ROBOTIC HIATAL HERNIA - GERD REPAIR

In selected cases of Gastroesophageal Reflux Disease (GERD), especially those associated with presence of a Hiatal Hernia (larger than normal esophageal opening in the diaphragm, through which the stomach shifts to the thorax), your doctor will recommend Surgical Repair of Hiatal Hernia & Reflux, ie suturing of the esophageal opening and of the upper part of the stomach, which restores the normal sphincter mechanism that prevents reflux of stomach contents. Surgical Repair is nowadays performed laparoscopically, ie through 5 small holes in the abdominal wall with a diameter of 0.5-1.5 cm. Robotic Hiatal Hernia Repair is an evolution of the laparoscopic techniques, performed through 5 small incisions 0.5-1.5 cm, using a robotic system that enhances view of the surgical field and greatly facilitates surgical manipulations, especially intra-abdominal suturing.

During a Robotic Hiatal Hernia Repair, surgeon SC Hirides, after gaining access to the abdomen and insufflating gas (carbon dioxide) to create the necessary workspace (pneumoperitoneum), will first check the entire abdomen. He will then assess the size and extent of the hiatal hernia and will reduce the stomach to its normal position within the abdominal cavity. He will then mobilize the lower esophagus and upper stomach and divide the fatty part between the stomach and spleen with great care, because there are several veins at this position. In the laparoscopic approach these veins are safely controlled thanks to the use of ultrasonic scissors. With robotic technology, this phase is performed safely either by robotic ultrasonic scissors or by a novel, bipolar coagulation device named Vessel Sealer. Surgeon Savvas Hirides will then suture the esophageal opening (closure of the diaphragmatic crurae), and fold the stomach behind the esophagus, creating a wrap of 360 degrees (Nissen fundoplication) or 270 degrees (Toupet) which will act as a new antireflux sphincter mechanism. After final inspection of the abdomen, incisions are sutured with strong sutures and skin is closed with an intradermal (invisible) suture and reapproximated in its original position.

READ MORE : BEFORE YOUR HIATAL HERNIA PROCEDURE

 

Dr. Hirides is the first Cypriot surgeon to be trained in Robotic Surgery. From January 2007 to August 2017, Dr. S.C Hirides worked at the  Clinic of General, Laparoscopic and Robotic Surgery of the Athens Medical Center  (Director: KM Konstantinidis), and actively participated in the  first Greek Robotic Surgery Program, with a total experience of more than 3500 surgeries. At the same time , he specialized in Robotic Hernia Surgery, Upper and Lower Digestive and Robotic Surgery for Morbid Obesity & Metabolic Diseases. 

He completed  with a scholarship the Postgraduate Program in Robotic Surgery of the Medical School of the National & Kapodistrian University of Athens  for the title "Master of Science" (MSc) and later he received the title of  Doctor of the University of Athens (PhD)  for his research in Metabolic Science. 

His first formal training in Robotic Surgery was in early 2007 at the University Hospital of Grosseto, Italy , a small town outside Siena, where the internationally renowned robotic hepatobiliary surgeon Pierro Giullanotti was teahing and operating at the time. Close to this great surgeon and his team (Dr. Chiridis's trainer in the laboratory was the now famous Indian surgeon, Jay Deep Palep), Dr. Chiridis was trained in the basic principles of robotic system setup, use of the control console, change of tools and performed cholecystectomy on an animal model. He also had the opportunity to attend pancreas surgeries by the famous Italian team currently based at the University of Illinois, USA.

This first training was followed by a large  series of advanced trainings in Advanced Laparoscopy  in international referral centers abroad  (Strasbourg - advanced laparoscopic surgery course (included practice in laparoscopic surgery of Nissen fundoplication and laparoscopic splenectomy course), Geneva 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 - Seminar on specialization in hernia surgery).

In 2009, Dr. Hirides traveled to Houston-Texas  to get trained in one of the first international meetings of Robotic Surgical Oncology, held at the renowned  MD Anderson Oncology Reference Center (PAROS meeting 2009) . In the same year he presented 6 pioneer works of Robotic Surgery   at the 19th International Congress  of IASGO in Beijing , China (19th World Congress of the International Association of Surgeons, Gastroenterologists, and Oncologists (IASGO), Beijing, China). That same year in  Chicago (ACS Clinical Congress) , he had the opportunity to test the new dual training console as well as the (experimental at the time) Single Site Robotic Platform after invitation of the manufacturing research team. In December 2009 he was elected  General Secretary of the Hellenic Scientific Society of Robotic Surgery and remains in this position until today .

In October 2010, the Board of Directors of the International Community of Robotic Surgery MIRA appointed him to  co-chair  with the internationally renowned robotic surgeon Ivo Broeders,  in the Scientific Program of the 2011 MIRA World Conference on Robotic Surgery. In the same year he successfully completed the  Course and Laboratory Session in Robotic Colorectal Surgery (Hands-on) of  UC University San Diego . There he had the opportunity to be trained in Robotic Colon Surgery with an emphasis on the robotic technique of Robotic Total Mesorectal Excision (robotic TME) and practical training in the laboratory, in cadaver donors.

In January 2011, together with Athens Medical Center team, they were the  first in the world to be trained in Robotic Cholecystectomy Without Incisions  in France and applied it as soon as they returned, simultaneously with a center in Italy and one in Switzerland.

In September 2012, Savvas Hirides  won the  silver medal  among 75 participants from all countries, in the annual  Robotic  Surgical Simulation Olympics in the framework of the international conference SLS-MIRA-SRS 2012, in B USA. At the same meeting, the doctor  received  two  awards for best video presentation that he had edited and sent himself, representing the team of the Athens Medical Center . He was then trained in  Advanced Upper and Lower Digestive Robotic Surgery 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 robotics course in Greece  which took place in the laboratories of the pharmaceutical company ELPEN. 

In January 2013 he attended the work of the clinic and the operations of the internationally renowned robotic surgeon and good friend Fabrizio Luca at the  IEO / European Institute of Oncology  in Milan, Italy. This clinic is considered a center of reference in Robotic Colon Surgery and its then director is also in America today. Dr. There, Hirides optimized his knowledge of very low anterior colectomy and  robotic TME  in rectal cancer. In October 2013 he successfully completed the skills course  Laparoscopic and Robotic Colon Surgery in Washington DC, USA. 

In November 2014  ,  Dr. Ηιrides received the Best Video Award from the organizing committee of the 29th National Greek Surgical Congress in Athens, for the presentation that he prepared and presented himself, entitled "Robotic Single-Site Colectomy", representing the team of Athens Medical Center.

In 2015, in the context of the launch of the first robotic program in Cyprus, Dr. Hirides was trained in the  new da Vinci Xi robotic system  in American Medical Center, Nicosia. 

Together with the Robotic Surgery team of the Athens Medical Center, Dr. Hirides also contributed to the launch of the  first Robotic Surgery Program in Thessaloniki  (Inter-Balkan Medical, Professor Dr. Basdanis), in Cyprus (American Medical Center Hospital)  and Sofia-Bulgaria  (Dovere Hospital).

He has  published extensively   in Greek and foreign journals, has co-authored numerous  medical books  (including the chapter on Robotic Hiatal hernia at Surgical Robotics/IntechOpen-2018) and has been a  guest speaker at numerous international surgical conferences  in Europe. , Prague, Geneva, Turin, Brussels, Vienna, Limassol, Paris, Sofia, Bucharest, Amsterdam), America (Quebec, Chicago, Boston, San Diego, San Francisco) and Asia (Beijing).

He has presented his personal experience with robotic hiatal hernia repairs in Greece (Athens, Thessaloniki, Ioannina), as well as abroad (Paris, Frankfurt, Milan, Boston).

He is a member of the  Hellenic Society of Surgery, the European Society of Laparoscopic Surgery (EAES), the International Society of Robotic Surgery (SRS), and the American College of Surgeons (FACS) .  

Today he performs  robotic surgical procedures from the whole spectrum of General Surgery  (abdominal wall hernias, hiatal hernias and reflux, stomach, gallbladder, small & large intestine, anus and perianal diseases and morbid obesity in Greece, Cyprus and Malta). 

"Our technique for Robotic Hiatal Hernia Repair comes from a large pool of knowledge and experience both in classic open techniques, as well as our long-term friction with modern laparoscopic and robotic approaches. This technique has made us known in Greece and Cyprus, and is applied with excellent results and minimal inconvenience for the patients, usually requiring no more than a single day of hospitalization. To date, our team has operated on patients aged 19-76 years, with a body mass index betweeen 19-53.5. Majority of our patients declare absolutely satisfied with their restored quality of life... "

 

 

Interview for Robotic Hiatal Hernia Repair on channel 9, Athens, Greece (November 2019)

 

Text Translated and Revised on 20-4-2022