Prof. Dr. Vassos Nikolaos MD, MSc, PhD, FEBS

• Expertise
• 18 years of experience

Treatment: Pilonidal cysts are treated using the most modern and personalized techniques, with the aim of achieving a radical cure, rapid recovery, and minimizing the patient's discomfort. A pilonidal cyst is an inflammatory condition of the coccyx region, often associated with the presence of hair in the subcutaneous tissue. It can manifest as an abscess, with acute pain and inflammation, or as a chronic fistula, with recurrent discharge and discomfort. Both simple cases without fistulas and complicated cases with multiple openings, fistulas, recurrences, or active abscesses The choice of the appropriate method is based on the patient's history, the anatomy of the area and the severity of the disease, as well as the possible existence of relapses. The most modern and minimally invasive technique is the Laser (SiLaC) method, in which endoscopic cleaning of the fistulous tract and photocoagulation with a special laser are performed. A proprietary fistuloscope (EPSiT technique) is used, which allows imaging and precise destruction of the pathological tissue. The technique is suitable for uncomplicated cysts without abscesses and is the first choice in new cases. Advantages of the method: minimal trauma, no stitches required, immediate return to daily activities (1-2 days), excellent aesthetic result. The closed technique (Karydaki method) is also used in recurrent or extensive cysts. This technique involves excision of the cyst and fistulas and plastic reconstruction with displacement of the wound outside the midline. Finally, open excision is indicated and applied in complicated cysts with abscesses or in cases with multiple or complex fistulas.

• Expertise
• 18 years of experience

Treatment: Surgical removal of melanoma with clear margins (R0 resection) is the cornerstone of treatment. The extent of resection is determined by the tumor’s characteristics and the anatomical region. In certain cases, sentinel lymph node biopsy (SLNB) is recommended for staging and detecting micrometastases. Depending on the stage of the disease, additional therapeutic interventions may be required, including: lymph node dissection, immunotherapy, targeted therapies, radiotherapy. All treatment decisions are made within the framework of a Multidisciplinary Tumorboard, with the aim of selecting the optimal treatment strategy. Surgical procedures performed are wide-ranging, requiring significant experience and expertise, and include: extensive excision of melanoma with defined safety margins, sentinel lymph node biopsy using modern detection techniques, radical lymph node dissection of the cervical, axillary, and inguinal regions, skin defect repair with skin grafts or local flaps, surgical resection of melanoma metastases. The advantages of modern surgical treatment of melanoma include: complete oncological resection with clear margins, low recurrence rate in early-stage disease, personalized surgical strategy, combination with immunotherapy in metastatic disease, preservation of function and aesthetics, compliance with international guidelines, close monitoring based on follow-up protocols. Proper initial management of melanoma significantly influences prognosis and chances of cure. Treatment should be provided by surgeon-oncologists specialized in oncological skin surgery, within a multidisciplinary team setting at specialized centers.

• Expertise
• 18 years of experience

Treatment: The main treatment is surgical removal of the tumor with adequate healthy margins (R0 resection), as complete oncological resection is a decisive prognostic factor. Surgical precision and respect for anatomical structures ensure the functionality and quality of life of the patient. Depending on the type and biological behavior of the sarcoma, treatment may also include: neoadjuvant (preoperative) or adjuvant (postoperative) radiotherapy, chemotherapy, targeted therapy, immunotherapy. Surgical treatment includes a wide range of highly specialized procedures, including: multi-organ resections of retroperitoneal sarcomas (removal of kidneys, adrenal glands, ureters, colon and rectum, pancreas, duodenum), para-aortic lymph node dissection, resection of tumors of the inferior vena cava and large vessels, extensive resections of pelvic and gynecological sarcomas, complex resections of upper and lower limb sarcomas with vessel and nerve preparation and reconstruction, resection of thoracic and abdominal wall tumors with restoration of wall defects, resection of gastrointestinal stromal tumors (GIST), Tru-Cut biopsy under ultrasound or CT-guidance, plastic reconstruction of surgical defects with local or free myocutaneous flaps, resection of sarcoma metastases in the liver, lung, or peritoneum. The advantages of the modern oncological surgical approach include: radical oncological resection, preservation of limb or organ function, reduction of the risk of local recurrence, possibility to combine surgery with radiotherapy or systemic therapy when required, compliance with international guidelines, structured follow-up and monitoring based on established protocols.

• Expertise
• 18 years of experience

Treatment: Modern techniques are used to treat the following conditions: inguinal hernia, femoral hernia, umbilical hernia, incisional hernia, linea alba hernia, abdominal adductor syndrome, diaphragmatic hernia. The only definitive treatment for hernias is surgery. Nowadays, minimally invasive techniques are generally preferred, with hospitalization usually lasting the same day or one night. The advantages of laparoscopic and endoscopic surgery for hernias include: 2–3 small incisions of a few millimeters, reduced postoperative pain, low risk of complications, faster recovery and return to work and daily activities, as well as improved cosmetic results. The choice of technique for inguinal hernia repair is individualized based on the patient's medical history, clinical picture, and personal needs or preferences. The main techniques include: laparoscopic intra-abdominal repair with mesh (TAPP) and laparoscopic extraperitoneal repair with mesh (TEP). In selected cases, where laparoscopy or general anesthesia is contraindicated, the classic open method with mesh (Lichtenstein method) is used. In very young patients, the open method without mesh (Shouldice method) may be employed. For particularly large or complex hernias, advanced techniques such as the Wantz and Stoppa methods are used. Special mention should be made of postoperative incisional hernias, which are often large, involve altered anatomy, and have a higher likelihood of recurrence. In this category, the innovative Fasciotens® system is now employed for repair.

• Expertise
• 18 years of experience

Treatment: The gallbladder is a small sac located under the liver that stores bile, a fluid necessary for the digestion of fats. The most common conditions affecting the gallbladder and bile ducts include: cholelithiasis (gallstones), polyps, acute or chronic cholecystitis, choledocholithiasis (stones in the bile ducts, pancreatitis due to gallstones, rare cases of gallbladder or bile duct cancer. In most cases, gallstones are asymptomatic. However, when they cause obstruction or inflammation, symptoms such as severe pain (hepatic colic), nausea, fever, jaundice, or pancreatitis may occur. The only definitive treatment is the removal of the gallbladder (cholecystectomy). The operation is performed using a minimally invasive technique (laparoscopic), with small-diameter instruments and tiny incisions (a few millimeters, often without the need for stitches), in a highly safe and precise environment. During laparoscopic cholecystectomy, the 3D technique is applied, and the Critical View of Safety (CVS) rule is strictly followed to ensure correct identification of anatomical structures. Additionally, intravenous indocyanine green (ICG) can be used to map the bile ducts and further reduce the risk of complications. Hospitalization lasts same-day or one night, and most patients can return to daily activities within a few days. The advantages of modern laparoscopic techniques include: minimal traumα, immediate mobilization, faster recovery, reduced risk of complications, excellent cosmetic results, high success rates and painless postoperative course.

• Expertise
• 18 years of experience

Treatment: Colon cancer is one of the most common cancers worldwide. It often develops insidiously, starting as a benign polyp, which over time can transform into a malignant tumor. Surgery is the main treatment, with the goal of complete cure, and may be combined with chemotherapy, radiotherapy, or immunotherapy, depending on the stage and location of the tumor. Surgery involves a colectomy (removal of part of the colon) with anastomosis to maintain normal bowel function. In some cases of rectal cancer, a temporary stoma is created, which is later reversed. Surgeries are performed either using minimally invasive methods (laparoscopic or robotic) or via the open method in advanced or recurrent cases.The golden rule for oncologically correct tumor removal is Complete Mesocolic Excision (CME) with Central Vascular Ligation (CVL). This technique involves precise ligation of the vessels at their origin, extensive lymph node clearance, and total removal of mesocolic or mesorectal tissue. It requires specialization and has been shown to improve survival rates and reduce the risk of recurrence.This method has been incorporated into international and German guidelines (S3 guidelines) and is considered the standard surgical technique for treating colon cancer.