New surgical session in Sofia

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.