Abdominal, tumour and robotic surgery

We specialise in abdominal surgery. We treat all of the organs that your favourite food encounters as it travels through your body.

Robotic surgery

Progress through technology

Robot-assisted surgery is a modern development in the field of minimally invasive surgery. The robot acts as an extension of the surgeon’s own arm. Besides providing maximum precision, it can perform movements that would be impossible for the human hand. It can perform 540° rotations, improve movement precision and eliminate trembling.

Greater precision for minimally invasive procedures

The advantages of minimally invasive surgery are manifold. It allows for smaller incisions, resulting in less postoperative pain and reducing the risk of infection. This shortens hospital stays and recovery times. It also results in smaller scars, which means fewer issues with wound healing and incisional hernias.

More treatment options

The benefits have reduced the obstacles to minimally invasive surgery in complex abdominal procedures. Robot-assisted surgery allows highly complex procedures to be carried out more easily and in a minimally invasive way. This benefits the surgeon and ultimately the patient.

Seeing more than the human eye

Robotic surgery enables real-time infrared viewing in the form of the Firefly system. This involves injecting a fluorescent dye that is harmless to the human body. This makes tumours visible and facilitates safe, complete removal of tumour metastases. The Firefly system can also be used to check intraoperatively created surgical connections (anastomoses) for sufficient blood flow.

Tumour surgery

Interdisciplinary, multimodal treatment of tumours

We believe in treating malignant tumours on a highly targeted basis. As such, we provide a bespoke plan and precise surgical treatment.

Several specialists are involved in the treatment of malignant tumours. We work closely with gastroenterologists, oncologists, radio-oncologists, and many other disciplines to provide the best treatment for our patients. Patients with a diagnosed tumour embark on an interdisciplinary tumour board review, where the details are discussed with all the necessary specialists. We then provide you with a detailed treatment plan and scientifically substantiated advice.

HIPEC – supplementary treatment in tumour surgery

Hyperthermic intraperitoneal chemotherapy (HIPEC) is the localised application of chemotherapy in the abdomen during surgery. It is used for tumours in the peritoneum (peritoneal carcinomatosis) and for eliminating any remaining tumour cells in the complete surgical removal of visible tumours (cytoreductive surgery, CRS).

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Treatment

Every procedure requires experience and routine. That is why our team specializes in certain areas.

  • Thyroid gland / Parathyroid gland

    Thyroid gland

    The thyroid gland (glandula thyroidea) is a butterfly-shaped endocrine gland located in the neck below the larynx. Its main function is to store iodine, produce iodine-containing thyroid hormones and the hormone calcitonin.

    Nodules in the thyroid gland
    Thyroid nodules are common and usually (80%) benign. Nevertheless, a hormone (TSH) determination and ultrasound examination is required for all nodules. If you are found to have an overactive thyroid (hyperthyroidism), we also require imaging using radioactively labeled substances (scintigraphy). You will often notice an excessive production of thyroid hormones yourself due to the symptoms of unexplained nervousness, increased sweating, diarrhea and even palpitations.

    Necessary surgery for thyroid nodules
    Surgery is necessary if symptoms occur, if malignancy is proven or if the hormone-active nodule is larger than 3 cm.
    In thyroid surgery, we distinguish between the removal of half of the thyroid gland (hemithyroidectomy) and the complete removal of the thyroid gland (thyroidectomy). Both procedures are performed under general anaesthetic and depend on the extent and stage of the tumor.

    Parathyroid gland

    The parathyroid glands are responsible for the calcium balance in our body. There are normally four of them and they are usually located near the thyroid gland.

    Parathyroid adenoma
    An overactive or underactive parathyroid gland has serious consequences for the entire body.

    If hyperparathyroidism occurs, this is usually (85-90%) due to a parathyroid adenoma. You will then often develop kidney stones, bone atrophy (osteroporosis) and possibly a stomach ulcer.

    If, on the other hand, you suffer from hypoparathyroidism, the most common symptoms are a depressive mood, muscle twitching or even muscle cramps.

    Examination and treatment options
    Parathyroid function is investigated in close cooperation with our endocrinology colleagues. Imaging (choline-pet CT) is used to localize the parathyroid gland showing hyperfunction.
    Surgical treatment is indicated for hyperparathyroidism and is usually performed via a small incision in the neck under general anesthesia.

  • Oesophagus / Stomach

    Oesophagus

    In Switzerland, oesophageal surgery is part of highly specialized medicine (HSM) and is performed by us in cooperation with specialists.

    Carcinomas in the upper gastrointestinal tract
    Esophageal carcinoma, gastric carcinoma and tumors at the gastroesophageal junction (AEG tumors) are treated exclusively on an interdisciplinary basis in collaboration with colleagues from gastroenterology, oncology and radiotherapy. The appropriate therapy depends on the location and extent of the tumor (tumor stage) and in most cases is multimodal (a combination of chemotherapy, immunotherapy and surgery).

    Gastroesophageal reflux (GERD)
    In this widespread clinical picture, reflux (regurgitation of stomach contents into the oesophagus) leads to heartburn with damage to the oesophageal epithelium and remodeling of the tissue to form a precancerous stage (Barrett's oesophagus). Reflux can also be caused by a diaphragmatic hernia (oesophageal/paraesophageal hernia). The surgical treatment approach for GERD depends on the patient's symptoms and the restoration of the anatomy (surgery according to Dor, surgery according to Toupet).

    Treatment options
    Die Entfernung der Speiseröhre (Ösophagektomie) ist beim bösartigen Tumor ein zentraler Eckpfeiler der kurativen Therapie. Bei der Speiseröhrenentfernung wird anschliessend meist der Magen hinter dem Brustbein nach oben gezogen und eine Verbindung wieder angelegt (Operation nach Ivor-Lewis oder McKeown).

    Stomach

    Gastric surgery is most performed as part of bariatric surgery. Bariatric surgery (e.g. gastric bypass or sleeve gastrectomy) is necessary to help you lose weight if diet and exercise have not been successful or if you have serious health problems due to your weight.

    Stomach cancer also usually makes stomach surgery unavoidable. Most stomach cancers that are diagnosed by doctors have progressed beyond the early stages. For this reason, almost all patients with stomach cancer require surgery to cure the disease. In partial gastrectomy, only part of the stomach is removed, in total gastrectomy the entire stomach is removed - as a rule, the stomach is removed together with all the surrounding lymph nodes.

    In surgery of the oesophagus and stomach, minimally invasive surgery, in particular robot-assisted surgery, offers advantages in early post-operative recovery.

  • Liver

    In Switzerland, liver surgery is part of highly specialized medicine (HSM) and is performed by appropriate specialists.

    Liver surgery and liver transplantation are currently the only curative treatment options for primary and secondary liver malignancies. Despite the ability of the liver to regenerate after tissue loss, a retention of 25-30% of the organ is considered a minimum requirement to avoid the risk of liver failure after partial surgical removal.

    Primary tumors in the liver
    Primary liver tumors include hepatocellular carcinoma (HCC) and cholangiocellular carcinoma (CCC). These cancers usually develop in previously diseased livers (fatty livers, livers with fibrosis, cirrhosis). This requires precise clarification of liver function before surgery can be carried out at low risk. We carry out liver wedge resections as well as anatomical liver segment resections through to hemihepatectomy and extended hemihepatectomy. In suitable cases, we perform these operations in a minimally invasive manner using the surgical robot.

    Secondary tumors - metastases in the liver
    Metastasis surgery is the most common indication for liver surgery. It is not the number of metastases that is decisive, but the amount of liver tissue that remains (FLR = future liver remnant) and its quality.

    Benign tumors in the liver
    In the case of benign tumors - hemangioma, focal nodular hyperplasia (FNH) - surgery is very rarely necessary. Exceptions to this are adenomas, which show a tendency to degenerate and may require surgery depending on the subtype. Benign tumors also include liver infestation by the fox tapeworm (Echinococcus). It can cause a serious liver disease in humans, alveolar echinococcosis. Transmission is feco-oral, usually through the consumption of forest fruits such as berries and mushrooms. In Switzerland, it is mainly foxes that are infested with the worm. Drug therapy cannot cure the disease, so surgical removal of the echinococcal cyst in the liver is the treatment of choice.

    Examination and treatment options
    Before an operation, we evaluate the quality of the liver parenchyma. In addition to clarifying the laboratory parameters, we offer specific liver function tests (ICG test, LIMAX, HIDA) and carry out liver volumetries (volume measurements) so that we can offer you a safe surgical solution. If your general condition is poor or your liver function is critical for liver surgery, we also have the option of treating tumors using radiofrequency ablation (RFA) or microwave ablation (MWA).

    If not enough liver tissue remains after resection of metastases, we can use special techniques to encourage the liver to grow. This usually involves first closing the portal vein +/- hepatic vein (venous deprevation technique) and sometimes cutting the liver parenchyma at the same time (ALPPS).

    The safe performance of major multi-stage liver surgery (two-stage hepatectomy, ALPPS) requires integration into a sensible oncological concept. By this we mean the integration of chemotherapy, radiotherapy and surgery into a joint treatment strategy. All our tumor patients are presented at the interdisciplinary tumor board and together we determine the optimal treatment path for the patient.

  • Gallbladder

    10-15% of the Swiss population have gallstones and 10-25% of these develop abdominal pain (usually cramp-like upper abdominal pain). Removal of the gallbladder (cholecystectomy) is one of the most common operations in the area of the bile ducts.

    Gallbladder surgery is usually minimally invasive and is necessary for gallbladder stones that cause pain.

    Cholecystitis
    Cholecystitis is an inflammation of the gallbladder that is usually caused by a gallstone blocking the gallbladder outlet. Patients usually experience symptoms such as abdominal pain, fever and nausea. The signs of gallbladder inflammation can be easily recognized by ultrasound. An operation should be performed as soon as possible.

    Mirizzi syndrome
    Mirizzi syndrome is a rare complication of gallbladder stones. A stone in the gallbladder or gallbladder duct presses on the common bile duct and blocks it. Patients develop jaundice (icterus) as the bile can no longer drain into the intestine.

    In the case of gallbladder disease, we will carry out the necessary investigations for you and then discuss the next steps and the various treatment options.

  • Pancreas

    In Switzerland, pancreatic surgery is part of highly specialized medicine (HSM) and is performed by specialists.

    Surgery remains the most important treatment for pancreatic ductal adenocarcinoma, and complete removal of the cancer offers a clear survival advantage, especially in early-stage disease.
    Surgical strategies for tumors in the head of the pancreas include pancreaticoduodenectomy according to Kausch-Whipple and pylorus-preserving pancreaticoduodenectomy according to Traverso-Longmire. Tumors in the body or tail of the pancreas can be removed by a left pancreatic resection (with spleen).

    Intraductal papillary mucinous neoplasia (IPMN)
    IPMNs are often discovered incidentally and can be a precursor lesion of pancreatic cancer. Although several guidelines for the treatment of IPMNs have been published, there are still many "gray areas" in the indication for surgery of IPMNs. If you have been diagnosed with an IPMN, we will advise you comprehensively as to whether only a follow-up or surgery is necessary in your case.

    Pancreatic cancer with infiltration of the blood vessels
    If the tumor has already reached the blood vessels, chemotherapy is used first. If the tumor responds to treatment, a complex operation with resection of vessels can be performed, sometimes the main vascular trunk of the abdominal cavity (coeliac trunk) must also be removed (Appleby operation).

    Neuroendocrine tumors (NET) of the pancreas
    Neuroendocrine tumors (insulinoma, gastrinoma, glucagenoma) can also be operated on by means of enucleation or central pancreatic resection due to their less malignant nature.

    In the case of benign tumors in the tail area of the pancreas, we perform a spleen-preserving pancreatic resection (Warshaw operation or Kimura operation), which is particularly advantageous with robot-assisted surgery.

    Chronic inflammation of the pancreas
    Surgery is an important cornerstone of treatment for chronic inflammatory diseases of the pancreas, especially when it comes to reducing pain. Here too, we offer you an individual treatment plan. Depending on the anatomy and extent of the chronic pancreatitis, we perform drainage operations (Frey operation, Partington-Rochelle operation, Pustow operation, Bern operation) or remove parts of the pancreas (Kausch-Whipple operation) through to complete removal (total pancreatectomy).

    Examination and treatment options
    In the case of pancreatic tumors, we are happy to organize a tailored approach to treatment for you. We assess the operability and discuss flanking measures of systemic therapy (chemotherapy, radiotherapy, immunotherapy) together with our oncologists at the interdisciplinary tumor board. You will then receive a detailed treatment plan and sound advice from us.

  • Small intestine

    Inflammation of the small intestine (e.g. chronic inflammatory bowel disease as part of Crohn's disease) or scarred adhesions from previous operations are usually the reason why surgery is necessary.

    The removal of a segment of the small intestine (e.g. in Crohn's disease) can usually be performed minimally invasively. Individual adhesions can also be removed using minimally invasive surgery. The removal of extensive adhesions, on the other hand, is usually performed via a median abdominal incision (median laparotomy).

    Crohn's disease
    In Crohn's disease, the repeated inflammation can lead to scarred constrictions (stenosis) or fistulas (newly formed connections between two organs). Acute bleeding or intestinal perforation can also occur. This may necessitate an operation to remove the affected segment.

    Adhesions/bridges
    Previous operations or inflammation can lead to flat or cord-like adhesions. These are usually present without causing symptoms. However, it is possible that these adhesions may strangulate a section of the intestine, leading to an intestinal obstruction. This often requires emergency surgery. The adhesions are loosened so that the path through the intestine is free again.

    Small intestine tumors
    The small intestine is only rarely the organ of origin of a tumor, but is often involved.
    Rare tumors include, for example, gastrointestinal stromal tumors (GIST), which occur predominantly in the stomach and small intestine, neuroendocrine tumors (NET) and, even more rarely, adenocarcinomas. During surgical treatment, a segment of the small intestine is also removed, including the associated lymph nodes.

    Treatment strategy
    In the area of the small intestine, too, clarifications are usually interdisciplinary with gastroenterologists, radiologists and, in the case of tumors, oncologists. You will then be advised by us and shown possible surgical solutions.

  • Large intestine / rectum

    There can be various reasons why an operation on the large intestine (colon) or rectum is necessary. Common causes are inflammation of diverticula (so-called diverticulitis) or chronic inflammatory diseases (Crohn's disease or ulcerative colitis), but colon cancer (colon carcinoma) or rectal cancer (rectal carcinoma) can also be a reason why an operation is unavoidable. The operation is performed as an inpatient procedure and usually requires a hospital stay of 5-10 days.

    Excellent minimally invasive surgical methods
    Most operations can be performed using the keyhole technique (minimally invasive). We often use robot-assisted surgery for this. With four to five 8 mm incisions, a highly precise and gentle operation can be performed. However, the laparoscopic technique is also frequently used. Open surgery with a larger abdominal incision is rarely necessary.

    Specific surgery according to tumor location
    Depending on where exactly in the colon the problem is located, the operation must be planned accordingly. The location of the problem can be determined by means of a colonoscopy and / or imaging (computer tomography CT or magnetic resonance imaging MRI). Typical operations are the removal of the right-sided (right hemicolectomy) or left-sided (left hemicolectomy) colon. It is also possible to remove the sigmoid colon (sigmoid resection) or the junction of the small intestine and large intestine (ileocecal resection). In the case of rectal problems, the rectum is removed (rectal resection). The maximum variant is the complete removal of the colon and rectum (proctocolectomy), which is only necessary in rare situations.

    A special case of bowel cancer is hereditary cancer (so-called hereditary bowel cancer). On the one hand, this concerns familial adenomatous polyposis (FAP), in which many polyps appear at a young age. On the other hand, there is hereditary non-polyposis colorectal carcinoma, abbreviated to HNPCC or Lynch syndrome. In these cases, in addition to the usual investigations, further investigations and genetic counseling are advisable, as tumours can also occur in other organs in addition to colorectal cancer and the risk is inherited.

    Examination and treatment options
    The preliminary clarifications are carried out in close cooperation with gastroenterologists (colonoscopy) and X-ray specialists. We are happy to support and advise you during these investigations and for the planning of targeted therapy. We will also discuss any necessary surgery with you in detail.

  • Anus / pelvic floor

    Proctology

    Proctology deals with diseases of the rectum and anal canal. Many procedures can be performed on an outpatient basis.

    We treat mariscus, perianal vein thrombosis, haemorrhoids, anal fistulas, fissures, condylomas, dysplasia or anal cancer as well as pilonidal sinus fistulas in the Bellaria and Opera outpatient surgery centers under short anaesthesia or local anaesthesia.

    Surgical techniques
    Most proctologic procedures are performed via the anus. Depending on the cause of the problem, the operation is adapted accordingly. We use all modern surgical methods and offer you state-of-the-art technology.

    Examination and treatment options
    Subspecialization is also an advantage for patients in proctology. At vivévis, we offer them these specialists. And here, too, we are networked with other specialists if additional clarifications are required.

    Pelvic floor

    Pelvic floor problems are a very common problem. Women are more frequently affected due to their anatomy and previous pregnancies and births. Pelvic floor prolapse can lead to protrusion of the rectum into the vagina (rectocele), internal protrusions (intussuception and enteroceles) or protrusion of the bowel (rectal prolapse). Fecal incontinence is also a common problem, but unfortunately it is rarely discussed. Talk to us if you would like to know more about this.

    Treatment options
    Many pelvic floor problems can be treated with conservative measures. Medication or pelvic floor physiotherapy play an important role here. Problems can be addressed surgically from the rectum or via the abdominal cavity.

    Pelvic floor problems often require surgical fixation of the rectum. This can be done from below through the anus (according to Rehn-Delorme or Atlemeier) or via the abdominal cavity. A decision is made here as to whether a bowel resection is necessary at the same time (Frykman-Goldberg) or whether only the rectum is fixed (mesh rectopexy according to D'Hoore or suture rectopexy). We perform most operations using a robot, as this enables precise fixation.
    We can also offer a surgical remedy for incontinence. A defective sphincter muscle can be reconstructed (sphincter repair/reconstruction) or, with sacral neuromodulation (SNM), we also have modern technology available to help with incontinence.

    An often taboo disease
    The problems described above are very common, but are rarely discussed in everyday life. This often leads to you feeling left alone and isolated. We encourage you to address these issues with us. Targeted investigations by a gastroenterologist or radiologist will help to get to the bottom of the problem.

  • Abdominal wall

    Hernias

    In general, a hernia is a defect in the abdominal wall from which the contents of the abdominal cavity push outwards and can become visible as a protrusion under the skin.

    Inguinal hernia
    This most frequently occurs in the groin area. As hernias do not regress, surgery is indicated in the long term. Minimally invasive (TEEP, TAPP), robot-assisted (r-TAPP) and open surgical procedures (Lichtenstein, Shouldice surgery) are available as treatment options. As a rule, meshes are inserted in all of these surgical techniques. Meshes reduce the tension on the structures of the body (tension-free).

    Umbilical hernia
    The navel is a physiological weak point in the abdominal wall. Hernias in this area are often only noticed when there is pain. Here, too, surgery is necessary in the long term. Minimally invasive (lap. IPOM), robot-assisted (TARUP) and open procedures (with insertion of a mesh into the abdominal wall for hernias > 1 cm) are available for the treatment of hernias. It is not uncommon for umbilical hernias to be combined with a rectus diastasis; this combination requires a choice of procedure tailored to the patient.

    Incisional hernia
    Every incision in the abdominal wall (scar) carries the risk of developing an incisional hernia. The hernia is usually visible as a bulge under the incision. Pain may be more or less pronounced. In the long term, an incisional hernia also requires surgical treatment (minimally invasive, robotically assisted or open). Every incisional hernia requires precise analysis (including localization, size, contents of the hernia sac, quality of the skin over the protrusion, patient risk factors for poor wound healing). A procedure tailored to the patient is then selected (tailored approach). Incisional hernias are also treated with a mesh.

    Parastomal hernias
    When creating an artificial bowel outlet in the abdominal wall (colon/small bowel stoma) or a urostomy (drainage of urine via the abdominal wall), a gap must be created to drain the stoma into the abdominal wall. These gaps are weak points, can widen and additional contents of the abdominal cavity can squeeze through the gaps (parastomal hernia). If there are no plans to reposition the stoma, a parastomal hernia must be treated using mesh (minimally invasive, robotic-assisted or open). This is often a complex procedure with a high risk of recurrence.

    Rectus diastasis (usually after pregnancy)
    During pregnancy, the straight abdominal wall muscles are stretched and move apart. This results in a physiological rectus diastasis of varying degrees, which usually disappears again after pregnancy. However, if this regression does not occur in part, the muscular function of the abdominal wall may be restricted. Physiotherapeutic measures are then primarily indicated, but if these do not lead to success, various surgical measures may be indicated. The aim is to restore the normal anatomy of the abdominal wall while taking aesthetic aspects into account. The procedures are minimally invasive, robot-assisted or open or a combination of these (hybrid techniques).

    Abdominal wall reconstruction
    If you have multiple hernias in the abdominal wall or even extensive abdominal wall defects due to various previous operations and scars, our specialists can offer you a customized abdominal wall reconstruction solution. We often work closely with our plastic surgery colleagues.

CRS - HIPEC

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

A highly specialized therapy for the macro- and microscopic removal of tumor cells

Cytoreductive surgery (CRS) is the surgical removal of all visible parts of the tumor. This is followed by hyperthermic intraperitoneal chemoperfusion (HIPEC). This involves hyperthermic intra-abdominal chemotherapy to treat any microscopic tumor remnants.

  • Areas of application

    Tumors that manifest themselves diffusely in the abdominal cavity (also known as peritoneal carcinomatosis) are often metastases of a tumor of the appendix, colon, stomach or a gynaecological tumor. The tumors migrate through the boundary layers and spread "freely" in the abdominal cavity. Primary tumors of the peritoneum (mesothelioma) are rare.

    For which diseases do we offer CRS and HIPEC?

    • Pseudomyxoma peritonei
    • Peritoneal carcinomatosis of gastrointestinal tumors (e.g. appendix, colon, rectum)
    • Peritoneal mesothelioma
    • certain ovarian carcinomas
  • Clarification

    ClarificationIn a first step, the extent of the tumor is determined by means of imaging (CT, PET, MRI) and, if necessary, also by means of laparoscopy (diagnostic laparoscopy). Once the type of tumor and its extent have been determined, the case is discussed in an interdisciplinary tumor board and a treatment plan is proposed.

  • Procedure

    First, all macroscopically visible tumors are surgically removed. This is followed by HIPEC: By using chemotherapy drugs directly in the abdominal cavity, they can be administered in appropriately high doses. The simultaneous heating of the chemotherapeutic carrier solution (dialysis fluid) improves the effect of the medication. The temperatures vary from 41° to 42° for 30-90 minutes.

  • Goal

    The aim is to completely remove the tumor cells macro- and microscopically. After the operation, short-term care in the intensive care unit is often necessary. The duration of hospitalization depends on the patient's general condition and the extent of the tumour infestation. Post-operative treatment is carried out by an experienced interdisciplinary team.

The vivévis team offers the entire range of oncological visceral surgery options.
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