Tuesday, November 01, 2005

Training session in Valencia

Today I travelled to Valencia to participate in a training session. We had a very complex patient, with a huge 130 gram prostate. These big prostates can be operated, but they require a longer operating time and patience. This operation took 3 hours and we applied 750.000 joules. The prostate had an enormous median lobe that occupied the prostatic urethra and protruded inside the bladder. We managed to vaporize it and to leave a huge prostatic cavity. It was a very interesting case, big prostates are always a challenge but this one was special for its peculiar anatomy. Some urologists think that median lobes are difficult to treat with the KTP laser, but it is rather easy to vaporize them completely, you only need to know some simple tricks.

We also realised that irrigation can be improved with a suprapubic 5 mm laparoscopy trocar. I did not carry with me the Reuter trocar I use in these difficult cases (it is getting more difficult to get it into an aeroplane - it is a sharp metallic object). So this was a good idea, nowadays all hospitals have laparoscopy trocars. This enhances irrigation, the vision gets very clear and it is very useful to operate big prostates with a very small risk and good results. The patient gets a 5 mm wound in his lower abdomen, that is not much of a problem at all. I took the plane back to Madrid, we have a Bank Holiday and tomorrow I will get a chance to rest for a while. I have to return to Valencia this thursday to participate in another rather difficult case.

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