Masterclass with Dr. Gaston in Madrid

This saturday we received a visit from Dr. Richard Gaston, from Bordeaux. He came to visit as part of an ongoing collaboration with the Institute of Advanced Urological Surgery, from Madrid. We did three radical prostatectomies in one day, and then Dr. Gaston returned to Bordeaux at 7 pm. He is considered one of the best laparoscopists in the world, invented the technique of laparoscopic radical prostatectomy, and has performed more than 2000 procedures.

In the photo, Dr. Castillón, the director of the laparoscopy unit of the ICUA, assisting Dr. Gaston. This initiative allows our patients to access being treated by a world class surgeon, while we keep on learning from the best surgeon in Europe.

Invitation to Johannesburg in South Africa

I have also received the confirmation of an invitation to travel to South Africa to help in the training of three surgeons that will perform their first cases of PVP (Photoselective Vaporization of the prostate) with a Greenlight KTP laser. I will travel to Johannesburg from July 16th-19th. They have scheduled 10-12 operations. I guess this time there will be no time for safaris, just for intense work.

Invitation to a State of the Art Congress in Belgium

Today I received the programme of a scientific meeting where I have been invited as speaker. It will take place in November in Belgium. A great honour given the high scientific level of this meeting and the prestige of other speakers: Piechaud, Stolzenburg, Marberger, Emberton, Van Poppel, Dasgupta, etc... The interest of my presentation will be to present my initial results with the new HPS system in the treatment of BPH.

New laparoscopy course of the EELU in Madrid

This weekend, the European School of Laparoscopic Urology has celebrated one of it's basic laparoscopy courses. I was invited again as a teacher. We have enjoyed a fantastic course, all alumni expressed their satisfaction with it and have registered for advanced courses. Dr. Castillón (watching the progress of the alumni in the photo above) keeps on contributing to the development and adoption of laparoscopy in Spain, congratulations!!!.

New training session at Puigvert

This tuesday, just after returning from Bologna, I went to Barcelona to participate in a training session at Fundació Puigvert. We did two cases and everything was uneventful. I believe there is only one session left before the summer holidays to conclude the training of the surgeons of this institution.

Congress of the Italian Society of Urology

Today I travelled to Bologna, Italy, to participate at the Annual Congres of the SIU (Italian Society of Urology), where I was invited to present my experience with Greenlight PV (PVP-Photoselective vaporization of the prostate). The session chair was Prof. Andrea Tubaro, a prestigious urologist from Rome, who is also a Greenlight user.
After an introduction where he has covered the basic physics of lasers, my role was to comment the technical details and surgical tips and tricks that allow for a succesful and safe operation. I have also presented the new HPS (High Performance System). Then Prof. Tubaro closed the meeting with a review of the published data on this laser. Then the turn for questions was opened and we enjoyed a lively discussion. This laser is also very hot in Italy and soon will replace TURP as the gold standard for the treatment of BPH in this country.
Tomorrow I fly to Madrid, and then will jump to Barcelona, where I will participate in a surgical training session at Fundació Puigvert.

Training session in Madrid

Today we received three visitors from Lisboa, Portugal, Dr. Correia, Severo y Gomes, who are about to start to use the Greenlight laser. We first did a theoretical session, where I explained the physical basis of this laser and the important technical details of this procedure, and then we went to theatre, where they could witness a PVP (Photoselective Vaporization of the Prostate). It is very nice to be able to receive a small group, because they allow for ample covering of all the aspects of this operation and they all have a chance to ask questions and see the procedure as it is being performed and grab all the small technical details and tricks.
Then we went for lunch to a very nice seafood restaurant, and we enjoyed the continuation of a very educative session...

Back to Barcelona

On Friday I went to Barcelona again to participate in another surgical training session at TEKNON. This time we performed three cases and everything was again uneventful. I am always impressed by the ability of this laser to operate patients without blood loss. This is a photo of the suction device that accumulates the irrigation fluid used during the operation, there was no blood at all in it.


I then went to visit Clínica CIMA, in Barcelona, because more and more patients from Barcelona want me to operate them with the Greenlight laser, but they do not want to jump to the city of Real Madrid ;-). This hospital is impressive, very modern, and my friend and prestigious urologist Dr. Vargas works there, we will very probably start a collaboration to allow me to operate those patients from Barcelona who want to be operated by me in their own city.

Training session in Barcelona

This wednesday I took a flight to Barcelona to participate in a training session in theatre at TEKNON. We operated two patients, both procedures were uneventful. I then returned to Madrid. I have to operate three of my own Greenlight patients on thursday.

Presentation of the HPS during the Spanish National Congress

Davanzia, the distributor of the Greenlight laser in Spain, invited me to present the brand new HPS (high performance system) during the National Congress Celebrated in Seville. We did it in a wonderful venue, the Hotel Alfonso XIII in Seville. I am looking forward to receiving the HPS in Madrid, apparently the first week of July. The impact of this new laser during the congress was very high.

Congress of the Spanish Urological Association, Seville.

The night of the 8th, after my trip to Paris to participate in a meeting of the Media Office of the European Association of Urology, I travelled to Seville. The morning of the 10th I had to participate at the plenary session of the Annual Congress of the Spanish Urological Association. Dr. Ojea Calvo and I had to debate TURP vs Greenlight laser, with Dr. Carlos Hernández moderating the session. We had 12 minutes to defend our technique and a 3 minute rebate turn. I was aggressive and I used some sense of humour as well, that worked out very well. The session was vibrant!! The moderator did not say who was victorious after the debate, but everybody was telling me that I smashed my opponent. So I guess at least I was the moral winner ;-).... Nothing too difficult, as TURP has nothing to do against Greenlight PV. This was my first slide...

Clínica Universitaria de Navarra

This thursday I took a flight to Navarra, in the north of Spain, to perform a Photoselective Vaporization of the Prostate. The prestigious Clínica Universitaria de Navarra, a nation-wide reference hospital in Oncology, is interested in this technique and they wanted to see it in their own hospital. They prepared a relatively difficult case, to judge the real utility of this technique. The patient had a diagnosis of prostate cancer that had been treated with external beam radiotherapy, and he had developed a urinary retention, so he could not void on his own and had to carry a catheter. But, as I anticipated, the operation was uneventful... everyone was impressed by the absence of bleeding and by the endoscopic result after the operation. I was told later on that the patient voided well without the catheter and went home, very happy. His wife could not believe he had been operated on, as the urine was so clear. This is the beauty of the Greenlight laser, it can be used in all patients, no matter how weak or difficult the patient might be...

Tomorrow I will travel to Paris, to participate in a committee meeting of the Media Office of the European Association of Urology, and from there I will fly to Sevilla, where I will participate in a face to face debate at the plenary session of the Annual Meeting of the Spanish Association of Urology, defending Greenlight Photovaporization of the prostate against TURP.

Puigvert once again

Tuesday morning I operated two of my patients in Madrid and then I took a plane to Barcelona. We are finishing the training period of the urologists at Puigvert Foundation in Barcelona. We will carry out two additional surgical sessions and they will be competent to carry on alone. It is important that they learn the technique properly, because they will soon initiate a clinical study that will compare TURP (Transurethral resection of the prostate) with Greenlight PV (Photoselective Vaporization of the Prostate). This study will not only look at clinical results, but also will take into account economical issues, performing a cost analysis. We did two cases in this session and the second one was relatively difficult, so we decided to use a suprapubic trocar to enhance irrigation and to allow us to finish the case with ease... this is a good trick for difficult cases. Then I returned to Madrid, to send the patients I operated the same morning home...

American Urological Association Annual Congress in Atlanta

Tomorrow will be the last day of the AUA Annual congress. This is the most important urological meeting in the world, and every year new tendencies and technologies are presented. I try to visit the USA every year, because here is where important new treatments and trends are presented. It has been a hard congress, because apart from attending scientific sessions, I had a lot of work.
Laserscope invited me to do two presentations on advanced concepts in Photoselective Vaporization of the Prostate. I also had the honour of being invited to participate in an informative session addressed to laserscope's investors, with Dr. Collins and Dr. Malloy, two world class surgeons and expert users of the GreenLight laser. I exposed my views on this technique and its future and I explained how fast it is being adopted by urological surgeons in Europe. There is a webcast available at laserscope's website, if anyone is interested to hear it).
Apart from that, I presented a poster on my experience with this technique in the congress. My contribution was to prove that as the surgeon gets more experience with Photoselective Vaporization of the Prostate, postoperative complications, although not serious, are reduced and also the energy used and the operative time diminish with experience.


It has been a tough but very interesting congress. I had the oportunity to try extensively the new higher power GreenLight laser, the brand new HPS system (High Performance System), and I have been able to confirm that it is an instrument far better than the KTP Greenlight laser we have been using, specially because it will make operating larger prostates much easier. After this initial experience, I have been invited to present it at the National Urological Congress in Spain, that will take place in Seville the 10th of July. Then we will take the HPS system to Madrid, where we will be able to start using it.
With 120 watts power and a colimated beam, a pedal to vaporize and another pedal to coagulate, operating with it will probably feel as driving a Ferrari. This coupled with its safety, will make the best ever existing laser for BPH...


Tomorrow I will attend the take home messages session at the congress and I will fly back to Madrid. I am desperate to see my daughters...

A dream come true: The new Greenlight HPS in Madrid !!!

Laserscope, the manufacturer of the Greenlight laser system, has announced the launch of a new device that improves the previous Greenlight laser. The new Greenlight HPS (High Performance System) improves the performance, allowing to operate patients in a shorter time. Being more powerful (up to 120 watts, from the previous 80 watts), it vaporizes tissue more efficiently. It will be a leap forward because it will allow to operate patients with bigger glands easily. It also has other advantages for surgeons and hospitals...
We had a system that had revolutionised surgery for Benign Prostatic Hyperplasia, but now we see a dream come true, we will have the definitive tool. It is great news for all patients and urologists around the world!!!
Laserscope has communicated me that the Institute of Advanced Urological Surgery from Madrid will be one of the 6 centers of the world to have access to this new system prior to it's big scale commercialisation. I will be one of the few first lucky surgeons to use this wonderful new laser!!!!
I will update this information in this blog as I get more details.

Double training session in Barcelona

Yesterday I went to Barcelona to participate in two consecutive training sessions. One took place in the Puigvert Foundation, where we operated two patients. I spent the night in Barcelona because we started a very complex case at TEKNON, a high risk cardiac patient that was operated uneventfully. Then I flew back to Madrid to prepare my case. I leave to Atlanta this thursday to participate at the American Urological Association Annual Meeting.

Puigvert Foundation II

I visited Puigvert Foundation today, in Barcelona, to participate as a mentor in a surgical teaching session. We operated two patients with the GreenLight PV technique (Photoselective Vaporization of the Prostate). We had the chance to try two new prototypes of cystoscope from a company specialised in the design of surgical instruments, so the session was specially interesting. Some surgeons very used to TURP (Transurethral resection of the prostate) need to adapt to this new technique, because the scope is handled with the left hand unlike the resectoscope for TURP. Also, the laser fiber has to be rotated in a sweeping motion that is different from the in-out excursions of the resection cutting loop. The manufacturers of endoscopes try to make this adaptation easier for surgeons adopting PVP. In an case, I thought these prototypes have a long way to improve to fulfil that goal...
I then came back to Madrid, I have to operate this saturday, my workload is increasing and most weeks I am operating 5-10 patients now.

New training session in Barcelona

Today I jumped to Barcelona to participate in a teaching session at the prestigious TEKNON hospital in Barcelona. In this ocasion we treated two patients with relatively small glands, so everything was uneventful. Today I will sleep in Barcelona, tomorrow I will participate in another session at Fundació Puigvert. My wife is here with me, so we will try to dine at Sergi Arola's restaurant at the Hotel Arts... his "patatas bravas" (hot potatos) have a reputation over here...

Virtual reality laparoscopy simulator

Today we have installed at the Institute of Advanced Urological Surgery (ICUA) a virtual reality simulator for laparoscopic surgery, with the help of Ethicon Endosurgery. Our institution cooperates closely with the European School of Urologic Laparoscopy (EELU), directed by Dr. Castillón, our laparoscopy expert.


This simulator is an amazing tool. It consists of a small robot connected to a computer that allows the surgeon to simulate a real surgery. It also allows to develop laparoscopic skills and familiarize with different instruments. The robot gives tactile feedback to the instruments, so when you use the simulator, you can feel the resistance opposed by tissues exactly as you would feel it in real surgery. The modules for intracorporal suturing are outstanding. The objective of these simulators is allowing the surgeon to train BEFORE engaging in mentored surgeries on patients. The European School will allow local urologists to use it by appointment.

Training session in Madrid

Today I had the pleasure of hosting Dr. Pedro López Cueto, from Puerto Vallarta, in Mexico. He is going to pioneer PVP in his country, being the first mexican urologist to adopt Greenlight PVP.
He came over to Madrid driving all the way down from Paris. We met at the EAU congress and he had a strong interest to come and see a PVP procedure performed by an expert. We spent some time together discussing the basics of lasers and their interaction with tissue, and the specific technical aspects of the Greenlight PVP procedure. We had one patient scheduled, who had a 110 gram prostate. So he had a chance to see a difficult case. We discussed all the tips and tricks and he was amazed of seeing a fantastic result in a patient with a relatively big prostate. The patient was discharged later that day and we went to have dinner together. We had four additional cases scheduled the following day, but unfortunately he had to go back to his country. I enjoyed very much his company and I can see he will become an important man in his country. He mentioned he would try to invite me to participate and perform a live PVP at the National Congress in Mexico in November.

European Association of Urology Congress, Paris

This month I attended the European Association of Urology Congress, in Paris. The most important urology meeting in Europe. It is always exciting to go and witness the recent advances in urology. There were a number of papers on Greenlight PVP, all very positive. I did not have time (I am quite busy, as you know) to prepare a paper for this congress, but I will do so at the American Urological Association - AUA Congress that will take place in Atlanta next month. I have also been invited by laserscope to lecture during the pre-congress and congress. I also participated in a meeting of the Multimedia office of the European Association of Urology, as a member of this office. And as faculty member of the European School of Urology, I directed a course on Multimedia and Urology. My presentation can be seen online in webcast format at : http://webcasts.prous.com/eau2006/article.asp?AID=242&CID=YY&CLID=2

Puigvert Foundation

This thursday I took a plane to Barcelona to help the urologists from the prestigious Puigvert Foundation to perform their first cases of Greenlight Photoselective Vaporization of the Prostate. This Puigvert Foundation is one of the most prestigious urological centres in europe, and they have decided to embrace Greenlight PV.
The surgical session was uneventful and I really enjoyed it. We operated three patients with relatively small prostates. One of them was a high risk patient. I then found out that the immediate postoperative recovery was very good, and that all patients were sent home without a catheter. All urologists that see this procedure live for the first time are amazed by the great advantage of operating patients with BPH without blood loss and by the extraordinary endoscopic result. I then went to the airport and took a flight to Paris, to participate at the Europan Urological Association annual congress.

South Africa Roadshow - Durban

At last we arrived at Durban. This time we took it easy as there was only one lecture scheduled. Durban is also a very attractive city from South Africa. I had the chance to walk in the beach for some time. The lecture had a great impact and most urologists working in Durban attended. PVP (Greenlight Photovaporization of the Prostate) has generated a great interest in South Africa, because while in countries as Denmark, where PVP is being performed in 14 out of 17 urology departments in that country, in South Africa this laser has just started its distribution by a prestigious company in South Africa, TecMed. These urologists were really anxious to get to know more about this technique they have read so much about. The discussion was very intense and the interest was really high.

So, this is the end of my trip to South Africa. I am very happy that I had a chance to get to know this wonderful country, and also because I have contributed to make PVP better known by my South African colleagues. I am sure also South African patients will start to benefit from it soon. I will return to Johannesburg tomorrow, where I will stay another day prior to returning to Madrid this Sunday. On Monday I will fly to Barcelona, where I will mentor the urologists from Fundació Puigvert, another very prestigious urology center that has decided to adopt PVP. That same day I will fly to Paris, to participate in the European Urological Association congress, where I am chairing a course of the European School of Urology.

South Africa has impressed me deeply. After drinking the waters of the zambeze, I think I will never be able to quench the thirst for Africa. I will never forget the night I spent with the lions, their flashy eyes and their overwhelming roars...

South Africa Roadshow - Cape Town

We took a morning flight to Cape Town. The most turistic city of South Africa. One could say Cape Town is like Marbella in Spain. The Weather was splendid, but we did not have much time to visit the city. Just after arriving to Cape Town, we went to the University Hospital, where the urology staff attended my lecture, that was followed by an animated discussion. It seems that public hospitals will take some time before adopting this technique, mainly because of lack of funds to invest in new technologies. One of the questions asked by these urologists was that with PVP there is no tissue that can be sent to the pathologist for histological analysis. I explained that if a tumor is suspected, then biopsies are indicated prior to PVP. Also I told them that when we decide to treat a patient with drugs, there is no tissue for histology...
Then we rushed out of there because at 6.30 pm we had another lecture where all urologists in private practice in the city were invited.Again I observed the same effect in the urologists attending this lecture, they were fascinated by PVP. When we were finishing the lecture we started hearing explosions outside, and when we went out to find out, a fantastic fireworks show had started. A good end for this lecture.... Tomorrow we will travel to Durban, to participate in the last lecture scheduled in this hectic roadshow.