Surgery at Clínica Teknon in Barcelona

This time I travelled to Barcelona to operate at Clinica TEKNON with Dr. Batista. It was a patient with high surgical risk and a big prostate that we operated uneventfully.

The laser endoscopic enucleation of the prostate is a fantastic treatment option for BPH due to its low risk and high efficacy.

Participation in Spanish National TV presenting the Da Vinci Robotic System

Again I was invited to participate in the national TV program "Saber Vivir".

This time I presented the Da Vinci Robotic System and we explained how it works and what is it useful for. This robot has really revolutionized urologic surgery and specially the treatment of urologic cancers that affect prostate, bladder and kidney.

This program can be seen in this link.

For more information on Robotic Surgery, our robotic surgery website is www.icirugiarobotica.com.

First implantation of a new device for the treatment of BPH in Spain: the iTIND

Today again we pioneered in the application of a new technology for the treatment of prostatic diseases. This time we implanted for the first time in Spain a Temporary Implantable Nitinol Device (iTIND). It is a sort of stent that is implanted under sedation in 5 minutes and after 5 days it is removed under local anesthesia. During the time it is implanted it creates three bladder neck incisions that improve the voiding quality of the patient.

The main advantage of this device is that it does not affect the patient's ejaculatory function and does not require catheterization or hospital stay. I am sure many patients will prefer this to having to take medication for a long period of time.

Lecture at the Autumn meeting of the Welsh Urology Society

This time I went to Wales invited by the Welsh Urological Society to participate in their Autumn meeting.

I was asked to discuss recent advances in the surgical treatment of BPH.

The meeting took place in an amazing place, the Hensol Castle, inside the Vale Hotel Complex in Wales.

It was an unexpected pleasure to find an old friend, who was a senior registrar with me at the Institute of Urology in London. Dr. Hugh Mostafid, who is now an expert in Bladder Cancer.

This tim

Talk and live surgery at the Live Surgery Congress of the Galician Society of Urology

This time I went to Lugo, to reach Burela, where the Live Surgery Congress of the Galician Society of Urology was celebrated.

My role was to give a talk and to perform a live Green Laser Anatomic Vaporization that was retransmitted to the auditorium of the Hospital in Burela. Everything went very well, it is always a great pleasure to visit Galicia and to meet my friends over there.

I was also interviewed by the Galician regional TV, the interview can be seen here.

New course on Robotic Radical Cystectomy at ORSI and OLV Hospital in Aalst, Belgium

Again I went to Belgium to participate in an advanced course on robotic radical cystectomy and intracorporeal urinary diversion at ORSI.

I had the privilege in this course of performing two robotic radical cystectomies with an intracorporeal diversion and I also went to the operating room to witness a case at the OLV hospital in Aalst.

I am very grateful to Dr. Mottrie for everything I have learned in these courses with him, but I have to say that I have received a lot from Dr. Giorgio Gandaglia, from the Hospital San Rafaele in Milan, who is spending six months working at the OLV hospital in Aalst, and who has taught me a great deal.

For many hears I have devoted myself to teach other colleagues, specially in the use of lasers for the treatment of prostate disease. My experience as a surgical teacher helps me value the generosity of those who teach what they know without limits, and Giorgio Gandaglia is a great teacher. I think he will become no doubt one of the leading urologists in europe in a few years!

New robotic surgical session with Dr. Richard Gaston

This weekend we had again a surgical session with Dr. Richard Gastón at Clínica CEMTRO. Dr. Gaston is now a member of our team at ICUA and he comes every month from Bordeaux to operate with us in Madrid.

Robotic surgery requires a lot of preparation and a precise coordination among our nurses at ICUA, the anesthetists, hospital nurses, and other personnel, to allow for an uneventful and smooth work.

Vanesa Cuadros, our chief nurse ensures that every detail is looked after and also makes sure that all the clinical information about the patient, his PSA, the result of the digital rectal examination, the information obtained in the biopsy or the transperineal MRI-US fusion mapping, the preoperative MRI are clearly looked at prior to the operation so it can be planned to the detail.

Our nurses, Sandra and Nuria are in charge or organizing all the surgical material necessary for any eventuality. They also assist us during the robotic procedures.

It is fantastic to be able to work in a team full of enthusiasm and will to perform an excellent job!

Live surgery during the Annual Congress of the Italian Society of Urology

This time I travelled to Italy to participate at the congress of the SIU, this time performing a live surgical procedure that was broadcasted to the main auditorium of the congress that was held in Riccione.

With the possibilities offered by modern technology, the operation was performed far from the congress venue, at the Hospital in Carpi, where Dr. Verrini, the head of the urology department was hosting this live surgery session.

My role was to perform an anatomic vaporization in a patient with a relatively big prostate with 80-90 cc.

They told me the main auditorium was full. ¡Everything went very well!

Surgical workshop to demonstrate GreenLEP in Delft, The Netherlands

This time I travelled to The Netherlands to visit the Hospital Reiner de Graaf, in Delft.

There I was kindly hosted by Dr. John Van Der Hoeven who was there with other Dutch colleagues for a surgical session on "En Bloc" GreenLight enucleation of the prostate.

First I gave a talk at the clinical session of the urology department and then we went to the operating room, where they had prepared three patients. Two of them had very large prostate glands.

The session went very well, although two of the cases were a little more difficult than usual. In one of the cases I showed the anatomic vaporization technique. The attending urologists were very impressed with the possibilities of the GreenLight laser with these new techniques for the treatment of benign prostatic hyperplasia.

I spent the weekend in Amsterdam, and I had a chance to visit the exhibition Body works, where they show "artistic" anatomic preparations of plastinated human bodies. It is amazing, I recommend it thoroughly.

This was a plastinated dissection of the urinary tract and the main vessels in a female subject. Fascinating!

Surgeries in Sofia, Bulgaria, to try the new Auriga XL system

This time I flew to Sofia to operate at the Hill Clinic, and to try the new 50 w Holmium laser Auriga XL.

In Madrid we have a 100 w Holmium laser from Lumenis, and I was curious to try it. I had heard that it allowed to perform endoscopic enucleation for the treatment of BPH, but that it maybe was a little slower than the 100 W lumenis laser.

I played with the output parameters of energy and frequency until I did with the settings that provided the tissue effect I like for the en bloc enucleation technique, and the truth is that we could work wonderfully with this laser, and we did not perceive any difference in the time we needed to complete a procedure as compared with GreenLight and Holmium 100 w.

The more I try different lasers the more I believe that despite the technical differences among different lasers, the most important factor is the experience of the surgeon. If the surgeon understands laser physics and knows the anatomy of the prostate well enough, there shouldn't be very significant differences among lasers. At the end, patients recover equally well, do not bleed much, and are very happy with their operation, irrespective of the wavelength. I do believe that Holmium and Thulium are technically more demanding for the surgeon (more difficult to use).

I also think that GreenLight en bloc enucleation is the most beautiful procedure, it allows visualizing the anatomy much better and it is extremely elegant and efficacious.

I got this from the staff at the Hill Clinic, a photo that summarizes the international visitors who came to learn to use the GreenLight laser during the last three years. Watching this gets to my heart, so much work, so many friends!

Experts meeting in London

From Brussels I flew to London to participate in an experts meeting summoned by the company Boston Scientific.

This company recently acquired American Medical Systems (the male products part, including the GreenLight laser), as well as the German laser manufacturer Starmedtec.

Now Boston offers three kinds of laser for BPH, the GreenLight XPS system, a 50 watt Holmium system (Auriga XL) and a Thulium laser (Vela XL).

Boston Scientific had summoned international experts in the use of lasers of different kinds, and it was very refreshing to sit down all together in one table and discuss openly the pros and cons of different kinds of lasers.

I realized that my experience is quite unique, as I have worked a lot with all three wavelengths and the majority of my colleagues specialize in one wavelength only. A very interesting meeting.

Partial nephrectomy course in Belgium

Again I travelled to Belgium to participate in another course with Dr. Alex Mottrie at the OLV Hospital in Aalst. This time It was a partial nephrectomy course.

I spent three intensive days in the course and I enjoyed it thoroughly, as I could see and do many robotic operations. Dr. Mottrie was trying a new system that allows to use 3D reconstructions of the anatomy of the patient based in their own imaging studies (CT Scan, MRI) offered by the company  Visible Patient.

These 3D reconstruction systems allow to plan the operations carefully and to increase their safety. It was definitely a wonderful course and three days of total immersion in robotic surgery, I love it!

Robotic work with Dr. Gaston in September

During the month of september, Dr. Gaston came to operate at  ICUA - Clínica CEMTRO twice, we operated two consecutive weekends several cases of prostate cancer as well as a partial nephrectomy with the Da Vinci Robotic System in a patient with a single kidney that went really well.

Despite the Da Vinci Robot is mainly known for its role in the treatment of prostate cancer, its role is paramount today for the treatment of kidney cancer, as it allows to perform complex partial nephrectomies with great safety, allowing for preservation of renal function.

It is a joy to see the patients recover after these robotic surgeries and to witness the excellent oncologic and functional results. I suppose the only drawback of the Da Vinci Robot is its cost. It is an expensive system and every time we operate the cost of the instruments is high, but I think it is no doubt a great advantage for the surgeon and the patients!

Participation in National Spanish TV presenting the Da Vinci Robotic System

Today we received at Clinica CEMTRO the visit of a live transmission team from Spanish National TV. They connected us to the program "La Mañana de la Uno" to present the Da Vinci Robotic System and comment on its usefulness to treat urologic conditions and specifically, in the surgical treatment of prostate cancer.

Participation in ERUS 2015 Congress in Bilbao

This morning I woke up early to travel to Bilbao and to spend the day at the ERUS 2015 congress on Robotic surgery in Urology. It was very well organized and it was extremely interesting to watch many surgeons performing live surgical retransmissions to the auditorium of the Euskalduna palace auditorium.

A congress with participation of urologists from ICUA, Dr. Estefanía Romero assisted Dr. Richard Gaston in a live surgery transmission.

Unfortunately I could not stay for the second day of the congress as we had been invited to participate in a live presentation in National TV of the Da Vinci surgical system and I had to return to Madrid.

GreenLEP training at Clinica Quirón in Barcelona

After the course on robotic surgery I flew to Barcelona to help Dr. Enrique Rijo, from the urology team at Clínica Quirón in Barcelona with his first steps with GreenLEP.

I love to work with colleagues who share the passion for what we do. Dr. Rijo is an enthusiast and is keen to learn.

As in every training session, we discussed all the details of the necessary instruments and morcellator.

Dr. Rijo had studied my videos and had visited me many times to see GreenLEP procedures, and he did a great job!

GreenLEP is an advanced technique, not easy, but perfectly teachable to a urologist with experience in vaporization and with desire to learn. I then returned to Madrid to rest a while. Dr. Rijo called later to tell me patients did very well afterwards.

Second part of the Da Vinci Robotic Surgical Course in Belgium

Again I went to ORSI-OLV in Belgium to complete another three days of advanced course of Robotic Surgery with the Da Vinci system.

There we had intensive work covering theoretical basis, surgery in cadavers and training models and attendance to the operating room at the OLV Hospital in Aalst.

It is really incredible to witness the amazing development that robotic surgery has experienced in the last years. Today it is possible to operate almost everything with robotic surgery!

I returned very happy, having learnt a great deal, to Madrid.

Surgeries in Alba, Italy

This time I went to Italy, specifically to the Hospital San Lazarus in Alba, to assist Dr. Fassolis with his training in anatomic vaporization of the prostate with the GreenLight laser. Dr. Fassolis has already got a great experience in prostate vaporization and he wanted to learn a couple of surgical tips and tricks to perform a proper anatomic vaporization.

We did three operations that went very well and I was happy to see how fast he learnt to perform the technique to perfection!

From Italy I departed to Brussels to participate in another advanced robotic surgical course at ORSI.

2 days of GreenLEP training in France

I started this season traveling to Strasbourg, where I reached a dinner with a group of local urologists where I gave a talk on laser for the treatment of BPH.

The following morning we went to Clinique Adassa, where they had prepared 5 patients to perform GreenLEP (Green Laser Enucleation of the Prostate) with my help. I assisted Dr. Weidmann and Dr. Faure to perform their first cases.

After finishing the surgical session, I drove to Montbeliard, where we had a similar plan for the following day. In the morning I went to Hopital Nord Franche Comté, in Montbeliard, where Dr. Atassi had prepared 8 patients to operate in two operating rooms during the day.

It was a tough session, we did not stop working all day.

Everything went well, and it was very clear that this is an advanced technique that can be taught and learnt with relative ease when there is previous experience with prostate vaporization and when the surgeon already has the basic skills and understanding of the physics to manipulate the green laser.

That night we went to the wonderful Museum Peugeot, where we had dinner and also I gave a talk on laser and BPH to the attending urologists.

The next morning I woke up early and returned to Madrid to rest!

Advanced radical prostatectomy training course at ORSI, Belgium

This time I travelled to Belgium to participate in an advanced three-day training course on radical prostatectomy at ORSI with Prof. Alex Mottrie.

In September I will return to complete the second part of the course for another three days.

It has been a great experience and an extremely well conceived, didactic and comprehensive course.

Prof. Mottrie is a great robotic surgeon and despite the fact that we have worked for the past 8 years with Dr. Richard Gastón, who is considered the "guru" of robotic surgery worldwide, and that we are spoiled by his geniality, it is always a pleasure to share with expert surgeons like Prof. Mottrie, compare the different points of view and the alternative surgical strategies.

It was also very nice to share with other urologists from Australia, Scotland, India, Italy and The Netherlands.