Originally posted June 3, 2014

I was honoured to be invited to perform a live surgical transmission to the congress Challenges in Endourology from Hopital Tenon, in Paris, France.

This session consisted of five surgeries, an electrosurgical enucleation, a TURP (Transurethral resection of the prostate) a Thulium laser enucleation, a Holmium laser enucleation and I was in charge of presenting the En Bloc Green Laser enucleation of the prostate, a technique that I have developed over the last few years.

All videos from the surgeries will soon be available at the websites of Challenges in Endourology and   SIU Academy.

The truth is that everything went really well. I had enough time to show the technique, and I was asked many questions. I was very happy and proud to have had the chance of presenting my technique in such an important forum.

When I was returning to the airport I received the call of Enrique Pérez Castro, a very important Spanish Urologist, internationally known for being the inventor of the ureteroscope, who was participating at the congress and witnessed the session. He was very kind and congratulated me for the session. I really liked to receive his call. I went back to madrid very happy!

Originally posted May 31, 2014

As every month for the last five years, I travelled to Sofia to participate at a surgical session where we performed Green laser enucleation of the prostate in patients with benign prostatic hyperplasia at Hill Clinic.

This time we did not have international visitors and was a more quite session. We did 10 operations and one of the patients had a huge prostate gland.

We were able to extract almost 200 grams of prostatic tissue from this patient (you have to deduct the 55 grams the plastic tissue basket weights).

All went very well and I returned happy to Madrid, although feeling a little bit of the "spring asthenia", e.g. wanting the summer to arrive to be able to rest!

Originally posted May 28, 2014

Again we received visitors to our operating room at Clínica CEMTRO. This time we were visited by Prof. Estevao Lima (Hospital de Braga), Dr. Rui Borges (Hospital de Boavista), Dr. Luis Osorio (Centro Hospitalar de Porto) and Dr. Frederico Branco (Centro Hospitalar de Porto/Prelada).

They were interested in the new treatment techniques for Benign Prostatic Hyperplasia (BPH) with the GreenLight laser and they witnessed two cases, one in which I performed an En-bloc enucleation of the prostate and another case in which I performed an anatomic vaporization. The both went very well and I could ascertain how they enjoyed watching it. Then they had to rush to the airport to return to Portugal.

Originally posted May 27, 2014

Again I travelled to Modena, Italy, to the Hesperia Hospital, to perform several operations in patients suffering from Benign Prostatic Hyperplasia with the GreenLight laser.

The session went very well and I could demonstrate the different techniques we use with this laser to the italian urologists who attended the session. All the cases went very well.

Dr. Ferrari always spoils us with an amazing parmesan cheese and vinegar from Modena from his own family's production, so delicious!

Originally posted May 23, 2014

This time I went to the University Hospital of Coimbra, Portugal, with Dr. Capitán, from the Hospital Fundación Alcorcón of Madrid. We had been invited to participate in a course on the treatment of BPH (Benign Prostatic Hyperplasia) with the GreenLight laser.

My role was to perform two live surgical procedures that were transmitted to the meeting room at the Hospital. I performed an anatomic vaporization that went very well, and a GreenLEP procedure of a very large gland, that was difficult and laborious, but ended very well.

My colleague Dr. Capitán presented the results of the GOLIATH study that demonstrates that GreenLight vaporization has similar results to classic TURP (Transurethral resection of the prostate) with shorter hospitalization, catheterization time and complications. Also presented some publications on cost-effectiveness that showed that GreenLight is cheaper for the public health system than conventional surgery.

And finally Dr. Alfredo Mota, head of the department of Urology of the University Hospital of Coimbra did his final remarks, very impressed for what he had seen that day, seeing is believing!!!

Originally posted May 21, 2014

This time we received the visit of Dr. Javier Vicente Prados (Granada), Guillermo Olaizola (Clinica Zorrozaure, Bilbao), Fernando Díez Caballero (Clínica Universitaria de Navarra) and Pedro Lanzat (Hospital del Tajo). We were also honored by the visit of Dr. David Rendón, former colleague at ICUA, who came to update himself with the new techniques.

I performed four operations at Clínica CEMTRO and we had a good chance to comment the new techniques step by step (anatomic vaporization, vapo-enucleation and en bloc enucleation) in depth. We had a great time.

It is always a pleasure to receive visits from colleagues who share the same passion for what we do!

Originally posted May 12, 2014

This time I flew to Oporto and drove from there to the Hospital Nossa Senhora da Assunção in Seia, near the Star mountains. There Dr. Antonio Oliveira had prepared two patients to operate with the Green Laser Enucleation technique.

Both cases did very well and after having lunch in Seia we drove again to the Hospital Cliria, of the Group Espirito Santo Saude, where I performed a similar operation.

All patients did very well and it was an opportunity to show my Portuguese colleagues the wonders of Green Laser enucleation and morcellation with the Piranha system from Wolf.

Originally posted April 30, 2014

Today we received at Clínica CEMTRO the visit of two urologists with a lot of experience in BPH laser surgery, Dr. Placer, from Hospital Vall d'Hebrón in Barcelona and  Dr. Sánchez Macías from the Hospital de Mollet.

We had programmed four operations but they only had time to see two of them prior to returning to Barcelona. It is always a pleasure to share time with BPH experts like them.

I showed them a hybrid technique, with median lobe enucleation and an En bloc GreenLight enucleation of the prostate. All patients went well and I only would have liked to share more time with them!

Originally posted April 29, 2014

Today we travelled to the Hospital in Heidelberg, Germany, to learn to do transperineal prostate biopsies with MRI-US fusion imaging.

I was accompanied by Dr. Estefanía Romero, from ICUA (left) and our super-nurse Vanesa.

Soon we will start to perform transperineal prostate biopsies based in the fusion of images of Multiparametric MRI with transrectal Ultrasound at  Clínica CEMTRO in Madrid.

This technique is based in that Multiparametric MRI "sees" the cancers and transrectal ultrasound rarely allows to see them. The biopsies are usually performed with ultrasound guidance and thus we do not know if we take the biopsy where the tumor is or not. With the Biopsee system we can use the data obtained in the multi parametric prostate MRI to fuse them with the real time ultrasound image we are seeing and direct the needle exactly to where the tumor is.

In the studies published with this technique, the diagnostic performance rises from 30% to 60% (it detects more cancers) and it allows to do it in the first biopsy, it allows us to differentiate tumors that deserve to be treated from those who do not, so it is really a technical wonder.

Also, performing the biopsies through the transperineal route reduces the risk of infection caused bu the biopsy from 3% (3 out of 100 patients develop acute febrile prostatitis that can be serious) to 0,4% (four infections in one thousand patients).

A very important step in the diagnosis of prostate cancer that we will start offering to our patients at ICUA this month.

Originally posted April 26, 2014

Again I went to Bulgaria to participate in a new surgical session. We operated 7 patients in two days.

This time we received important visitors, like Dr. Andrea Tubaro, from La Sapienza University in Rome, Dr. Shahin Tabatabaei, from Harvard, Boston, USA, Dr. Edward Collins, from San Francisco, USA, Dr. Peter Weib from Siegen, Germany, Dr. Tobias Mebner, from Gehrden, Germany, and we also had Sasha Röhling and Glynn Burt, from AMS, the company that manufactures the GreenLight Laser.

The interest for the new techniques that I developed is progressively greater and that is why we receive more and more visitors from all over the world. These sessions are very interesting as they also allow to talk long on BPH surgical treatment and we all learn!

Dr. Shahin Tabatabaei and "Chip" Collins are my dearest friends and form part of the IGLU group (International GreenLight Laser Users) and we also had a chance to talk and enjoy to be together. A fantastic session!

Originally posted April 24, 2014

I went to the Spanish National TV to participate in the program "Saber Vivir" (know how to live) of the matinee program on the first channel.

We spoke about bladder hyperactivity, of the new drug Betmiga for its treatment, of laser surgery for BPH and transperineal biopsy of the prostate guided by MRI-US image fusion. I had a great time.

Also my colleague and laparoscopy and pelvic floor dysfunction expert Dra. Romero, from our team at ICUA, participated.

Suelo pélvico débil y próstata agrandada

Originally posted April 23, 2014

Today we received the visit at ICUA - Clínica CEMTRO of the Drs. Ahmed Elshal and Mahmoud Laimon, from Mansoura, Egipt, Dr. Michel Jabbour, from Beirut, Lebanon and my close friend Dr. Edward Collins, from San Francisco, USA.

I performed four operations and we also had time to chat on the physics of lasers and all technical aspects between cases. I could demonstrate all technical variants of the use of the GreenLight laser for the treatment of BPH, anatomic vaporization, vapo-enucleation, and the En Bloc enucleation technique.

The session went very well, and then we went out for dinner together. Dr. Collins is joining me to Bulgaria as he is very interested in the GreenLight Enucleation technique that I have developed over the last 5 years. There we will meet other urologists and friends.

Originally posted April 15, 2014

After the European Association of Urology Annual Congress I travelled to Sofia, Bulgaria. There I went to the Hill Clinic where we had organized a full intensive day of surgeries to demonstrate the En bloc Green Laser Enucleation of the Prostate technique for the treatment of BPH to two visitors from Canada (Dr. Dean S. Elterman) and Jeff Bennet, from USA, who had also been in Stockholm for the European Congress.

I performed 7 surgeries in a full day surgical schedule that went very well. Then I returned to Madrid to take some days to rest for the Easter Holidays.

Originally posted April 12, 2014

This time I went to Stockholm to participate at the Annual Congress of the European Association of Urology, really the most important European Congress with more than 14.000 participants from all over the world.

My role was to participate in a session of the ESUT (European Society of Uro-Technology) that organized an amazing surgical program that took place at the Karolinska Hospital and were transmitted live to the audience of the congress.

These are very appreciated sessions as they allow urologists from all over the world to watch experts performing surgery in real time.

I had the great honor to be invited to perform an operation in a patient with Benign Prostatic Hyperplasia. I performed the GreenLight En Bloc Enucleation procedure that I have developed during the last 4 years.

Everything went well during the operation and I received many positive comments from some friends and colleagues, some of them through twitter.

The urologists in the auditorium could visualize both the endoscopic image (left) as the image in the operating room, and what my hands were doing during the operation.

I hope the patient will recover well and improve his quality of life. Next year during the next EAU congress they will present the results of the operation and will tell how the patient is feeling.

Originally posted March 29, 2014

Again I travelled to the Ammerland Klinik in Westerstede, Germany, to participate in a symposium on minimally invasive surgery in urology. My role was to perform a live transmission of a Green Laser Eucleation of the Prostate, that was broadcasted from the hospital to the hotel where the symposium was celebrated.

They chose a patient with a prostate over 140 cc, a difficult case, to allow me to demonstrate live the advantages of this technique even in complex cases.

The case went wonderfully well, I could demonstrate the technique steps and its advantages, the excellent visualization, the absence of bleeding, the perfect anatomical dissection and the speed, as we could finish in less than 90 minutes of surgery. I was accompanied by my friend Dr. Schmidt, and I enjoyed the assistance of personnel from Richard Wolf, the company that manufactures the best surgical instruments to carry out this procedure and the best morcellator in the world, the Piranha system with the single use fast blades Vmax.

This was the weight of the tissue retrieval basket, that we will send for histological analysis. A big prostate gland indeed!

Then I went to the hotel where the symposium took place, and there I gave a talk on the evolution of surgery with the GreenLight laser.

Then I returned to Madrid to enjoy the rest of the weekend, after having worked hard for 15 days.

Originally posted March 28, 2014

Again I travelled to Sofia to operate at a two-day surgical session at Hill Clinic. This time we received the visit of two German Urologists, Dr. Klaus Brunken and Dr. Ulrich Witzsch. Also I was very happy to receive the visit of my good friend Dr. Benjamin Choi, from New York.

We shared a very intense surgical weekend, with 12 surgical operations in which I showed them the technique of prostatic enucleation with the Greenligh laser. It is always interesting to share these experiences with other expert colleagues, as their comments are very interesting and make me learn a lot!

Originally posted March 26, 2014

Today we had an intense surgical day at Clínica CEMTRO. We performed five surgical operations and we received the visit of the French urologists Dr. López and Dr. Riviere, from the Hospital Saint Augustin in Bordeaux,  Dr. Mandron, from Toulouse, my friend Dr. Paulo Ferreira de Matos Guimaraes, from Lisboa, Dr. Antonio Guilherme Oliveira, from Figueira da Foz and lastly the Spanish urologists Dr. Marcos Cepeda from Hospital Rio Hortega in Valladolid and Dr. Manu Díaz, from the Hospital General de Catalunya.

We perfomed anatomic vaporization, vapo-enucleation and GreenLight enucleation. A very intense and interesting session with many visitors to the operating theatre!

Originally posted March 21, 2014

This time I went to Italy to visit the Ospedale Santa María degli Angeli in Pordenone, Italy, where I was invited to participate at a course on advance techniques for the treatment of BPH with the GreenLight laser.

There I operated with Dr. Lorenzo Ruggera, who was already visiting us in Madrid, and other urologists invited to the course. We performed three operations demonstrating the anatomic vaporization and vapor-enucleation technique. All went very well and then I departed to Sofia, via Munich, for a surgical weekend.

Originally posted March 7, 2014

Again I flew to Modena, Italy, to operate with Dr. Giovanni Ferrari at the Hesperia Hospital.

Giovanni had prepared a surgical session with four patients, and we received the visit of five italian urologists who came to see procedures. I performed two GreenLEP (Green Laser enucleation of the prostate) procedures in two patients with big prostates (bigger than 100 cc) and two hybrid procedures of vapo-enucleation.

These procedures guarantee the total removal of BPH (benign prostatic hyperplasia) tissue and allow to obtain a fantastic and durable result in patients with this condition. I think all urologists who come to witness it are convinced that it is a new approach for the treatment of BPH that is interesting and convincing!

The Piranha morcellator from Richard Wolf is a wonderful instrument, it allows to extract prostatic tissue from the bladder at a 10-20 gram per minute pace. Using it one can morcellate a 100 gram prostate in 5-10 minutes. This has shortened the procedures very much, and I think it is a factor that will contribute to push the adoption of laser endoscopic enucleation worldwide.

Originally posted February 28, 2014

Again I flew to Sofia to visit Hill Clinic to operate as I have been doing every month for the last four years. This time we received the visit of Dr. D'Arrigo, from the Ospedale Cannizzaro di Catania, Italy, who came to witness the Green Laser Prostatic Enucleation procedures we carry out here.

It was a very intense session with 16 operations of Green Laser enucleation of the prostate. Everything went very well and every day I am more convinced that this is an impressive procedure. All the urologists in the world should learn it and show it to their patients!