Surgeries in the Military Hospital of Ammán, Jordan

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

More surgeries in Sofia

This weekend I travelled to Sofia, we operated again during the weekend patients in the Hill Clinic, with Dr. Kalchev. This is the first time I have seen the sun in Bulgaria.... it seems the spring is finally here...