Originally posted September 25, 2013

Again I visited the Hospital at Ponte San Pietro, near Milano, to work with Dr. Fenice. He has offered me to come to operate regularly the most difficult cases of BPH with the GreenLight laser and from now on it will be an ongoing collaboration.

This time I did two GreenLEP procedures (GreenLight enucleation of the prostate), that went very well. During the operation the blood loss is minimal, and this is how the urinary catheter looked like after the operation. A tube conducts saline solution to the bladder, and the other tube brings it out, but there is no blood at all. Great!

The following day Dr. Fenice told me that the patients were doing well and were going home. From now on, the Hospital at Ponte San Pietro will be another regular place of work for me. I am very happy.

Originally posted September 24, 2013

During my previous trip to Bulgaria I was interviewed for the most prestigious TV program on health in Bulgaria. Today I got it and I include it here.



The goal of the interview, to clarify things after Angelina Jolie was submitted to a bilateral mastectomy for carrying a defective form of the BRCA1 gene.

Right after that happened, the London Based urologist Roger Kirby told the press that after sequencing the BRCA2 gene in a man with a non aggressive form of prostate cancer, he found a mutation in the gene. This mutation decided him to recommend radical surgery for his prostate tumor that normally would not be treated. This was very polemic and hence, the interview.

I tried to clarify that some people carry a mutated form of these genes that does carry out the normal function of suppression of tumor growth. Men who carry these defective forms of the gene have a higher risk of prostate cancer and usually also more aggressive, but it is not justified to carry out preventive surgery in all carriers. It is more logical to watch them closely and if the tumor arises treat them aggressively.

Originally posted September 22, 2013

I woke very early to catch a flight to Rome at 6.00 am. I was picked up at the airport to drive to L'aquila to participate at the UROLEAGUE Congress from the Association of Italian Urologists (AURO) that took place at the Hospital San Salvatore, chaired by Prof. Di Clemente.

The surgical schedule was very interesting, with the participation of great italian urologists. I was the only foreign urologist invited to operate.

With Prof. Di Clemente

I had to do two procedures one after the first, an anatomic vaporization with GreenLight laser of a trilobulated 80 cc adenoma, and a GreenLEP procedure (GreenLight Enucleation of the Prostate) in a prostate bigger than 100 cc.

Both cases went very well, and were retransmitted to the congress venue, in a nearby hotel. Dr. Mutto moderated the session and he relayed questions from the floor during the operation. Both were successful.

During the operations I noticed my mobile vibrating in my pocket, and later I found out that it was a message from one of my colleagues that was cheering me during the live procedure! Interesting times we live in...

Originally posted September 17, 2013

Today we received in our surgical theatre at Clínica CEMTRO the visit of Dr. Thomas Dean, urologist from Sydney, Australia.

He was very interested to see a GreenLEP procedure (GreenLight Enucleation of the Prostate). I performed a case,  a patient with a prostate bigger than 100 cc, that went very well.

The enucleation itself took 40 minutes and the morcellation took other 15. A very beautiful case. I think he went away happy and impressed by the technique. If I can, I will take him to the Flamenco show tomorrow ;-)

In the meantime, in the surgical theatre just beside mine, Dr. Guillén was retransmitting a Master Class to more than 300 hospitals in all the world using the Google Glass. He performed a chondrocyte transplant using his cable free endoscope and using surgical instruments developed at Clínica CEMTRO.

Originally posted September 12, 2013

This time I visited the prestigious Clinique Saint Agustin in Bordeaux, France

This clinic is the most important center in Europe in laparoscopic urology. There they perform 5000 laparoscopic procedures and more than 1000 robotic surgeries per year. Dr. Gaston, Dr. Piechaud and their colleagues are very well known worldwide for their specialization in laparoscopy and specially in robotic radical prostatectomy.

Dr. Richard Gaston ready to start a robotic laparoscopic prostatectomy with one of the two robots available at St. Agustin

Dr. Gastón has collaborated with us for the last 7 years and comes to operate every month to Clínica CEMTRO, we are very good friends.

The reason for this invitation was that the urologists at Saint Agustin wanted to learn to perform Holmium laser enucleation of the prostate in patients with big prostates, e.g. high volume benign prostatic hyperplasia.

They prepared five patients that we operated in two days, and I had the occasion to demonstrate the details of this technique. All patients had big glands, some also had big and multiple bladder calculi (stones) that we could fragment seamlessly with this Holmium laser. We also tried the Storz morcellator, that has improved recently and the Piranha system with the Vmax blades, my favourite morcellator.

All surgeries went very well and patients recovered extremely fast. My french colleagues were very happy to see this and I think they were convinced that it is perfectly possible to treat big prostate adenomas with laser enucleation. Also they could ascertain its superiority to the laparoscopic approach they were using up to now, as patients can be discharged the next day as opposed to three days after the laparoscopic operation.

With Dr. Piechaud during the surgical session

I really enjoyed collaborating with these great urologists, true living legends of urology, and help to light their enthusiasm for laser prostatectomy. It was a great honor to help them and I returned to Madrid very happy after this session.

Originally posted September 4, 2013

Again we had Dr. Gaston with us to operate at Clinica CEMTRO.

Dr. Gaston is an international expert in urooncology and laparoscopy who works at Clinique Saint Augstin in Bordeaux. He has been collaborating with us in Madrid for seven years.

In the surgical session, he was assisted by Monique, her nurse from Bordeaux and Dr. Estefania Romero, our expert laparoscopist at ICUA.

This time we tried the VIKING system for 3D laparoscopic high definition visualization.

Dr. Gaston invited me to visit their department in Bordeaux next week to help them with their fist cases of laser prostatectomy.

Originally posted August 30, 2013

My holidays are over, time to get back to work!

This season has started very well, we did a surgical session at Hill Clinic, in Sofia, Bulgaria.

This time we operated for two days, and all operations went very well. The GreenLEP procedure (GreenLight Enucleation of the Prostate) is a wonderful operation, very fast and safe. Every time I do it I am more convinced that this is much superior to conventional surgery in every sense. I am so proud that I conceived this technique and perfected it to the point it is today.

I love to see the smiles of operated patients and to be able to offer them the best possible results with this technique.

Originally posted August 21, 2013

I went to Gran Canaria to participate in the section "Saber Vivir" (know how to live) from the program La Mañana de la 1 of Spanish National TV.

We spoke about a lot of things, in this wonderful morning TV program on health, including bladder ageing, and bladder problems in women and men.

Saber vivir - Consejos urológicos para el verano 21/08/13

Saber vivir - Consejos urológicos para el verano 21/08/13

Originally posted July 26, 2013

Again I went to Sofia to operate at Hill Clinic,  this is my last trip before I take my summer holidays.

This time we had a lot of work and we did 23 prostatectomies in several days.

I am very fortunate to be able to collaborate with Hill Clinic. I feel we help a lot of patients. It is typical there to operate old patients with big prostatic glands that carry a urinary catheter, with a lot of co-morbidities (cardiac, diabetic patients) that make them high risk surgical candidates.

Everything went very well, the laser enucleation technique is no doubt the gold standard for the treatment of BPH. It is impressive to see the patients the next day, as if we had not operated them. I love to see how we can operate a high number of patients with a minimal complication rate. In this session, for example, no patient had any significant intra or postoperative complication. The surgical time is getting shorter, we did some of the procedures in less than 30 minutes.

We operated patients with small, medium and big prostatic sizes (we extracted 160 grams of tissue from one of the patients with a huge gland). We left a lot of work for the pathologist, literally kilos of prostate tissue.

Then I returned to Madrid. I work monday and tuesday and then I will take my summer holidays. Despite my love for my work I feel like resting a little bit!

Originally posted July 16, 2013

Today we received the visit of two representatives from the laser manufacturing company Lumenis, who came to watch surgeries and to exchange knowledge and ideas.

I performed several operations with Holmium laser that went really well.

Moshe Shtengel, Director of Global Marketing of Lumenis, left a comment in our visitors book.

Originally posted July 11, 2013

Yesterday I went to the hospital in Udine, Italy, to help Dr. Simone Crivellaro in a surgical session. The objective was to help him with his first case of GreenLEP (GreenLight Enucleation of the Prostate). Dr. Crivellaro had already been at Hill Clinic in Bulgaria to witness some procedures some months ago.

We performed two operations in two patients with very large prostates, of 120 grams. Maybe they were not the best patients to learn with, as big prostates are technically more demanding.

I performed the first case, we obtained 115 grams of prostatic tissue, and then Dr. Crivellaro started the second case and I finished it. We also obtained a big volume of tissue, 110 grams of prostatic adenoma, in this case.

The session was very interesting. I believe this technique can be taught when the surgeon already has experience with vaporization. Dr. Crivellaro told me he has operated already 300 patients with vaporization. Now he will have to develop his experience with GreenLEP.

Originally posted July 2, 2013

Today we received the visit of Dr. Richard Gaston who came to operate with us at Clínica CEMTRO.

We performed two laparoscopic radical prostatectomies in patients with prostate cancer. We had Dr. Juarez, from Gran Canaria, joining us for the session as we were operating one of his patients.

Everything went very well, Dr. Gaston is a true master of the technique and he feels at home operating with us after seven years of collaboration, also our colleague Estefanía Romero was trained in laparoscopy at his center, so they work in perfect synchrony.

Again he commented his interest of welcoming me in September at Clinique Saint Agustin in Bordeaux to help them start with their experience with their brand new Holmium laser for the treatment of BPH and I will help them with pleasure.

Originally posted June 30, 2013

Today I woke up early and took the high speed train to reach Zaragoza in time to reach the  Hospital Viamed Montecanal to demonstrate the use of the GreenLight XPS laser to Dr. Jorge Rioja and his uncle, Dr. Carlos Rioja, as they have recently adopted this technology.

They had programmed three surgical cases. I demonstrated the anatomic vaporization technique, the vapo-enucleation technique and the GreenLight Enucleation of the prostate (GreenLEP).

All cases went really well and I really enjoyed the company of my friends, sharing tips and tricks in this  very nice new hospital in Zaragoza.

Originally posted June 30, 2013

This time we received visitors from the american company Neotract, to watch how we performed the treatment of two patients suffering of BPH (benign prostate hyperplasia) with the UROLIFT system.

This UROLIFT system is very ingenious and technologically sophisticated and allows to treat patients with mild or moderate BPH symptoms in a minimally invasive fashion, improving their symptoms without altering their ability to ejaculate. This is common in other forms of surgical treatment of BPH.

The technique consists in introducing a sophisticated cystoscope in the urethra of the patient under sedation.

The device introduces a needle in the prostate that releases a titanium filament that is fixed outside the prostate capsule.

Another filament is deployed in the inside of the urethra and a suture joins both filaments compressing the prostatic tissue, to widen the urethral lumen and allow for the easier passage of urine.

Normally four of these are placed, and this allows the patient to improve his urinary symptoms and many times, to abandon the medical treatment they were having.

In the published clinical studies, patients improve significantly, and this improvement is maintained during at least three years.

I think it is a very reasonable option for young men with BPH symptoms that want to improve their urinary symptoms without losing the ability to ejaculate.

Originally posted June 27, 2013

Again I traveled to Modena to operate with Dr. Giovanni Ferrari (in the photo with me) at the Ospedale Hesperia.

This time we had a surgical session with three patients and we received the visit of Dr. Francesco Vacirca, from Sicily, Dr. Giancarlo Carloni and Dr. Riccardo Lombi, from Perugia and Dr. Livio Bilotta, from Tivoli.

I performed three different operations with the GreenLight laser, an anatomic vaporization, a vapo-enucleation and a complete enucleation or GreenLEP (GreenLight Enucleation of the Prostate) of a patient with a very big prostate gland.

All the cases went really well and then I returned to Madrid in the afternoon.

Originally posted June 26, 2013

This month I was interviewed by this Spanish magazine.

Originally posted June 22, 2013

Again I travelled to Sofia, Bulgaria to operate at Hill Clinic.

In this occasion we celebrated the fourth anniversary of the clinic. I started to collaborate with them three years ago and since then we perform the GreenLEP (GreenLight laser enucleation of the prostate) technique to treat the clinic's patients suffering from Benign Prostatic Hyperplasia.

To celebrate the event, Hill organised several activities and an open doors day where for the first time in Bulgaria we could show the GreenLight SIM, a computerized simulation of GreenLight laser vaporization of the prostate, a tool for urologists to train themselves before treating a real patient.

For me it has been a great experience to collaborate with Hill Clinic all these years, it has allowed me to develop this technique progressively, perfect it, introducing minute improvements as I got to understand how to make this procedure faster and safer. Interestingly, we reached 300 Enucleations the day of the 4th anniversary, we did 43 in 2010, 75 in 2011, 103 in 2012 and 79 up to now in 2013.

This weekend, as it is usual, we performed 14 operations in three days that went really well.

These are the specimens of prostatic tissue that we sent to the pathologist for histological analysis. This technique allows to extract all the adenomatous tissue independently of the prostate size and to analyze it.

Also the technique has improved a lot with the new Vmax blades of the Piranha morcellator, that allow for an extremely fast morcellation. In this extract from the intraoperative data of two of the cases we did this weekend we can see the prostatic volume as estimated by abdominal ultrasound, the weight of the tissue extracted (137 g and 73 g), the energy used, the firing time of the laser at 80 w and 40 w settings, the active morcellation time and the total morcellation time. It is impressive to be able to extract adenomatous tissue in such a short time (137 grams in 14 minutes and 26 seconds and 73 grams in four minutes and 5 seconds of real time), as it allows us to perform most cases in under one hour.

I am really convinced that any urologist who sees the work we do will agree that there is no justification nowadays to keep performing open prostatectomy.

The truth is that there I feel great, with my friends and colleagues from Buglaria. I really believe that we form an elite team of laser prostatectomy at the top level. In the photo from left to right, Dr. Botsevski, the nurse Ms. Petia, Dr. Kotsev, Mr. Lubo and Dr. Georgiev, all of them great professionals.

Originally posted June 20, 2013

Today we had programmed three GreenLEP operations. We received the visit of two representatives from Germany and USA of the surgical instrument manufacturer Richard Wolf.

They also came interested in seeing the GreenLEP procedures (GreenLight Laser Enucleation of the Prostate). Normally we use their surgical instruments to perform this operation.

I am specially happy with the Piranha morcellator, with the new rotational blades Vmax, that allows us to extract the prostatic adenomatous tissue once we have enucleated it from its capsule and pushed it into the bladder.



Our surgical procedure time has been reduced much since we use them, because we achieve a very fast morcellation of 10 grams per minute during the morcellation phase, that is really impressive. Typically, to enucleate a 100 gram prostate we would need 40-45 minutes for the enucleation step, 5 minutes to change the instruments and start the morcellation and 10 minutes to finish. This is a true leap forward if we compare this with previous enucleations, where to morcellate 100 grams  of tissue we had to work for about 40 minutes.

In this occasion I also showed them the pre and postoperative transrectal ultrasound picture, that shows the beauty and value of this surgical technique.

Originally posted June 18, 2013

Today we received the visit of Mr. Mike Kujak, the general manager of American Medical Systems, the company producing the GreenLight laser in the US, as well as many other medical devices for the treatment of pelvic health problems.

He came to Madrid interested to see in person the GreenLEP (GreenLight laser enucleation of the prostate) technique that I have developed, as well as the anatomic vaporization technique. The postoperative ultrasound of the prostate we enucleated showed a perfect job! It was impressive. We probably removed 90 grams of tissue and the cavity was perfect!

After we finished the two procedures we went out for dinner in Madrid. I have to say that despite my close relationship with this company for many years it is the first time I see a CEO "coming down to the kitchen"to see first hand how their products are used. I was very positively surprised by this attitude. He left a comment in our visitor book.

Later on our Pathologist confirmed we had extracted 90 grams of tissue.