A typical example is Da Vinci, a state-of-the-art robotic system with which complex surgical operations are performed with extreme precision, safety and minimal invasiveness.

With two Da Vinci Xi at Hygeia clinic, two Da Vinci Xi at Metropolitan Hospital, one Da Vinci Xi at Metropolitan General and one Da Vinci Xi at the Apollonian Private Hospital of Cyprus, HHG Group provides the most advanced services in robotic surgery. In fact, it is the only group in Greece and in Europe that has six (6) state-of-the-art Da Vinci Xi robotic systems.

The evolution of robotic surgery in medicine

Robotic surgery has evolved through decades of research, technological innovation and collaboration between various scientific fields. Surgical technology developed from the 1950s and 1960s with the creation of robotic arms for various applications and evolved with the introduction of the laparoscopic method, allowing operations with very small incisions. Later, robotic surgery came with advanced systems such as the ‘Da Vinci Surgical System’.

Da Vinci incorporates the latest scientific advances in technology, enabling the surgeon to perform robotic operations with greater flexibility and precision thanks to the autonomy of the robotic arms. These arms allow surgeons to further refine their technique to effectively tackle the most difficult situations, such as operating on extremely obese or petite patients.

The advantages of surgery with the Da Vinci system are:

• Better surgical outcome
• Shorter hospital stay
• Fewer blood transfusions
• Reduced postoperative pain and complications
• Less risk of infections
• Faster recovery
• Better aesthetic result
• Faster return to daily activities

What does the Da Vinci system offer compared to other surgical methods?

The Da Vinci Xi system has been designed in a way that allows all future innovations to be fully integrated into a flexible platform:

• Includes advanced tools with wrist-like mobility.
• Features the Vessel Sealer diathermy, which even allows articulated movement for vessel ligation.
• It has systematic software upgrades and supports products that allow operations to be performed through a single port (single port surgery).

In this context, it is applied in more and more specialties and surgeons prefer it, as it has dramatically improved the results of surgical operations. Characteristically, Mr. Vassilis Poulakis, Urologist-Andrologist Surgeon and Director of the Robotic Urology Center and Urology Clinic of the Metropolitan Hospital, has performed pioneering and complex robotic operations of particular difficulty and complexity with the Da Vinci method, making him one of the most experienced Robotic Surgeons – Urologists of the world.

Among the distinctions and awards that Dr. Vassilis Poulakis has received, of great importance is his award from “Ituitive”, the manufacturer of the Da Vinci robotic system, and the Sofmedica company, which represents the robotic system in Greece. He was distinguished as the second best Robotic Surgeon in the world, regardless of specialty and first in Europe, with more than 8,500 robotic operations, performed exclusively and entirely by him (June 2021).

How is a Da Vinci procedure performed?

From the operating console of the Da Vinci Xi system, the surgeon is in a comfortable position and faces a three-dimensional enlargement of the surgical field, magnified up to 15 times. From there, it controls the entire robotic system.

The console is equipped in its upper part with special handles, on which the surgeon places his fingers. He moves special levers to command the robot’s surgical arms and uses the foot switches on the bottom to coordinate various movements, such as the use of diathermy and camera movement. Every movement of the surgeon’s hand, wrist and fingers is translated precisely and in real time into corresponding movements of the robotic arms in the surgical field.

In addition, the new system offers a skills simulator for training surgical staff. The robot’s wheeled arm has four arms – one for the endoscopic camera and three for the endoscopic tools. These are inserted into the patient’s body through small incisions.

In the Da Vinci Xi system, the arms are thinner, offering greater range of motion, and the tools have a longer reach. In addition, the system provides voice assistance for guidance, quick and accurate connection to the patient through a laser targeting system. Anatomical access is revolutionary as it combines the functionality of a single attached arm (camera) system with the flexibility of a mobile platform.

After connection, we simply aim at the anatomical target field and the system automatically positions the robotic arms for optimal surgical configuration. This allows access to any point of the surgical field inside the patient’s abdomen. In addition, the Da Vinci Xi has a built-in diathermy energy source, with the ability to manage and minimize the unipolar and bipolar energy required for surgery.

The Da Vinci Xi system achieves excellent visualization of anatomy in 3D and HD, with high magnification. The optic is lined up at the end of the endoscope, allowing the surgeon to see with absolute clarity and natural colors. The camera, endoscope and cable are integrated into a portable design with no need for a cover and no need for focusing by the surgeon (it’s done automatically). The camera can be placed on any of the 4 arms depending on the stage of the operation. Finally, the system provides the possibility of fluorescence (Firefly Fluorescence Imaging), which offers visual imaging and assessment of vessels, bile ducts and tissue perfusion.

What surgeries can be done robotically with Da Vinci?

The main application of robotic surgery was and remains urology and the advantages that are ensured are multiple:

– Prostate disorders

1. Radical prostatectomy for prostate cancer.
2. Intercystic prostatectomy for benign prostatic hypertrophy.

– Bladder disorders

1. Removal of diverticula and bladder stones.
2. Partial or radical cystectomy and creation of an orthotopic neocyst or a ureteroenterostomy for invasive bladder cancer.

– Kidney / ureter diseases

1. Radical nephrectomy for very large kidney tumors.
2. Partial nephrectomy (lumpectomy) for tumors up to 5-6 cm, exophytic as well as endophytic (as pioneers have been carried out in Health and with the help of intraoperative ultrasounds) in order to preserve renal function.
3. Radical nephroureterectomy for tumors of the ureter or renal pelvis.
4. Removal of large or symptomatic kidney cysts.
5. Kidney biopsy.
6. Pelvicoplasty in pelivoureteric junction stenosis.
7. Treatment of nephroptosis or mobile kidney.
8. Removal of ureter, renal pelvis – kidney stones.
9. Resolution of ureteral adhesions (ureterolysis).
10. Treatment of ureteral strictures.
11. Treatment of vesicoureteral reflux.

– Andrological diseases

• Treatment of varicose veins.
• Treatment of abdominal ectopic testis.

– Gynecological diseases

• Treatment of pelvic floor prolapse in women with or without incontinence (e.g. sacrocollopexia).

– Thoracic surgical diseases

– Hernias

Robotic surgery represents an extraordinary technological development in the field of surgery. The Hellenic Healthcare Group is always ahead of developments and adopts cutting-edge technologies in order to offer excellent healthcare and create value for the patient, the doctor and all its partners.