Athens Medical Center Robotic Surgery Clinic

ATHENS MEDICAL CENTERATHENS MEDICAL CENTER

ATHENS MEDICAL ATHENS MEDICAL CENTERCENTER

About the Group About the Group and Roboticand RoboticSurgical ClinicSurgical Clinic

S.C.Hiridis MDGeneral Surgeon

Bern 2009


• The largest Medical Group in Greece

• 1500 beds

Athens Medical Centre S.A.

The Company's principal activities are the establishment and operation of medical centres in Greece and other Balkan countries. Company operates a medical centre in Athens as well as a clinic in Paleo Faliro and Thessaloniki. Also acts as consultant to the Albanian Ministry of Health services. The Group has diagnostic centres in Russia, Romania, Bulgaria and the Czech Republic.


President of Athens Medical Group, Dr. G.Apostolopoulos

1983 : foundation of Athens Medical CenterToday, leading role in the field of health care in southeastern Europe.Listed in Superbrands catalogueForbes Magazine ranks us among the 200 most important companies in the worldEuropean Business Magazine : 100 most important Companies


ATHENS MEDICAL NETWORK

• 8 modern hospital Units for high-quality health care services• 7 of them in Attica –Athens area• 8th : Thessaloniki –Transbalkanic Center• “perhaps the most modern hospital unit in Europe”

• G.Britain, Imperial College Medical School • 1.200 hospital bed• 3000 employees• Since 21-1-2009 agreement with another large private hospital “Errikos Dynan” for opening of Gynecologic Clinic of 147 beds, ICU, neonatal ICU, day-clinic


Surgical Clinic ofAthens Medical CenterK.M.Konstantinidis, MD,PhD,FACS

Director of General, Laparoscopic and Robotic Surgery Athens Medical CenterAthens Medical Center

President of Greek Scientific Society of Robotic SurgeryPresident of Greek Scientific Society of Robotic SurgeryPresident of Greek Society for Bariatric & Metabolic President of Greek Society for Bariatric & Metabolic

SurgerySurgery

ATHENS MEDICAL CENTERATHENS MEDICAL CENTER Versatility in General Surgical Applications

Bariatrics Roux-en-Y Gastric Bypass, Gastric Banding, Biliopancreatic Diversion

Colon/Small Bowel Hemicolectomy, Sigmoid Colectomy, Ileocectomy, Abdominal-perineal resections, Low Anterior Resection, Small Bowel Stricturoplasties

Esophageal/ Foregut Heller myotomies, Nissens, Gastric Resections, Gastric Pacing Wires, Esophagectomies (Transhiatal or Transthoracic),

Hepatobiliary/pancreatic Lobectomies, Segmentectomies, Choledochal-jejunostomy, CBD Exploration, Distal Pancreatectomy, Whipple, Ampullectomy

Other Live donor nephrectomies, adrenalectomy, Hernias Splenectomy, Aortofemoral Bypass, AAA

General Surgery

www.kkonstantinidis.com

ATHENS MEDICAL CENTERATHENS MEDICAL CENTERRobotic Telesurgery : the future of surgery ?



Year 2000: Dr.Konstantinidis introduces Surgical Robotics- Aesop Robot





2002 Robotic Surgery Course Hackensack University Medical Center,USA


Surgeons Console

Surgical Cart

Insite Vision System

da Vincida Vinci®® Surgical Surgical SystemSystem

da Vinci Surgical System











First Robotic Surgical Operation in Greece

• 26/9/2006 • ATHENS

MEDICAL CENTER

• Robotic Cholecystectomy

• Woman 35 years• Dr.K.M.Konstanti

nidis

ATHENS MEDICAL CENTERATHENS MEDICAL CENTER235 Robotic Operationsover 500 with urologic procedures

3%



Stockholm – EAES 2008



Quebec – MIRA 2009• 2011 organization of MIRA assigned to Greece

(Dr.K.Konstantinidis – Athens Medical Center)


• New Instrumentation • New techniques• Investigational surgery• Training tools• Haptics• Navigation• Augmented Reality

Interested in emerging surgical technologies

Augmented Reality – aided Robotic Surgery


3D reconstructions used intraoperatively for navigation


3D reconstructions used intraoperatively for navigation


“This is modern medicine at its

very best”

Thank you for

your attention



• Over the past two decades, both the – mortality – and the morbidity associated with pancreatic

surgery have been reduced substantially.

• high-volume centers: perioperative mortality now < 3%

Surgery of the pancreas for benign or malignant diseases


• more careful patient selection, • better understanding of surgical

anatomy, • advances in critical care medicine, • and improvements in the

management of perioperative complications

Decreased Mortality-morbidity


• pancreaticoduodenectomy (the Whipple procedure),

• distal pancreatectomy (open and laparoscopic),• longitudinal pancreaticojejunostomy (the

Puestow procedure), • enteric drainage of pancreatic pseudocysts

(open and laparoscopic), • and palliative bypass for unresectable

periampullary cancer

Procedures


• noninvasive modalities – transabdominal ultrasonography, – computed tomography, – and magnetic resonance imaging

• and invasive modalities – endoscopic retrograde cholangiopancreatography

[ERCP] – and endoscopic ultrasonography [EUS].

Preoperative Evaluation


• can identify – changes associated with chronic pancreatitis, – biliary and pancreatic duct dilation, – and the presence of pseudocysts.

• In the setting of malignant disease, it may demonstrate – dilated intrahepatic and extrahepatic bile ducts, – liver metastases, – pancreatic masses,– ascites, – and enlarged peripancreatic lymph nodes.

• A malignancy of the pancreas typically appears as a hypoechoic mass; ultrasonography reveals a pancreatic mass in 60% to 70% of pancreatic cancer patients.

Transabdominal ultrasonography


• preferred noninvasive imaging test for pancreatic disease, having largely supplanted ultrasonography in this context.

• Helical CT can delineate the anatomy of the pancreas and the surrounding organs in considerable detail, and it can easily define pancreatic calcifications, inflammation, necrosis, and masses.

• Pancreatic cancer usually appears as an area of pancreatic enlargement with a localized hypodense lesion.

• A triple-phase intravenous contrast study is ideal for the assessment of pancreatic lesions.

• Thin cuts are obtained through the pancreas and the liver during both the arterial phase and the venous phase after the injection of I.V. contrast material.

• Besides being used to determine the primary tumor size, CT is used to look for and evaluate invasion into local structures or metastatic disease.

helical (spiral) CT



Laparoscopic Surgery of the pancreas



Robotic Surgery of the Pancreas



Robotic Surgery - NISSEN



Conclusions• Augmented reality technology is in its infancy

– there are still many risks, difficulties, and limitations to be assessed. • Safety is of course paramount:

– a minor miscalculation could result in the patient’s death. • Augmented reality relies upon an exact registration of virtual to real life,

– and misalignment cannot be allowed. • It is important that the surgeon retains tight control and can monitor,

evaluate, – and adjust factors throughout a procedure that depends on augmented reality.

• Ergonomics and ease of use must also be considered. • Augmented reality uses a variety of monitors, cameras, and complex

computing equipment, which must be of a high quality but also affordable. – The relatively high costs are likely to drop with increased demand and availability.



The future

• Future developments for augmented reality may encompass the application of augmentation to other senses as well.

• In particular, adding and removing sound might be useful.

• Auditory signals could warn if a surgeon begins to stray from the augmented resection line, – and this could also help in preoperative planning and the

training of surgeons.



References

• http://medvis.vrvis.at/projects/aras/• http://www.ariser.info/projects/studierstube.php• http://jama.ama-assn.org/cgi/content/full/29

2/18/2214-b• http://www.se.rit.edu/~jrv/research/ar/index.

html• http://student.bmj.com/issues/08/03/life/108

.php


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Health & Medicine

Athens Medical Center Robotic Surgery Clinic