Robotic & Thoracoscopic Thoracic Surgery
Since its official establishment in 2017, the Department of Minimally Invasive Thoracic Surgery has achieved numerous firsts, both in Greece and across Europe, in thoracoscopic and robotic thoracic surgery. Procedures ranging from the simplest to the most complex have been performed with complete success and such positive impact that the Department has been firmly established as a center of Robotic Surgery.
The greatest global development in thoracic surgery in recent years has been the rapid rise of minimally invasive methods, both thoracoscopic surgery (VATS: Video-Assisted Thoracoscopic Surgery) and robotic thoracic surgery (RATS: Robotic-Assisted Thoracic Surgery).
Always at the forefront of medical innovation, Metropolitan Hospital established the first Department of Minimally Invasive Thoracic Surgery in Greece, under the direction of Dr. Emmanouil Georgiannakis, with the mission of advancing thoracoscopic and robotic surgical techniques.
With two state-of-the-art Da Vinci Xi robotic systems, the department has performed a wide range of thoracic procedures of varying complexity, achieving national and regional milestones across the Intuitive Southeastern Europe Region (SEERS). On November 17, 2017, Mr. Georgiannakis performed the first thoracic surgery in Greece using the advanced Da Vinci Xi robotic system, followed on February 7, 2018 by the first robotic pulmonary lobectomy. Since then, numerous such procedures have been successfully carried out.
Lung Cancer
Patients with lung cancer represent a particularly sensitive group, as rapid staging (assessment of disease extent) is essential, alongside determining eligibility for surgery. When patients reach the operating stage, they must be safeguarded against complications and enabled to recover swiftly, ensuring their overall condition remains stable and allowing them to proceed more easily with subsequent oncological treatments.
Minimally invasive techniques provide the best possible recovery, minimize complications, and offer surgeons the precision required for excellent oncological outcomes. Patients at the Metropolitan Hospital Department of Minimally Invasive Thoracic Surgery who have undergone thoracoscopic and robotic procedures for lung cancer have consistently experienced remarkable recoveries.
Benign Lung Diseases
Patients with benign lung conditions typically require less extensive surgery than oncology patients, which makes the decision for surgery particularly significant. Many hesitate to undergo traditional open thoracic surgery due to the size of the incisions involved. Minimally invasive techniques, performed through incisions as small as one centimeter, make it much easier for patients to proceed with surgery.
Examples include pulmonary hamartomas, lung cysts, and benign cavitary lesions caused by fungi or bacteria.
Outcomes of robotic thoracic surgery for such conditions are especially impressive, with hospital stays of only two to three days and almost no morbidity, leaving patients genuinely impressed.
Mediastinal Disorders
Another important category involves mediastinal masses, which may include thymic hyperplasia, thymomas, teratomas, and germ cell tumors. These conditions usually affect younger patients, for whom open surgery requiring sternotomy (sternal division) can be particularly daunting. Minimally invasive thoracic surgery, performed through small one-centimeter incisions, achieves excellent results and represents a significant advancement compared with traditional sternotomy. Both thoracoscopic and robotic procedures of this kind have been successfully carried out at the Metropolitan Hospital Department of Minimally Invasive Thoracic Surgery.
Conditions Treated at the Department of Minimally Invasive Thoracic Surgery
- Lung cancer
- Benign lung diseases
- Lung cysts
- Pneumothorax
- Thoracic trauma
- Recurrent pleural effusions
- Pulmonary empyema
- Thymic lesions
- Other mediastinal masses
- Esophageal disorders
- Autoimmune lung diseases (staging and identification)
- Metastatic disease from other organs
Procedures performed at the Department of Minimally Invasive Thoracic Surgery
- Wedge lung resections
- Lung segmentectomies
- Pulmonary lobectomies
- Empyema resections
- Thymectomies
- Resections of other mediastinal tumors
- Resections of emphysematous bullae
- Lung biopsies
- Pleural biopsies
- Chest wall biopsies
- Mediastinal lymph node biopsies
- Mediastinal lymph node dissections
- Esophageal myotomies
- Resections of benign esophageal tumors
Minimally Invasive Thoracic Surgery Techniques
Thoracoscopic (VATS)
- Uniportal VATS: all instruments and the camera are inserted through a single incision of about 3–4 cm.
- Biportal VATS: instruments are inserted through one incision, while the camera is introduced through another.
- Multiportal VATS: instruments and the camera are inserted through three or four separate entry points.
Robotics (RATS)
- Three-port robotic technique
- Four-port robotic technique
Additional techniques at Metropolitan Hospital
Intraoperative CT imaging (O-arm II) is available for the localization of nodules without the need for manual palpation.
For selected patients requiring less demanding procedures, surgeries have also been successfully performed without general anesthesia (Non-Intubated) with excellent results.
Advantages of Minimally Invasive Techniques
- Significant reduction of postoperative pain
- Minimal need for intensive care unit stay after surgery
- Rapid return to daily activities
- Lower rates of postoperative infections
- Reduced overall postoperative complications
- Reduced need for medication during hospitalization
- Reduced need for blood transfusions
- Possibility of CO2 insufflation to expand the surgical field and in cases where a double-lumen tube cannot be placed by the anesthesiologists
Advantages of Robotic Surgery
In addition to all the above:
- Greater surgical precision
- Three-dimensional, high-definition visualization of the surgical field with superior detail
- Elimination of even natural hand tremor when using instruments