Visitors from Morocco

This week we received visitors to Clínica CEMTRO, Dr. Saadallah khalid, Dr. Benjellorin Saad and Dr.  Fekkak Hamid, from Casablanca. I showed them the current technique for Greenlight vaporization of the prostate and they could clearly see the difference between the 120 watt GreenLight HPS system and the new 180 watt GreenLight XPS. We saw very interesting cases.

Then I took them to Casa Patas to see some flamenco, we had a great time!

More visitors... this time from Spain

This week we were honored by the visit of colleagues from Hospital Fundación Jimenez Díaz, Madrid, and Hospital Rio Hortega, Valladolid.

I showed them how the new GreenLight XPS allows to perform a good prostatectomy even in very large prostates.


The last case was quite impressive. The patient had a very big prostate and was a high risk surgical candidate. He had a giant intravesical median lobe. We applied a mixed technique, vaporizing first the anterior and lateral part of the adenoma with a Moxy fiber, that allows to work at 120 watts, vaporizing very fast. I took a lot of care in  preparing very well the area near the urinary sphincter, and then we proceeded to enucleate all the median lobe with a 2090 fiber, more resilient to mechanical force and ideal for enucleation. We worked at 80w-vap/40w-coag to enucleate the median lobe. After it floated freely in the bladder we extracted it with the Piranha morcellator from Wolf. I think we extracted about 60 grams of tissue... and at the end of the procedure we had used 500.000 joules. This mixed technique, using vaporization first and enucleation next is very interesting, because enucleating the median lobe after the vaporization of the lateral and anterior tissue is a piece of cake.

On the ohter hand, this type of technique would allow many surgeons who use GreenLight to face bigger prostates with better results, and it is not as difficult as the complete enucleation of the adenoma. Maybe also this initial preparation of the sphincter allows for a very low rate of sphincteric continence.


The following photos illustrate the completeness of the procedure.

Pre and postoperative transrectal ultrasound, longitudinal view

Pre and postoperative transrectal ultrasound, transverse view

New surgical session in Bilbao

Again I took a plane to go to Bilbao. We had programmed a session with two operations. Two patients with symptoms of benign prostatic hyperplasia (BPH) with two 80 cc prostates. We used the new GreenLight XPS 180 watt system. Both surgeries were uneventful.

Then I returned to Madrid rather early, to rest for the weekend.

Trip to Valladolid to learn to use the UROLIFT System

This afternoon I took the high speed train to Valladolid, to learn to use the new Urolift System to treat mild symptoms of benign prostate hyperplasia (BPH). I had known about this system before from my friend Dr. Henry Woo, from Australia, who was involved in the first trials in humans with this new system. It is also being evaluated at the Hospital del Rio Hortega, in Valladolid, and I was invited to see how Dr. Marcos Cepeda implanted this system in two patients.

It is a new concept for the treatment of lower urinary tract symptoms suggestive of BPH. It consists in applying two, four or six sutures with a special applicator, under local anesthesia + sedation into the prostate, and these compress the prostatic tissue opening the prostatic urethral lumen to facilitate micturition. The application was rather straightforward.

The main advantages of this system are: it is a minimally invasive system, with very low risk. It benefits younger patients, with smaller prostates, with moderate symptoms and it has the advantage of not altering ejaculation, a specially important issue in younger patients.

The disadvantages are for me that it is quite expensive and that there is a limited clinical experience published yet. My friend Dr. Woo tells me that it does not benefit all patients treated, but in those who benefit it is an elegant solution and long lasting, which prevents from having to receive medical treatment for years. He calls it "the surgical pill", precisely because it  is a minimally invasive intervention that can substitute medical treatment.

We sill see how it goes. It is available right now at the Institute of Advanced Urological Surgery in Madrid.

World Congress on Controversies in Urology, Paris, France

This weekend I went to Paris to participate in the IV World Congress on Controversies in Urology. I participated in a symposium on GreenLight Laser treatment for BPH.  It was very interesting and there was a lot of participation from the public. Paris was wonderful, as always, but it was freezing.

This photo shows us just before the symposium, with Drs Bachmann (Basel), Reich (Munich), Alivizatos (Athens) y Thomas (UK).

Then I returned to Madrid, I got a terrible cold in Paris ;-(

Surgeries in Bilbao, Hospital de Basurto

Last thursday I took a plane early in the morning to go to Bilbao, to the Hospital de Basurto, to perform a surgical demonstration of the new GreenLight XPS 180 watt laser. We did two cases in the morning and the residents could perform most of the operations. Then Dr. Unda took me out for lunch "the vasque way". I like so much the Vasque Country ;-) Then I returned to Madrid to start my holidays!!

Visitors from Saudi Arabia, Lebanon and Galicia

This week we had two days full of GreenLight surgeries and we received visitors coming from Saudi Arabia,  (Dr. Maher Moazin, from Hospital King Fahd Medical City and Dr. Ali Bin Mahfooz, from King Faisal Specialist Hospital), from Lebanon (Dr. Fouad Honeine) and from Galicia, Dr. Andrés Rodríguez Alonso, from Hospital Arquitecto Marcide, in Ferrol.

Training in Casablanca

This time I travelled to Casablanca to participate in the training of Professors Abdennabi Joual and Rabii. They had recently visited Madrid to see GreenLight XPS laser operations.

We did five operations that took place without any trouble. Then we went to a local hotel for a press round because this is the first GreenLight laser that is installed in Morocco. Sadly I had no time to visit Casablanca...

GreenLight XPS 180 watt laser: Anatomic PVP Technique

Here I am presenting a new technique, the "Anatomic" PVP that aims to remove the whole adenoma from the prostate by localizing anatomical landmarks that will help achieving this goal. This enhances the durability of the procedure and achieve lower PSAs postoperatively.

I hope you enjoy, comments are welcome!


GreenLight XPS 180 watt laser "Anatomic" Photoselective Vaporization of the Prostate from Fernando Gómez Sancha on Vimeo.

Presentation of the new GreenLight XPS laser in Spain

This Friday I participated in the official presentation of the new GreenLight XPS 180 watt laser that took place at the University Hospital Fundación Alcorcón, in Madrid.

One of the talks was about how to apply the basic science to clinical practice. I used a new tool to make presentations called PREZI, that allows for online publication. Logically this is only the presentation, but not my voice explaining it... but it is certainly remarkable and that is why I publish it here (you will see it better if you click on more on the lower right and choose full screen).

Fisiopatología del láser on Prezi

Surgeries at the General University Hospital in Valencia

This thursday I took an early flight to go to Valencia. I had to show the new GreenLigth XPS 180 watt laser. There I met my old friends Dr. Emilio López Alcina and Dr. Enrique Illueca.

The hospital was in a messy state, as they are refurbishing, but the surgical session was fantastic. We did two operations during the morning that were very succesful. Then I returned fast to Madrid. This laser is impressing everybody that gets to see it in action.

More surgeries in Sofia

This weekend I was in Sofia. We had to operate on saturday and sunday, we had seven patients.

On Sunday we finished somewhat earlier than usual and Dr. Kalchev took me to see the Vitosha mountain, a wonderful place that belongs to the Balkan mountains, just near Sofia, where bulgarians use to sky in the winter. There was no snow yet, but one could feel that soon it will be really cold there.

It is an old vulcano, and it had this massive rocks flowing down... impressive!

On Monday I returned to Madrid early in the morning.

Live surgery in Santiago de Compostela

Thursday night I flew to Santiago de Compostela, the next morning I had to perform a live procedure on a patient with benign prostatic enlargement using the new GreenLight XPS 180 watt laser. The operation was transmitted to the meeting room at the Hospital de Conxo, where the congress was held.

The operation was uneventful and I could show the anatomic vaporization technique, in which the surgical capsule of the prostate is found to make sure that the adenoma is vaporized to completion.

Then I had to do a long trip Santiago-Madrid-Milán-Sofia to arrive in Sofia that same night.

Surgeries in Valladolid

This friday I went to Valladolid, to operate with Dr. Amón Sesmero, in the new Hospital Rio Hortega. A very impressive hospital, with very modern installations and all high quality.

As it is happening in many public hospitals now in Spain, they are considering the acquisition of a GreenLight XPS 180 watt laser. We did two operations and they could see the speed of this new laser and how it is perfectly possible to perform a "down to capsule" prostatectomy, a true endoscopic adenomectomy.

We had a great time, then I returned to Madrid, I had to see patients and operate in the evening.

Trip to South Africa

From Beirut I flew to Johannesburg. I flew during the night in one of the new Airbus 380, an impressive plane.

I arrived in the morning and we went directly to Linksfield Hospital, where my friends Dr. Fisher, Barmania, Cohen and Bowden were waiting to participate in a surgical session with two cases. First I had a good shower, shave and cofee, and then we started the operations.

We talked in detail of the subtle details of technique, that are paramount to obtain optimal results.

Then we went out for dinner and the next day we went to the Welgevonden Game Farm, an amazing Game farm. There we spent two wonderful days driving in the park and spotting wild animals.

We also saw Bushmen paintings on caves, really impressive.

A wonderful trip. South Africa is a really amazing place. (All animal photos are copyright Rai Landau).

New trip to Beirut

Again I was invited to go to Beirut. This time we were inaugurating a GreenLight unit in the Hospital du Levant. I flew through Paris and Air France lost my luggage where I carried my surgical instruments. Luckily we could find another set of instruments rather fast and we could perform four operations throughout the day. We also had time to meet the press. All cases went very well.

From there we went to Hospital Bahman to give a talk. Many urologists, radiologists and general practitioners attended. Then I went to the airport to finally get my luggage and then I took a flight to Johannesburg.

Surgeries in Vitoria

This time I went to Vitoria in the north of Spain to help Dr. Javier Extramiana and Dr. Alberto Marquina with their first experience with the GreenLight XPS 180 watt laser. We did two operations that were very successful. Then I came back to Madrid very fast, I had to operate that evening.

Surgeries in Fundació Puigvert

This morning I went to Fundació Puitvert, invited to assist Dr. Montlleó and Dr. Ponce de León with their first contact with the GreenLight XPS. We did two operations that went wonderfully and everyone was amazed to see the speed of vaporization of this new laser, and how this speed is maintained throughout the procedure. Then I came back to Madrid to prepare my luggage to fly to the USA.

Congress of the Italian Urological Society

In this ocassion I went to Milán to participate in a symposium on GreenLight that took place during the Congress of the SIU (Societá Italiana de Urología).

I presented the new GreenLight XPS laser and I had to talk about GreenLEP (Greenlight laser enucleation of the prostate), that generated a lot of interest.

I Learned that I have received invitations to participate in various congresses this year.... It is going to be a busy year. When the symposium finished, I went out for dinner and took a plane to Barcelona.