Imperial College London

Dr George Garas

Faculty of MedicineDepartment of Surgery & Cancer

Honorary Clinical Research Fellow
 
 
 
//

Contact

 

g.garas

 
 
//

Location

 

Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

//

Summary

 

Publications

Publication Type
Year
to

67 results found

Garas G, Holsinger FC, Grant DG, Athanasiou T, Arora A, Tolley Net al., 2015, Is robotic parathyroidectomy a feasible and safe alternative to targeted open parathyroidectomy for the treatment of primary hyperparathyroidism?, INTERNATIONAL JOURNAL OF SURGERY, Vol: 15, Pages: 55-60, ISSN: 1743-9191

Journal article

Garas G, Palazzo F, Athanasiou T, Darzi A, Tolley Net al., 2015, Is There a Role for Robotic Surgery in the Treatment of Differentiated Thyroid Cancer?, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland (ASGBI), Publisher: WILEY-BLACKWELL, Pages: 194-194, ISSN: 0007-1323

Conference paper

Garas G, Qureishi A, Zacharakis E, Athanasiou T, Tolley Net al., 2015, Should we be Operating on all Thyroid Cancers? The Paradigm of Papillary Thyroid Microcarcinomas, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland (ASGBI), Publisher: WILEY-BLACKWELL, Pages: 168-168, ISSN: 0007-1323

Conference paper

Garas G, Zarogoulidis P, Efthymiou A, Athanasiou T, Tsakiridis K, Mpaka S, Zacharakis Eet al., 2014, Spontaneous esophageal rupture as the underlying cause of pneumothorax: early recognition is crucial, JOURNAL OF THORACIC DISEASE, Vol: 6, Pages: 1655-1658, ISSN: 2072-1439

Journal article

Qureishi A, Garas G, Mallick A, Parker Det al., 2014, The psychosocial impact of hearing aids in children with otitis media with effusion, JOURNAL OF LARYNGOLOGY AND OTOLOGY, Vol: 128, Pages: 972-975, ISSN: 0022-2151

Journal article

Georgalas C, Vlastos I, Picavet V, van Drunen C, Garas G, Prokopakis Eet al., 2014, Is chronic rhinosinusitis related to allergic rhinitis in adults and children? Applying epidemiological guidelines for causation, ALLERGY, Vol: 69, Pages: 828-833, ISSN: 0105-4538

Journal article

Garas G, Okabayashi K, Ashrafian H, Darzi A, Athanasiou Tet al., 2014, Response to Amaral et al., Thyroid, Vol: 24, Pages: 779-780, ISSN: 1050-7256

Journal article

Christakis I, Constantinides V, Garas G, Joseph J, Tolley N, Palazzo Fet al., 2014, Minimally Invasive Endocrine (Thyroid, Parathyroid, Adrenal) Surgery: Evolution of Operative Techniques, Safety, Effectiveness and Outcomes, Minimally Invasive Surgery: Evolution of Operative Techniques, Safety & Effectiveness and Long-Term Clinical Outcomes, Pages: 1-66, ISBN: 9781629488387

© 2014 Nova Science Publishers, Inc. The field of endocrine surgery has seen significant changes over the last 10 years. New surgical techniques in thyroid, parathyroid and adrenal surgery characterised by reduced trauma of access and new technology have heralded minimally invasive techniques that have allowed surgeons to perform operations with results similar to traditional approaches whilst offering advantages in recovery time and cosmesis. Surgery is the only definitive cure for primary hyperparathyroidism(PHPT). Sir John Bland Sutton performed the first recorded parathyroidectomy sometime before 1917 but it is Felix Mandl who in 1925 performed the first successful parathyroidectomy for hyperparathyroidism. The surgical strategy for the identification and safe removal of the diseased parathyroid glands has evolved into a safe effective technique with a high success rate in experienced hands. However the arrival of new imaging and surgical technology, an increased understanding of the surgical anatomy and the accumulated experience have been the drivers for developing minimally invasive techniques. Bilateral neck exploration(BNE) with visualisation of all 4 parathyroid glands remains the gold standard treatment of PHPT but only in cases where the localisation studies do not conclusively localise the disease or in cases of persistent or recurrent hyperparathyroidism. Most parathyroidectomies are performed by one of a number of minimally invasive techniques. Such techniques include the endoscopic approach which offers the benefits of magnification, the minimally invasive videoscopically/endoscopically assisted parathyroidectomy (MIVAP) which offers the advantages of the endoscopic approach via a gasless central approach. The focused lateral mini-incision parathyroidectomy is probably the most widely used since it requires no additional instruments, is quick and can be performed under local anaesthetic with equivalent success rates to the other techniques and s

Book chapter

Kayani B, Garas G, Arshad M, Athanasiou T, Darzi A, Zacharakis Eet al., 2014, Is hand-sewn anastomosis superior to stapled anastomosis following oesophagectomy?, INTERNATIONAL JOURNAL OF SURGERY, Vol: 12, Pages: 7-15, ISSN: 1743-9191

Journal article

Aziz O, Ashrafian H, Jones C, Harling L, Kumar S, Garas G, Holme T, Darzi A, Zacharakis E, Athanasiou Tet al., 2014, Laparoscopic ultrasonography versus intra-operative cholangiogram for the detection of common bile duct stones during laparoscopic cholecystectomy: A meta-analysis of diagnostic accuracy, INTERNATIONAL JOURNAL OF SURGERY, Vol: 12, Pages: 712-719, ISSN: 1743-9191

Journal article

Qureishi A, Garas G, Shah J, Birchall Jet al., 2014, A two-cycle prospective audit of temporal bone computed tomography scan requests: improving the clinical applicability of radiology reports, JOURNAL OF LARYNGOLOGY AND OTOLOGY, Vol: 128, Pages: 49-52, ISSN: 0022-2151

Journal article

Mazarakis NK, Judd O, Garas G, Sama AMet al., 2013, An unusual basal skull injury resulting in CSF leak and a novel method to repair, BRITISH JOURNAL OF NEUROSURGERY, Vol: 27, Pages: 830-832, ISSN: 0268-8697

Journal article

Cho WS, Garas G, Morgan A, Chaurasia Met al., 2013, Patient Compliance to Continuous Positive Airway Pressure (CPAP) Therapy for Sleep Apnoea: a Completed Audit Cycle, Publisher: SPRINGER LONDON LTD, Pages: 522-522, ISSN: 0021-1265

Conference paper

Garas G, Okabayashi K, Ashrafian H, Shetty K, Palazzo F, Tolley N, Darzi A, Athanasiou T, Zacharakis Eet al., 2013, Which Hemostatic Device in Thyroid Surgery? A Network Meta-Analysis of Surgical Technologies, THYROID, Vol: 23, Pages: 1138-1150, ISSN: 1050-7256

Journal article

Mitchell HK, Garas G, Mazarakis N, McGlashan Jet al., 2013, Extramedullary relapse of multiple myeloma in the thyroid cartilage., BMJ Case Rep, Vol: 2013

Multiple myeloma involving the thyroid cartilage is a very uncommon disease entity. Only 10 cases have been reported in the international literature to date and as such it constitutes a rare and challenging diagnosis to make. We report the case of a 63-year-old man with a background of malignant melanoma and multiple myeloma both of which were in remission at the time of presentation. The patient presented with hoarseness and a large neck mass that turned out to be an extramedullary deposit of his previously treated multiple myeloma indicating disease relapse. The differential diagnosis of a mass in the thyroid cartilage is discussed. Despite its rarity, this diagnosis should be considered even in patients with no history of multiple myeloma, as it can arise de-novo in the thyroid cartilage (extramedullary plasmacytoma). The importance of the multidisciplinary team (MDT) approach as well as recent advances in treatment are also discussed.

Journal article

Mitchell HK, Garas G, Mazarakis N, McGlashan Jet al., 2013, Extramedullary relapse of multiple myeloma in the thyroid cartilage, BMJ Case Reports

Multiple myeloma involving the thyroid cartilage is a very uncommon disease entity. Only 10 cases have been reported in the international literature to date and as such it constitutes a rare and challenging diagnosis to make. We report the case of a 63-year-old man with a background of malignant melanoma and multiple myeloma both of which were in remission at the time of presentation. The patient presented with hoarseness and a large neck mass that turned out to be an extramedullary deposit of his previously treated multiple myeloma indicating disease relapse. The differential diagnosis of a mass in the thyroid cartilage is discussed. Despite its rarity, this diagnosis should be considered even in patients with no history of multiple myeloma, as it can arise de-novo in the thyroid cartilage (extramedullary plasmacytoma). The importance of the multidisciplinary team (MDT) approach as well as recent advances in treatment are also discussed.

Journal article

Persaud R, Garas G, Silva S, Stamatoglou C, Chatrath P, Patel Ket al., 2013, An evidence-based review of botulinum toxin (Botox) applications in non-cosmetic head and neck conditions., JRSM Short Rep, Vol: 4, ISSN: 2042-5333

Botulinum toxin (Botox) is an exotoxin produced from Clostridium botulinum. It works by blocking the release of acetylcholine from the cholinergic nerve end plates leading to inactivity of the muscles or glands innervated. Botox is best known for its beneficial role in facial aesthetics but recent literature has highlighted its usage in multiple non-cosmetic medical and surgical conditions. This article reviews the current evidence pertaining to Botox use in the head and neck. A literature review was conducted using The Cochrane Controlled Trials Register, Medline and EMBASE databases limited to English Language articles published from 1980 to 2012. The findings suggest that there is level 1 evidence supporting the efficacy of Botox in the treatment of spasmodic dysphonia, essential voice tremor, headache, cervical dystonia, masticatory myalgia, sialorrhoea, temporomandibular joint disorders, bruxism, blepharospasm, hemifacial spasm and rhinitis. For chronic neck pain there is level 1 evidence to show that Botox is ineffective. Level 2 evidence exists for vocal tics, trigeminal neuralgia, dysphagia and post-laryngectomy oesophageal speech. For stuttering, 'first bite syndrome', facial nerve paresis, Frey's syndrome, oromandibular dystonia and palatal/stapedial myoclonus the evidence is level 4. Thus, the literature highlights a therapeutic role for Botox in a wide range of non-cosmetic conditions pertaining to the head and neck (mainly level 1 evidence). With ongoing research, the spectrum of clinical applications and number of people receiving Botox will no doubt increase. Botox appears to justify its title as 'the poison that heals'.

Journal article

Garas G, Jarral O, Tolley N, Palazzo F, Athanasiou T, Zacharakis Eet al., 2013, Is there survival benefit from life-long follow-up after treatment for differentiated thyroid cancer?, INTERNATIONAL JOURNAL OF SURGERY, Vol: 11, Pages: 116-121, ISSN: 1743-9191

Journal article

Garas G, Kayani B, Tolley N, Palazzo F, Athanasiou T, Zacharakis Eet al., 2013, Is there a role for intraoperative recurrent laryngeal nerve monitoring during high mediastinal lymph node dissection in three-stage oesophagectomy for oesophageal cancer?, INTERNATIONAL JOURNAL OF SURGERY, Vol: 11, Pages: 370-373, ISSN: 1743-9191

Journal article

Qureishi A, Garas G, Tolley N, Palazzo F, Athanasiou T, Zacharakis Eet al., 2013, Can pre-operative computed tomography predict the need for a thoracic approach for removal of retrosternal goitre?, INTERNATIONAL JOURNAL OF SURGERY, Vol: 11, Pages: 203-208, ISSN: 1743-9191

Journal article

Garas G, Ibrahim A, Ashrafian H, Ahmed K, Patel V, Okabayashi K, Skapinakis P, Darzi A, Athanasiou Tet al., 2012, Evidence-Based Surgery: Barriers, Solutions, and the Role of Evidence Synthesis, WORLD JOURNAL OF SURGERY, Vol: 36, Pages: 1723-1731, ISSN: 0364-2313

Journal article

Arora A, Garas G, Kotecha J, Acharya A, Khemani S, Kotecha Bet al., 2012, Can Biometric Measures Predict TORS Feasibility?, Otolaryngol Head Neck Surg, Vol: 147

Objective: 1) Investigate whether subjective evaluation of patient suitability for Transoral Robotic Surgery (TORS) is reliable. 2) Establish if TORS feasibility can be assessed using anthropometric measures and Mallampatti grade. 3) Determine which biometric characteristics warrant further clinical evaluation. Method: Cadaver study (n = 42) conducted between April 2010-2012. Seven anthropometric measurements and Mallampati grade were recorded. Three head and neck surgeons assessed TORS feasibility. Adequate visualization of tonsil, tongue base, vallecula, and epiglottis were recorded using 2 TORS mouth gags. Significant anthropometric differences between full and suboptimal visualisation groups were identified. Results: There was a negative correlation between subjective difficulty impression and actual transoral visualization for all anatomical regions (R (2) = 0.32, P < .05). Six anthropometric measures were identified whose mean values were significantly different between full and suboptimal transoral visualization groups. Suboptimal visualization of the tongue base was associated with shorter mean sterno-mental (P < .01) and cricoid-mental (P = .02) lengths and greater mean neck circumference (P = .04). Suboptimal visualization of the vallecula and epiglottis were associated with a short ramus width (P = .03) and long ramus length (P = .05). The mean Mallampati grade was higher in the suboptimal visualization group for tongue base (P < .01), vallecula (P < .03), and epiglottis (P < .04). Conclusion: Subjective assessment is an unreliable predictor of TORS feasibility. Anthropometric measures of the neck, mandible, and Mallampati grade are valuable indicators which can potentially be used to devise a weighted predictive scale. Further clinical evaluation is warranted to determine the true predictive value of these anthropometric measures and Mallampati grade.

Journal article

Arora A, Sharma SD, Garas G, Awad Z, Darzi A, Tolley NSet al., 2012, Robotic-Assisted Thyroidectomy: The First UK Experience., Otolaryngol Head Neck Surg, Vol: 147

Objective: To review our initial experience of robotic thyroidectomy, describe modifications for a Western population, and establish a robust framework for implementation in the UK. Method: Prospective feasibility study (n = 15) performed in a tertiary referral center over 18 months. Procedure-related measures included conversions to open, operative time and the learning curve. Patient-related measures included biometrics, trans-axillary dissection area, voice and swallow function, pain, scar cosmesis, and global quality of life using validated assessment tools. Results: Thyroid lobectomy was performed in 15 patients with no conversions to open. The average BMI was 25.6 (range, 19-35). Mean operative time was 200 minutes. A larger trans-axillary dissection area increased the total operative time. The average size of the excised nodule was 2.5 cm (range, 1.5-6.5 cm). All patients were discharged within 24 hours. No permanent complications occurred. There was 1 temporary brachial plexus neuropraxia which resolved within 5 days. The mean follow-up time was 7 months. The mean scar cosmesis score significantly improved from 56% on day 1 postoperatively to 98% at 12 months (P = .01). Conclusion: Robotic thyroidectomy is feasible for selected patients in the UK. The primary advantage is avoidance of a neck scar. Optimal arm position which minimizes brachial plexus injury is crucial. Validated training methods are necessary for safe adoption. A randomized clinical study will establish the clinical efficacy compared with conventional surgery.

Journal article

Arora A, Garas G, Awad Z, Budge J, Cox J, Palazzo F, Tolley NSet al., 2012, Robotic Parathyroidectomy: A Prospective Case Control Study., Otolaryngol Head Neck Surg, Vol: 147, Pages: P65-P66

Objective: 1) To assess the clinical efficacy and cost-effectiveness of the robotic approach compared with conventional targeted minimally invasive parathyroidectomy. 2) To evaluate whether the absence of a neck scar associated with the robotic approach offers any advantage(s) over conventional targeted minimally invasive parathyroidectomy. 3) To compare patient satisfaction between the 2 techniques. Method: Prospective case control study of 30 patients that underwent targeted parathyroidectomy over 4 years (May 2009-February 2012) in a tertiary referral endocrine center. Fifteen patients had a robotic and 15 an endoscopic approach. Outcomes assessed included operative time, blood loss, biochemistry, pain, scar cosmesis, voice, quality of life, and complications. Results: In all cases the parathyroid adenoma was successfully removed. There was 1 robotic conversion. Mean robotic operative time was approximately double that of the conventional approach. There were no significant differences in mean blood loss. Initial normalization of PTH and adjusted serum calcium levels occurred in 29 cases. The mean visual analogue score (VAS) for scar cosmesis was superior in the robotic cohort from 2 weeks (84% vs 65%, P < .01) to 1 year (94% vs 62%, P < .01). Postoperative VAS pain scores were similar in both groups (P < .05). All EQ5 HD quality of life parameters significantly improved in both cohorts (P < .05). Conclusion: The robotic approach is a feasible "scar-less in the neck" alternative to conventional targeted minimally invasive parathyroidectomy with a superior cosmetic outcome. However, this novel approach is not suitable for all patients and appropriate patient selection is vital. Finally, the high cost of robotic parathyroidectomy currently hinders its more widespread use.

Journal article

Garas G, Madani G, Tolley N, 2012, Radiology Quiz Case 2 Retropharyngeal prevertebral lipoma, ARCHIVES OF OTOLARYNGOLOGY-HEAD & NECK SURGERY, Vol: 138, Pages: 424-425, ISSN: 0886-4470

Journal article

Garas G, Jones N, 2012, Is there a role for measurement of nasal IgE antibodies in diagnosis of Alternaria-induced rhinitis in children?, ALLERGOLOGIA ET IMMUNOPATHOLOGIA, Vol: 40, Pages: 69-70, ISSN: 0301-0546

Journal article

Garas G, Persaud RAP, 2012, The modified Merocel (R) pope ear wick in severe acute otitis externa management, CLINICAL OTOLARYNGOLOGY, Vol: 37, Pages: 85-86, ISSN: 1749-4478

Journal article

Qureishi A, Mallick A, Garas G, 2012, ENT and litigation: An update and comparison to other surgical specialities, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland (ASGBI), Publisher: WILEY-BLACKWELL, Pages: 118-118, ISSN: 0007-1323

Conference paper

Tolley N, Arora A, Palazzo F, Garas G, Dhawan R, Cox J, Darzi Aet al., 2011, Robotic-Assisted Parathyroidectomy: A Feasibility Study, OTOLARYNGOLOGY-HEAD AND NECK SURGERY, Vol: 144, Pages: 859-866, ISSN: 0194-5998

Journal article

Garas G, Ifeacho S, Cetto R, Arora A, Tolley Net al., 2011, Prospective audit on the outpatient management of patients with a peritonsillar abscess: closing the loop: how we do it, CLINICAL OTOLARYNGOLOGY, Vol: 36, Pages: 174-179, ISSN: 1749-4478

Journal article

This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.

Request URL: http://wlsprd.imperial.ac.uk:80/respub/WEB-INF/jsp/search-html.jsp Request URI: /respub/WEB-INF/jsp/search-html.jsp Query String: id=00337755&limit=30&person=true&page=2&respub-action=search.html