Complex Benign Surgery

Complex benign gynaecologic surgery is sometimes best performed by a subspecialist.  Dr. Tranoulis has the advanced training to deal with the potentially difficult surgical situations often associated with previous surgery, obesity, and multiple comorbidities. If there is any suspicion of gynaecological cancer, your operation should always be performed by a gynaecological oncologist such as Dr. Tranoulis, who has the skills to remove the cancer and perform the appropriate staging procedure.

Although keyhole (laparoscopic or robotic) surgery is the best approach for most  benign procedures, open surgery may be required in some cases of benign pathology if it is predicted to be difficult, or when there is any risk that a cancer may be found. Gynaecological Oncologists are often called to assist general gynaecologists with these cases as they have the most experience with these difficult surgeries. Extensive experience with this surgery allows Dr. Tranoulis to perform these procedures safely and, if a cancer is found, perform the right procedure at that time rather than the patient needing a second operation.

Surgery for Endometriosis

Dr. Tranoulis has surgical expertise in nerve-sparing and fertility-preserving treatment options for severe infiltrating endometriosis. His aim is to avoid multiple surgical operations for deep endometriosis and clear the disease in a single surgical procedure, even if the disease affects multiple organs and systems. 

In order to achieve this, Dr Tranoulis uses the 'excisional technique' to remove  the disease in full whilst minimising damage to the ovarian reserve, other pelvic organs, nerves and blood vessels. 

In case of bowel, urinary tract and/or diaphragmatic endometriosis, Dr. Tranoulis offers a range of treatment options, all of which are performed as minimal-access (laparoscopic or robotic) operations by deticated specialist gynaecology, urology and colorectal surgeons. 

Surgery for Fibroids

Dr. Tranoulis offers various fertility-sparing treatments for fibroids, including  keyhole (laparoscopic or robotic) myomectomy or, in case of submucosal fibroids, hysteroscopic trans-cervical fibroid resection (TCRF), a procedure performed vaginally and which doesn’t require any cuts in the abdominal wall. 

Robotic or laparoscopic myomectomy involves removing the fibroids by keyhole surgery either vaginally (small cut in the vagina) or via a small 3-5 cm cut in the lower abdomen at the “bikini line” or in the umbilical area. Robotic myomectomy is similar to a laparoscopic myomectomy, but advanced technology allows us to use natural wrist movements to control a sophisticated system of robotic surgical tools from outside the body, while viewing the whole operation in 3D. 

Dr. Tranoulis performs open surgery for cases of very large uterine fibroids (to avoid any spillage of potential cancerous cells that can occur with keyhole surgery and ‘morcellation’ of these tumours) or numerous fibroids, and where there has been multiple previous surgeries (which results in scarring or adhesions).

If future fertility is not a consideration, Dr. Tranoulis offers a hysterectomy, with or without preservation of the ovaries. This is usually performed via keyhole surgery (laparoscopic or robotic). Keyhole hysterectomy is usually quicker, with faster recovery times, and results in less postoperative pain and blood loss than with traditional techniques.

Surgery for Pelvic Organ Prolapse

Dr. Tranoulis has extensive experience with minimally-invasive surgical procedures, including robotic surgery, which often results in fewer noticeable scars, quicker recovery times and a shorter hospital stay.

In case of weakened pelvic floor tissues, Dr. Tranoulis offers keyhole (laparoscopic or robotic) reconstructive surgery to repair the pelvic floor and return the pelvic organs to their original position.

A hysterectomy may be the treatment of choice for women who have a prolapsed uterus and are not planning to have additional children. Laparoscopic or robotic surgery is generally performed when possible.

Ovarian Cysts

Dr. Tranoulis usually performs keyhole (laparoscopic or robotic) surgery for simple ovarian cysts. In case of very large cysts or when there isany chance of cancer (to avoid spilling these cells inside the abdomen which may occur with keyhole surgery), Dr. Tranoulis performs open surgery. Extensive experience with this surgery allows Dr. Tranoulis to perform these procedures safely and, if a cancer is found, perform the right procedure at that time rather than the patient needing a second operation.

Why Robotic Surgery ?

The main benefits of robotic surgery in comparison with traditional laparoscopy are:

• Better visibility due to 3D screen which allows estimation of depth
• Higher range of movements compared to the restricted rotation of the human hand
• Increased stability of surgical tools, which eliminates the slight tremor of human hand
• More accuracy of surgical movements as a result of the above
• Seated position of the gynaecologic surgeon and general ergonomics that minimise physical fatigue, especially in surgeries with longer duration 

The benefits of a robotic surgery are even more important in demanding surgeries, such as oncology surgeries, the removal of enlarged uterus (total hysterectomy) or uterine fibroids, the treatment of deep infiltrating endometriosis (DIE) and the repair of pelvic organ prolapse. The use of robotic technology allows minimally invasive approach for highly complicated surgeries due to better vision and dexterity offered by the robotic Instrumentation.

For the above conditions, studies suggest that the potential benefits of robotic surgery include:

Excellence in Surgical Care

Dr. Anastasios Tranoulis and Dr. Dimitra Georgiou offer the latest surgical innovations with emphasis on minimally invasive procedures. These include:

• Laparoscopic or robotic myomectomy
• Laparoscopic or robotic hysterectomy
• Laparoscopic or robotic excision of endometriosis
• Laproscopic or robotic repair of pelvic organ prolapse (sacral colpopexy, pectopexy)