Publication
The progress of minimally invasive endoscopic surgery in Greece
Minimally invasive endoscopic surgery (MIES) means treatment and diagnosis through very small incisions or natural openings - such as the vagina - using a special camera called an endoscope and specialised instruments, achieving:
- Small incisions on the body
- Less pain
- Less blood loss
- A better cosmetic result
- Faster recovery
The basic techniques are laparoscopy (for the abdomen and pelvis) and hysteroscopy (for the uterus), replacing traditional open surgery (laparotomy).
Minimally invasive endoscopic surgery (MIES) has made significant progress in Greece, applying modern techniques across various specialties, such as gynaecology, orthopaedics, ear, nose and throat surgery (ENT) and general surgery. This progress is based on the adoption of new technologies, such as robotics and the use of high-definition endoscopes, resulting in safer, more effective and less invasive treatments - as is also evident from the international presence of Greek surgeons at congresses.
In recent years, the development of endoscopic surgery has become the basis for treating many gynaecological problems - problems that required surgical repair.
Hysteroscopy and robotics are the present and the future of gynaecology
There are difficult gynaecological conditions that have been emerging more frequently in recent years, thanks to better detection through improved scientific methods of diagnosis, with the help of technology and of artificial intelligence.
It is now certain that the development of the technology and of the microsurgical techniques - laparoscopy and hysteroscopy - applied in modern clinical practice is so great that it demands specialised skills and knowledge from the doctor, specialised and experienced nursing staff, as well as modern, purpose-designed operating facilities, so that procedures can be carried out successfully and safely for the patients.
What laparoscopy is
Laparoscopy is a surgical technique which replaces the large incision of traditional surgery with 3 or 4 much smaller incisions in the skin, of the order of 0.5-1 centimetre. A special high-definition, magnifying camera is used, transmitting the image from inside the body, along with instruments adapted to pass through these very small incisions.
The aim of the technique is to treat the same conditions that in the past were treated with open surgery, but with far less pain, faster recovery and a clearly better cosmetic result. In addition, there is less blood loss and a lower rate of post-operative infection, thanks to the precision that laparoscopic instruments provide.
It requires specialist expertise and, because of the dramatically improved results compared with traditional surgery, a very large proportion of gynaecological operations is now performed laparoscopically - a characteristic example being the diagnosis and treatment of endometriosis.
Other examples of procedures now treated laparoscopically are adhesions, conditions of the fallopian tubes and the ovaries, the removal of fibroids or even of the whole uterus (hysterectomy), without the size limitations of the past, as well as difficult gynaecological conditions such as endometriosis and adenomyosis.
These procedures are performed under general anaesthesia, and the patient returns to daily life promptly, without discomfort or problems, after remaining in the clinic for as many days as the case requires.
What hysteroscopy is (diagnostic - operative)
Hysteroscopy is a technique that allows the doctor to see inside the uterus, and specifically inside the endometrial cavity, transmitting images with great magnification and precision.
It is used in cases where anatomical anomalies or conditions of the uterine cavity are suspected, such as polyps, fibroids, a uterine septum, endometrial hyperplasia or cancer.
It is an important examination, required for a reliable diagnosis in cases of abnormal bleeding, infertility or suspicious ultrasound findings, and also for their treatment.
For diagnostic purposes (diagnostic hysteroscopy) it can be performed with or without anaesthesia, in the consulting room (office hysteroscopy), and it is well tolerated by the majority of patients.
Recovery is extremely quick and the woman can return home within a few hours.
What is robotic surgery?
Robotics gives us tremendous possibilities for diagnosis as well as treatment. It is a minimally invasive method in which the specialist surgeon operates robotic arms through a high-technology console, gaining three-dimensional, magnified vision and millimetre precision in their movements.
The daVinci Xi works as an extension of the surgeon's hand. It offers unique flexibility even in difficult anatomical areas, and is used in many surgical specialties - in urology, gynaecology and general surgery.
Robotic surgery offers remarkable possibilities in real time during operations, for example with fibroids, where the uterus is reproduced as a three-dimensional model, giving us an endoscopic image of the fibroids inside the uterus. This is called the creation of a three-dimensional model in real time, so-called augmented reality.
It offers remarkable possibilities thanks to the synthesis of computer data during the operation in real time, incorporating programmes in which a three-dimensional model is constructed from a series of three-dimensional images obtained from CT or MRI scans. In this way the exact shape of the uterus and the pathology within it can be identified precisely.
(Augmented reality - AR - in minimal-access surgery and in gynaecological oncology.)
