Surgical treatment of neuroendocrine tumors (NETs) with laparoscopic resection in Hospital Bogenhausen Munich

About the department

The Department of General, Abdominal, Endocrine, Minimally Invasive and Bariatric Surgery at the Hospital Bogenhausen Munich offers the full range of services in the areas of its specialization. The department's surgeons perform interventions on the abdominal organs, thyroid gland and adrenal glands. Of particular interest is the treatment of cancers. The department is certified as the Colon, Esophageal and Pancreatic Cancer Center by the German Cancer Society. In addition, the department provides the surgical treatment of morbid obesity. The specialists of the medical facility keep pace with innovations, so most of the operations in the department are performed using sparing minimally invasive techniques. When performing laparoscopic operations, surgeons make only a few small skin incisions, which significantly reduces the risk of complications during and after surgery, while postoperative recovery takes less time. Such surgical procedures contribute to mild pain and almost do not leave scars. The department also offers robot-assisted surgery. Medical care is provided in cooperation with gastroenterologists and endocrinologists, which guarantees an integrated approach. The Chief Physician of the department is Prof. Dr. med. Ayman Agha.

The department widely uses robot-assisted surgery, which is an innovation in modern medicine and allows the doctors to perform surgical procedures with pinpoint accuracy and minimal trauma to healthy tissues. In 2019, the department started using the state-of-the-art da Vinci XI robotic system for sparing, but highly effective surgical treatment of abdominal diseases. The department successfully performs robotic interventions for gastrointestinal cancers, pancreatiс diseases and colorectal pathologies. In addition, the da Vinci XI robotic system allows the specialist to perform effective surgical treatment of gastroesophageal reflux disease, left-sided pancreatic resection, resection of liver and adrenal tumors. As in classic laparoscopic surgery, when performing robot-assisted surgery, the surgeon makes only a few small skin incisions through which he inserts special surgical instruments and a miniature video camera. All surgical manipulations are performed by a robot, but it follows the orders of a specially trained surgeon who sits at the control panel of the device and studies images of the operating field in multiple zooming. The main advantage of the da Vinci surgical system is its impeccable precision. The surgeon can clearly see all the anatomical structures in the surgical field, including nerves and blood vessels, so the functional results of the operation are significantly improved. It is also important that after robotic surgery the patient recovers as soon as possible and does not experience severe pain.

The department's surgeons often admit patients with cancers of the gastrointestinal tract and liver. The department's medical team annually performs over 400 operations for colon cancer and more than 50 operations for pancreatic, stomach and esophageal cancers. The department's ​​competence also includes the treatment of peritoneal carcinomatosis. The patients with such a diagnosis can undergo not only surgery to remove the tumor, but also hyperthermic intraperitoneal chemotherapy (HIPEC), which is available only in the best medical facilities of Europe. The HIPEC procedure is performed immediately after tumor resection and involves injecting heated chemotherapy drugs directly into the abdominal cavity. Such an approach allows the specialists to completely destroy metastases and tumor cells invisible to the surgeon's eye. The high effectiveness of hyperthermic intraperitoneal chemotherapy has been confirmed by clinical trials. Cancer treatment requires an interdisciplinary approach, and therefore a treatment regimen for each patient is developed during tumor boards with the participation of specialists from related medical fields. The department's surgeons have long experience, while many tumor resection procedures are performed using minimally invasive techniques, which is an undeniable advantage for the patient.

In the field of endocrine surgery, the focus is on the treatment of thyroid and adrenal diseases. In order to exclude damage to the recurrent laryngeal nerve located in the immediate vicinity of the thyroid gland, the department's specialists use intraoperative monitoring. The department's surgeons can boast of a special competence in the treatment of nodular goiter and thyroid cancer. The basis of cancer therapy is surgical removal of the thyroid gland, which is often complemented by radioiodine therapy. The department also provides treatment for thyrotoxicosis. When treating patients with such a diagnosis, endocrinologists are involved in the therapeutic process. The specialists initially try to compensate for the disease with the help of drugs. If drug treatment does not give the desired result, the patient is indicated for surgery. The team of the department's doctors also specializes in the surgical treatment of adrenal adenomas, Cushing's syndrome, pheochromocytomas and hormonally inactive adrenal tumors. Whenever possible, minimally invasive surgery is preferred. 

The department's surgeons admit patients with morbid obesity. In this field, the specialists cooperate closely with the Department of Endocrinology, Diabetology, Angiology and Obesity Treatment, which offers special weight loss programs, including diet therapy, an individually selected complex of dosed physical activities, behavioral therapy and qualified psychological care. Bariatric surgery is the last-line treatment, and therefore the department's doctors resort to it only in severe cases, when conservative methods do not help to get rid of excess weight, which carries risks to the patient's health. The department's surgeons specialize in gastric sleeve surgery, gastric bypass surgery, gastric banding and intragastric balloon placement. In rare cases, biliopancreatic diversion (Scopinaro procedure) can be performed.

The department's range of surgical services includes:

• General and abdominal surgery
  • Surgical treatment of cancers
    • Colon cancer surgery
    • Stomach cancer surgery
    • Pancreatic cancer surgery
    • Esophageal cancer surgery
    • Liver cancer surgery, including resection of liver metastases
    • Peritoneal carcinomatosis surgery, including hyperthermic intraperitoneal chemotherapy (HIPEC)
  • Surgical treatment of gallstones, inflammatory gallbladder diseases
  • Surgical treatment of inflammatory bowel disease (Crohn's disease and ulcerative colitis)
  • Surgical treatment of inguinal hernias and epigastric hernias
  • Surgical treatment of diverticulitis
  • Surgical treatment of proctologic diseases (pathologies of the rectum and anus)
  • Appendectomy
• Endocrine surgery
  • Surgery for thyroid diseases
    • Nodular goiter
    • Hyperthyroidism
    • Thyroid cancer
  • Surgery for adrenal diseases
    • Adenomas
    • Cushing's syndrome
    • Pheochromocytoma
    • Hormonally inactive tumors
• Bariatric surgery
  • Sleeve gastrectomy
  • Gastric bypass surgery
  • Gastric banding
  • Intragastric balloon placement
  • Biliopancreatic diversion (Scopinaro procedure)
• Minimally invasive and robot-assisted surgery, including for resection of malignant gastrointestinal tumors
• Other medical services