LAPAROSCOPIC CHOLECYSTECTOMY AND ROBOTIC SINGLE-SITE CHOLECYSTECTOMY
In certain pathological situations of the gallbladder, your doctor will
recommend cholecystectomy, ie surgical removal of the gallbladder. Such cases
include symptomatic gallstones (stones formed from bile), cholecystitis
(inflammation of the gallbladder wall), motility problems (gallbladder
dyskinesia) and others. Cholecystectomy is typically carried out
laparoscopically, ie through 4 small incisions in the abdominal wall with a
diameter ranging 0,5-1cm, whereas the classic (open) cholecystectomy remains
useful in cases that a laparoscopic technique is not possible. For laparoscopy, our team uses novel
laparoscopic instrumentation of 2.5mm instead, thus minimizing the incisions and
optimizing the final cosmetic result (MINI-LAP CHOLECYSTECTOMY).
Robotic Cholecystectomy is the evolution of laparoscopic and occurs through
one incision of a few millimetres, with the use of a robotic system (Robotic
Single Site Surgery). After training in Strasbourg with this novel technique, Dr.
S. Hirides participated to the first worldwide Robotic Cholecystectomy without
(visible) scars, which took place at Athens Medical Center in the beginning of
2011, and signified the starting point of this types of surgery for the rest of the
world. Until today these procedures take place only from the robotic team of
Athens Medical Center in all of Greece and Cyprus.
During a robotic or laparoscopic cholecystectomy, surgeon S.C.Hirides will
gain access to the abdomen and will fill it with gas (carbon dioxide) to create
the necessary workspace (pneumoperitoneum). Then, he will inspect the whole
peritoneal cavity (diagnostic laparoscopy), and he will remove any adhesions
(reactive tissue in the abdomen) around the gallbladder. After that he will
dissect its vessels (cystic duct and cystic artery), recognize them, and divide
them between specialized clips (hemolocks). After that is complete, using
special instruments which cut while cauterizing, he will gradually remove the
gallbladder from the liver bed. Gallbladder is removed from the subumbilical
incision into a plastic bag (endobag). All incisions are sutured and the skin is
reapproximated intradermally to its original position.
Once you wake up, you may feel a little bit dizzy from the sedation. Close your
eyes and take deep breaths. You will then be transferred to the ward to recover
Thanks to Robotic Surgery, procedures without incision (incisionless surgery)
are now a reality in Greece and Cyprus, exclusively performed from the team of
Athens Medical Center. S.Hiridis performs this procedure using the most recent
robotic systems and the “Single-Site” add-on platform, through 9 millimeter
incisions which are hidden with special suturing techniques near the umbilical
region. Results are excellent, especially for patients who desire to avoid the
multiple incisions of laparoscopy and the risks of scar formation.
In Single Site robotic surgery special instruments with size of only a few
millimetres are inserted into the abdominal cavity through a single incision and
crossing at the entry point. This crossing is then reversed electronically,
resultingin restoration of ergonomy for the surgeons, which means that Dr
Hiridis holds the right instrument in his right hand and the left instrument in his
left hand. Till today this was impossible with conventional laparoscopy. Thus,
the operation is performed smoothly and with absolute control over the
instruments with a stable 3D, HD camera supported by the robotic arm.
Visualization of the surgical field is high-definition, stereoscopic and helps keep
the surgeon at ease in order for him to perform with complete safety each step
of the operation. Robotic Single Site has a large variety of instruments specially
designed for it. A bipolar coagulation forceps was recently added. During single
site, the robot literally frees the hands of the surgeon, even in difficult cases,
like diffuse inflammation of the gallbladder (acute cholecystitis).
Patients that underwent Single Site Cholecystectomies report complete
satisfaction with the team and the operation, whereas recently the scientific
community has observed that these patients do not complain about
postoperative pain from pneumoperitoneum, as it occurs with classic,
(conventional) laparoscopic surgery. This phenomenon may be attributed to the
lesser amounts of carbon dioxide gas required for Robotic Surgery, as the
abdominal wall is partially supported by the powerful robotic arms.
Patients undergoing Robotic Cholecystectomy require only a single incision
(Robotic Single Site Cholecystectomy) and are usually discharged from the
hospital on the following day and return to their work within 1-2 days without
any discomfort and practically “no incision”.
Dr. Hiridis is the first surgeon of his generation to be trained on Robotic
Surgery in Greece. From January 2007 till August 2017, Dr.S. Hiridis worked
as a consultant for the General, Laparoscopic and Robotic Surgical Clinic of
Athens Medical Center (Director: Mr.M Konstantinidis) and participated to the
first Greek Program of Robotic Surgery, gaining an overall experience of more
than 3500 operations. At the same time he also specialized in Robotic Hernia
Repairs, Upper and Lower GI Surgery, Obesity and Metabolic Surgery.
He completed with a scholarship his master’s degree in Robotics Surgery from
the Medical Faculty of National and Kapodistrian University of Athens with the
title “Master of Science” (MSc) and was awarded the title of University of
Athens Doctorate (PhD) for his research in Metabolic (Diabetes) Surgery.
His first official training in Robotic Surgery was in early 2007 at the Grosseto
University Hospital in Italy, a small town outside Sienna, directed by the world
famous hepatobiliary robotic surgeon Pierro Giullanotti. Near this great
surgeon and his team (Dr. Hiridis’ instructor in the lab is now the famous
Indian surgeon, Jay Deep Palep), Dr. Hiridis was trained on the basic
principles of the robotic system setup, use of the control console, instrument
change, and performed cholecystectomies in animal models. He also had the
opportunity to attend and observe pancreatic operations, by the famous Italian
team, currently based at the University of Illinois, USA.
This first training session was then followed by a large number of training
courses in Advanced Laparoscopy at international reference centers abroad
(Strasbourg-advanced laparoscopic surgery, Geneva-single incision
laparoscopic surgery course, San Francisco-advanced course on minimally
invasive upper and lower GI surgery, Vienna-advanced course on ventral and
inguinal hernia surgery, Amsterdam-MIS for benign and malignant pelvic
disease, Frankfurt-masterclass on hiatal hernia and GERD).
In 2009, Dr. Hiridis travelled to Houston-Texas to be trained in one of the first
international meetings of Robotic Oncology Surgery, held within the well-
known oncology reference center MD Anderson (P.A.R.O.S meeting 2009).
During the same time period he presented 6 innovative works of Robotic
Surgery at the 19 th International Oncology Congress of IASGO in Beijing,
Chinas (19 th World Congress at the International Association of Surgeons,
Gastroenterologists, and Oncologists (IASGO, Beijing, China).
During the same time period in Chicago (ACS Clinical Congress), he had the
opportunity to test the new dual training console as well as the (then
experimental) Single Site Robotic Platform after the invitation of the
In December 2009, he was elected General Secretary of the Greek Scientific
Company of Robotic Surgery and he remained to this position till august 2017.
In October 2010, the Board of the International Robotic Surgery Community
MIRA assigned him co-chair together with the world-famous robotic surgeon
Ivo Broeders, for the Scienctific Program of the 2011 World Congress of
During the same year he successfully completed the Course and Laboratory
Session In Robotic Colorectal Surgery (Hands-on) of UC San Diego University.
There he had the opportunity to train in the Robotic ColoRectal Surgery with
emphasis on robotic technique for Total Mesorectal Excision (robotic TME)
and practical workshop practice, in cadaveric donors.
In January 2011, together with Dr.Konstantinidis they were the first surgeons in
the world to get trained in Single Site Robotic Cholecystectomy in France,
which they applied immediately as soon as they returned to Greece, along with
a center in Italy and one in Switzerland (February 2011).
In September 2012, Dr.Hirides won a silver medal among 75 international
participants, during the annual Robotic Surgical Simulation Olympics at the
2012 SLS-MIRA-SRS, Boston-United States. At the same meeting doctor
received two awards for the best video presentation that he had edited and sent
himself representing the team of Athens Medical Center.
He was then trained in Advanced Robotic Upper and Lower Digestive System in
Bucharest (Professor Irinel Popescu) and Robotic Thyroidectomy with
Neurophysiological Monitoring, in Cluj-Napoca (Professor Constantea).
In July 2012, he participated as an instructor in the first hands-on course of
robotics in Greece which was held in the laboratories of the pharmaceutical
In January 2013 he observed the clinical works and the operations of the
internationally known robotic surgeon and good friend Fabrizio Luca at the
IEO/ European Institute of Oncology in Milan, Italy. This clinic is considered
as a reference center in Colorectal Robotic Surgery and Dr,Luca is also
working in the States today. Dr. Hiridis optimized his knowledge there on the
very low rectal surgery and robotic mesorectal excision (robotic TME) for
In October 2013, he successfully completed the Laparoscopic and Robotic
Colon Surgery course in Washington DC, USA.
In November 2014, Dr.S.Hiridis received his first award for the best edited
video presentation of his work at the 29 th Panhellenic Congress of Surgery from
the President of the Greek Surgical Society, entitled “Robotic Single-Site Right
Colectomy” representing the team of robotic surgery from Athens Medical
In 2015, he participated in the launch of the first robotic program in Cyprus
which gave Dr.Hiridis the opportunity to be trained to the latest robotic system
Da Vinci Xi by the manufacturing company at the American Medical Center of
Together with the Robotic Surgery team of the Athens Medical Center,
Dr.Hiridis participated to the first Robotic operations in Thessaloniki (Athens
Interbalkan Center, professor Dr.Basdanis), and in Sofia-Bulgaria (Dovere
He has numerous publications in Greek and Foreign surgery journals, he
participated in the writing of numerous scientific papers and as an invited
speaker at international conferences of Robotic Surgery in Europe (Stockholm,
Seville, Prague, Geneva, Turin, Brussels, Vienna, Limassol, Paris, Sofia,
Bucharest, Amsterdam) in America (Quebec, Chicago, Boston, San Diego, San
Francisco) and Asia (Beijing).
He is a member of the Greek Surgical Society, the European Association of
Laparoendoscopic Surgery (EAES), the International Society of Robotic
Surgery (SRS), and the American College of Surgeons (title FACS).
Nowadays, he performs robotic procedures from the entire spectrum of General
Surgery (abdominal hernia, hiatal and reflux surgery, stomach, gallbladder,
small and large intestine, anal and perianal disease and obesity) in Greece and
Cyprus. His patients are absolutely satisfied with both choices of robotic
surgery choice as well as of their robotic surgeon Dr.Savvas C. Hirides.