New surgical session in Sofia

Again I travelled to Sofia for another surgical session. I departed on Sunday with the intention of operating the same day, but the plane broke down and I had to spend the whole day at the airport... finally I got a new flight and managed to reach sofia after a true horrible day at several airports...

The two following days we operated patients at Hill Clinic, some with very big prostates, with the help of the wonderful urologists at Hill, Dr. Kocev, Dr. Botzevski, and Dr. Georgiev. The combination of the "en bloc" enucleation technique and the new Vmax blades for the Piranha morcellator allows us to operate big glands in a reduced time.

This prostate weighed approximagely 170 grams and it only took 17 minutes to morcellate it. To me this represents a true step forward in enucleative surgery for the treatment of BPH.

The session went very well and then I returned to Madrid. Christmas holidays are approaching and I feel like resting a little!

Italian and Spanish visitors

Yesterday afternoon, the mythic 12-12-12, we received the visit of two italian urologists, Dr. Claudio Dadone and Dr. Oscar Fenice at Clínica CEMTRO in Madrid. The GreenLight laser is generating a great interest in Italy!

Also we were joined by Dr. Julio Fernández del Álamo, from the Hospital of Torrrejón in Madrid, who is very interested in learning the enucleation technique. Julio works with Dr. Luis Llanes, my partner at ICUA in Madrid, an expert in the endourological treatment of stones and head of department of this hospital.

We performed two surgeries, an anatomical vaporization and a GreenLEP (GreenLight Enucleation of the prostate), that went very well. Then we went for dinner to el Corral de la Morería, a Flamenco restaurant, we had a great time!!!

Surgeries in Modena

This time I went to Modena via Milán. I rented a car to drive to Modena and I slept there to start in the morning with a new surgical session with Dr. Giovanni Ferrari at Hesperia Hospital. In this occasion we were joined by Dr. Lorenci and Dr Malossini, from the Ospedale di Trento,  who came to see the operations.

We did four operations that went really well, one of them was relatively more difficult, a man with a huge prostate. We did a GreenLEP procedure (GreenLight Enucleation) and we extracted 160 grams of tissue with the Piranha Morcellator from Wolf. I then had to return driving to Milan and took a plane back to Madrid.

Dr. Ferrari told me the next day that all patients were feeling well!

Live GreenLEP in Mannheim, Germany

This time I was invited to participate at the congress "Innovations and Classics in Endourology and Imaging" that took place in Mannheim, Germany.

My role at the congress was to perform a GreenLight Enucleation of the prostate (GreenLEP) procedure, that was transmitted to the main auditorium at the Rosengarten Congress Center.

The patient they selected was very complex. Had a huge prostate and bladder stones, but everything went very well. The transmission time was reduced, but I could demonstrate the basis of the GreenLEP technique, specially useful in big glands.

It was a great honor to operate in the hospital where Dr. Peter Alken developed percutaneous renal surgery, I had a great time.

European GreenLight Trainer Meeting in Brest, France

This time I went to the University hospital in Brest, France, to participate in a meeting of urologists who are trainers of other urologists in the GreenLight Laser use for the surgical treatment of BPH in Europe.

The objective of the meeting was to unify criteria as well as to share ideas and knowledge. The meeting was hosted by Prof. Fournier, who told us about his experience and who showed us the technique for continous intraoperative monitorization of laser vaporization with transrectal ultrasound.

Dr. Fournier came to visit me in Madrid in September 2009, and already then we commented the importance of transrectal ultrasound (TRUS) as a quality control of the procedure. I normally use TRUS before the procedure and at the end of it, or intraoperatively if I find it necessary, but only punctually.

Prof. Fournier has developed in these years a very ingenuous way to use a standard TRUS device to monitor the operation continuously in a very simple way. I loved the idea and I think it would be most useful for surgeons learning the procedure.

This way the surgeon has two views, the endoscopic view and the ultrasound monitoring in the same screen, very interesting.

I contributed presenting the different technical variations I use with the GreenLight laser, the anatomic vaporization with capsular localization, the vapo-enucleation and the GreenLEP (GreenLight enucleation procedure). I believe both approaches are compatible.

A very interesting meeting in the company of my colleagues, also passionate for prostatic laser surgery.

At Spanish National TV

Today I went to the Spanish National Television - RTVE, to participate in the program "La Mañana de la 1", with the famous Mariló Montero.

As always, it is a lot of fun to participate, and I had a great time. We spoke a little bit about pelvic floor problems and we demonstrated the new 3D laparoscopic system from Storz, that allows us to operate with 3D vision inside the abdomen, using a dummy patient.

Here below, the full video.

Saber vivir - Vejiga y próstata

• Saber vivir - Vejiga y próstata

Sesión quirúrgica en Sofia, Bulgaria

Again we had a two-day surgical session at the Hill Clinic in Sofia, Bulgaria.

In this session we operated 10 patients in two days with the GreenLEP technique (GreenLight Enucleation of the Prostate). The technique has been improving and now we can start the procedure with an apical dissection, liberating the external sphincter from the apex of the adenoma, which protects it much better, and the surgical time is greatly reduced.

In this occasion, we had the visit of Dr. Andrés Sempere. He trained as I did at the Hospital de La Princesa in Madrid, he just left as a certified urologist when I became a first year resident. Dr. Sempere is going to start working in Dubai soon, and he wanted to learn this enucleation technique. We had a great time!

Two-day surgical session in Bari, Italy

In this ocassion I went to Bari, Italy, to help Prof. Arcangelo Pagliarulo and Dr. Gaetano de Rienzo, from the huge Policlinico Hospital, to learn the new techniques for anatomic vaporization and GreenLight Enucleation of the prostate.

The Policlínico is like a city, full of healthcare buildings, very impressive. We did nine surgeries in two days, and we had time enough to discuss every technical aspect of these operations.

Then I had to go to Bulgaria, but as the flight connection was difficult, I flew to Rome, from there to Athens in Greece, slept at the airport hotel and then departed to Sofia in the morning. A little tough schedule!

Surgeries at Hesperia Hospital in Modena, Italy

I am happy because I have established an agreement for collaboration with Dr. Giovanni Ferrari, by which I will operate with him in Modena, Italy, every month.

Yesterday we did three GreenLight vapo-enucleations in illustrious patients with big prostates that underwent really well. I am happy to collaborate with Dr. Ferrari, he is a top urologist and a very charming man.

I bought at the airport on my way back some italian cheese and Módena vinegar, of course... and I have to return via Lisbon, a tough schedule, but I was happy.

Live surgery in Torino, Italy

I arrived in Torino to participate at the congress Technology & Training in Endourology, organised at the Ospedale Cottolengo by Prof. Cesare Scoffone.

My contribution was to perform an anatomic vaporization of the prostate with the GreenLight laser that would be transmitted live to the congress main room filled up with italian endourologists. The patient I had to operate had a catheter, and I could do a good job while I demonstrated the technical aspects of the operation as didactically as possible.

In the room, Dr. Naspro and Dr. Fasolis asked me questions and relayed the questions that other colleagues in the audience wanted to ask.

Then I did a talk to demonstrate other techniques with GreenLight laser, the vapo-enucleation and the En Bloc GreenLEP (GreenLight Enucleation of the Prostate).

That night we went to the readers circle in Torino, situated in a beautiful palace in the center of the city, and we enjoyed the congress' gala dinner, that was amazing. Prof. Scoffone addressed us during the dinner. He is a genuine man, a great urologist that works with illusion to contribute positively to improve the quality of endourology in his country. The truth is that this generous attitude always moves me and makes me proud of belonging to this wonderful specialty. It has been a great congress.

Then I came back to Madrid to rest for the remainder of the weekend.

Surgical session in Milano, Italy

This time I travelled to Milano in Italy to introduct Dr. Epifanio Scardino to the technique of anatomic vaporization of the prostate for the treatment of Benign Prostatic Hyperplasia with the GreenLight laser at the Casa di Cura San Camillo.

The session went very well and Dr. Scardino seemed to me to be a charming man, we had a great time together.

Then I departed to Torino, where I had to participate at the congress Technology and Training in Endourology, where I had to contribute by doing a live surgical demonstration and a talk on GreenLight laser new surgical techniques.

Visitor from Kuwait

Today we had a surgical session at Clinica CEMTRO in which we operated four patients suffering from BPH with GreenLight laser, and Dr. Ehabsayeddr Elmallah, from Taiba Hospital, Kuwait came to visit us in the operating room.

We had a chance to comment basic science and all the technical aspects of this kind of operation and I showed him all the tips and tricks and approaches we use in these cases. Soon I will go with him to Kuwait to help him with launch his laser unit.

Conference in Dubai - EUSC 2012

This time I travelled to Dubai, at the United Arab Emirates, to give a conference at the first annual congress of the Emirati Urological Society. I spoke about surgery for benign prostatic hyperplasia with the GreenLight laser. The title of my presentation was "Exploring the boundaries of GreenLight for the treatment of BPH" and I tried to explain that not only GreenLight has a brilliant present (the european and american urological associations recognize it as a standard option of treatment for BPH), and that there are now two published meta-analysis that back this up (level of evidence 1), but also that the new techniques I have developed, the anatomic PVP, the vapo-enucleation of the middle lobe, and the GreenLEP procedure (GreenLight Enucleation of the prostate), the future looks even better.

I worked hard in this talk, and it was very welcomed by the public. The following day I had to moderate a session on minimally invasive treatment of urinary stones, very interesting. Dubai is an impressive city, with big buildings and constant activity... luckily it was not too hot as now it is winter over there. I had a great time and then I returned home. It is a long journey.

Surgical Session with Dr. Richard Gaston

This week, as every month, we had a surgical session with Dr. Richard Gaston. He came to Madrid to operate with Dr. Estefanía Romero and myself two patients with prostate cancer at Clínica CEMTRO.

Dr. Gastón performs more than 500 laparoscopic radical prostatectomy every year, with excellent oncological results (e.g. curing the cancer) as well as functional results (preservation of urinary continence and erectile function).

EAU 8th South Eastern European Meeting and surgeries in Sofia

The EAU 8th South Eastern European Meeting took place this year in Sofia, and we presented our experience with GreenLEP (GreenLight Enucleation of the Prostate) that we have acumulated during the last years at the Hill Clinic in Sofia.

In order to see it you have to notice that we stuck an ipad on the poster, so that urologists could see the video of the technique. It was sensational!

In the photo below, with the other authors of the poster, the urologists from Hill Clinic.

Then we started the surgical session, as every month. This time we had 15 GreenLight enucleations in 3 days, that went really well. In this session we registered all surgical times and data because we were trying the new Vmax blades for the Piranha Morcellator, from Richard Wolf.

We are very impressed to see the amazing efficiency of morcellation that these blades provide. We managed to morcellate 10 grams of tissue for every minute of morcellation surgical time. It is espectacular, we sent an abstract for the EAU with the data.

In this photo, all the specimens we obtained during the three days, that were sent for histological evaluation.

At last I returned to Madrid, very happy. Operating so many patients in such a short time is always a wonderful learning experience, and the enucleation technique keeps sophisticating itself, becoming more simple, faster and safer.

Surgeries in Milano

Again I travelled to Milan to perform another surgical demonstration at the Istituto Clínico Città Studi, with Dr. Marco Raber.

I performed two operations with the GreenLight laser. An anatomic vaporization and a partial enucleation, that went very well. The second case was a patient with a massive prostate.

From Milano I went to Sofia stopping in Viena, as I lost the direct flight....

Visitors from Lebanon

Today we received the visit of two urologists from Lebanon who came interested in seeing the operations we had programmed for the day.

I performed three operations with the GreenLight XPS laser showing all the technical variations, the anatomic vaporization, the vapo-enucleation (middle lobe enucleation) and the GreenLEP (GreenLight laser "En bloc" enucleation of the prostate).

The truth is that these options allow me to offer my patients an optimal result, with minimal risk and very satisfactory. They left very happy with what they had seen and learnt.

Transperineal biopsy with RMN-US fusion course at Guys Hospital London and Ginsburg study group meeting

This week I went to London, to participate in a course on transperineal prostatic biopsy organized by  Mr. Rick Popert at Guy's Hospital in London.

Very interesting, a move is taking place in the UK and Germany from the transrectal biopsy of the prostate for the diagnosis of prostate cancer (a simple procedure that can have serious infection complications) towards the transperineal biopsy, with a near zero risk of serious infection and allowing much better targeting based on MRI image fusion with Ultrasound and with a higher diagnostic yield.

The new 3 Tesla MRI is providing a much better diagnostic study of the prostate and there is now technology that allows to import the images from the MRI study into a special Ultrasound device, and the FUSION of both images allows to direct the biopsies to the suspect areas in the MRI. It allows to be sure that the suspect areas are properly targeted.

To me this approach seems totally logical and it improves diagnosis and reduces the risks. It is going to be extremely useful for those cases where we consider no treatment (active monitoring), to increase the diagnostic precision in cases with prior negative biopsies and to indicate which patients are suitable for focal treatments with cryosurgery and HIFU.

We have been doing transperineal biopsies for some time in Madrid, in patients with prior negative biopsies and we are happy to see that we were in the right track. Clinica CEMTRO has acquired a new 3 Tesla MRI that will be active soon, and I hope to be able to offer this type of transperineal biopsy targeted with MRI-US fusion to my patients very briefly.

The following day I participated at the meeting of the Ginsburg study group for transperineal biopsy with MRI-US fusion, and from now on I will contribute to the investigations of the group on this type of biopsy.

Surgery in Rome

Right after my visit to Milán, I went to the Azienda Ospedaliera San Giovanni Addolorata in Rome.

There Dr. Gianluca D'Elia welcomed me to perform a GreenLight XPS laser surgical operation. He runs a minimally invasive surgical unit with emphasis in Robotic surgery.

I showed them the technique for capsular localization, that they had never seen. Unfortunately we did not have time to operate the second patient that was programmed that day. I rushed back to Madrid to rest during the weekend.

Surgeries in Milano, Italy

This time I travelled to Milano, with Dr. Marco Raber, who has decided to incorporate the GreenLight technology to be able to offer his patients the 180 watt laser prostatectomy.

In the morning we performed three operations that went very well. I showed him the maneuvers to localize the capsule and allow to perform a radical removal of the adenomatous tissue. Soon I will return with him to demonstrate other techniques, as the GreenLight Enucleation.

Surgeries in Beirut, Lebanon

Again I travelled to Lebanon to help Dr. Mohamad Aluuan, head of the urology department at the Central Military Hospital of Beirut, to learn to operate patients with benign prostatic hyperplasia with the new laser GreenLight XPS 180 watts.

It was a tough schedule, as I got there at 3 am and slept only some hours before starting a long surgical session. We operated six patients, one of them with a 150 gram prostate, and then that night I returned to Madrid.

It was a very nice session and the head of the military healthcare of Lebanon offered me a beautiful plaque of the Lebanese army as a reminder of my stay there.

In the photo, with Toni Abboud, Dr. Mohamad Aluuan and Bassem Zarif, at the end of the surgical session.

Dr Gaston performs laparoscopic 3D operations in Madrid

As every month, Dr. Richard Gastón visited us from Bordeaux, and came to Clínica CEMTRO to operate patients with localised prostate cancer with us. This time we performed several laparoscopic radical prostatectomies using the new laparoscopic videolaparoscope from Karl Storz, a system that provides high definition (HD) and three dimensional view (3D) inside the patient's abdomen.

This was the first time this system was used in a private center in Madrid. It uses a special laparoscopic camera that allows the surgeons, through the use of special 3D glasses, to have a vision in three dimensions (3D) and High Definition (HD) of the interior of the abdomen of the patient. It is an important development because it allows to be more precise with the movements and facilitates enormously the complex laparoscopic manouvers, as intracorporeal suturing.

The operations went really well, and we were all convinced that this visualization system in 3D and HD facilitates laparoscopic surgery enormously and it is a big advantage in our daily work and logically will result in faster and safer operations for patients.

Surgeries in Sofia and New Piranha Morcellator

This time I went to Sofia to operate at the Hill Clinic, and we started a study to evaluate the performance of the new Vmax blades for the Piranha Morcellator, from Richard Wolf.

We did 10 GreenLight Enucleations of the prostate in two days, and we took the opportunity to register the time it took to morcellate the tissue with the new blades. It was really impressive, in one of the patients we could morcellate 70 grams of tissue in 5 minutes!!

I firmly believe this improved morcellation is going to make enucleation more easy and affordable for surgeons, as the morcellation step of the operation was so much shortened that we could operate the 10 patients in less than an hour!

We will submit the results of the study to the European Association of Urology congress that will take place next year in Milan.

AURO Congress in Genoa, Italy

After my trip to Morocco, I flew to Milano and from there I drove to Genoa, where I participated at the AURO (Hospital urologists association) congress in Italy.

It was a very interesting session where we spoke of Holmium Laser, Tulium Laser and GreenLight laser for the treatment of BPH. I always learn so much from my colleagues...

I specially enjoyed a video of an enucleation en bloc of a bladder tumor presented by Dr. Migliari, a very interesting technique, maybe with a bright future.

Surgeries at the Military Hospital in Rabat, Morocco

This time I went to Morocco to show the Urologists at the Military Hospital in Rabat the wonders of the GreenLight laser for the treatment of benign prostatic hyperplasia.

We did a surgical session with two patients, one with a 60 gram prostate and another one with 100 grams, that went very well.

After sleeping that night in Rabat, I departed from Casablanca to Milano, to participate at the AURO Congress.