Dr. Fernando Gómez Sancha - English

Surgeries in Treviso, Italy

2012-01-26T13:26:00.000+01:00

On thursday I left early in the morning to Italy, to perform a surgical demonstration with the GreenLight XPS 180 watt at the Civil Hospital of Treviso. There I was with Prof. Maccatrozzo, Dr. Merlo and Dr. Paolo Guaitoli, who came all the way from Udine to watch the surgeries (the last two doctors in the photo below).

I had a first patient with a monster prostate with a huge median lobe and I had to perform a hybrid technique. At first I could not enter the bladder with the laser cystoscope due to the humungous median lobe. I vaporized the lateral lobes using 600.000 joules and then I found the capsular plane on top of the veru montanum to progressively enucleate the median lobe until it was hanging from a small pedicle at the bladder neck. Then I used a bipolar resectoscope to resect the median lobe, in a totally bloodless fashion, and when we weighted the prostate chips, 70 grams! We checked with intraoperative transrectal ultrasound that we had removed the whole adenoma... a difficult case, but we managed it safely. The second patient had a smaller prostate and we did a good job too. I really enjoyed the session.

Then I went to the airport, where I had to wait to leave to Sofia, Bulgaria, because the airport had been closed due to heavy snowing. Finally I got there at 2 am...

Italian visitors

2012-01-25T12:14:00.000+01:00

Today we had a surgical session with three operations with the GreenLight XPS laser for the treatment of benign prostatic hyperplasia (BPH). We received the visit from four italian urologists interested in this type of laser. The operations went very well and we had a chance to talk in depth about the basic science and the different properties of various wavelengths.

New book chapter: PELVIC PAIN

2012-01-23T17:32:00.000+01:00

Soon the new book "Pelvic Pain", edited by Mary Montenegro, will be available. We have contributed with a chapter on myofascial syndrome in patients with chronic pelvic pain.

The book can be found here.

Conference in Edinburg, Scotland

2012-01-20T00:17:00.000+01:00

This thursday night I flew to Edinburgh to participate in the Celtic Urology Network Meeting, that brought together urologists from Scotland, Wales and Ireland, in an update session on the treatment of Benign Prostatic Hyperplasia (BPH).

I really liked to reach Edinburgh, a wonderful city. That night I had dinner with my friend Dr. Andy Thomas, and I got ready in the morning for my talk later that day.

I could only take this photo of the attendees. I spoke about the anatomic photoselective vaporization of the prostate as well as the GreenLEP (GreenLight Enucleation of the Prostate). I had a great time.

Then I returned to Madrid to spend the weekend, I could not enjoy Edinburgh enough, but I really look forward to coming back some day.

Visitor from Dubai

2012-01-11T13:40:00.000+01:00

Today we received the visit of Dr. Ismail Abbara, from Dubai, who came to visit us and witness some surgical procedures with the GreenLight laser for the treatment of BPH, at our operating room at Clínica CEMTRO in Madrid.

I performed two anatomic vaporizations and a GreenLEP procedure (GreenLight Enucleation of the prostate) that went very well. Then we could enjoy dinner together, very nice. He said he wanted to invite me to perform a live surgery in a congress in Dubai in the next future.

Surgeries in Lebanon

2011-12-17T08:56:00.000+01:00

This time I came to Beirut to accompany Dr. Imad Ghantous at the Hôpital Libano-Français, in Zahle, a city near Beirut.

We had a very tough schedule, with six surgeries and a talk to the hospital doctors, as well as other urologists who came to see the session.

I explained the basic science, the interaction of laser with prostatic tissue, basic concepts that are very important and need to be clearly understood in order to work with this laser.

A tough day, but very successful, all operations went well. The following day I returned to Madrid, a long trip Beirut-Rome-Madrid. I am starting to feel that I need to rest this Christmas.

Surgeries at Ospedale San Antonio, Padova, Italy

2011-12-16T08:37:00.000+01:00

Today I flew to Bergamo and drove towards Padova, where I performed two operations in two patients with benign prostatic hyperplasia, to demonstrate the new technique of anatomical vaporization of the prostate with the GreenLight XPS laser.

There I was hosted by the head of the department of urology, the kind Dottore Massimo del Bianco. We spent a very nice morning in the operating theatre, discussing pros and cons of this laser and the effect of the economic crisis in the Italian healthcare system. The operations were successful and I could demonstrate the benefits of this technique for the patients.

Then I departed to Rome, to connect to Beirut. A very tough trip, I arrived in Beirut after 3 am...

Surgical session in Sofia

2011-12-09T08:26:00.000+01:00

Again I travelled to Bulgaria to operate patients with big prostates at the Hill Clinic in Sofia. It started snowing showing that Christmas and the end of the year is near. Everything comes to an end!

New paper on European Urology

2011-12-04T10:13:00.001+01:00

Yesterday I saw in European Urology the new paper I have published with other international experts in laser treatment of BPH (Benign Prostatic Hyperplasia), analyzing the results obtained with the new GreenLight XPS 180 watt laser.

It is the analysis of the early experience with this laser, that is very satisfactory.

This is the first paper published with results of this new laser in the world, and it surely will be thoroughly cited.

Surgeries with Dr .Gaston, from Bordeaux, France

2011-12-03T18:51:00.001+01:00

Today I woke up early to pick up Dr. Richard Gaston at the airport. He came to operate two patients with us, to perform two radical laparoscopic prostatectomies.

As always, we operated with him Dra. Romero, from our team at ICUA, and myself, with the added pleasure of receiving the visit of two local urologists. Dr. Gastón told me today that he will operate this year more than 500 patients at Clinique Saint Agustin. He is a true genius of surgery and his knowledge of the micro anatomy of the prostate is amazing.

He also commented that he wants to invite me to visit Bordeaux so I can show them our technique of laser treatment of BPH.

Visit of Prof. Amici, from Rome

2011-11-30T08:06:00.000+01:00

Today we received the visit of Prof. Amici, from the Ospedale Fatebenefratelli Isola Tiberina in Rome, Italy. I did two operations to show the anatomic vaporization concept, very interesting cases. The first patient had a 75 cc gram prostate with a big median lobe. I did a mixed technique, vaporizing lateral lobes and enucleating the median lobe into the bladder, and later morcellated it. The second patient had a smaller gland, about 40 cc, I did an anatomic vaporization down to capsule in 35 minutes.

I could demonstrate with intraoperative transrectal ultrasound how it is perfectly possible to perform a radical vaporization of the adenoma, with no bleeding, in a simple and fast way. I think he was convinced that this laser GreenLight XPS allows to perform a fantastic job with minimum morbidity. I think I will go to his hospital soon to help him perform his first cases.

Surgeries in Buenos Aires, Argentina

2011-11-26T08:53:00.000+01:00

This weekend I went to Buenos Aires, where I was invited by my friends Edgardo Becher, Marcelo Borghi and Victor Chernobilsky, from the prestigious Centro de Urología de Buenos Aires.

The Centro de Urología is an ambulatory surgical center where they have already operated more than one thousand patients with the GreenLight Laser. The objective of my visit was to help them start with the GreenLEP (GreenLight Enucleation of the Prostate) technique, so that they can offer this to their patients, specially those with bigger prostates.

Dr. Borgi, happy after finalizing an enucleation procedure

It is a great pleasure to work with expert surgeons, they had no problems to grasp the technique, we only had to polish small but important details to do this kind of operation, that is technically more demanding than simple vaporization.

I had a great time with them, they are wonderful urologists and remarkable human beings, now even more friends.

Surgeries with Dr. Muchster

2011-11-18T12:52:00.000+01:00

Today I flew to Rottenburg, Germany, to visit Dr. Muschter.

They asked me to visit him in his hospital in Rottenburg to evaluate him as a surgeon, to ensure that he can do a good job with the GreenLight laser, so he can be admitted for a randomized clinical trial, the "Goliath Study". This is a requisite in these randomized trials, that aim to demonstrate the true differences between treatments.

This trial is going to compare the results of conventional surgery with transurethral resection of the prostate (TURP) with those of Photoselective Vaporization of the Prostate (PVP) with the GreenLight Laser.

Prof. Muschter is one of the most active urologists in the laser field in the history of urology. I had a chat with him that was pure gold for me, I learnt a great deal from him and his vast experience with all kinds of lasers for many years.

Of course, he is a master surgeon as well. He also showed me his installations, that are impressive due to their functionality and equipment. It was a very nice day.

Then I came back to Madrid to rest during the weekend, after several weeks non-stop working!

Visitors from Italy, Canary Islands and Peru

2011-11-16T09:55:00.000+01:00

Today we had programmed operations at Clínica CEMTRO and we received the visit of many urologists from Italy, Las Palmas de Gran Canaria, and of my friend, Dr. Jorge Saldaña, from Perú, who is touring across Spain and has taken the opportunity to pay a visit to see some operations.

Waiting for the patient to get ready

We operated three patients, two vaporizations and one enucleation, that went really well. Among the visiting urologists was Dr. Naspro, who has published extensively on laser prostatectomy and is an internationally known laser surgeon. He found very interesting the concept of anatomic vaporization, down to the capsule, and the new possibilities of GreenLight enucleation with a side firing fiber.

With Dr. Jorge Saldaña

Then we went to the flamenco show, as always, and we had a lot of fun!

Surgeries in Sofia, Bulgaria

2011-11-13T09:36:00.000+01:00

Following with my collaboration with the Hill Clinic in Sofia, in this occasion we had two very busy days.

On Saturday I arrived a little later than planned from Athens, and we started to operate a little bit late. We had six operations scheduled for the day. On sunday we operated five more patients. We did ten GreenLEPs (GreenLight enucleations) and one vaporization, and all of them were fine. One of the patients had a 230 g prostate, and all the other patients had prostates over 100 g.

To me, operating in Hill is always very interesting, the cases they select for me are the more complex, bigger prostate glands. Operating complex case after complex case in this way is an excellent opportunity for me to keep learning small details, trying technical variations that allow me to mature and perfect even more the GreenLEP technique.

We received a visit from a local urology professor from Sofia and I showed him the GreenLEP technique. He left us very impressed with what he saw, being able to treat these patients with big prostates with such a minimally invasive way, such elegant procedure is always very surprising.

The fastest procedure took 40 minutes, we can do this procedure faster, safer and more satisfactorily. It was an intense weekend, but very interesting and productive. It is always a pleasure to go to Sofia.

San Luigi Hospital, Torino

2011-11-11T09:08:00.000+01:00

From Belgrade I flew to Torino, Italy, where I had to visit Hospital San Luigi, to perform a demonstration of the GreenLight XPS 180 watt laser in action. I did two operations with the urologists of San Luigi. The Italian hospitals are very well equipped and in this one there is a lot of robotic laparoscopic procedures being carried out.

We had a problem with the visibility during the operation as we tried to use a three chip endoscopic camera. These are not ideal for GreenLight surgery, as the image gets too saturated.

Then we used a high definition camera that was amazingly good. I showed them the anatomic vaporization technique by with the prostatic capsule is localized to allow for a complete removal of the adenoma.

Then I left to Milan, where I tried to catch a flight to Sofia. Unfortunately I was late and I lost the flight, and I had to find an alternative option, fly to Athens, sleep there and then fly to Sofia early in the morning.

Surgeries in Belgrade, Serbia

2011-11-10T08:43:00.000+01:00

I went to Belgrade, Serbia, to help in the presentation of the new GreenLight XPS 180 watt laser at the Dean's building of the University of Serbia.

The distributor company of Americal Medical Systems in Serbia, Medicon, donated a laser to the Clinical Center of Serbia, the most relevant urology department in the country, to allow the Serbian people to access to this treatment at the national health service.

I presented the technology and its advantages and then I performed two live procedures, that were transmitted to the room, full of local dignitaries, as the Serbian Minister of Health, or the ambassador of the United States in Serbia.

The session was very successful. I enjoyed thoroughly helping to introduce this marvelous technology in a country like this.

I also had a very nice moment when one of the patients I operated in my previous visit to Belgrade, a famous serbian actor who had a huge prostate gland, on whom I performed a GreenLight enucleation, a very difficult case, came to see me. He very kindly described how well he was feeling and how happy he was, he brought one of his movies for me and we spoke about his life in cinema, and commented on Emir Kusturiça, who directed him in multiple occasions, and who I love as a director.

Soon I will return to Serbia to train the urologists who are going to start using this laser.

Participation in "La Mañana" - Spanish National TV

2011-11-08T08:14:00.000+01:00

Today I participated in the National TV program "La Mañana.

This time we speak about urinary tract infections. It is always nice to go to the TV and contribute to expand the public knowledge on urological disease.

Surgeries in University Hospital Infanta Leonor, in Madrid

2011-11-04T07:51:00.000+01:00

Today I visited Hospital Infanta Leonor, in Madrid. I did three operations with the GreenLight XPS 180 watt laser in the morning session. I really liked this new hospital. It is a very modern and beautifully designed hospital.

The interest for GreenLight laser has reached public hospitals in Spain, where the low risk and short hospital stay that this laser allow for the treatment of patients with benign prostatic hyperplasia is becoming interesting.

Surgeries in Quito, Ecuador

2011-11-01T22:00:00.000+01:00

I could reach Quito after a long trip. My plane from Avianca broke down while trying to take off, and the flight was cancelled, so I had to wait one day to travel. I was going to operate with Dr. Ricardo Yépez and Dr. Saskia Suarez, at Hospital Carlos Andrade Marín.

Con el Dr. Ricardo Yépez antes de entrar en el Hospital

I was very impressed by quality of the technical equipment available in the surgical rooms in this hospital. It seems the government is investing heavily in infrastructure and has pushed healthcare forward significantly.

The objective of this visit was twofold, the first objective was to help my colleagues to start with GreenLight Enucleation of the prostate. We operated two days and we went through step by step surgical technique and we could deepen in details and improve several important technical aspects.

Prostate enucleation is a complex technique and to be able to perform it properly it is important to have specific surgical instruments, an impeccable anesthetic technique, a properly trained surgical team and to pay great attention to detail. The clinical results are excellent and many of the patients we operated, not specially easy cases, went home the same day of the operation.

The second objective was to support Dr. Yépez and Dr. Suarez with the planification of the first international congress of the GRILUR (Grupo Iberoamericano de Láser en Urología) that will take place in this hospital in July 26th-29th, 2012, with special focus in the minimally invasive treatment of benign prostatic hyperplasia (BPH) as well as of urinary stones. It will be an important congress, with live surgeries and the participation of international experts. We had a good chance to comment on the current status of the organization of the meeting that aims to gather those spanish and american urologists interested in the use of lasers for the treatment of urinary tract diseases.

We also had a chance to travel to the east where we visited amazing places and I was able to enjoy my friend's hospitality.

Then I returned to Madrid. A long trip, but definitely worth it!

Surgical Session in Gran Canaria

2011-10-23T09:25:00.000+02:00

This weekend I went again to Gran Canaria, to collaborate with my old friend, Dr. Juarez del Dago, in a surgical session with the new GreenLight XPS 180 watt laser. We operated several patients that went really well.

In the photo, Dr. Juarez and his marvelous nurse, Loly, getting ready for the operations.

Surgical Session with Dr. Rix

2011-10-17T09:11:00.000+02:00

Today we had the pleasure of hosting Dr. Gerald Rix, an expert in the technique of Holmium Laser Enucleation of the prostate at Clinica CEMTRO in Madrid.

We commented the surgical technique at large and his convictions regarding this procedure. His advice was excellent and I carried out several procedures while he commented his ideas and tips and tricks. All surgeries were successful!

Dr. Rix interestingly speaks a perfect spanish as he was raised in Spain as a child. We had a great time and I am very grateful to him, he is a great teacher.

I am convinced that it is crucial that surgeons from different countries and hospitals share their knowledge, as this will improve our skills for the benefit of our patients.

XVIII Congress of the Canarian Society of Urology

2011-10-15T08:46:00.000+02:00

In this chance I travelled to Gran Canaria to participate in the Congress of the Canarian Urology Society, to speak about lasers. The congress was organized by the Gabinete de Urología y Andrología, captained by Dr. Juarez del Dago in a wonderful hotel in Mogán.

The congress started with a non-urological talk on the Timple from Canarias, a string instrument that is very popular over here. Very interesting, we had Germán López, one of the best timplists in the world and a fantastic spanish artist. I did not know him, but now I am his fan. Here a video of the artist with his Timple... a wonderful instrument.

The level of the scientific sessions was very high as we had the luxury of having Dr. Richard Gaston who spoke about laparoscopy and also Dra. Estefanía Romero, from our team, that also presented on the surgical indication of Benign Prostatic Hiperplasia.

I spoke, as always, about lasers, and my participation was reflected in the congress daily newspaper as well as in a local newspaper Canarias 7.

As always, going to Canarias is wonderful, and I had a great time among friends.

Surgeries in Naples, Italy

2011-10-12T14:17:00.000+02:00

This wednesday I flew very early to Rome, and then to Naples, to visit Hospital Federico II.

There I met Professor Vincenzo Mirone and his team of urologists, that had prepared three patients so I could demonstrate the technique of anatomic vaporization of the prostate.

Dr. Mirone was the former president of the Italian Association of Urology and is currently its secretary general, he was very kind and we talked about the characteristics of GreenLight Laser and its interaction with prostatic tissue.

The three operations were successful and it was nice to see Naples on the way to the airport, it was a sunny and marvelous day. I had some time to try the local mozzarella, really good.

The return trip was tougher after such an early start. I arrived in Madrid around 12 pm, but happy.

Visitors from Vitoria-Gasteiz

2011-10-10T19:58:00.000+02:00

Yesterday we had a surgical session at Clinica CEMTRO, where we operated several patients. This time we enjoyed the visit of a group of urologists from Hospital Santiago Apostol, from Vitoria-Gasteiz.

I could demonstrate to them a case of anatomical vaporization of the prostate and another case of Greenlight laser enucleation. We had a great time as they already have a big experience with the use of the GreenLight HPS 120 watt laser and are now going to start using the new GreenLight XPS 180 watt laser and we could share experiences and knowledge.

Surgery with Dr. Gastón at Clínica CEMTRO

2011-10-08T19:37:00.000+02:00

The morning of the 8th I woke up early in Sofia to return to Madrid. And from the airport I went to Clinica CEMTRO where we operated with Dr. Richard Gaston in the morning.

Dr. Gaston is maybe the most important expert in the world in laparoscopic radical prostatectomy and has been a member of our team for five years, coming every month to operate with us to Clinica CEMTRO.

In this occasion Dr. Estefanía Romero and I helped him. Dr. Romero was trained in Bordeaux with Dr. Gaston.

I was impressed when Dr. Gaston decided not to leave a drain in the patient, a usual thing to do after a radical prostatectomy, and this allowed the patient to be discharged the following morning, because he was feeling perfectly well.

New surgical session in Sofia

2011-10-08T19:27:00.000+02:00

The 6th and 7th I worked in Bulgaria, operating at the Hill Clinic of Sofia. We had a lot of patients and little time to operate them, so it was an intense surgical session, with patients with big and difficult prostates, but we could operate all of them successfully.

These two days were the last days of good weather in Sofia... I returned from there and it started to snow over Vitosha mountain.

Visitors from Sweden and Italy

2011-09-27T10:13:00.000+02:00

In this occasion we had two days of surgery to demonstrate the techniques of Greenlight anatomic vaporization and Greenlight enucleation to our important visitors from Sweden and Italy.

I demonstrated how it is possible to ensure the full removal of the adenoma by the use of the Anatomic Vaporization technique in different types of prostates. Finally I performed a GreenLight Enucleation in a massive prostate, which was very difficult and demanding, but we managed to finish the procedure successfully by performing the morcellation of the adenoma inside the prostatic capsule.

We love to receive visitors and to share our knowledge with other colleagues!!!

Trip to Bérgamo

2011-09-22T09:58:00.001+02:00

I took an early flight to Bergamo, Italy, to spend the day with Dr. Ivano Vavassori, one of the best surgeons in Europe in the treatment of BPH with laser. I witnessed four surgical procedures that he brilliantly completed. A good opportunity to compare the differences and pros and cons of Holmium laser enucleation and GreenLight laser enucleation, and to learn from a true master of surgery.

I am always impressed to see the surgeons that by working hard and passionately achieve perfection in the execution of surgical procedures. Dr. Vavassori is on top of that a delightful human being.

Roadshow in Perú

2011-08-13T01:39:00.001+02:00

This month of August I travelled to Perú to participate in various courses with live surgical transmissions as well as to give some lectures.

I started in Lima with two days of surgeries (7 patients) at the Clínica San Borja, with Dr. Elvis Sueldo. We operated in Perú for the first time with the new GreenLight XPS 180 watt laser. I also could demonstrate the technique of endoscopic enucleation followed by morcellation (GreenLEP). I also did a presentation for the attendees, who were very impressed by the anatomic vaporization technique (that localises the prostatic capsule to ensure full removal of the adenomatous tissue), as well as by the side firing enucleation technique.

There I met, apart from Dr. Elvis Sueldo, my good friends Dr. Daniel Porto and Javier Zeballos

Then I travelled to the wonderful city of Arequipa, where we also did two sessions of surgery (6 patients), demonstrating the technique. The operations were transmitted to a room full of urologists, other specialty doctors and nurses interested in learning about this technique.

In arequipa I also took part in the National Congress of the Peruvian Urological Association. I participated with a lecture on GreenLight Laser, stressing that both the AUA (American Urological Association) as the EAU (European Association of Urology) recommend GreenLight laser as a standard option for the surgical treatment of BPH in their Guidelines.

Then I had a chance to visit Machu Picchu for a couple of days... It is one of the most impressive places I have seen, it was my second visit and I liked it even more than the first. One feels overwhelmed up there, trying to understand what would the Incas have in their minds to dare to build an impossible city in the top of a mountain...

Then I returned to Lima, where we had to operate at the Police Hospital, where I did a prostatic vaporization and the enucleation of a big prostate.

The enucleation case was a patient with a very high PSA, near 30 ng/mL, with two previous negative biopsies and a volume over 100 grams. The surgery was smooth and we got plenty of tissue for histology.

Lastly, that same day I gave a talk at the Peruvian Society of Urology. This ended my participation in this wonderful roadshow in Perú. Now I will take my holidays until September!

Foreign visitors

2011-07-21T00:48:00.001+02:00

Today we had the great honor of receiving the visit of two great urologists. Professor Lacoste, from France, and Professor Merhej, from Lebanon.

I did two procedures at Clinica CEMTRO where I could show them the technique of anatomic vaporization of the prostate, that consists in vaporizing the whole prostatic adenoma using two principles: One, capsular localization, that allows for a complete vaporization of the adenoma. Two, the use of intraoperative TRUS (Transrectal Ultrasound) monitoring of the procedure, a fantastic way of guaranteeing the completeness of the procedure.

I think both were satisfied with the new concepts. I always enjoy sharing my experience with my colleagues.

Talk in Gran Canaria

2011-07-17T13:14:00.002+02:00

This Friday I came to Gran Canaria hosted by my friend and great urologist Dr. Juarez del Dago, that had organised a conference for medical practitioners on the treatment of BPH (benign prostatic hyperplasia) with the GreenLight Laser.

I was interviewed by the regional TV channel. I tried to explain how fast BPH surgery is changing worldwide, and how today the classic surgical approaches for the treatment of BPH, open surgery and TURP (transurethral resection of the prostate) are losing favor and are becoming obsolete. I also explained that the American Urological Association and European Association of Urology recognize this fact in their latest guidelines.

Surgical Session with Dr. Gaston

2011-07-12T20:53:00.000+02:00

Today we operated at Clínica CEMTRO with Dr. Gastón and Dr. Estefanía Romero, we had programmed three laparoscopic radical prostatectomies and a laparoscopic partial nephrectomy. It has been an intense session and extremely interesting. Dr. Gaston is a true master, one of the best surgeons if not the best in the planet for radical prostatectomies. Dr. Romero studied with him in Bordeaux and follows his steps very closely, she is a wonderful surgeon!

It is scientifically proven that the experience of a surgeon with an operation, e.g. the number of operations he has performed, or performs monthly, determines the rate of complications and the goodness of results. It may seem a simple thought but many patients do not know, or do not give it enough importance. The more experienced the surgeon the best results and the less complications their patients experience.

Many patients tell me "I want to be operated with laser" or " I want to be operated with laparoscopy". It is clear that a minimally invasive operation sounds more attractive than and old fashioned one, but, ¿who is the surgeon who will perform the operation? This is the key question.

This only pushes me forward to pursue my way of hyperspecialisation in laser surgery for BPH (Benign prostatic hyperplasia). To try to reach perfection in the execution of an operation, for the benefit of my patients.

Foreign visitors

2011-07-08T12:20:00.001+02:00

I was lucky enough today to receive the visit in our theatre in Clinica CEMTRO of two Swiss urologists,
Dr. Matthias Zimmermann (University Hospital Zurich), Dr. Werner Hochreiter (Hirslanden Klinik) and a Spanish colleague from Vitoria, Dr. Guevara.

We did three GreenLight operations in patients with big prostates, that were smooth. Two of them were GreenLight Enucleations, another one was an anatomic vaporization of the prostate. A very interesting session as Dr. Hochreiter (smiling on my right side) developed years ago the Mushroom technique for enucleation followed by bloodless transurethral resection of the prostatic lobes, joined to the bladder neck by a small pedicle. A highly experienced man with a lot of experience in Holmium laser surgery as well as greenlight. We had very interesting conversations.

The patients did very well and were discharged the following morning, so I can rest this weekend for a change!

Surgeries in Sofia, Bulgaria

2011-06-26T12:04:00.011+02:00

This weekend I went as usual every month to Sofia, Bulgaria. We operated at the Hill Clinic many patients with big sized prostates, or "bulgarian prostates" as we use to joke.

The GreenLEP technique is mature now, and we can operate these prostates with safety, removing the whole adenoma. We separate it from the prostatic capsule and push it to the bladder, and we extract it with a special device that allows fragmentation of the adenoma and extraction of the tissue through the uretha, without having to make any incission. I have a great time in Bulgaria, we have this intense surgical sessions, patient after patient, that I enjoy so much. Five surgeries in one day with prostates ove 100 grams is quite a working session.

This sunday I had time to walk a round Sofia in the evening, and I realised it was the aniversary of the death of Michael Jackson, time flies so fast!!!

Surgeries in Santander

2011-06-23T11:43:00.000+02:00

Today I flew to Santander to help Dr. Alberto Asensio and Dr. Chema Monje to familiarise themselves with the new GreenLight XPS 180 watt laser. We did two operations in patients with relatively big prostates that were uneventful. It was a very nice and productive session.

Then I rushed to the airport with very little time and in the boarding lounge shop I saw the sold "Sobaos Pasiegos", that brought back memories from my childhood. My mother was born in Santander and lived in El Astillero, and the emotion was so intense that I could not help eating one. Upss, I have to start my diet again...

Portuguese National Association Congress

2011-06-17T10:22:00.000+02:00

Thursday night I left Madrid to Oporto, and from there I was taken to Esposende, a turistic area where the Annual Congress of the APU (Portuguese Urological Association) was being celebrated.

My contribution was to participate in a symposium on GreenLight Laser for the treatment of Benign Prostatic Hyperplasia. The only free moment was early in the morning. I had a chance to walk in this wonderful beach. Then I returned to Madrid. I had to operate on Friday afternoon.

Live surgery in Paris, France

2011-06-11T12:41:00.003+02:00

This time I was invited to participate in the congress "Challenges in Endourology", that took place in Paris.

My role here was to perform a live surgical intervention that would be transmitted live to 400 urologists from all over the world. Also I participated in a video session where I had to present a video, right after surgery.

First I demonstrated the GreenLEP technique, the GreenLight Enucleation of the Prostate in a patient with a prostate weighing 100 grams. The operation was uneventful and there was no special incident. I could complete enucleation and morcellation and extraction of the adenomatous tissue in under 70 minutes. I received many questions from the floor and I was answering them while I was operating. In the photo, with Prof. Alexander Bachmann by my side.

Then I rushed to the hotel where the congress was being celebrated. I presented a video also on GreenLight Enucleation and I answered the questions they did to me. Attendees were very impressed with a prostatic enucleation with the GreenLight XPS 180 watt laser, with the absence of bleeding, with the fact that I enucleated the adenoma in one piece, with a side-firing fiber... they did not imagine this was possible.

Then I came to Madrid, happy after the meeting in Paris. During the last eight years I have lived dedicated to this, with a lot of sacrifice and a lot of passion for prostatic surgery. Devoted in body and soul to improve my technique to be able to offer it to my patients, and to be able to teach it to my colleagues so they can offer it to their patients... I felt the whole effort was worth it.

First GreenLight Surgeries in Belgrade, Serbia

2011-06-05T19:45:00.001+02:00

This is the first time I visited Serbia. I was invited to inaugurate the first GreenLight XPS laser in this country.

First I gave a talk at the prestigious Urology Clinic at Belgrade, maybe one of the biggest urological centers in Europe (if we do not count Rusia), if my memory is correct, with 120 urology beds.

Then I went to the surgical theatre to perform three surgical operations, two vaporizations and one enucleation in one patient with a huge prostate.

The following day we woke up early to go to the Serbian National television where we participated in an interview on this new method to operate patients with symptoms secondary to benign prostatic hyperplasia.

Then I did other four operations, three vaporizations and another enucleation of a huge prostate.

I really liked serbian urologists, great surgeons in a not so privileged environment, with hunger for new technologies and an impresive thirst for learning.

Roadshow in Portugal

2011-06-02T11:58:00.001+02:00

This week I travelled to Portugal, with the intention of carrying out workshops in three hospitals. One was in Figueira da Foz, another one in Braga and finally in Oporto. For different reasons we could not operate int he first two, and we only managed to operate in the third, Hospital San Joao in Porto.

There I performed three surgical operations on patients with Benign Prostatic Hyperplasia (BPH), with the GreenLight XPS 180 watt laser. I did two vaporizations and one enucleation. The local urologists were amazed. They want to come to visit in Madrid to see if they can learn the procedure. Some days later they told me patients were all OK.

We went all for lunch a wonderful beef steak and then I rushed to the airport. I had to travel to Serbia to help launch this new laser in this country.

Surgeries in Bulgaria

2011-05-29T11:42:00.000+02:00

Again I travelled to Bulgaria to operate during the weekend at Hill Clinic in Sofia. This city really shines differently when the weather is good and there is sun...

We had three days of surgeries with 13 patients. The session really worked out well and we had no problem with the patients. The operations were fast and efficient, and the prostate sizes were not small!!!

This is the board at the entrance of the surgical theatre... with the patients list for two of the days. Not specially small prostates!!!

Second meeting of the Iberoamerican Group of Laser in Urology

2011-05-23T22:03:00.002+02:00

The second meeting of the GRILUR (Grupo Iberoamericano de Láser en Urología) took place in Lima, Perú. We gathered there to discuss advanced techniques with GreenLight laser. Dr. Jorge Saldaña, from Lima, organised the meeting, with great success.

I took the responsibility of performing five surgeries with the GreenLight laser, I did five GreenLEPs (GreenLight Enucleation of the Prostate), to be able to explain the step by step way to perform it to the attendees, who were very interested in starting this in their work centers. All the operations were uneventful, it is a mature technique, and very reproducible, and all the attendees understood the advantages and peculiarities of this technique over conventional vaporization.

All the group attending GRILUR 2011, after the surgical marathon. Dr. Alexis Alva, Dr. Daniel Porto, Dr. Cesar Quincot, Dr. Luciano Nuñez, Dr. Dario Soto, Dr. Marcelo Borghi, Dr. Jorge Saldaña, Dr. Javier Zeballos, Dr. Elvis Sueldo, Dr. Fernando Gomez Sancha, Dra. Saskia Suarez, Dr. Ricardo Yepes, Dr. Carlos Zuñiga.

The second day we discussed the future of GRILUR, up to now it was a meeting of friends interested in exchanging experiences and knowledge on the use of lasers in urology.

Dr. Saskia Suarez, Dr. Ricardo Yepes, from Ecuador, with ample experience in the use of the GreenLight Laser, are in charge of organising the next GRILUR meeting in Quito, Ecuador, in July 2012. On my left hand side, Dr. Jorge Saldaña, organiser of this year's meeting.

We decided to push the group forward, so every year we will cellebrate an annual meeting where we will offer live surgical demonstrations and scientific presentations to allow to compare different kinds of lasers used in urology, for the treatment of benign prostatic hyperplasia and urinary stone disease. If any spanish or southamerican urologist wants to join the group, please contact us at GRILUR@googlegroups.com.

Surgeries in Policlínica Guipuzkoa

2011-05-20T10:30:00.000+02:00

Yesterday I took an early flight to San Sebastián, to go to Policlínica Guipuzkoa with my friends and great urologists Dr. Azparren and Dr. Madina. They are very experienced laser surgeons and wished to see the new GreenLight XPS in action.

We had a great time together and everything was uneventful. I returned to Madrid to pack, I have to fly to Lima now.

New published paper

2011-05-20T10:21:00.000+02:00

I just received the paper we have had published at Urodinámica Aplicada, a prestigious journal of the SINUG (International Society of Neurourology and Urogynaecology). It is the result of our collaboration with Dr. Fernando Itza (pelvic pain expert), Dr. Daniel Zarza (neurofisiologist) and Lydia Serra (physiotherapist specialised in chronic pelvic pain) in the treatment of patients with Chronic Pelvic Pain Syndrome.

American Urological Association Annual Congress: Washington DC

2011-05-17T17:42:00.000+02:00

This time the AUA congress took place in Washington DC.

In this occasion I had three things to do:
First, I participated in a course on advanced techniques with the new GreenLight XPS 180 watt laser, with Prof. Oliver Reich, from Munich.

Second, I participated in a Symposium on lower urinary tract symptoms due to bening prostatic hyperplasia, in front of more than 100 urologists from all over south america, with Dr. Mark Spearman, a very well known Guru of this subject from the UK.

And finally, we presented our work at the congress, a summary of the IGLU's (International GreenLight Users Group) experience with the new GreenLight XPS 180 watt laser.

Many dinners, meetings, courses, bumping into friends, new projects and ideas, the AUA congress is always fun and nice, and a good opportunity to update oneself.

Surgeries with Dr. Richard Gastón

2011-05-10T10:04:00.001+02:00

As every month, Dr. Richard Gaston came with us to operate at Clinica CEMTRO. Dr. Gaston is maybe (and without maybe) the most experienced urological laparoscopist in the world. In this session we did three operations that were uneventful. Dr. Gastón is a true surgical master!

Visitors from Norway, Bulgaria and Spain

2011-05-04T17:17:00.000+02:00

In this occasion we received the visit of Dr. Vyturys Svedas, from Norway, Dr. Anakievski, from Bulgaria and Dr. Ricardo Esteban. We did two cases, a normal vaporization and a GreenLEP procedure and then we went out for some flamenco. This time I forgot to take a photo for the blog ;-(

Surgical workshop in Navarra

2011-04-14T14:47:00.001+02:00

This Thursday I flew early to go to the Hospital de Navarra, where they had prepared a scientific session with theoretical talks and live surgery on the treatment of benign prostatic hyperplasia with the new greenLight 180 watts. We had a great time and I had time to return to Madrid that day.

Surgeries in Bulgaria

2011-03-28T20:28:00.000+02:00

Again I spent the weekend in Bulgaria, operating at the Hill Clinic in Sofia, with Dr. Iliya Kalchev.

We operated a lot over the weekend, and then we were invited to the National Bulgarian TV, where we were interviewed on the GreenLight Laser treatment for benign prostatic hyperplasia (BPH).

Interview in Bulgarian TV from Fernando Gómez Sancha on Vimeo.

Then on tuesday I returned to Madrid, as I had to operate in Clinica CEMTRO.

Surgeries in Gran Canaria

2011-03-25T20:07:00.000+01:00

On thursday evening I flew to Gran Canaria to meet again my good friend Dr. Juarez, an expert in the treatment of benign prostatic hyperplasia with GreenLight laser. In this occasion I was going to accompany him in his first cases with the brand new GreenLight XPS 180 watt laser.

We performed two operations that underwent wonderfully well and then we went out for lunch together, to get an update in our respective lifes.

Then I came to Madrid in the afternoon, the following day I had to fly to Sofia for another surgical session at the Hill Clinic.

World Premiere of "There be Dragons"

2011-03-23T19:46:00.000+01:00

This Wednesday I was fortunate to attend the World Premiere of the brand new movie "There be dragons", directed by Roland Joffé (director of "The Mission" and "The Killing Fields"), produced by my brother, Ignacio Gómez-Sancha. It is first released in Spain, and soon in the rest of Europe, America, and the rest of the world.

Olga Kurylenko, Roland Joffé and Ignacio, in the presentation of the Movie

I feel so proud of him and of the amazing job he has performed in the production of this movie that I decided to pay tribute to him from here.

During the las two years I have witnessed the hardships and the immense efforts that Ignacio and his family have endured in the production of this movie. The combined efforts and genius of the director, the actors and the rest of people involved in this project have given birth to a true work of art.

I recommend the movie wholeheartedly, regardless of your beliefs or inclinations, because I believe it will leave a footprint in you, as it has already done in me.

Ignacio has proven to me again that great achievements, those who are really worth it, are only reached with passion, dedication and effort without measure, with deep love and respect for one's job and devotion for his loved ones. Congratulations Ignacio!

European Association of Urology Congress - Vienna

2011-03-20T19:02:00.001+01:00

This weekend I travelled to Vienna to participate in the European Association of Urology (EAU) Annual Congress. I participated in a Symposium on the surgical treatment of benign prostatic hyperplasia (BPH) with Drs. Alexander Bachmann (Switzerland), Oliver Reich (Germany) and Llorente (Spain). Very important data was presented on the results of a comparative study between transurethral resection of the prostate (TURP) and GreenLight HPS (120 watt) laser treatment carried out at the Fundación Hospital de Alcorcón from Madrid. Also we communicated the first worldwide results of the GreenLight XPS 180 watt laser from the IGLU (International GreenLight Users Grup), where I had collaborated with our results at the ICUA (Institute of Advanced Urological Surgery, in Madrid).

There was a lot of public and there was a great interest in the results of the new GreenLight XPS. I presented a comparison between the HPS laser and the XPS laser, to demonstrate the great advantages of this new laser. Although there is no voice-over, this short video shows the difference in efficiency of vaporization. The new laser is probably between 2-3 times faster than the HPS, and as the new Moxy fiber does not degrade during the procedure, it is possible to obtain a better performance with the energy used.

Comparison GreenLight HPS vs XPS from Fernando Gómez Sancha on Vimeo.

Then I returned early to Madrid, the following Monday I had to operate some patients.

Visitors from Israel

2011-03-02T02:02:00.000+01:00

Today we were honoured to host Dr. Gabriel Gilon, from the Rabin Medical Center Bellinson, Tel Aviv, accompanied by Mr. Sam Goldberg. Both were very interested in seeing greenlight laser prostate operations. This afternoon they witnessed three operations that were really smooth and succesful. I explained to them the anatomic PVP technique, that ensures a complete removal of adenomatous tissue.

I think they were impressed and to celebrate the success of the day we went out for dinner and some flamenco!

Visit of Dr. Joao Pippi Salle

2011-02-27T20:40:00.001+01:00

This weekend we received the visit of Dr. Pippi Salle, who came to Madrid to operate with us a one year old boy with a severe congenital malformation of the penis. He and Dr. Enrique de la Peña, the pediatric urologist of our team at the Institute of Advanced Urological Surgery, operated the boy with success at Hospital NISA Pardo de Aravaca, in Madrid.

Dr. Enrique de la Peña with Dr. Pippi Salle after the operation

Dr. Pippi Salle is one of the geniouses of current urology, he has described several surgical procedures and is one of the most respected pediatric urologists worldwide. He is originally from Brasil, but works in Toronto, Canadá.

Then, as we always do when we receive visitors, we took Dr. Pippi Salle to have dinner at Restaurante Botín, and then to the flamenco show at Casa Patas, that was magnificent!

Invitation to speak at the European Congress

2011-02-25T10:59:00.000+01:00

I have received an invitation to speak on GreenLight Laser surgery for BPH at the European Association of Urology Annual Congress that will take place in Viena next month. I will be there to tell our experience with the new GreenLight XPS 180 watt laser!

Visitors from Morocco

2011-02-24T17:18:00.001+01:00

This week we received visitors to Clínica CEMTRO, Dr. Saadallah khalid, Dr. Benjellorin Saad and Dr. Fekkak Hamid, from Casablanca. I showed them the current technique for Greenlight vaporization of the prostate and they could clearly see the difference between the 120 watt GreenLight HPS system and the new 180 watt GreenLight XPS. We saw very interesting cases.

Then I took them to Casa Patas to see some flamenco, we had a great time!

More visitors... this time from Spain

2011-02-17T19:16:00.000+01:00

This week we were honored by the visit of colleagues from Hospital Fundación Jimenez Díaz, Madrid, and Hospital Rio Hortega, Valladolid.

I showed them how the new GreenLight XPS allows to perform a good prostatectomy even in very large prostates.

The last case was quite impressive. The patient had a very big prostate and was a high risk surgical candidate. He had a giant intravesical median lobe. We applied a mixed technique, vaporizing first the anterior and lateral part of the adenoma with a Moxy fiber, that allows to work at 120 watts, vaporizing very fast. I took a lot of care in preparing very well the area near the urinary sphincter, and then we proceeded to enucleate all the median lobe with a 2090 fiber, more resilient to mechanical force and ideal for enucleation. We worked at 80w-vap/40w-coag to enucleate the median lobe. After it floated freely in the bladder we extracted it with the Piranha morcellator from Wolf. I think we extracted about 60 grams of tissue... and at the end of the procedure we had used 500.000 joules. This mixed technique, using vaporization first and enucleation next is very interesting, because enucleating the median lobe after the vaporization of the lateral and anterior tissue is a piece of cake.

On the ohter hand, this type of technique would allow many surgeons who use GreenLight to face bigger prostates with better results, and it is not as difficult as the complete enucleation of the adenoma. Maybe also this initial preparation of the sphincter allows for a very low rate of sphincteric continence.

The following photos illustrate the completeness of the procedure.

Pre and postoperative transrectal ultrasound, longitudinal view

Pre and postoperative transrectal ultrasound, transverse view

New surgical session in Bilbao

2011-02-04T11:17:00.000+01:00

Again I took a plane to go to Bilbao. We had programmed a session with two operations. Two patients with symptoms of benign prostatic hyperplasia (BPH) with two 80 cc prostates. We used the new GreenLight XPS 180 watt system. Both surgeries were uneventful.

Then I returned to Madrid rather early, to rest for the weekend.

Trip to Valladolid to learn to use the UROLIFT System

2011-02-01T10:55:00.003+01:00

This afternoon I took the high speed train to Valladolid, to learn to use the new Urolift System to treat mild symptoms of benign prostate hyperplasia (BPH). I had known about this system before from my friend Dr. Henry Woo, from Australia, who was involved in the first trials in humans with this new system. It is also being evaluated at the Hospital del Rio Hortega, in Valladolid, and I was invited to see how Dr. Marcos Cepeda implanted this system in two patients.

It is a new concept for the treatment of lower urinary tract symptoms suggestive of BPH. It consists in applying two, four or six sutures with a special applicator, under local anesthesia + sedation into the prostate, and these compress the prostatic tissue opening the prostatic urethral lumen to facilitate micturition. The application was rather straightforward.

The main advantages of this system are: it is a minimally invasive system, with very low risk. It benefits younger patients, with smaller prostates, with moderate symptoms and it has the advantage of not altering ejaculation, a specially important issue in younger patients.

The disadvantages are for me that it is quite expensive and that there is a limited clinical experience published yet. My friend Dr. Woo tells me that it does not benefit all patients treated, but in those who benefit it is an elegant solution and long lasting, which prevents from having to receive medical treatment for years. He calls it "the surgical pill", precisely because it is a minimally invasive intervention that can substitute medical treatment.

We sill see how it goes. It is available right now at the Institute of Advanced Urological Surgery in Madrid.

World Congress on Controversies in Urology, Paris, France

2011-01-31T19:56:00.001+01:00

This weekend I went to Paris to participate in the IV World Congress on Controversies in Urology. I participated in a symposium on GreenLight Laser treatment for BPH. It was very interesting and there was a lot of participation from the public. Paris was wonderful, as always, but it was freezing.

This photo shows us just before the symposium, with Drs Bachmann (Basel), Reich (Munich), Alivizatos (Athens) y Thomas (UK).

Then I returned to Madrid, I got a terrible cold in Paris ;-(

Surgeries in Bilbao, Hospital de Basurto

2010-12-23T10:28:00.002+01:00

Last thursday I took a plane early in the morning to go to Bilbao, to the Hospital de Basurto, to perform a surgical demonstration of the new GreenLight XPS 180 watt laser. We did two cases in the morning and the residents could perform most of the operations. Then Dr. Unda took me out for lunch "the vasque way". I like so much the Vasque Country ;-) Then I returned to Madrid to start my holidays!!

Visitors from Saudi Arabia, Lebanon and Galicia

2010-12-15T10:19:00.003+01:00

This week we had two days full of GreenLight surgeries and we received visitors coming from Saudi Arabia, (Dr. Maher Moazin, from Hospital King Fahd Medical City and Dr. Ali Bin Mahfooz, from King Faisal Specialist Hospital), from Lebanon (Dr. Fouad Honeine) and from Galicia, Dr. Andrés Rodríguez Alonso, from Hospital Arquitecto Marcide, in Ferrol.

Training in Casablanca

2010-12-08T10:10:00.002+01:00

This time I travelled to Casablanca to participate in the training of Professors Abdennabi Joual and Rabii. They had recently visited Madrid to see GreenLight XPS laser operations.

We did five operations that took place without any trouble. Then we went to a local hotel for a press round because this is the first GreenLight laser that is installed in Morocco. Sadly I had no time to visit Casablanca...

GreenLight XPS 180 watt laser: Anatomic PVP Technique

2010-12-04T17:36:00.000+01:00

Here I am presenting a new technique, the "Anatomic" PVP that aims to remove the whole adenoma from the prostate by localizing anatomical landmarks that will help achieving this goal. This enhances the durability of the procedure and achieve lower PSAs postoperatively.

I hope you enjoy, comments are welcome!

GreenLight XPS 180 watt laser "Anatomic" Photoselective Vaporization of the Prostate from Fernando Gómez Sancha on Vimeo.

Presentation of the new GreenLight XPS laser in Spain

2010-12-03T16:15:00.001+01:00

This Friday I participated in the official presentation of the new GreenLight XPS 180 watt laser that took place at the University Hospital Fundación Alcorcón, in Madrid.

One of the talks was about how to apply the basic science to clinical practice. I used a new tool to make presentations called PREZI, that allows for online publication. Logically this is only the presentation, but not my voice explaining it... but it is certainly remarkable and that is why I publish it here (you will see it better if you click on more on the lower right and choose full screen).

Fisiopatología del láser on Prezi

Surgeries at the General University Hospital in Valencia

2010-11-25T15:55:00.010+01:00

This thursday I took an early flight to go to Valencia. I had to show the new GreenLigth XPS 180 watt laser. There I met my old friends Dr. Emilio López Alcina and Dr. Enrique Illueca.

The hospital was in a messy state, as they are refurbishing, but the surgical session was fantastic. We did two operations during the morning that were very succesful. Then I returned fast to Madrid. This laser is impressing everybody that gets to see it in action.

More surgeries in Sofia

2010-11-20T15:59:00.003+01:00

This weekend I was in Sofia. We had to operate on saturday and sunday, we had seven patients.

On Sunday we finished somewhat earlier than usual and Dr. Kalchev took me to see the Vitosha mountain, a wonderful place that belongs to the Balkan mountains, just near Sofia, where bulgarians use to sky in the winter. There was no snow yet, but one could feel that soon it will be really cold there.

It is an old vulcano, and it had this massive rocks flowing down... impressive!

On Monday I returned to Madrid early in the morning.

Live surgery in Santiago de Compostela

2010-11-19T08:20:00.001+01:00

Thursday night I flew to Santiago de Compostela, the next morning I had to perform a live procedure on a patient with benign prostatic enlargement using the new GreenLight XPS 180 watt laser. The operation was transmitted to the meeting room at the Hospital de Conxo, where the congress was held.

The operation was uneventful and I could show the anatomic vaporization technique, in which the surgical capsule of the prostate is found to make sure that the adenoma is vaporized to completion.

Then I had to do a long trip Santiago-Madrid-Milán-Sofia to arrive in Sofia that same night.

Surgeries in Valladolid

2010-11-12T09:06:00.001+01:00

This friday I went to Valladolid, to operate with Dr. Amón Sesmero, in the new Hospital Rio Hortega. A very impressive hospital, with very modern installations and all high quality.

As it is happening in many public hospitals now in Spain, they are considering the acquisition of a GreenLight XPS 180 watt laser. We did two operations and they could see the speed of this new laser and how it is perfectly possible to perform a "down to capsule" prostatectomy, a true endoscopic adenomectomy.

We had a great time, then I returned to Madrid, I had to see patients and operate in the evening.

Trip to South Africa

2010-11-05T08:48:00.000+01:00

From Beirut I flew to Johannesburg. I flew during the night in one of the new Airbus 380, an impressive plane.

I arrived in the morning and we went directly to Linksfield Hospital, where my friends Dr. Fisher, Barmania, Cohen and Bowden were waiting to participate in a surgical session with two cases. First I had a good shower, shave and cofee, and then we started the operations.

We talked in detail of the subtle details of technique, that are paramount to obtain optimal results.

Then we went out for dinner and the next day we went to the Welgevonden Game Farm, an amazing Game farm. There we spent two wonderful days driving in the park and spotting wild animals.

We also saw Bushmen paintings on caves, really impressive.

A wonderful trip. South Africa is a really amazing place. (All animal photos are copyright Rai Landau).

New trip to Beirut

2010-11-02T08:04:00.000+01:00

Again I was invited to go to Beirut. This time we were inaugurating a GreenLight unit in the Hospital du Levant. I flew through Paris and Air France lost my luggage where I carried my surgical instruments. Luckily we could find another set of instruments rather fast and we could perform four operations throughout the day. We also had time to meet the press. All cases went very well.

From there we went to Hospital Bahman to give a talk. Many urologists, radiologists and general practitioners attended. Then I went to the airport to finally get my luggage and then I took a flight to Johannesburg.

Surgeries in Vitoria

2010-10-29T07:04:00.001+02:00

This time I went to Vitoria in the north of Spain to help Dr. Javier Extramiana and Dr. Alberto Marquina with their first experience with the GreenLight XPS 180 watt laser. We did two operations that were very successful. Then I came back to Madrid very fast, I had to operate that evening.

Surgeries in Fundació Puigvert

2010-10-19T13:54:00.001+02:00

This morning I went to Fundació Puitvert, invited to assist Dr. Montlleó and Dr. Ponce de León with their first contact with the GreenLight XPS. We did two operations that went wonderfully and everyone was amazed to see the speed of vaporization of this new laser, and how this speed is maintained throughout the procedure. Then I came back to Madrid to prepare my luggage to fly to the USA.

Congress of the Italian Urological Society

2010-10-18T13:36:00.001+02:00

In this ocassion I went to Milán to participate in a symposium on GreenLight that took place during the Congress of the SIU (Societá Italiana de Urología).

I presented the new GreenLight XPS laser and I had to talk about GreenLEP (Greenlight laser enucleation of the prostate), that generated a lot of interest.

I Learned that I have received invitations to participate in various congresses this year.... It is going to be a busy year. When the symposium finished, I went out for dinner and took a plane to Barcelona.

Trip to Bulgaria

2010-10-17T13:18:00.001+02:00

Again I travelled to Bulgaria to perform more surgeries. In this session we operated 12 patients from friday to sunday. All of them had huge prostates. We did 11 enucleations that went very smoothly. Dr. Kalchev confirmed later that all patients were alright.

I am working on the concept of performing an en-bloc enucleation of the adenoma, and not in two or three pieces. Almost all enucleations in this session were en-bloc. The great advantage of this attitude is that it is extremely fast. In some of these patients the enucleation time was under 30 minutes. Of course, later on one has to proceed to morcellate the adenoma, that also takes time depending of its size.

A very interesting and nice surgical session. On Monday morning I flew to Milan, to participate in a symposium of the Italian Urological Society.

Visitors from Lebanon and Morocco

2010-10-05T08:28:00.011+02:00

This time we received the visit of two urologists from Morocco and three urologists from Lebanon, also very interested in seeing the new GreenLight XPS laser in action.

I organised two surgical sessions where I could demonstrate the new laser, the anatomic vaporization technique and the basis of enucleation. They were very impressed with the surgical results we can obtain today with this laser. Probably when they start operating with this laser in their countries I will help them with their first cases.

Visit from Dr. Sahoo, from India

2010-09-28T08:14:00.002+02:00

We received in Madrid the visit of Dr. Sahoo, from India. After his experience with the Greenlight PV, he wanted to get acquainted with the newer higher power lasers and the latest surgical tips and tricks.

We first went together to Barcelona, to the Hospital Remei, where I had to support Dr. Mandaña, a GreenLight expert who was performing his first cases with the 180 watt laser. Then in Madrid we had another surgical session where I could demonstrate both vaporization and enucleation techniques.

Surgeries in Menorca

2010-09-24T07:46:00.000+02:00

This time I flew to Menorca to demonstrate how the new GreenLight XPS 180 watt laser performs. The staff at the Urology Department of the Hospital Mateu Orfila, from Mahón, leaded by Dr. Gascón received me warmly inviting me to dinner.

The following day we could check the performance of this laser in three surgical sessions. I took the opportunity to stay in Menorca until Sunday. It is a wonderful island, although it rained a lot... (I must recognize that I am being a little lazy with my camera and that the photographs are not so good).

Surgeries in Lérida

2010-09-21T07:30:00.002+02:00

I woke up early to take the high speed train to Lérida, where I had to perform some surgeries to demonstrate the new GreenLight XPS 180 watt laser. I operated two patients that went perfectly well and then I returned to Madrid.

This new laser is now much more attractive. It vaporizes tissue twice as fast, reducing surgical time significantly. I am working on a new technique, the "anatomic PVP" that allows to vaporize the adenoma completely, localizing the prostatic capsule to provide a clear anatomical reference to surgeons. I will try to present it in this year's European Congress.

Incontinence on TV

2010-09-20T20:47:00.000+02:00

After my holiday in August, this course started with an invitation to participate in a TV program. We spoke about urinary incontinence. It is always fun to participate in these programs.

http://www.rtve.es/mediateca/videos/20100920/saber-vivir---perdidas-orina-20-09-10/881722.shtml

National Congress in Lima, Perú

2010-08-07T12:53:00.000+02:00

Finally, to finish working prior to my summer holidays, I went to Lima, Perú. I had been invited to the National Congress of the Peruvian Urological Society. I had to talk about lasers and BPH and also about cryosurgery and HIFU for the treatment of prostate cancer.

During the weekend I took the opportunity to visit the city of Lima and the ruins of Pachacamac. I enjoyed thoroughly.

There I met my Peruvian friends, Dr. Elvis Sueldo, César Quincot and Jorge Saldaña. On Monday they had arranged four operations. I could demonstrate different technical variants with the GreenLight HPS laser, including the anatomic PVP and the principle of the GreenLEP technique.

We had time to perform a presentation where I commented all the aspects of basic science and surgical technique.

As always it was a great pleasure to be with them and we had a great time. They later told me that patients fared very well. I returned to Madrid a little tired, but wanting to start my holidays after a very tough year, with lots of work and travelling.

Surgeries in the Military Hospital of Ammán, Jordan

2010-08-02T12:21:00.000+02:00

I flew from Beirut to Ammán. It is a short flight, one hour or so. From the airport we went directly to the Military Hospital of Ammán, where I did two GreenLight laser vaporizations.

As we were in military instalations I did not take any photos of the hospital or the surgical theatre. The following day we had a second session with two additional cases. I was impressed with the urology department, a building with three dedicated surgical rooms, and a very capable and trained personnel, with experience in war surgery. It was a great pleasure to share two days with them.

Ammán gave me a very good impression, but I did not have time to visit Petra, a real pity... I had to go back to Madrid to catch a flight to Lima, Perú. I will return to Jordan, for sure.

Trip to Beirut, Lebanon

2010-07-31T11:37:00.001+02:00

As a prelude to my summer holidays, I went to Beirut to participate in a workshop on GreenLight Laser, that took place at the Clemenceau Medical Center, a hospital associated with Johns Hopkins Medical International.

We did six operations throughout the day, two of which were transmitted to the audience that attended the workshop. I demonstrated how to reach the prostatic capsule and perform a nearly complete vaporization of the adenomatous tissue using the new technique "anatomic PVP".

I also gave a talk on GreenLight HPS prostate vaporization and I presented the new GreenLight XPS and the new enucleation technique.

The next day I had to depart to Ammán, in Jordan, where we had programmed two days of surgery. I had a great time in Beirut, the libanese urologists are extremely nice people and we could enjoy libanese food!.

New trip to Bulgaria

2010-07-26T13:07:00.000+02:00

Again I went to Sofia, where we had a surgical session for three days, very interesting. We did many operations and some of them were really challenging, with huge glands that we managed to enucleate with success. In this photo, some of the specimens for histological analysis... I like very much this collaboration with the Hill Clinic in Sofia. All the staff are now perfectly trained and everything runs smoothly, it is a great pleasure to operate there.

Trip to Milán

2010-07-07T12:51:00.000+02:00

In this occasion I participated in a laser symposium in Milano, Italy. I watched several Holmium laser enucleations of the prostate. I am very interested in understanding all the technical variations of laser prostatic surgery. I learnt a great deal.

Talk and surgeries in Gran Canaria

2010-07-03T14:25:00.001+02:00

After the first experience with the New GreenLight XPS, I took a plane to Gran Canaria, to participate in a meeting organised by my friend, Dr. Francisco Juarez del Dago.

My role was to contribute with a talk, with an impressive panel of experts. I took my daughters with me, who had a great time. I was exhausted due to the frantic activity I had had during the month of June, but it is always a pleasure to visit Gran Canaria and to see my great friends there.

On saturday morning, Dr. Juarez had prepared two operations in Clinica San Roque and we had a very interesting surgical session. We treated to patients, one with a huge prostate and the second patient with a small one. Both went very well. The next morning we sent both patients home, happy. Later that day I returned to Madrid.

First surgery in the world with the GreenLight XPS 180 laser and the new MoXy Fiber

2010-06-30T13:19:00.001+02:00

This week I have had the pleasure to become the first surgeon in the world to use the New GreenLight XPS 180 watt laser with the new MoXy fiber. This new laser and this new fiber are a great step forward and they improve greatly what we could achieve with the previous generation, the GreenLight HPS 120 watt laser.

The plan was to evaluate this laser in 10 European Centers during the month of July. It was going to be evaluated first in Europe, because the EU approved it for clinical use prior than the american FDA.

I had the honor of being the first user worldwide!

We performed seven operations in the Clinica CEMTRO and we received the visit of various representatives from the manufacturing company, American Medical Systems, very interested to see the laser in action! Soon I will publish a video with my comments and my opinion on the new characteristics of this impressive new laser for the treatment of Benign Prostatic Hyperplasia.

We operated seven patients in two days and we could ascertain the superiority of this laser over the previous generation. It allows to operate patients with the same safety but much faster than before, almost twice as fast as we estimated in theatre. We checked with pre and postoperative ultrasound that we had done a great job extracting the hyperplastic tissue almost completely.

It is fascinating to check day by day how the vertiginous technological acceleration is impacting fully in medicine, allowing us to treat our patients safely, faster and more comfortably. It is really wonderful to be able to witness these advances first hand.

I am also happy because I have received an invitation to participate in the advisory committee of this company to participate in the development of the next generation of this laser. My role will be to help with my ideas and opinions to keep improving the treatment of Benign Prostatic Hyperplasia.

New surgical session in Bulgaria

2010-06-27T13:04:00.001+02:00

Again I travelled to Sofia to operate in the famous Hill Clinic. This time we had a very busy schedule. My friend, Dr. Luis Izquierdo, came with me as he was interested in establishing links and collaborate as well with this clinic.

We arrived on Saturday, and I went to theatre to operate two patients. On Sunday we started at 8 o'clock and we finished at 1 am the following day. We did five laser prostatectomies, a patient with prostate cancer who was treated with HIFU (The first patient in Bulgaria treated with this technique) and also a high risk patient with a huge bladder tumour. On Sunday morning we operated four GreenLight prostatectomies before I returned to Madrid.

Very hard work, but very satisfactory. I was later told that all patients did quite well after the operations.

Jornadas Gallegas de Urología

2010-06-23T12:50:00.001+02:00

This time I was also invited to participate in the Jornadas Gallegas de Urología that took place in the Hospital de Conxo. I did two prostatectomies with the GreenLight HPS 120 watt laser. Both prostates had huge median lobes, but we could operate them without any trouble. They were scheduled the day prior to my participation, we recorded both so I could offer an edited version the following morning.

I showed them the new technique that I have named "Anatomic PVP", in this technique the prostate capsule is identified to ensure that the whole adenoma is vaporized, right down to the prostatic capsule. I also presented the new GreenLight XPS 180 watt laser, that has just been presented and we will use briefly.

New visit of Dr. Richard Gastón

2010-06-22T12:40:00.000+02:00

Again we received the visit of Dr. Richard Gastón to perform radical prostatectomy in some patients with localized prostate cancer. The session was wonderful and we all enjoyed operating in the Clínica CEMTRO in the best possible conditions.

We have confirmed Dr. Gastón's next visit for the 31st of July.

Surgeries in Mallorca: Hospital Son Dureta

2010-06-20T10:58:00.001+02:00

This friday I flew to Mallorca, to demonstrate the GreenLight HPS laser in action. I went to the Hospital Son Dureta, the biggest in the Island.

They had prepared two patients with Benign Prostatic Hyperplasia (BPH) and they wanted to see the technique because they are considering acquiring a laser for their hospital. After the publication of Dr. Benejam of his experience in major ambulatory surgery in Manacor, proving that GreenLight HPS treatment of BPH is cheaper than traditional surgical treatment, public hospitals in Spain are considering this treatment more seriously.

It was a fantastic session because both cases did very well. I showed them the new technique anatomic laser prostatectomy, where the surgical capsule is clearly localized, to ensure a complete vaporization of the adenomatous tissue.

It was a specially nice session because my friend, Dr. Fernando García Montes, an international expert in reconstructive pelvic surgery, works there. He and I shared a year working at the Institute of Urology in London, where we forged a true friendship. It is so good to have FRIENDS.

AUA annual congress - AMS Launches it's new GreenLight XPS laser

2010-06-04T11:48:00.001+02:00

I have spent this week in San Francisco, where the AUA Annual Meeting was taking place. In this congress we were presenting a poster with the excellent results of the treatment of Benign Prostatic Hyperplasia with the GreenLight HPS 120 watt laser, carried out by the IGLU (Internationa GreenLight Laser Users Group).

I also participated as faculty in a training session on advanced techniques with the GreenLight, sposored by American Medical Systems, although this time I did not take any photos... vary interesting. The new procedure GreenLEP (GreenLight Enucleation of the Prostate) attracts a lot of interest from my colleagues who use the GreenLight HPS to vaporize high volume prostates.

It has been a very exciting congress, and finally AMS launched the new GreenLight XPS laser, 180 watts, that will be available soon (more information in: http://www.amsgreenlight.com)

This new laser offers:

Higher power (higher speed) with the same safety profile - 180 watts but with a thicker laser beam, with the same surgical dose as the 120 watt laser. This thicker beam will translate into higher efficacy of vaporization and shorter surgical times.
Better and more durable laser fibers, with a fiber tip irrigation system that keeps it in good shape throughout the procedure (minimal deterioration and thus, maximal efficiency), and a built in protection mechanism that makes it stop if it heats too much.
An improved coagulation.

I spent some time trying it with a bull's prostate and it really looks as if the vaporization efficiency has improved significantly. It is certainly a major improvement that will help us treat big size prostates.

On June 30th we will perform the first operations in the world with this new laser. The Institute of Advanced Urological Surgery has been selected with other 9 european centers to perform the first clinical study with this laser.

It is clear that the laser treatment of BPH was one of the most vibrant aspects of this congress. Many companies presented their new and improved devices, Holmium, various diode lasers, Thulium, each of them with their strenghts and weaknesses... no doubt, the classic TURP (Transurethral resection of the prostate) and open prostatectomy are seeing their last days of life...

Another weekend in Sofia, Bulgaria

2010-05-23T10:30:00.001+02:00

Again I travelled to Sofia, to operate at theHill Clinic where we did eight operations. It is quite tough to operate during the weekend as well, it basically means that your week lasts 15 days rather than 7.... no time to rest. The staff at the Hill Clinic is like a small family and after having worked here several times I can say I feel here as comfortable as if I was home.

In the photo with Dr. Kalchev, who pioneered the use of GreenLight in Bulgaria. After various surgical sessions with him he has acquired a very good technique and is now a proficient operator. The thing is that the complexity of the cases they receive here is really high, because patients in Bulgaria only go to the doctor if there is no other option, very late, when they already have complicated prostates, with bladder stones and diverticulums... and Dr. Kalchev, kindly lets me do these cases ;-)

New publication in Urology Times

2010-05-15T10:58:00.001+02:00

The May Issue of Urology Times is devoted to comparing GreenLight vaporization of the prostate with the bipolar electrosurgical techniques in the treatment of Benign Prostatic Hyperplasia. My contribution was to participate in a round table with other international experts that was later published in this issue of Urology Times. It is a very popular publication among urologists, specially in the USA.

Visitors in Theatre

2010-05-14T10:15:00.000+02:00

This thursday we had programmed a surgical session and we received the visit of some new employees of the company American Medical Systems, who wanted some training on GreenLight Laser Prostatectomy.

I performed two operations, a prostate vaporization and a GreenLEP procedure, and then we had some time to talk on the technique, laser basic science and its application to the procedure and the recommendations on how to train other doctors to perform these operations.

Visit from Dr. Bautrant

2010-05-13T10:01:00.000+02:00

These days we have received the visit of Dr. Bautrant. Dr. Bautrant is one of the leading experts in pelvic pain in Europe.

The chronic pelvic pain syndrome is a group of diseases caused in the pelvis, from different etiologies and different clinical presentations (perineal pain, chronic prostatitis, urethral or vaginal pain...) generally very difficult to treat successfully.

During the last five years I have teamed with Dr. Fernando Itza (a pelvic pain expert), Lydia Serra (a specialised physiotherapist) and Dr. Zarza (a brilliant neurophysiologist) and we have succeeded in reaching a specific diagnosis of the problem in the majority of patients, and also in improving or even curing some of these patients.

Dr. Bautrant came to Madrid to help us with some difficult patients and he showed us the technique for pudendal nerve release, that can be very helpful in selected patients with pudendal nerve entrapment syndrome.

Visitors from Ireland

2010-05-10T06:12:00.000+02:00

This friday I had the pleasure to receive the visit in Madrid of Mr. Keane, Mr. Thompson and Mr. McCarthy, from Ireland. They are about to launch a laser prostatectomy unit and they wanted to see procedures. It was very interesting to comment the surgical technique and all the tips and tricks I know to perform a good prostatectomy with them.

More surgeries in Caracas

2010-05-06T22:58:00.001+02:00

The following day I went to the Instituto Metropolitano Docente de Urología (IMDU), a surgical day-care center participated by 26 local urologists. I first gave a talk on GreenLight prostatectomy and then I went to the surgical theatre, where I performed two operations.

Both went very well and we could comment many of the new principles of an anatomic prostate vaporization (localization of the capsule followed by vaporization down to the capsule).

Then we ate a wonderful "Pabellón Criollo" in the hospital before we departed to the Centro Médico de Caracas, where I met Dr. Jose Manuel Pardo, current President of the Sociedad Venezolana de Urología and Dr. Leonardo Borregales. They had prepared another case for the afternoon and I performed a GreenLight Enucleation of the prostate, and we discussed the steps to follow to perform it safely.

The next day I packed and took my case to the Instituto de Clínicas y Urología tamanaco, with Dr. Juan Carlos Vargas and other well known urologists, like Dr. Dario Soto, who had flown from Maracaibo. Dr. Vargas had prepared three patients with prostates weighing 60, 100 and 120 grams. I did three enucleations in the same theatre where we presented the GreenLight Photoselective Vaporization of the Prostate two years ago for the first time in Venezuela.

Then I went to the airport, back to Madrid. It has been another intense trip, with a lot of work, but very stimulating. All the urologists I met were excited by this technique and they thought that the GreenLEP technique is a very attractive operation for patients with big prostates. I love Venezuela, everybody here is nice and warm and I always have a great time!

Trip to Caracas

2010-05-05T01:07:00.000+02:00

Last sunday I took a direct flight to Caracas. When I arrived I went to the hotel to spend the night, to start with a four day programme of surgeries in different centers.

The first day I had to visit the Centro Integral de Urologia UNO, with Dr. Gastone Valongo. Dr. Valongo has been performing greenlight operations for more than a year and he wanted to see advanced techniques, so we operated four patients and did four GreenLight prostatic enucleations (GreenLEP) throughout the day.

As this is an ambulatory center, all patients were discharged home carrying a catheter, that would be pulled out the following day in the outpatient clinic. It is very interesting to see the effect in my colleagues to realize how it is perfectly possible to enucleate prostates with this laser and with a side-firing fiber.

Then I was invited to have dinner in a wonderful Italian restaurant... we had a lot of fun and finally I went to bed very tired due to the time difference.

The following day, this morning, I went to the Policlínica La Arboleda, with Dr. Ivanhoe Acero and his team.

There I started with a lecture on GreenLight laser technique and then we did a procedure, that I started and was finished by Dr. Acero, who followed my indications to perform a perfect job.

Now I am at the Hotel, waiting Dr. Acero to pick me up for dinner. Caracas is not very safe to wander around, so I have slept for a while and I took the opportunity to write the blog. More tomorrow.

Visit from Prof. Tubaro, from Rome

2010-05-01T09:11:00.000+02:00

Yesterday we received the visit in Madrid of Prof. Tubaro, from Rome. He is a very prestigious urologist, very well known in Europe, extremely active and an international expert in BPH. He was very interested to see the GreenLight Enucleation of the Prostate. I operated two patients and we had a chance to talk about the details of the technique. He also thought this technique has a bright future and many advantages over vaporization in big sized prostates.