About the department:
The Department of Surgery at the Heart and Brain Center of Excellence is highly technologically equipped and prepared to provide the most modern and gentle surgical methods for patients from Burgas and the region. It employs proven surgeons who have specialized in leading clinics in the country and abroad.

The department performs highly specialized diagnostic and surgical work on diseases of the stomach, small and large intestine, rectum, gallbladder, liver, pancreas, mammary and thyroid glands and all types of hernias of the abdominal wall. We offer patients the most compassionate, safe and proven modalities to treat their ailments, and the clinic offers a fully integrated, multidisciplinary and individualized approach to each patient.

The department is state-of-the-art equipped including a DaVinci X robotic platform, latest generation laparoscopic equipment with intra-operative cholangioscopy and ultrasonography capabilities, high frequency electrosurgery modules and an ultrasound destructor (CUSA).

Activities:
Oncosurgery and hepatopancreatic surgery

Surgical oncology is a subspecialty of surgery that focuses on the surgical treatment of tumors, particularly malignant ones. The modern treatment of oncological diseases today involves a team approach, with chemotherapists and radiotherapists actively involved in the treatment of these diseases in addition to the surgeon. Treatment modalities for malignant diseases are individualized according to the specific stage of the disease, as well as to the patient. Surgical treatment includes radical surgical interventions (removal of the entire tumor with its draining lymph nodes) and palliative (surgeries that aim to improve the quality of life of patients for whom radical surgeries are not possible).

Our team is focused on the treatment of all solid tumors in the abdominal cavity and retroperitoneum, as well as thyroid and mammary cancers. Close collaboration with fellow radiotherapists and chemotherapists from ‘Heart and Brain’ Burgas and other cancer centres allows us to plan the best and evidence-based treatment for each individual patient and their disease.

Liver

Located in the upper right quadrant of the abdomen, the liver can be a site for the development of primary hepatocellular carcinoma as well as being a host for the development of metastases (disseminations) from other malignancies. The decision about surgical treatment and the type of surgical intervention should be made by a surgeon experienced in liver surgery. Many patients initially declared inoperable after consultation with a liver surgeon are actually suitable for surgical treatment. Operative treatment of liver tumors ranges from hemihepatectomies (removal of half of the liver) to segmental resections and metastasectomies, which is a sparing technique given that metastatic liver disease is a chronic disease and several operations are sometimes necessary to control the disease.

Pancreas and biliary tract

Although small in size, the pancreas can develop one of the most malignant tumours in the abdominal cavity, the removal of which requires extremely complex surgical interventions. In pancreatic tumours, symptoms appear late, the most alarming being icterus (yellowing of the skin and visible mucous membranes). Other symptoms, although consistent with very advanced disease, are bleeding from the digestive tract and low back pain. Pancreaticoduodenectomy (or also removal of the duodenum and head of the pancreas) is considered one of the most complex operations, involving a severe destructive and extremely delicate, sometimes performed with magnifying loupes reconstructive part of the operation. Many patients seek surgical treatment when the tumor can no longer be removed entirely. Numerous palliative surgical and non-operative interventions have been developed and implemented to improve patients’ quality of life.

Treatment of diseases of the gastrointestinal tract

Large intestine

Colorectal cancer (colorectal cancer) is the most common malignancy of the gastrointestinal tract. It is hereditary in approximately 10% of patients and sporadic in the other 90%. It usually arises on the basis of the adenoma-carcinoma sequence. Colorectal cancer is always suspected at age over 50 years and unmotivated intestinal complaints, anaemia or discrete subileus. Any intestinal bleeding is suspicious for malignancy until the presence of a tumor is ruled out by a complete view of the colon (colonoscopy). This also applies to patients with haemorrhoids. Evidence of bleeding haemorrhoids does not exclude the presence of cancer. The main and primary treatment of localized disease is surgical – complete resection of the intestinal tumor site and draining lymph nodes, and treatment is standardized. The type of surgery depends on the anatomic localization of the tumor and the stage of the disease. In the early stages it leads to complete cure. It is possible to end the operation with a permanent colostomy (anus preter). Today, advances in surgical science offer many patients the possibility of performing resection of rectal tumors without removing the permanent anus preter, and preserving normal pelvic-reservoir functions.

Stomach

Stomach cancer is the second most common cancer worldwide after lung cancer and is a socially significant disease for our country. In our country, it is the second most common malignancy originating from the gastrointestinal tract. Risk factors for the development of gastric carcinoma are: adenomas, polyps, Helicobacter pylori infection, chronic atrophic gastritis, condition after gastric resection, pernicious anaemia, barrett’s oesophagus. Fibrogastroscopy (FGS) remains the gold standard for diagnosis and screening of gastric cancer, although mass screening is not routinely performed in Bulgaria. The surgeries used for gastric carcinoma depend on its location, and can range from resection of part of the stomach to complete removal of the stomach, as well as complete removal of the gastric lymphatic basin. In individual patients they can be more extensive – operations with removal of parts of adjacent organs as well.

Minimally invasive (laparoscopic) surgery

Laparoscopic surgery is a modern surgical technique in which abdominal operations are performed through one or several small openings in the abdominal wall (0.5 – 1 cm) instead of the traditional large incisions. A special thin camera (laparoscope) and micro-instruments are inserted through each incision to reach the organ or pathological process. The laparoscope transmits images from the abdominal cavity to monitors in the operating room. During surgery, the surgeon sees detailed images of the abdominal organs in real time. This system allows the surgeon to perform the same operations as traditional ones, but with greater precision. Aiming to inflict as little trauma to the body as possible during surgery through a minimal incision results in faster patient recovery, less pain in the post-operative period and a better aesthetic effect. Unlike traditional surgery, laparoscopic operations do not lead to suppression of the patient’s immune system. Almost all surgical interventions in the field of elective and emergency abdominal surgery can be performed in a minimally invasive (laparoscopic, endoscopic) way. Our team has routinely performed a wide range of laparoscopic surgeries for a variety of conditions for many years:

• Cholecystectomy (gallbladder removal)
• Inguinal hernioplasty (for groin hernias)
• Operations for gastroesophageal reflux disease and diaphragmatic hernias
• Operations for diseases of the stomach and colon
• Operations for diseases of the pancreas
• Liver operations for benign and malignant diseases
• Appendectomy (removal of the appendix)
• Suprarenectomy (adrenal gland operations)
• Splenectomy (removal of the spleen)

The advantages of this technique in a purely medical aspect are due to the small surgical incisions, sparing the patient’s immune system and the possibility of magnifying and detailing the image during surgery. The advantages for the patient are:

• less postoperative pain
• shorter hospital stay
• faster recovery
• better cosmetic effect
• lower complication rate
• insignificant blood loss.

Robotic surgery

The DaVinci X robotic surgical platform has been implemented in the Heart and Brain Hospital Burgas. Robotic surgery, as a natural evolution of the minimally invasive techniques advocated by the department, offers unprecedented precision and safety for the patient. Robotic surgery can be applied in all areas of general surgery. The uniqueness of the DaVinci system includes fine articulating instruments that completely mimic and even surpass the natural movements of the human hand, intuitive controls, 3D vision and multiple magnification, giving the surgeon 100% control during surgical intervention.

Endocrine surgery

Endocrine surgery, as a relatively new subspecialty in general surgery, focuses on surgery of the endocrine glands – thyroid, parathyroid, adrenal and hormonally active pancreatic tumors. The main purpose of this type of surgery is the removal of parts or the complete removal of the gland in order to normalize the hormonal balance or prevent the spread of the disease when it is a cancer (malignant) disease. The most common candidates for surgical treatment are patients with thyroid diseases – benign (nodular goiter and thyrotoxicosis) and malignant (thyroid cancer). Our team has the necessary expertise and years of experience in the surgical treatment of patients with such diseases.

Treatment of hernias of the anterior abdominal wall and diaphragm

Hernial disease is one of the most common surgical pathologies. Minimally invasive (laparoscopic) approaches for the treatment of hernias in the inguinal region, hernias of the anterior abdominal wall, those after surgery and diaphragmatic hernias have been introduced and are routinely applied in the clinic. The reduced surgical trauma and biomechanically better placement of the prosthetic material in laparoscopic interventions ensures a faster postoperative recovery and return of the patient to his/her normal routine.

Emergency surgery

The organization of round-the-clock admission and treatment of surgical emergencies (appendicitis, stuck hernia, perforated ulcer, ileus, peritonitis, etc.) allows timely diagnosis and their surgical treatment.