Surgical weekend in Bulgaria

Again I travelled to Sofia, for another surgical weekend. I worked hard at the Hill Clinic and then returned to Madrid.

I am always happy to know about the patients operated in previous sessions, and the feedback is fantastic, the results of GreenLEP (GreenLight Enucleation) are very good.

In this visit the marketing department of the clinic took some photos and gave me some for the blog.

In this photo during an operation at Hill Clinic. It is a very fast and efficient surgical room, it is a pleasure to work there.

In this photo with some members of the Hill Clinic team, with Drs Kocev and Georgiev in my right hand side and Dr. Bocevsky (with a white gown in my left hand side). With a blue head cover, Petia, a wonderful nurse who is really good and helps me during the operations.

Surgeries in Bergamo

Today I traveled to Bergamo, Italy, to help Dr. Deiana and Naspro with their first cases with the GreenLight XPS laser at the Ospedali Riuniti di Bergamo.

In the photo with Dr. Naspro this morning. We had very interesting discussions about the use of different types of lasers for the treatment of BPH...

Then I returned to Madrid late at night.

Surgeries in Ospedale San Antonio, Padova, Italy

Again I flew to Italy to participate in a surgical session at the Ospedale San Antonio in Padova, Italy. I did two operations with Dr. Del Bianco, on two patients with prostatic sizes of 80 cc and 70 cc, that went very well.

They have a fantastic urological surgical center, with three operating rooms only for urology.

A tough day, I departed Madrid at 6 am and returned at 12 pm... very tired!

Cirugías con el Dr. Gastón

Today we had another surgical session with Dr. Gaston at the
Clínica CEMTRO in Madrid.

He is an exceptional laparoscopist and his anatomical knowledge of the prostate and his surgical resources are unparalleled. Helping him operate is a true privilege. I had a great time operating with him and with Dr. Estefanía Romero. The surgeries were a true surgical masterclass.

He has also mentioned his intention to invite me to participate in a GreenLight laser training workshop he wants to organize in Bordeaux. It will be an enormous pleasure to collaborate with him in whatever he needs.

Surgeries in Bulgaria

I spent this weekend in Sofia, Bulgaria, where I did a surgical marathon of laser prostatectomies at the Hill Clinic. It was very cold, and Sofia was covered with snow. This was the view from the doctors resting room at the clinic.

All surgeries went very well. The GreenLEP technique detaches the adenoma from the capsule in one piece and we push it into the bladder and later we aspirate it out with a special device called morcellator. This technique has progressively evolved and is now very structured and reproducible. I am thinking this is the moment to start working on a video that describes the steps of this wonderful technique so I can publish it here.

Surgeries in Treviso, Italy

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.