Surgeries in Belgrade, Serbia

I went to Belgrade, Serbia, to help in the presentation of the new GreenLight XPS 180 watt laser at the Dean's building of the University of Serbia.

The distributor company of Americal Medical Systems in Serbia, Medicon, donated a laser to the Clinical Center of Serbia, the most relevant urology department in the country, to allow the Serbian people to access to this treatment at the national health service.

I presented the technology and its advantages and then I performed two live procedures, that were transmitted to the room, full of local dignitaries, as the Serbian Minister of Health, or the ambassador of the United States in Serbia.

The session was very successful. I enjoyed thoroughly helping to introduce this marvelous technology in a country like this.

I also had a very nice moment when one of the patients I operated in my previous visit to Belgrade, a famous serbian actor who had a huge prostate gland, on whom I performed a GreenLight enucleation, a very difficult case, came to see me. He very kindly described how well he was feeling and how happy he was, he brought one of his movies for me and we spoke about his life in cinema, and commented on Emir Kusturiça, who directed him in multiple occasions, and who I love as a director.

Soon I will return to Serbia to train the urologists who are going to start using this laser.

Participation in "La Mañana" - Spanish National TV

Today I participated in the National TV program "La Mañana.

This time we speak about urinary tract infections. It is always nice to go to the TV and contribute to expand the public knowledge on urological disease.

Surgeries in University Hospital Infanta Leonor, in Madrid

Today I visited Hospital Infanta Leonor, in Madrid. I did three operations with the GreenLight XPS 180 watt laser in the morning session. I really liked this new hospital. It is a very modern and beautifully designed hospital.

The interest for GreenLight laser has reached public hospitals in Spain, where the low risk and short hospital stay that this laser allow for the treatment of patients with benign prostatic hyperplasia is becoming interesting.

Surgeries in Quito, Ecuador

I could reach Quito after a long trip. My plane from Avianca broke down while trying to take off, and the flight was cancelled, so I had to wait one day to travel. I was going to operate with Dr. Ricardo Yépez and Dr. Saskia Suarez, at Hospital Carlos Andrade Marín.

Con el Dr. Ricardo Yépez antes de entrar en el Hospital

I was very impressed by quality of the technical equipment available in the surgical rooms in this hospital. It seems the government is investing heavily in infrastructure and has pushed healthcare forward significantly.

The objective of this visit was twofold, the first objective was to help my colleagues to start with GreenLight Enucleation of the prostate. We operated two days and we went through step by step surgical technique and we could deepen in details and improve several important technical aspects.

Prostate enucleation is a complex technique and to be able to perform it properly it is important to have specific surgical instruments, an impeccable anesthetic technique, a properly trained surgical team and to pay great attention to detail. The clinical results are excellent and many of the patients we operated, not specially easy cases, went home the same day of the operation.

The second objective was to support Dr. Yépez and Dr. Suarez with the planification of the first international congress of the GRILUR (Grupo Iberoamericano de Láser en Urología) that will take place in this hospital in July 26th-29th, 2012, with special focus in the minimally invasive treatment of benign prostatic hyperplasia (BPH) as well as of urinary stones. It will be an important congress, with live surgeries and the participation of international experts. We had a good chance to comment on the current status of the organization of the meeting that aims to gather those spanish and american urologists interested in the use of lasers for the treatment of urinary tract diseases.

We also had a chance to travel to the east where we visited amazing places and I was able to enjoy my friend's hospitality.

Then I returned to Madrid. A long trip, but definitely worth it!

Surgical Session in Gran Canaria

This weekend I went again to Gran Canaria, to collaborate with my old friend, Dr. Juarez del Dago, in a surgical session with the new GreenLight XPS 180 watt laser. We operated several patients that went really well.

In the photo, Dr. Juarez and his marvelous nurse, Loly, getting ready for the operations.

Surgical Session with Dr. Rix

Today we had the pleasure of hosting Dr. Gerald Rix, an expert in the technique of Holmium Laser Enucleation of the prostate at Clinica CEMTRO in Madrid.

We commented the surgical technique at large and his convictions regarding this procedure. His advice was excellent and I carried out several procedures while he commented his ideas and tips and tricks. All surgeries were successful!

Dr. Rix interestingly speaks a perfect spanish as he was raised in Spain as a child. We had a great time and I am very grateful to him, he is a great teacher.

I am convinced that it is crucial that surgeons from different countries and hospitals share their knowledge, as this will improve our skills for the benefit of our patients.

XVIII Congress of the Canarian Society of Urology

In this chance I travelled to Gran Canaria to participate in the Congress of the Canarian Urology Society, to speak about lasers. The congress was organized by the Gabinete de Urología y Andrología, captained by Dr. Juarez del Dago in a wonderful hotel in Mogán.

The congress started with a non-urological talk on the Timple from Canarias, a string instrument that is very popular over here. Very interesting, we had Germán López, one of the best timplists in the world and a fantastic spanish artist. I did not know him, but now I am his fan. Here a video of the artist with his Timple... a wonderful instrument.



The level of the scientific sessions was very high as we had the luxury of having Dr. Richard Gaston who spoke about laparoscopy and also Dra. Estefanía Romero, from our team, that also presented on the surgical indication of Benign Prostatic Hiperplasia.

I spoke, as always, about lasers, and my participation was reflected in the congress daily newspaper as well as in a local newspaper Canarias 7.

As always, going to Canarias is wonderful, and I had a great time among friends. 

Surgeries in Naples, Italy

This wednesday I flew very early to Rome, and then to Naples, to visit Hospital Federico II.

There I met Professor Vincenzo Mirone and his team of urologists, that had prepared three patients so I could demonstrate the technique of anatomic vaporization of the prostate.

Dr. Mirone was the former president of the Italian Association of Urology and is currently its secretary general, he was very kind and we talked about the characteristics of GreenLight Laser and its interaction with prostatic tissue.

The three operations were successful and it was nice to see Naples on the way to the airport, it was a sunny and marvelous day. I had some time to try the local mozzarella, really good.

The return trip was tougher after such an early start. I arrived in Madrid around 12 pm, but happy.

Visitors from Vitoria-Gasteiz

Yesterday we had a surgical session at Clinica CEMTRO, where we operated several patients. This time we enjoyed the visit of a group of urologists from Hospital Santiago Apostol, from Vitoria-Gasteiz.

I could demonstrate to them a case of anatomical vaporization of the prostate and another case of Greenlight laser enucleation. We had a great time as they already have a big experience with the use of the GreenLight HPS 120 watt laser and are now going to start using the new GreenLight XPS 180 watt laser and we could share experiences and knowledge.

Surgery with Dr. Gastón at Clínica CEMTRO

The morning of the 8th I woke up early in Sofia to return to Madrid. And from the airport I went to Clinica CEMTRO where we operated with Dr. Richard Gaston in the morning.

Dr. Gaston is maybe the most important expert in the world in laparoscopic radical prostatectomy and has been a member of our team for five years, coming every month to operate with us to Clinica CEMTRO.

In this occasion Dr. Estefanía Romero and I helped him. Dr. Romero was trained in Bordeaux with Dr. Gaston.

I was impressed when Dr. Gaston decided not to leave a drain in the patient, a usual thing to do after a radical prostatectomy, and this allowed the patient to be discharged the following morning, because he was feeling perfectly well.

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...