Athens Medical Center. This system consists of a console in which the surgeon sits, a tower with electronic systems and high-resolution screens, and finally the four robotic arms where the robotic tools are adapted. Through the console and a special camera, the surgeon views the inside of the body three-dimensionally and commands the robotic tools through special handles (joysticks) and pedals. As such, the surgeon has complete control of the robotic arms holding the camera and the tools, which enter the patient's body through incisions of minimal size (7mm to 10mm).
The robotic tools are particularly versatile and perform the surgeon's movements with extreme precision, while in the last 1.5cm they perform the same and even more movements than the human hand.
The da Vinci system does not replace the surgeon, because by itself it makes no move. There is no "autopilot" setting. However, it uses advanced technology that enhances the surgeon's ability to apply minimally traumatic surgery. The surgery is performed exclusively by the surgeon, his gestures are transported electronically to the instruments with absolute precision and stability, in real time. The robotic system cannot be programmed to carry out the operation itself or perform it without the surgeon. In other words, the robotic system mimics the movements of the surgeon on the joysticks, with movements of its arms, on a smaller scale. In addition, electronic systems can absorb the natural trembling of the surgeon's hands with the stable robotic tool movements. The da Vinci robot is designed so that the surgeon has complete control over all four robotic arms, as if they were his hands.
The da Vinci system is the perfect result of the collaboration of Engineering, Electronics and Computer Science and will always be a loyal assistant. To date, the daVinci system is the only surgical robot available on the market and approved by the FDA for use in surgery.
Some of the advantages of the daVinci robotic system include the increased precision of movements, the wider movement of the tools, greater mobility, three – dimensional view, the ability to intervene in small and inaccessible areas, where the ergonomics of the system constitute the surgeon more secure during the operation. Patients benefit from shorter hospital stay, less pain, less blood loss, minimal risk of infection, better cosmetic result, speedy recovery and faster return to day-to-day activities.
In 2006, for the first time in Greece, the da Vinci robotic system was installed at Athens Medical Center, with which Prof. K. Konstantinidis and his team have carried out over 2,000 robotic operations to date, covering the whole spectrum of general surgery, on a daily basis. The great experience of Prof. K. Konstantinidis with more than 15,000 laparoscopic operations has served as the perfect backbone for the development of minimally traumatic surgical techniques, such as robotics in particularly difficult and demanding operations. Surgical indications for minimally invasive techniques of laparoscopic and robotic surgery do not differ, since robotic surgery is the evolution of laparoscopy. Their main difference lies in complex operation, where robotic surgery allows the surgeon to perform the procedure bloodlessly, without having to resort to open surgery. In the hands of an experienced surgeon, the three-dimensional view of the robotic camera and the agility of the robotic instruments become weapons for the bloodless and effective treatment of a large number of surgical conditions such as:
- Diaphragmatic hernia and gastroesophageal reflux
- Esophageal achalasia
- Cholelithiasis and gall bladder polyps
- Ventral and inguinal or sports hernia
- Colon, stomach and duodenal neoplasms
- Pancreatic, liver, spleen neoplasms
- Neoplasms of the kidney, adrenal gland, prostate and bladder
- Enlarged Spleen (Splenomegaly)
- Morbid obesity (gastric sleeve and gastric bypass)
- Gynecological conditions (fibroids, ovarian cysts, endometriosis, neoplasms)
Single Site Robotic Surgery is a latest innovation in the field of Surgery. The surgeon operates again with the help of a robotic system, but all the instruments enter the abdomen through a single incision, 15 mm small, instead of four. The entrance of the surgical instruments through the same entrance gate is technically very demanding, mainly because all the tools are on the same axis.
True to its commitment to lead medical advances by offering high-quality health services, Athens Medical Group has been a pioneer in Robotics Surgery for 13 years, and has been supplied the latest Robotic Surgery system, da Vinci Xi HD, version 2019.
The new robotic system that has been installed and has been fully operational at Athens Medical Center maintains and significantly improves the characteristics of the previous da Vinci Xi systems, which relate to the excellent three-dimensional vision and flexibility of surgical instruments, while offering new important features in the field of ergonomics and imaging.
The incorporation of FireFly technology (ICG) is particularly important for controlling organ blood supply, complicated hepatobiliary anatomy, the localization of lymph nodes, as well as avoiding blood loss and intraoperative complications. Also, this particular system, a special order for Athens Medical Center, has its own stapling tools that facilitate complicated surgery of the intestine for anastomosis to avoid colostomy, large and difficult diaphragmatic hernias and all oncology operations. Thus, the need for open surgery is almost non-existent, except in rare cases.
In addition, it provides intraoperative navigation, which is particularly important since, with the superimposition of imaging examinations, such as CT scan, we know in real time the exact location of the lesion, better identifying the anatomy. The flexibility of its arms and its ability to manoeuvre in very narrow spaces make it easy for surgeons to perform oncology operations.
Interdisciplinary Team of the Highest Standards
The Robotic Surgery team of Athens Medical Group has so far carried out over 8,000 operations of all kinds. It has more than 40 global and pan-European “firsts” and the world's largest expertise in Single Site surgery. Its members are official trainers of Robotic Surgery in Greece, Cyprus, Romania, Serbia, France, Latvia, Thailand and the United Kingdom, in collaboration with IFSO, IRCAD, ORSI, EAU.
