University Hospital Bellvitge

Today I went to Barcelona, to perform a surgical demonstration at the University Hospital in Bellvitge, with Dr. Eladio Franco. I did two operations, a patient with a 120 gram prostate and a second case with a somewhat smaller prostate.


Everything went fine, and we had a good time. I was impressed by this urology department, with three theatres running morning and afternoon. A very high surgical volume... these hospitals benefit from the Greenlight laser, because they shorten hospital stay for prostate surgery.


Then I returned to Madrid, to get ready for my next trip. Tomorrow I travel to Holland, to the urology department at Nijmegen, one of the most prestigious places in Europe. From there I will travel to New Delhi, where I also have to operate again...

Surgeries in Mallorca

On Friday I had to operate in Madrid, I had scheduled another laser case and then I took a plane to Mallorca. A beautiful Spanish island in the mediterranean sea.

After his recent visit to Madrid to see some operations, Dr. Salvá coordinated a surgical session in the Clínica Juaneda, because a wide group of urologists who operate in this hospital will start using the HPS laser. I performed 4 operations, three patients with straightforward prostates and another very old and weak patient with a huge 120 gram prostate. All surgeries were succesful and we had a great time, the session was very dinamic and fun.


Then we went to a Vasc restaurant and we celebrated... I came back to Madrid, a little bit tired after so much action, but happy. I almost had no time to breath the air of Mallorca... one suspected there were beautiful beaches nearby, cristal clear sea waters, but I could not see them this time...

Visitors in Madrid

Today I had scheduled 4 operations with the Greenlight HPS laser in Madrid, and I had two spanish visitors. Two urologists, one from Madrid and another one from Zaragoza, who will start operating with the HPS laser soon. It is always so nice to have visitors, we always have worthwile discussions and I learn a great deal...


The truth is that more and more Spanish urologists opt for offering this treatment to their patients, I think it will not be long until this technique becomes the favourite treatment for BPH worldwide. It is certainly my first option for more than four years now...

Surgery in Clinica CIMA, Barcelona

Todau I went to Barcelona to perform a demonstration with the new HPS laser. They already use the 80 watt system and were interested in upgrading to the new HPS and wanted to see it in action. Going to Barcelona is starting to be like taking the bus to go to work...

Trip to India (III): Lecture and a Cosmic Joke

At last, the 17th, I did my lecture. It was very successful because I had devoted a lot of effort in its preparation. The presentation contained various multimedia animations and videos and I got many congratulations...


Then I could relax and my wife, who had been visiting the Guru, Ramesh Balsekar, for the previous two days, took me to see him. This enlightened man is 96 years old, and every day he opens his house to visitors from all over the world, who formulate questions. He responds clearly and without any doubt in his mind. It was a very interesting experience. He is a very intense man. Basically, he says that our destiny is predestined, we are only mere instruments of God, or the "Cosmic Law", and there is no way to change this. Therefore, we have to accept this and stop suffering. When the session was over, some of the visitors in Ramesh's house went out to a nearby bar to have a coffee. I met the young editor who publishes his books, and when I was telling him that I was a urological surgeon and that I had visited Mumbai before for laser procedures, I suddenly remembered that when I did my first surgical session in Hospital Ali Khan, in Mumbai, Dr. Chibber mentioned that I was operating a very holy man from Mumbai. Some minutes after this we were certain that I had operated Ramesh the last year. We went up to his house again to see him and to tell him. He recognized me and confessed that he was feeling very well after his operation, and gave us some books. My wife was amazed. The editor suggested that all this was a "Cosmic Joke"... the destiny had brought us all together to laugh with us...

Trip to India: (II) Training workshop

Today I had to go to a hospital in Mumbai, to mentor a local urologist. For some reason, they could not organise patients for the surgeries. So I just sat down for a couple of hours and showed videos and presentations to the urologist who will perform the Greenlight surgery in my laptop.


Later on that day, we went to the official inauguration of the congress, and all the international faculty received a present. Then there was a dinner and a party and everybody started dancing. All indian urologists use the Bolliwood style, and interestingly, Bolliwood is very nearby the congress venue.

The best part of these trips is the amount of friends one makes. In the photo with Dr. Shailesh Raina.

Trip to India: (I) Live surgery

This wednesday I took off with my wife towards Mumbai. My wife came with me because she wanted to visit a famous indian Guru, Ramesh Balsekar, who lives in Mumbai. We first flew to Amman, in Jordan, and then connected to Mumbai. Unfortunately I could not get any sleep during the flight. We arrived at 5.00 am and went to Juhu, in Mumbai, where the congress took place. It was a joint congress of the SIU (Société Internationale d'Urologie) and the ICS (International Continence Society). The congress newsletter published an interview they had done some time before...
I had to participate in a live surgery workshop at the Jaslok Hospital the first day, mentor a surgeon from Mumbay the second day, and to lecture the third day.
When we arrived to the hotel, they were waiting for us to go to the Jaslok Hospital. I had some minutes to have a shower and dring a strong coffee and there we went. I first gave a 30 minute talk while the patient was anaesthetised and then I performed the operation that was transmitted to the meeting room.


It was a straightforward case and the attendees were very impressed by the easiness and the speed of the procedure. Then I went back to sleep to the hotel...

Surgeries in Barcelona

Yesterday I went to Barcelona to operate again with Dr. Batlle at the Delphos Hospital. We did two cases that were uneventful and I went back home as fast as I could. This Friday is a holiday in Madrid, I will be able to get some rest...

Mini-Symposium in Umea, Sweden

This Monday I went to the airport, I had to fly to Sweden to participate in a Mini-Symposium and when I was checking in they told me I would not be allowed to fly to Stockholm, there was overbooking and I should stay in Madrid... I explained my situation, and that I was traveling to Sweden to perform surgeries on patients and they rang the captain of the flight, who assured me that if there was no seat available I would fly in the cabin with them. Unfortunately there was a seat available at the end. From Stockholm I flew to Umea. I arrived late and I went to bed directly, we had quite a programme for the following day.

The next morning we went to the University Hospital in Umea (Norrlands Universitetssjukhus), where I met my old friend Bengt Friedrich, I had not seen him for some years, we worked together for the European Society of Residents in Urology.

First I gave a lecture on the treatment of benign prostatic hyperplasia with the new high powered Greenlight HPS laser and then I did three consecutive operations. All cases were succesful and we enjoyed an intense surgical day. At 4 pm, when we went to the ward to see the first patient we had operated in the morning, the patient was not in his room!!! They had removed the catheter and he felt so well that he went for a walk around the hospital... this was very impressive for the Swedish doctors, they had never seen such a fast postoperative recovery.

When we finished we went to have dinner with the urologists of the department and then I flew back to Stockholm so I could return in an early flight to Madrid...

Trip to Mexico (IV): Cancun, Instructional Course and Poster Session

Later on in Cancún, I participated in other scientific activities at the World Congress of Endourology. First I gave a lecture on Greenlight laser prostatectomy at the Instructional Course on laser prostatectomy with Dr. El-hilali (Canada), Nakawaga (Japan) and Richard David (USA).

I was not wearing a tie because the congress code of conduct recommended NOT wearing ties... It seems it is normal in Cancun. Later on, in the afternoon, I moderated a poster session with Dr. Peter Gilling (New Zealand).

Centers from Greece, Switzerland, USA, UK and Germany presented their experience with the 80 watt Greenlight laser, with excellent results.

Trip to Mexico (III): Guadalajara - Live surgery for the World Congress of Endourology

This morning I woke up early to go to the Medical Center Puerta de Hierro, in Guadalajara (the Hospital where Dr. Jorge Gutierrez, the president of the World Congress of Endourology works), where all surgeries being transmitted live to Cancun would take place.

The set-up was impressive. Six simultaneous theatres, with many minimally invasive operations scheduled for the morning. In Cancun, three big screens and three moderators, to allow the more than 1200 urologists registered in the congress to choose what comments to listen to. It was very impressive to walk around the surgical theatres, world class surgeons in every one of them...

Dr. Octavio Castillo (Chile) performing a laparoscopic radical prostatectomy.

Dr. Ralph Clayman (EE.UU), performing a PCNL (Percutaneous Nephrolythotomy).


Dr. Peter Gilling (New Zealand), perfoming a Holmium laser enucleation of the prostate.

Dr. Mantu Gupta (EE.UU.), performing a flexible nephroureteroscopy.

My patient was an old man that had carried a urinary catheter since January. His prostate was relatively small and the operation took 35 minutes, but I had time enough to explain the new technique of photoselective vaporization of the prostate with the new high powered Greenlight HPS laser.


This technique was agreed at the IGLU (International Greenlight Users) Group meeting celebrated in Madrid in July. I thought it would be a good idea to name it "PVP 2.0" (Photoselective Vaporization of the Prostate 2.0) to differenciate it from the technique we used with the former 80 watt Greenlight PV laser, and to express that this technique should not aim to produce a tunnel in the prostate, but to perform a proper prostatectomy. The surgery went really well, it could not have gone better.

When I finished, my urology partner, Dr. Nacho Castillón, who was in Cancun at the convention center, sent me an SMS text message: "Fer: ha salido pfrto! ers un fenomeno, nacho". Ahh, I was so satisfied!!!. Everybody happy, the patient was grateful and I was so happy to be able to demonstrate in the most important forum in the world of endourology the fruit of so much effort and so much passion... When I was younger I was a professional swimmer, I trained very hard and I dreamt with going to the Olympic games. I felt as if I had achieved that, but in the world of Urology. It was quite an experience.
In the photo with Pilar Laguna, Octavio Castillo, Lee Roningen and Emily Smith.

Later on we went to the airport. The congress had prepare a private flight for all the surgeons that operated in Guadalajara, so we could return to Cancun as soon as possible. Then, at the hotel in Cancun, I had dinner by the beach, and I went to bed very tired, but so happy.

Trip to Mexico (II): Mexico D.F. - Hospital Angeles Pedregal

Today we did another workshop in another hospital in Mexico D.F. This time we did two operations and then another talk. Everything went fine. One of the patients was the father of a local doctor. I asked him to come to theatre to be with his father. When I went out of the operating room his family had bought me a huge bottle of the finest tequila. I will drink it (little by little) to his health!!


After finishing the training session, we went to the airport to fly to Guadalajara. That night I went to Dr. Jorge Gutierrez's house, the prestigious Mexican urologist and president of the World Congress of Endourology, who had invited for dinner to all surgeons operating live at the World Congress. There I shared the table with Jean de la Rosette, Pilar Laguna, Octavio Castillo, Gunter Janetschek, Ralph Clayman, Peter Gilling... we had a great time.

The next day I will operate a patient with BPH and the operation will be transmitted to the World Congress venue in Cancún.

Trip to Mexico (I): Mexico D.F. - Hospital Angeles Lomas

This Sunday I flew to Mexico DF. I planned to participate in a coupe of workshops in this city and then travel to Guadalajara to perform a live surgery that will be transmitted to the World Congress of Endourology that takes place in Cancún. It is a week long trip and I am very happy to be invited to such an important congress.

The first workshop took place in the Hospital Angeles Lomas. I did a talk on Greenlight laser treatment of Benign Prostatic Hyperplasia and then I performed a surgical procedure.

It was a delightful session and I had the pleasure of meeting there my old friends Dr. López Cueto, from Puerto Vallarta, the pioneer user of the Greenlight laser in Mexico, and with Dr. Francisco Barrios, also an early adopter of this technology.

I first gave a talk on Greenlight laser for the treatment of BPH.

Then we went to the surgical room to perform a procedure that was retransmitted to the meeting room. Dr. Barrios was with me in theatre and Dr. López Cueto was the moderator from the meeting room.

After the operation, we gave certifications to those attending the session and we went together for dinner.

I was impressed by the quality of this Hospital and by the human warmth of these mexican doctors.

Surgical session in Cabueñes and meeting with the press

Today I visited the Hospital in Cabueñes, Asturias. I went to see my colleagues and friends Dr. Muruamendiaraz, Cuervo and Tamargo. They pioneered this treatment modality in Asturias some years ago, and organised a surgical session and a press round.



The cases were difficult, huge prostates, purely Asturian. I had a hard time completing them, but I could manage them satisfactorily at the end, we had time to discuss the Greenlight laser with the press.

These are some links related to the pressround output...

http://www.elcomerciodigital.com/gijon/20071018/gijon/cabuenes-pedira-salud-incorporacion-20071018.html
http://www.lne.es/secciones/noticia.jsp?pRef=1794_35_568351__Gijon-Laser-verde-para-prostata

http://tv.lne.es/index.php?detector=2310&UserID=8037120181496261193121940000703500&VideoId=3546


Then we went to have lunch at 5 pm, and after that there was no need for dinner....

Weekend in Gran Canaria

Wednesday morning I departed to Gran Canaria (one of the Canary Islands) with my family. On thursday, we operated in the Clínica Santa Catalina with Dr. Juarez, the Director of the Gabinete de Urología y Andrología in Gran Canaria. Dr. Juarez had scheduled three operations with the new Greenlight HPS, two big prostates and a smaller one, that were uneventful.



We had a great time together, discussing the new technical aspects and all the tips and tricks I recently learned. The truth is that on top of collaborating professionally we have become very good friends and we will spend the rest of the weekend together with the family in Gran Canaria.

Surgery in Sevilla

This Tuesday I took the high speed train to Seville to help a colleague with a difficult case. A patient with a huge prostate.

It was kind of weird to see that in the contiguous theatre a group of urologists struggled with an open prostatectomy in a patient with BPH... I was suprised to see how in the same moment in history, in the same place, a patient received the classic treatment and another patient the modern Greenlight laser treatment. Our patient left home the morning after and the other patient will have to stay at least 5 days in hospital, and will leave anemic, after having endured the postoperative recovery of open surgery....

The operation went fine, although it was a long one (I delivered 800.000 Joules) and then I took the train back to Madrid.

Athens

After finishing my friday morning surgical list (I did two laser cases, one of them had a huge 220 g prostate) I took the plane to Athens, where I had to meet my colleagues from the IGLU (International Greelight Users) Group. We had a lot to talk about. We are working on a paper pooling our prospective experience with the Greenlight HPS laser, and also a supplement describing the technique and recommendations of use and training, that will be published in European Urology.




We used the opportunity that the congress on Innovations & EBM in Urology was being celebrated there and that Gordon Muir, Alex Bachmann and Jean de la Rossette were already there, because they were presenting data on this laser in the symposium. Oliver Reich and I travelled to see them all there. The place was really beautiful, and very close to athens.


I had a ticket to return on saturday, but the meeting took longer than anticipated and I changed the flight to Sunday. I used the opportunity to work with Gordon Muir in a paper on surgical technique we are preparing together.

Visitor from Portugal

Today I had programmed some operations in Madrid, and we received the visit from Dr. Fino Correia, from Portugal. I did two Greenlight HPS laser prostatectomies, on a 60 gram and then a 220 gram prostate in an 81 year old high risk patient. We had time enough to discuss every aspect about the technique, and I shared all my surgical tricks with him.

We had a great time, and both operations went fine. I then drove to the airport as I am leaving today to Athens, to a meeting. I found out that my plane is delayed, so I started writing this entry of the blog.

I managed to enucleate a fragment from the median lobe of the prostate and extract it with a
Boston Scientific's Zero Tip big stone extraction basket, in order to show Dr. Correia the fine line of coagulated tissue that this laser produces. I took the photo with my mobile, and it is not perfectly clear, but it is easy to see how little damage this laser causes to the prostate, and how it coagulates just enough to avoid bleeding, but not more than that.

Morning in Barcelona

Today I woke up earlier than my alarm clock. I could not sleep any more, so I decided to go to the airport taking my time and listening to nice music. We had programmed a training session with Dr. Batlle in Barcelona. As I travel quite a lot in aeroplanes, I followed Gordon Muir's advice and bought a pair of noise-cancelling headphones that are amazing, they virtually supress the background noise in the airplane. I have an iPod and I listen to relaxing music while I think and watch the sky... I specially love to see Barcelona waking up from the air, it is really special.

We have operated an anticoagulated patient with an 80 gram prostate together, everything went fine. I slept all the way back to Madrid in the aeroplane...

Montecelo Hospital in Pontevedra

After sleeping at the Parador de Pontevedra, I went to the Montecelo Hospital in Pontevedra, with Dr. Meirás and Dr. Lobato, to perform a demonstration of the new Greenlight HPS in action. I only did one case, because they wanted to see how to operate a huge prostate.


The case was very successful, but it was long and relatively difficult. I used a suprapubic drainage trocar to improve visibility during the operation. I then left to the airport and returned to Madrid.