Laparoscopic and Robotic Surgery Today and Tomorrow

Interview with k.Konstantino Constantinides, Director General & Laparoscopic Surgery at the Medical Center of Athens

Q: The general public heard for years the term "laparoscopy" and knows that this is a relatively new method of surgery. However I starting telling us what is laparoscopic surgery, in order to have a more accurate picture of the thing.

A: Laparoscopic surgery is perhaps the most important developments in General Surgery during the 20th century. Developed mainly in the last decade the use of fiber optic technology and video. As states and the etymology of the word "laparoscopy" (from "lapara" = belly and "purpose" = I, note) during laparoscopy see inside the abdomen. This simply means that while so far in the open surgery did some surgical incisions to open the abdomen and cheirourgisoume under direct vision, surgeons are now seeing the scope zoomed in screen.

Q: And how one goes belly to see the field surgeon?

A: Starting the intervention make a 1 cm incision in the navel and through this we introduce the laparoscope in the abdomen under direct vision without the risk of injury to a innard (technique Hasson). This is followed by other smaller sections 2.4 length 0.5 cm, through which we import special tools abdominal laparoscopic surgery. The surgeon and the assistant viewing the surgical field at a magnification of two screens.

E: When did it start laparoscopic surgery?

A: Until 1987, the year for the first time became the first laparoscopic cholecystectomy by Mouret, the laparoscopy not been used by surgeons. Since then, the endoscopic technique has led to a revolution kath'imera surgical practice, as previously had done the introduction of general anesthesia and antibiotics.

Q: What exactly is this revolution?

A: In that the technique is performed standard surgical epemvaseis with the following advantages:

Minimum; surgical trauma ( «minimally invasive surgery» or "minimally invasive surgery).

With Icon, 8-15 times magnification and better lighting, which leads to better see the time surgeons.

• Less blood loss.

Also as a result of less surgical trauma we have:

Great; reduction of postoperative pain

Faster recovery;

; Faster hospital discharge.

Lower costs, hospitalization.

; Rapid return to work.

; Almost eliminate postoperative complications related to the trauma (suppuration, division, hernia, chronic pain, etc.).

; Almost eliminate postoperative adhesions and their consequences.

• Less respiratory and cardiovascular complications.

, Lack of contact with the patient's blood, which protects the surgical team from the transmission of viral infections such as hepatitis & AIDS.

Q: What interventions can be done laparoscopically today?

A: The current applications of laparoscopic surgery has expanded to a wide range of interventions in lower and upper abdomen including both simple and sophisticated (advanced) operations. If surgeons are the group that is really experienced laparoscope, then the question is rather what interventions are not now performed laparoscopically.

Q: Could you tell us briefly what abdominal surgery can perform an experienced laparoscopic team as we speak?

A: Gladly. We refer first to the operations performed frequently after the spanioteres.

, Laparoscopic cholecystectomy and bile duct exploration in conjunction with Intraoperative cholangeiografia, Intraoperative cholidochoskopisi and Intraoperative ultrasound. This is the most widely used laparoscopic surgery, and is widely used to treat patients with gritty gallbladder or bile duct, and in patients with acute cholecystitis. If no experience, then there are actually complications that can be addressed even very heavy gall bladder without surgery turned into "open" only in a less than 1%. In simple cholelithiasis patient go on the same day or the next morning at home and return quickly to work.

Laparoscopic Appendectomy, which is an acknowledged method of treatment of acute appendicitis. The laparoscopy is particularly important here because it allows us to test met throughout the abdomen. This helps in the differential diagnosis of underlying pathology, that is if we see the exact cause of symptoms is indeed an acute skolikoeiditis. This is a huge advantage of laparoscopy More generally and of particular importance when surgeons one women of reproductive age. This is because young women are often gynecological problems pretend the picture of acute appendicitis. In this case, laparoscopy may reveal and solve surgical problems such as ovarian cysts, ovarian torsion, salpingitis, Ectopic pregnancy, pelvic adhesions, endometriosis, etc. put into this important patient group are especially pleased that prevent intra-abdominal adhesions, that could be a barrier to having children, there is no unnecessary interventions and decorative result is excellent.

Laparoscopic hernia repair; address (inguinal or koiliokilis). The application of laparoscopic approach in recent years has established the technique of total exoperitonaikis rehabilitation network (TEP), which now applies internationally with great success. The surgery has few complications and low recurrence rate (<1%). Patients getting a few hours after surgery, no significant pain, and go on the same day or the next home. The surgical trauma is minimal. The laparoscopic treatment of inguinal ideal for bilateral hernias and recurrences after previous open surgery.

As far as patients with koiliokili, they also can be treated laparoscopically at little trauma. Particular impressive is that patients with large koiliokiles, where the open surgical wound, it would be great and recovery significantly slower and painful.

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, Laparoscopy in acute abdomen (peritonitis) and trauma. In centers with a large laparoscopic experience and good coordination of the surgical team laparoscopy is used to treat the injured in the acute surgical abdomen. The laparoscopy is in principle important for the final diagnosis (eg, from bleeding the patient or which body suffers just a peritonitis), and for treatment (eg: cleaning peritonitis, sewing pierced stomach ulcers, antimetomisi intraventricular haemorrhage, etc. ). The gain of the patient that resolved the problem without a large incision, as is customary in such cases, recovery is much faster, much less pain and minimize the potential for intra-abdominal adhesions.

Laparoscopic treatment, Gastroesophageal reflux disease (GERD) and hernia. The indications for laparoscopic surgery antipalindromiki are: a) the persistent symptoms of reflux or complications treated, b) Non-cooperating patients (often because of cost medicines) c) New-age patients seeking surgical repair rather than lifelong drug / dietary therapy, d ) Patients with complications of GERD such as Barret's Esophagus, stenosis, aspiration, persistent reflux. It is essential to good Preoperative functional testing of the esophagus (gun, pH meter). Oi patients with this entity formulate particularly benefit from the laparoscopic approach, because the open surgical interventions have required too much even if thorakokoiliaki intersection. This is not surprising that for example in U.S. antipalindromikes laparoscopic surgery is to address the selection of more than 10 years.

Laparoscopic treatment; occluded ileum / symfytikis disease. The laparoscopy is ideal for most cases of patients presenting with obstructive ileus due to adhesions or chronic recurrent episodes are due to incomplete ileus symfytikis disease. In these patients is very important not to become large surgical incisions to NE are not further trauma surfaces could naodigisoun to create additional adhesions.

Laparoscopic colectomy, which is usually done as assisted. This means that the majority of surgery is performed laparoscopically, and only the shunt is open, since we export the gut by 5.6 cm incision. The cut is not possible to avoid because there will come from the ektammen section. The laparoscopic method has been introduced today in benign diseases of the colon such as diverticulosis, polyps, etc. With regard to colon cancer, one of the most common cancers in Western societies, although not completed large prospective randomized studies, all So far evidence in favor of laparoscopy: The oncological outcome of patients appears to differ from that of the open. On the contrary, there could be superior to the laparoscopic approach in stage III, as seen from a European study recently completed. This superiority, it is shown that there is finally assigned to a much better immune response of the body where the laparoscopy, since it is a much smaller operation blow to the organization.

; Laparoscopic surgery for treating of morbid obesity. Already established is the placement technical laparoscopic adjustable gastric ring (lapband), vertical compartmentalisation in Mason and gastric «bypass». Such interventions are appropriate when the BMI (Body Mass Index = ie body weight divided by height squared) of the individual is greater than 35 - 40. In this case the disease is characterized as obesity accompanied by various other disorders such as elevated blood pressure, disorders of ventilation, blood circulation, diabetes, etc. Patients are generally no longer lose weight by other methods and are candidates for surgical treatment. The laparoscopy offers little trauma, does not destroy the root canal treatment, followed by rapid recovery. In particular, the gastric ring installed and easily removed laparoscopically and is considered a method with few complications because it destroys the anatomy of the stomach. The surgeon should have dealt with this issue globally and is very experienced laparoscopically.

, Laparoscopic treatment of gynecological diseases. Almost all gynecological disorders can be treated laparoscopically where there is a experience. Laparoscopy diagnosis and initially treat endometriosis, adhesions in the pelvis lyoume, remove ovarian cysts, even if very large uterine fibroids ekpyrinizoume or in some cases we hysterectomy. We can also cheirourgisoume ectopic pregnancies with minimal interference in the abdomen and conservation of the fallopian tubes. In the laparoscopy gynecological disorders is of particular diagnostic and therapeutic value without creating adhesions that could prevent a woman to become pregnant later.

Laparoscopy; FOR staging and palliative treatment of gastrointestinal cancer. This application is a great offer

method in cancer patients in the minimally invasive part because it can provide diagnostic-take-crop biopsies under direct vision on the one hand and comfort implementation interventions (bypass usually) with specialized techniques such as biliary-intestinal anastomoses, stomach-intestine, enteroenterikes, eileostomia, nistidostomia, colostomy conditions.

Laparoscopic treatment; gastro12daktylikou ulcer. Develop and implement specific interventions such as laparoscopically ypereklektiki vagotomi, intervention Taylor (front and rear stem oromyotomi), etc., with very good results in reducing gastric acidity and ulcer healing chronic health.

, Laparoscopic liver surgery: in addition to the much greater biopsy, the excision of benign tumors, cysts and Echinococcus cyst and informal Hepatectomy. It also includes innovative applications as RF (= radiofrequencies = radio frequency) for liver metastases. The treatment using radio is now well known established to deal with liver metastasis, especially cancer of the colon.

, Laparoscopic adrenalectomy: It is now an acknowledged and safe method of addressing a wide range of endocrine diseases and sufficiently removes the adrenal tissue in all pathologies including ypofysiogenous Cushing.

, Laparoscopic pancreatic surgery: Where specific or individual interventions and include the distal pancreatectomy and ekpyrinisi insulinomas. Also, diagnostic laparoscopy is appropriate to precede laparotomy to control metastases and peritoneal implants in cases of pancreatic cancer.

, Laparoscopic (or thorakoskopiki) treatment of achalasia of the esophagus with advantage to laparoscopic application kardiomyotomis in Heller, which has been completely replace open surgery. This technique has proved safe, highly effective and with minimal post-operative problems. The image magnification provides accurate separation of muscle fibers.

, Laparoscopic splenectomy in selected patients, by a specialized team. This is an operation which got more and more international experience. The largest of the spleen removed in our clinic was huge and weighed 5.5 pounds. This was a patient with hematologic disease. The decorative result after such an operation was impressive.

Laparoscopic pelvic lemfadenektomi, which is the most popular application of laparoscopy in urology, with a privileged position in prostate cancer and cancer of the bladder and the penis.

, Laparoscopic treatment of urinary incontinence in women with a particular focus on suspension of the bladder neck to restore kysteo ourithrikis-angle (Burch).

Q: What are the principal conditions to address a patient laparoscopically?

A: Laparoscopy is a prestigious and well established method both internationally and in Greece, but must apply to centers that provide adequate anesthesia and laparoscopic equipment by an experienced surgical team to avoid complications.

Laparoscopic surgery today is separated into basic laparoscopy including diagnostic laparoscopy, cholecystectomy and Appendectomy and "advanced» (advanced) laparoscopy including intra-and exoperitonaiki collated and execution of the other aforementioned interventions. Here of course we must say that even interventions that are considered "essential" may be difficult in some patients are particularly inflammation, adhesions, etc. Thus, for dealing a severe cholecystitis or complicated appendicitis should normally be of special laparoscopic experience.

With the introduction of robotic surgery over the last 6 years the performance of laparoscopic operations is easier for the surgeon because in fact the robot serves as a third hand which holds the laparoscope and obey the commands of the surgeon with maximum accuracy ..

There are currently two types of robots, was a''hand''(AESOP) which holds the laparoscope and that has many''hands''(ZEUS) with which the surgeon to perform laparoscopic surgery distance .

The robot actively engaged in the performance of laparoscopic operations obeying the commands of the surgeon, who the guides.

It is certainly one of the many achievements that have achieved the sophisticated medical technology that brings the surgeon and the smart machine.