Originally posted October 20, 2015

Again I went to Belgium to participate in an advanced course on robotic radical cystectomy and intracorporeal urinary diversion at ORSI.

I had the privilege in this course of performing two robotic radical cystectomies with an intracorporeal diversion and I also went to the operating room to witness a case at the OLV hospital in Aalst.

I am very grateful to Dr. Mottrie for everything I have learned in these courses with him, but I have to say that I have received a lot from Dr. Giorgio Gandaglia, from the Hospital San Rafaele in Milan, who is spending six months working at the OLV hospital in Aalst, and who has taught me a great deal.

For many hears I have devoted myself to teach other colleagues, specially in the use of lasers for the treatment of prostate disease. My experience as a surgical teacher helps me value the generosity of those who teach what they know without limits, and Giorgio Gandaglia is a great teacher. I think he will become no doubt one of the leading urologists in europe in a few years!

Originally posted October 16, 2015

This weekend we had again a surgical session with Dr. Richard Gastón at Clínica CEMTRO. Dr. Gaston is now a member of our team at ICUA and he comes every month from Bordeaux to operate with us in Madrid.

Robotic surgery requires a lot of preparation and a precise coordination among our nurses at ICUA, the anesthetists, hospital nurses, and other personnel, to allow for an uneventful and smooth work.

Vanesa Cuadros, our chief nurse ensures that every detail is looked after and also makes sure that all the clinical information about the patient, his PSA, the result of the digital rectal examination, the information obtained in the biopsy or the transperineal MRI-US fusion mapping, the preoperative MRI are clearly looked at prior to the operation so it can be planned to the detail.

Our nurses, Sandra and Nuria are in charge or organizing all the surgical material necessary for any eventuality. They also assist us during the robotic procedures.

It is fantastic to be able to work in a team full of enthusiasm and will to perform an excellent job!

Originally posted October 12, 2015

This time I travelled to Italy to participate at the congress of the SIU, this time performing a live surgical procedure that was broadcasted to the main auditorium of the congress that was held in Riccione.

With the possibilities offered by modern technology, the operation was performed far from the congress venue, at the Hospital in Carpi, where Dr. Verrini, the head of the urology department was hosting this live surgery session.

My role was to perform an anatomic vaporization in a patient with a relatively big prostate with 80-90 cc.

They told me the main auditorium was full. ¡Everything went very well!

Originally posted October 9, 2015

This time I travelled to The Netherlands to visit the Hospital Reiner de Graaf, in Delft.

There I was kindly hosted by Dr. John Van Der Hoeven who was there with other Dutch colleagues for a surgical session on "En Bloc" GreenLight enucleation of the prostate.

First I gave a talk at the clinical session of the urology department and then we went to the operating room, where they had prepared three patients. Two of them had very large prostate glands.

The session went very well, although two of the cases were a little more difficult than usual. In one of the cases I showed the anatomic vaporization technique. The attending urologists were very impressed with the possibilities of the GreenLight laser with these new techniques for the treatment of benign prostatic hyperplasia.

I spent the weekend in Amsterdam, and I had a chance to visit the exhibition Body works, where they show "artistic" anatomic preparations of plastinated human bodies. It is amazing, I recommend it thoroughly.

This was a plastinated dissection of the urinary tract and the main vessels in a female subject. Fascinating!

Originally posted October 3, 2015

This time I flew to Sofia to operate at the Hill Clinic, and to try the new 50 w Holmium laser Auriga XL.

In Madrid we have a 100 w Holmium laser from Lumenis, and I was curious to try it. I had heard that it allowed to perform endoscopic enucleation for the treatment of BPH, but that it maybe was a little slower than the 100 W lumenis laser.

I played with the output parameters of energy and frequency until I did with the settings that provided the tissue effect I like for the en bloc enucleation technique, and the truth is that we could work wonderfully with this laser, and we did not perceive any difference in the time we needed to complete a procedure as compared with GreenLight and Holmium 100 w.

The more I try different lasers the more I believe that despite the technical differences among different lasers, the most important factor is the experience of the surgeon. If the surgeon understands laser physics and knows the anatomy of the prostate well enough, there shouldn't be very significant differences among lasers. At the end, patients recover equally well, do not bleed much, and are very happy with their operation, irrespective of the wavelength. I do believe that Holmium and Thulium are technically more demanding for the surgeon (more difficult to use).

I also think that GreenLight en bloc enucleation is the most beautiful procedure, it allows visualizing the anatomy much better and it is extremely elegant and efficacious.

I got this from the staff at the Hill Clinic, a photo that summarizes the international visitors who came to learn to use the GreenLight laser during the last three years. Watching this gets to my heart, so much work, so many friends!

Originally posted October 1, 2015

From Brussels I flew to London to participate in an experts meeting summoned by the company Boston Scientific.

This company recently acquired American Medical Systems (the male products part, including the GreenLight laser), as well as the German laser manufacturer Starmedtec.

Now Boston offers three kinds of laser for BPH, the GreenLight XPS system, a 50 watt Holmium system (Auriga XL) and a Thulium laser (Vela XL).

Boston Scientific had summoned international experts in the use of lasers of different kinds, and it was very refreshing to sit down all together in one table and discuss openly the pros and cons of different kinds of lasers.

I realized that my experience is quite unique, as I have worked a lot with all three wavelengths and the majority of my colleagues specialize in one wavelength only. A very interesting meeting.

Originally posted September 30, 2015

Again I travelled to Belgium to participate in another course with Dr. Alex Mottrie at the OLV Hospital in Aalst. This time It was a partial nephrectomy course.

I spent three intensive days in the course and I enjoyed it thoroughly, as I could see and do many robotic operations. Dr. Mottrie was trying a new system that allows to use 3D reconstructions of the anatomy of the patient based in their own imaging studies (CT Scan, MRI) offered by the company  Visible Patient.

These 3D reconstruction systems allow to plan the operations carefully and to increase their safety. It was definitely a wonderful course and three days of total immersion in robotic surgery, I love it!

Originally posted September 25, 2015

During the month of september, Dr. Gaston came to operate at  ICUA - Clínica CEMTRO twice, we operated two consecutive weekends several cases of prostate cancer as well as a partial nephrectomy with the Da Vinci Robotic System in a patient with a single kidney that went really well.

Despite the Da Vinci Robot is mainly known for its role in the treatment of prostate cancer, its role is paramount today for the treatment of kidney cancer, as it allows to perform complex partial nephrectomies with great safety, allowing for preservation of renal function.

It is a joy to see the patients recover after these robotic surgeries and to witness the excellent oncologic and functional results. I suppose the only drawback of the Da Vinci Robot is its cost. It is an expensive system and every time we operate the cost of the instruments is high, but I think it is no doubt a great advantage for the surgeon and the patients!

Originally posted September 17, 2015

Today we received at Clinica CEMTRO the visit of a live transmission team from Spanish National TV. They connected us to the program "La Mañana de la Uno" to present the Da Vinci Robotic System and comment on its usefulness to treat urologic conditions and specifically, in the surgical treatment of prostate cancer.

Originally posted September 16, 2015

This morning I woke up early to travel to Bilbao and to spend the day at the ERUS 2015 congress on Robotic surgery in Urology. It was very well organized and it was extremely interesting to watch many surgeons performing live surgical retransmissions to the auditorium of the Euskalduna palace auditorium.

A congress with participation of urologists from ICUA, Dr. Estefanía Romero assisted Dr. Richard Gaston in a live surgery transmission.

Unfortunately I could not stay for the second day of the congress as we had been invited to participate in a live presentation in National TV of the Da Vinci surgical system and I had to return to Madrid.

Originally posted September 12, 2015

After the course on robotic surgery I flew to Barcelona to help Dr. Enrique Rijo, from the urology team at Clínica Quirón in Barcelona with his first steps with GreenLEP.

I love to work with colleagues who share the passion for what we do. Dr. Rijo is an enthusiast and is keen to learn.

As in every training session, we discussed all the details of the necessary instruments and morcellator.

Dr. Rijo had studied my videos and had visited me many times to see GreenLEP procedures, and he did a great job!

GreenLEP is an advanced technique, not easy, but perfectly teachable to a urologist with experience in vaporization and with desire to learn. I then returned to Madrid to rest a while. Dr. Rijo called later to tell me patients did very well afterwards.

Originally posted September 11, 2015

Again I went to ORSI-OLV in Belgium to complete another three days of advanced course of Robotic Surgery with the Da Vinci system.

There we had intensive work covering theoretical basis, surgery in cadavers and training models and attendance to the operating room at the OLV Hospital in Aalst.

It is really incredible to witness the amazing development that robotic surgery has experienced in the last years. Today it is possible to operate almost everything with robotic surgery!

I returned very happy, having learnt a great deal, to Madrid.

Originally posted September 8, 2015

This time I went to Italy, specifically to the Hospital San Lazarus in Alba, to assist Dr. Fassolis with his training in anatomic vaporization of the prostate with the GreenLight laser. Dr. Fassolis has already got a great experience in prostate vaporization and he wanted to learn a couple of surgical tips and tricks to perform a proper anatomic vaporization.

We did three operations that went very well and I was happy to see how fast he learnt to perform the technique to perfection!

From Italy I departed to Brussels to participate in another advanced robotic surgical course at ORSI.

Originally posted September 3, 2015

I started this season traveling to Strasbourg, where I reached a dinner with a group of local urologists where I gave a talk on laser for the treatment of BPH.

The following morning we went to Clinique Adassa, where they had prepared 5 patients to perform GreenLEP (Green Laser Enucleation of the Prostate) with my help. I assisted Dr. Weidmann and Dr. Faure to perform their first cases.

After finishing the surgical session, I drove to Montbeliard, where we had a similar plan for the following day. In the morning I went to Hopital Nord Franche Comté, in Montbeliard, where Dr. Atassi had prepared 8 patients to operate in two operating rooms during the day.

It was a tough session, we did not stop working all day.

Everything went well, and it was very clear that this is an advanced technique that can be taught and learnt with relative ease when there is previous experience with prostate vaporization and when the surgeon already has the basic skills and understanding of the physics to manipulate the green laser.

That night we went to the wonderful Museum Peugeot, where we had dinner and also I gave a talk on laser and BPH to the attending urologists.

The next morning I woke up early and returned to Madrid to rest!

Originally posted August 26, 2015

This time I travelled to Belgium to participate in an advanced three-day training course on radical prostatectomy at ORSI with Prof. Alex Mottrie.

In September I will return to complete the second part of the course for another three days.

It has been a great experience and an extremely well conceived, didactic and comprehensive course.

Prof. Mottrie is a great robotic surgeon and despite the fact that we have worked for the past 8 years with Dr. Richard Gastón, who is considered the "guru" of robotic surgery worldwide, and that we are spoiled by his geniality, it is always a pleasure to share with expert surgeons like Prof. Mottrie, compare the different points of view and the alternative surgical strategies.

It was also very nice to share with other urologists from Australia, Scotland, India, Italy and The Netherlands.

Originally posted August 10, 2015

Again I was invited to participate in the TV program Saber Vivir, this time directed by Teresa Viejo, in which we spoke on urinary tract infections in the summer time. As always it was a pleasure to participate and spread useful healthcare related concepts through Spanish TV. The program can be seen here.

Originally posted July 31, 2015

This time I went to the Hill Clinic in Sofia, Bulgaria, to film a teaching video on the Green laser en bloc enucleation technique that the surgical instrument manufacturer Richard Wolf wants to distribute worldwide.

We performed several operations and we filmed the technique step by step as well as many explanations on surgical technique.

It is a good opportunity to teach the technique I developed now 6 years ago to urologists worldwide. I am very happy with the simplicity of it as well as with the results we obtain. It is a very important advance on the surgical treatment of BPH that is going to allow many urologists to learn the technique in a simple way.

Originally posted July 30, 2015

This time I went to Milán to visit the European Institute of Oncology in Italy. There I met Prof. Ottavio de Cobelli who invited me to his operating room to witness a Da Vinci robotic radical prostatectomy in a patient with prostate cancer.

It was an interesting morning in which I could see the strategies they use systematically. It was their first day with the new Robot Da Vinci Xi and they had to use some tricks to be able to work with the alexis access port which was perfect for the 12 mm tracers, but not so good for the 8 mm robotic ports from the new Da Vinci Robot.

It was a very interesting morning. Dr. Cobelli is a great expert. These experiences let me copy the good ideas from other centers, but it also makes me realize the incredible quality level of our work with the Da Vinci Robot, inspired by Dr. Richard Gaston.

Then I went to the airport to travel to Sofia the next day, I have been invited to produce an educational video on GreenLight Enucleation of the prostate.

Originally posted July 24, 2015

As usual, Dr. Gastón came to Madrid to work with me at Clínica CEMTRO and we performed two days of radical prostatectomy cases prostatectomía radical robótica.

We are very impressed with the functional results we are obtaining in the patients we have operated during the last few months with the latest generation Da Vinci robot. The robot itself is a technological wonder, but what is really important to be able to achieve these results, a high quality urinary continence and the preservation of erectile function, is the vast experience of Dr. Gaston in robotic surgery. To me it is an immense privilege to be able to assist him every month and to learn from a master like him. In surgery it is paramount to share the experience, what has been learnt by one surgeon performing thousands of cases, to avoid mistakes, to achieve objectives. Learning from a true master is a luxury and an unparalleled opportunity.

After many years dedicated with devotion to the treatment of prostatic diseases, I feel we have managed to build up a urology department where we offer the best in the diagnosis of prostate cancer and in the treatment of BPH and prostate cancer.