Wednesday, October 26, 2005

Training Marathon in Valencia

Today I have travelled to Valencia, to participate in a surgical kind of Marathon at the General Hospital.
We have operated four patients, two before lunch and other two after lunch. Fortunately, the patient's prostates were relatively small, and this has allowed us to spend a little bit more than an hour in each case.
Three urologists have had their first experience with photoselective vaporization of the prostate, and have tried the technique under my supervision. These urologists are already experienced endoscopic surgeons, and for them the learning process consists in adapting to a new surgical tool and different physical principles and technical details, but the truth is that they are operating in a familiar environment (most experienced urologists have operated hundreds or thousands of prostates with the traditional technique, transurethral resection of the prostate - TURP). One should start operating small prostates, it is definitely the way to learn. Things are not so simple as prostatic size increases and it is not advisable to try to operate a big prostate without previous experience with small ones.
All surgeries have developed smoothly, even when patients were rather old and one of them was terribly frail. He wanted to get rid of his urinary catheter and was happy to learn that there was a safe option for him. Nobody wanted to operate him in his state with the classic technique, due to the high surgical risk.
During these training seminars, once the surgeon learning the technique has had his go, I usually take over and finish the case, to make sure the patient will do well. This is the right way to learn new surgical procedures, because the patient should not have to suffer the learning curve of the surgeon. It would be very rare to experience a serious complication with this operation in the hands of a relatively inexperienced surgeon, but maybe the result of the operation would not be as espectacular if the surgery is not performed correctly.
Photoselective vaporization of the prostate (Greenlight PVP) is such a safe operation that patients will go home tomorrow without a catheter. We all finished the day happily and we went back home after a busy day.

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