Conditions and Treatments 

Slipping rib syndrome (SRS) is a condition where the affected rib slips under the superior adjacent rib. During this movement the intercostal nerve is trapped triggering the symptoms.

These include persistent discomfort, sharp pain in the lower ribs along with a burning sensation and possible radiating symptoms to the anterior ribs or the back. 

While still relatively unfamiliar to most healthcare providers it accounts for approximately five percent of all musculoskeletal chest pain. 

Initial diagnosis can be made with clinical examination and confirmed with a dynamic ultrasound along with intercostal nerve block injection.  Conservative treatment include rest, analgesia, anti-inflammatory medication and surgery for the stabilisation of the rib can provide a definitive solution in selected patients. 

A collapsed lung (pneumothorax) is a condition that occurs when air enters the space between the chest wall and the lung (pleural space). It is usually an acute event with symptoms of chest pain and shortness of breath. 

Treatment of pneumothorax depends on the underlying cause, the size of the pneumothorax and patients clinical condition.

In small pneumothorax with no symptoms, the lung may re-inflate on its own and further intervention is necessary. If the pneumothorax is large or the patient has trouble breathing, a small plastic tube (chest drain) may be inserted into the pleural space to remove the air and re-inflate the lung. If these methods are not effective or the lung collapses again, a surgical treatment with Video-assisted thoracoscopic surgery (VATS) or Robotic Asssisted with the Da Vinci Robot approach, may be indicated. 

Through small incisions (‘keyhole approach’) we insert the fiber-optic camera and the necessary instruments into the chest cavity aiming to remove the responsible for the pneumothorax abnormal lung tissue and to perform pleurodesis in order to prevent future recurrence. 

For further information about the surgical approach of the collapsed lung please contact me.

Pleural effusion, also called water on the lung, is an excessive build-up of fluid in the space between the lung and the chest cavity. Different causes – benign and malignant (cancerous)- can be responsible for the fluid collection and symptoms usually include shortness of breath, chest pain and dry cough.

The type of treatment is determined by the underlying cause and the severity of the effusion. In principle, the initial treatment involves drainage of the fluid from the chest cavity, either with a needle or a small tube inserted into the chest. 

In many cases a surgical intervention with minimally invasive approach (VATS- keyhole) is mandatory to remove the fluid, take biopsies (to establish a definitive diagnosis) and insert talc powder (pleurodesis) to prevent the effusion for recurring. A single small incision in made for the insertion of instruments and the patient is usually discharged home within couple days. 

For further information about the minimally invasive surgical approach of the pleural effusion please contact me.

Pericardial effusion, sometimes referred to as "fluid around the heart", is the abnormal build-up of excess fluid around the heart and into a sac called pericardium. Various causes –benign and malignant are associated with this fluid accumulation that in many occasions can be a life-threatening situation. 

Urgent management of a pericardial effusion includes the insertion of a needle into the pericardial sac in order to decompress the fluid accumulation and relieve the symptoms. In many occasions, the fluid will re accumulate. 

Our surgical approach includes a small sub-xiphoid single 3cm incision. A small cut is performed in the pericardial sac to drain the fluid, relieve the symptoms and take appropriate biopsies for definitive diagnosis. Then a communication- window is performed between the pericardial sac and the peritoneum of the abdomen so in case of continuous fluid production it will be absorbed in the abdominal cavity. With this technique (pericardial-peritoneal window) no drains are necessary and the patient can be discharged home within 24 hours. 

For further information about this minimally invasive surgical approach please contact me.

Empyema is the accumulation of pus in the pleural space, the cavity between the lungs and the inner surface of the chest wall. 

Empyema is typically caused by an infection such as pneumonia or following surgery and if left untreated (initial treatment with chest drain and antibiotics) can be associated with significant risk for the patient. Depending the stage of empyema and the clinical condition of the patient a surgical intervention can be offered through minimally invasive approach –VATS – keyhole surgery. 

Through a small incision the pus can be drained and the infected lining of the lung and chest wall can be removed providing a definitive treatment and allowing the lung to re-expand. 

For further information about empyema surgical approach please contact me.

Emphysema represents an ongoing and progressive disease of the lungs caused largely by cigarette smoking. Eventually it damages the lungs and makes breathing difficult.

Lung volume reduction surgery (LVRS) is a surgical procedure to remove the diseased and emphysematous lung tissue. By removing the diseased and over-inflated part of lung we allow the expansion of the healthy remaining, functional lung. 

Lung volume reduction surgery has been shown to improve breathing ability, lung capacity, and overall quality of life in selected patients.

The effectiveness of this surgery depends on the location or extent of the diseased tissue, as well as the patient's exercise tolerance and fitness to tolerate surgery. Following a thorough consultation and relevant investigations every patient is discussed in specialised multidisciplinary meeting and if appropriate a surgical option is offered, tailored to the needs of each patient. 

For further information about the emphysema surgery please contact me.

The only recommended screening test for lung cancer is low-dose computed tomography (also called a low-dose CT scan, or LDCT). 

Patients with a history of heavy smoking (30 pack years or more) and still smoke or have quit within 15 years and are between 55 and 80 years old are candidates for screening with LDCT.

If you would like further information about lung cancer screening you can contact me. 

A lung nodule is a small round or oval-shaped lung growth less than 3 cm in diameter. If the growth is larger than that, it is called a pulmonary mass and is more likely to represent a cancer. 

A lung nodule can be either benign or malignant (cancerous).

If the nodule is benign, it usually does not require surgical treatment. 

If the nodule is malignant, then a surgical resection may be indicated and that can be performed with minimally invasive surgical approaches. t 

Our goal is to keep the patient safe from an undiagnosed cancer, while only recommending an invasive procedure if absolutely necessary.

If you would like further information about Lung Nodules and their surgical management you can contact me. 

Lung cancer depending on its type and stage can be treated with surgery, chemotherapy, immunotherapy, radiation therapy or a combination of treatments. 

For early-stage lung cancer, surgery is usually the best option and the procedure involves removing a portion of the lung or even the entire lung to ensure cancer clearance. 

Surgical approaches vary from the traditional open thoracotomy to minimally invasive approaches including Video Assisted thoracoscopic surgery (VATS) and Robotic Assisted Surgery with the utilization of Da Vinci Robot. 

In selected patients, the Da Vinci Robot is indicated to remove the cancer through very small incisions. The da Vinci System features a magnified 3D HD vision system and special instruments that enable the surgeon to operate with enhanced vision, precision, and control.

Depending the size and location of the cancer and considering the risks of surgery we can decide together with patient the best approach, for the best oncological outcome and long term survival.

For further information about the surgical management of early lung cancer please contact me.

It is well established that more than 75% of patients with non-small cell lung cancer (NSCLC) are diagnosed in advanced stages (IIIA-IV) where the disease has spread to vital organs and other parts of the body.

In these patients, the role of surgery is not well defined, nevertheless complete cancer resection can be achieved in selected cases, with good long-term survival. 

In the context of a multidisciplinary team each patient with advanced lung cancer can be discussed individually and appropriate management plan can be organised.

For further information about the surgical management of advanced lung cancer please contact me.

Metastatic lung tumours develop when cancer from different parts of the body spreads to the lungs. Surgical removal of metastases can be indicated depending on the number of tumours, the remaining healthy lung tissue after surgery, and the time since diagnosis of the primary cancer.

Where possible, minimally invasive approach either with VATS or the Da Vinci Robotic System can be utilised with excellent results and reduced length of stay and discomfort. 

Primary tumours that can be associated with lung metastases include colorectal cancer, head and neck cancer, malignant melanoma, osteosarcoma, renal cell cancer, soft tissue sarcoma and testicular cancer.

Our patients are treated in close collaboration with a dedicated multidisciplinary team 

For further information about lung metastases surgery please contact me.

Treatment of thymoma and thymic carcinoma depends on the stage of the condition and whether it has spread to other areas. Most treatments will involve surgery, radiation therapy, chemotherapy or a combination of these treatments.

For early stages of thymoma and thymic carcinoma, surgery is often the only treatment needed and that can be performed via minimally invasive surgical approach including the Da Vinci Robotic System. When the cancer has progressed to a later stage, surgery may be used to remove as much of the tumour as possible.

For further information about thymoma and robotic assisted thymectomy please contact me.

For patients suffering from myasthenia gravis, there are several types of treatment options available, of which one is surgery with the Da Vinci Robot. This involves the removal of the thymus gland and the procedure is called thymectomy.

Purpose of a thymectomy is to remove the source of abnormal antibody production causing the disease. Following thymectomy, 70 percent of patients will have complete remission or significant reduction in their medication within a year of the procedure. The other 30 percent of patients who have thymectomy experience no change in their symptoms. 

According to the American Association of Neurologists, patients who have thymectomy are two times as likely to experience remission as those who have medical treatment alone.

The current surgical approaches for a thymectomy are median sternotomy (this requires splitting of the sternum), transcervical (neck) incision and thoracoscopic(keyhole) approach with or without the Da Vinci Robot.

Robotic Thymectomy with the Da Vinci Robot offers numerous potential benefits over traditional open-chest surgery, including shorter hospital stay, less pain and scarring. The procedure is performed through three tiny incisions in the right chest and the patient can be discharged home within couple of days. 

For further information about Myasthenia Gravis and robotic assisted thymectomy please contact me.

Rib fracture is commonly caused by trauma to the chest wall and is usually associated with severe long-standing pain when breathing. Long term consequences may include chest wall abnormalities, chronic discomfort and decreased lung function.

Most broken ribs heal without surgery and that process usually takes up to 6 months. 

In selected patients, where the healing process is delayed or abnormal and the discomfort is significant, an operative technique called rib plating can be beneficial.

Rib plating is a pioneering technique that dramatically reduces pain and recovery time. 

Rib plating is an operation performed under anaesthesia that involves an incision made over the broken rib/s. Titanium plates and small screws are used to stabilize the broken ribs in the correct position, minimize the pain and reduce the deformity of the ribcage, while allowing patients to breathe normally.

For further information about fractured ribs and rib plating/fixation please contact me.

The thoracic outlet is a small area between the collarbone, first rib and vertebra and it includes blood vessels, nerves and muscles. Compression of these structures can cause pain in the neck and shoulder, numbness and tingling of the fingers, and a weakness in the arm. 

This group of symptoms is known as thoracic outlet syndrome (TOS).

Thoracic outlet syndrome can be difficult to diagnose and it is important that you choose an experienced medical team to treat your TOS. 

Treatment options for TOS include Physical therapy, Pain medications, Lifestyle changes, Clot-dissolving medications.

In selected patients Surgery can be indicated to relieve the long-standing symptoms and that usually includes resection of the first rib through a small incision. This is done under general anaesthesia:

For further information about the surgery for Thoracic Outlet Syndrome please contact me.

Excess sweating (hyperhidrosis) is a clinical condition that can have an impact in patients’ quality of life. Sweating, from the hands, feet, underarm and facial blushing can cause embarrassment and withdrawal from social commitments.

Several conservative methods are currently available to relief from symptoms but many patients have found that they still suffer from excessive sweating. These patients do not have more sweat glands than others - they have an oversensitive reaction caused by the sympathetic nerve. Following a careful consultation with the surgeons and a thorough and detailed medical history, surgery can be a beneficial option for patients with hyperhidrosis with immediate relief from symptoms.

ETS (Endoscopic Thoracic Sympathotomy) is a minimally invasive surgical procedure (keyhole) that involves cutting the responsible sympathetic nerve for the sweat reaction. Depending the type and location of excessive sweating the sympathetic nerve is cut in specific places improving effectiveness and reducing any complications, including compensatory sweating.

ETS is performed as keyhole surgery. Two tiny incisions (5mm each) are performed in the underarm area and the patient following the procedure can go home the same or the following day. The effect of surgery is immediately visible and in most of cases the level of satisfaction reaches 100%.

For further information about surgery for hyperhidrosis please contact me.

Bronchoscopy is a simple procedure to look directly at the airways in the lungs using a thin, lighted tube called bronchoscope. 

Under direct vision we can assess the voice box (larynx), trachea, large airways to the lungs (bronchi), and smaller branches of the bronchi (bronchioles).

During this procedure, the surgeon can evaluate suspicious areas, obtain samples and tissue for further investigations and remove foreign bodies. 

For further information about diagnostic bronchoscopy please contact me.

Castleman's disease is a rare benign lymphoproliferative disorder of unknown aetiology. The disease occurs in two clinical forms with different prognoses, treatments and symptoms: a unicentric (unifocal) form (UCD), which is solitary, localized, and a multicentric (multiofocal) form characterized by generalized lymphadenopathy and systemic symptoms.

For unicentric Castleman's Disease of the thoracic cavity there are evidence that surgical resection appears to be the most effective treatment. 

In selected patients, the surgical approach can be performed minimally invasive with the utilization of the Da Vinci Robot.

For further information about Castleman’s Disease please contact me.