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Hratch Karamanoukian MD FACS
Board Certified Vein Surgeon, Vein Treatment Center, Buffalo Niagara


Dr. Hratch Karamanoukian is a cardiovascular and thoracic surgeon who has specialized in minimally invasive cardiac surgery, thoracic surgery, robotic surgery and vein disorders. He is a Diplomate of the American Board of Surgery (recertified 2009) , Diplomate of the American Board of Thoracic Surgery and Diplomate of the American Board of Phlebology (venous disorders and venous surgery).  Dr. Karamanoukian is a Fellow of the American College of Surgeons (FACS).

Thirteen years ago, in 1999, Dr. Karamanoukian, Jacob Bergsland MD FACS and Tomas Salerno MD FACS were the first surgeons in the Buffalo Niagara region to perform robotic surgery. At the time, only a handful of surgeons in the United States and Europe performed robotic surgery. The trio, performed robotic cardiac surgery and robotic thoracic surgery. The first application was performing robotic thoracic sympathectomy for hyperhidrosis (excessive sweating). Since then, surgeons in the area have introduced this technique in pediatric surgery (Dr Philip Glick) and prostate surgery (Roswell Park Cancer Institute). Thirteen years later (2010), they have introduced 'robotic heart surgery' and urologic surgery at a local South Buffalo Mercy Hospital. 


Dr. Karamanoukian obtained his training at UCLA, the University of Southern California and the University at Buffalo. He has graduated from Honors Collegium at UCLA with a Bachelor's degree in Biochemistry. After obtaining his medical degree (MD) from the University of Southern California (USC), Dr. Hratch Karamanoukian completed his residency training in general surgery and thoracic surgery with highest honors from the University at Buffalo. In addition to two dozen research awards during his training as a surgical resident, Dr. Hratch Karamanoukian received the Worthington Schenck Resident Teacher of the Year Award, Dr. Rutecki Memorial Award given to one Graduating Chief Surgery Resident and Best All Around Graduating Resident Award. As such, he was awarded 3 out of 5 awards at graduation from a class of 10 chief resident peers in 1997. Dr. Hratch Karamanoukian was administrative Chief Resident in Cardiac Surgery from 1998 - 1999 and received the George Schimert award for outstanding graduating resident. Dr. Hratch Karamanoukian is listed in 'Guide to America's Top Surgeons' by the Consumers Research Council of America (2008, 2009, 2010, 2011 and 2012). Dr. Karamanoukian received the 2009, 2010, 2011, 2012 designation from the Consumers Research Council of America for his expertise in Phlebology in 'Guide to America's Top Surgeons'.


Dr. Hratch Karamanoukian has performed NIH sponsored research (1992-1995) at the Childrens Hospital of Buffalo in the fields of pulmonary hypertension, inhaled nitric oxide, surfactant physiology and fetal surgery. His work, under Dr. Philip Glick , Bruce Holm and Frederick Morin III has improved the survival of critically ill infants born with congenital diaphragmatic hernia (CDH) and surfactant deficiency. Children born before 32 weeks gestation have benefited from the surfactant research conducted at Childrens Hospital of Buffalo. Calf lung surfactant was developed, studied and administered in animal models and later premature infants and was the basis of the scientific and clinical research done by Dr. Hratch Karamanoukian between 1992 and 1995. Dr. Hratch Karamanoukian, Dr. Duncan Wilcox and Dr. Stuart O'Toole performed the clinical and laboratory research that culminated in the routine administration of surfactant to neonates born with congenital diaphragmatic hernia. As well, research was conducted to repair defects of the diaphragm in the fetus and published in peer reviewed journals and presented worldwide in scientific forums. Some of the seminal research in inhaled nitric oxide (iNO) for infants with CDH was performed by this group of researchers at the Childrens Hospital of Buffalo with NIH research grants and awards received for their work. The greatest reward, however, was the improved survival of very sick neonates with congenital diaphragmatic hernia (CDH) that would have otherwise not survived without surfactant replacement and inhaled nitric oxide therapy.


He has also done seminal research in fetal surgery at the Childrens Hospital with Dr. Philip L Glick, a pediatric surgeon of international stature and pioneer in the field of fetal surgery. Childrens Hospital of Buffalo was the second center in the United States that developed a clinical program in fetal surgery (1989) - The Buffalo Institute of Fetal Surgery (BIFT). Dr. Hratch Karamanoukian's work in congenital diaphragmatic hernia and fetal surgery is ranked as # 13 out of the top 30 researchers in the world in the field of congenital diaphragmatic hernia (CDH) according to This brings him tremendous pride and gives him the continued inspiration to continue his clinical research work. Dr. Hratch Karamanoukian continues to do clinical research in several topics in the disciplines of phlebology (venous diseases and disorders), lymphedema, restless legs syndrome and hyperhidrosis (excessive sweating).


Dr. Karamanoukian has published more than 140 scientific articles in peer reviewed journals in the field of fetal surgery, robotic surgery, beating heart surgery, pulmonary hypertension, congenital diaphragmatic hernia, cardiovascular surgery and cardiovascular medicine. He has authored or co-authored 41 books: medical specialty textbooks and review books in the fields of cardiac surgery, thoracic surgery and general surgery. His review books have helped thousands of general surgery residents pass their written and oral surgery board examinations (for the American Board of Surgery and American Board of Thoracic Surgery). These books, titled ABSITE Combat Manual (first and second editions),  Thoracic Surgery Board Review, Red Manual for the Surgery Boards, Blue Maual Basic Science Review (volumes 1,2 and 3) among others, are well recognized by trainees sitting for their speciaty board examinations. He has also written Cardiac Surgery Secrets and Thoracic Surgery Secrets. Cardiac Surgery Secrets is in 2nd Edition by Elsevier Press and has been translated into Russian, Portuguese, Spanish, Armenian, Chinese and Turkish editions.  


To see the entire list of Dr. Karamanoukian's books click on the link


Dr. Karamanoukian is former Director of the Center for Less Invasive Cardiac Surgery and Robotic Heart Surgery at Kaleida Health. He held that position from 1999 to 2005.


He is a pioneer in beating heart surgery and robotic heart surgery. He was one of the first surgeons in the United States to perform beating heart robotic coronary artery bypass surgery and robotically assisted thoracic surgery. His work with the Zeus Robotic System and AESOP Robotic System was presented in more than a dozen scientific meetings in the US, Europe and Japan. Dr. Hratch Karamanoukian has also taught beating heart robotic heart surgery and was part of the FDA trial utilizing the Zeus Robotic System in beating heart coronary artery bypass surgery. Dr. Karamanoukian has also performed seminal research in the field of flow measurement in coronary arteries (coronary flowmetry using transit time flow mearement techniques) and has written a book called "Intraoperative Graft Patency Verification in Cardiac and Vascular Surgery". This has propelled these fields into verifying results of bypass surgeries in terms of verifying patency and optimizing surgery outcomes in cardiac and vascular surgery. Dr.Karamanoukian also trained with Drs. Tomas Salerno and Jacob Bergsland, both noted international experts in the field of beating heart surgery. He has coauthored a textbook called Beating Heart Coronary Artery Surgery, published by Blackwell Publishing. He has presented his cardiac surgery research in dozens of international and national symposia and taught fellows in the discipline of minimally invasive cardiac and robotic surgery.


He is a member of Advanced Cardiac Surgical Associates, with offices at the Georgetown Plaza in Williamsville, NY and in East Amherst and Clarence, NY.  He also shares an office with Dr. Raffy Karamanoukian, a plastic surgeon with offices in Beverly Hills, California and Santa monica, California.  Together, the two brother surgeons have performed the VNUS Closure procedure in several dozen Hollywood notables in the last 5 years and EVLT in countless others. Dr. Raffy Karamanoukian has since established the Santa Monica Veins Center. Dr. Raffy Karamanoukian has established a world renowned center for vein care and has an international clientele that travel to Southern California to have VNUS Closure, Venefit Procedure, VenaCure EVLT Never Touch, ClariVein Procedure, ultrasound guided sclerotherapy and specialized vein procedures. He has a concierge service including ties to private clinics in Dubai, United Arab Emirates, Kuwait, Saudi Arabia and Lebanon.


Dr. Karamanoukian has traveled the world and volunteered to teach the EVLT and VNUS Closure procedures to other surgeons. On one of his trips to Poland, he taught the VNUS Closure procedure (now called Venefit Procedure) to a group of 12 vascular surgeons. Dr. Karamanoukian has volunteered a mission to Ecuador in 2009 and performed 25 venous procedures in a rural hospital. The medical mission was organized by the Hope for Tomorrow Foundation and Charity Anywhere. Dr. Karamanoukian successfully completed a medical mission to Ho Chi Minh City, Vietnam in May and June of 2010. Dr. Karamanoukian performed 42 procedures and taught venous surgery to local vascular surgeons. The EVLT VenaCure Never Touch procedure was performed on individuals with venous stasis ulcers. This trip was organized by the Hope for Tomorrow Foundation with all equipment costs and travel costs paid for by the Karamanoukian Family Foundation. The Hope for Tomorrow Foundation was founded by a pioneering plastic surgeon, Dr. Jeffrey Meilman of Williamsville, NY. In late May and early June 2011, Dr. Karamanoukian travelled to Les Cayes Haiti with the Hope for Tomorrow Foundation along with a group of phsician assistant students and faculty from Daemen College and D'Youville College to perform venous surgery and general surgery. Overall, the group of surgeons including orthopedic surgeons from Erie County Medical Center ECMC (Drs. Mark Anders and Brian Smolinski), plastic surgeons (Dr Jack Kotlarz and Meilman) and a general surgery resident performed over 125 surgical procedures and taught the physcian assistant students from Daemen College and D'Youville College surgical technique and suturing. In 2012, Dr. Kramanoukian traveled to Armenia and Nagorno Karabakh Republic (NKR) where he donated an endovenous ablation device and a portable duplex machine and started a state of the art Vein Treatment Center - none existed prior to his mission in the NKR. Dr. Karamanoukian collaborated with Dr. Davit Khachatryan of the Central Republican Hospital in Stepanakert, NKR. Accompanying Dr. Karamanoukian for this trip with the Hope for Tomorrow Foundation was Dr Armen Roupenian of Massachussetts, a vascular surgeon. Dr. Karamanoukian returned in September 2012 to NKR fo rmore vein procedures and teachings.


Dr. Karamanoukian has donated an EVLT machine to surgeons in the Republic of Armenia for them to perform this procedure in lieu of ligation and VEIN stripping. This has been a highly successful program. As well, he has donated surgical instruments for use in a vascular and ophthalmology center of excellence in the Republic of Armenia and the province of Nagorno Karabakh.


Dr. Karamanoukian has been singularly noted for developing the most advanced and comprehensive Vein Treatment Center in the United States. The Vein Treatment Center was established in 2003. He was one of the few surgeons in the United States to perform the VNUS Closure procedure in the office setting. As well, he is the first in the world to perform the VNUS and EVLT procedures in a bilateral fashion in a single office visit and has presented this data with 2 year outcomes in 2009. He currently performs all of his surgical procedures at the Vein Treatment Center in Williamsville and Clarence, NY. The Vein Treatment Center is a National Center of Excellence for Vein Disorders. Dr. Karamanoukian is also Director of the Center for Excessive Sweating.


Dr. Karamanoukian is currently focused on providing the BEST surgical care to patients needing thoracic surgery and venous surgery in Western New York. He is currently involved as a consultant to two NIH funded research studies at the University at Buffalo in the field of tissue engineered vascular grafts.


Dr. Karamanoukian is actively involved in research in the area of venous disorders and  presented his data at the American Collee of Phlebology(2008, 2009). Two  clinical research assistants are also employed at the Vein Treatment Center in collecting data to enhance the practice of phlebology and improve the quality of life of patients with venous disorders. He is a member of the Association for Academic Surgery, Society of Thoracic Surgeons, American College of Phlebology, American Medical Association, International Society of Minimally Invasive Cardiac Surgery, among others. Dr. Karamanoukian is present two scientific research papers in oral presentation in endovenous vein procedures (VNUS and EVLT) at the 2009 American Phlebology meeting in Palm Desert, California in November 2009.


Dr. Hratch Karamanoukian is on the Board of Trustees of Daemen College in Amherst, NY.


Dr. Hratch Karamanoukian supports local arts and you can see his collection of 'modern paintings of the U.S. Presidents' by Clarence artist Blair Rusin - look at 'Support The Arts Buffalo' by clicking on this link


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