Invitation to operate in Chile 2

Today we had the fist surgical session, with Dr. Fernando Coz, head of the department of Urology of the Military Hospital in Santiago de Chile. We have operated three patients with relatively small prostates (40-55 grams), so the session was uneventful. It was a very fruitful session, all the attendants learned the physical bases of laser-tissue interaction and we have reviewed all the tips and tricks that make PVP (Photoselective Vaporization of the prostate) a safe and efficient operation. Tomorrow we will perform three more surgeries and then I will dictate the conference I announced in the previous post of this blog.

Training and conference in Chile

Today I travel to Santiago de Chile. I have been invited to train the urologists of the Military Hospital of Santiago de Chile on PVP (Photoselective Vaporization of the Prostate). We will operate three patients per day during three days, November 29th and 30th and December 1st. The 30th I will also dictate a conference at the Military Hospital, organised by the Chilenian Urology Society.

Training Marathon in Bilbao

I spent the whole day in Bilbao training a group of urologists on PVP (Photoselective Vaporization of the Prostate). We operated four patients, the first one had a 120 gram prostate and the rest had prostates weighting 40, 60 and 70 grams. We stopped for lunch and I had the chance to enjoy again the vasc cuisine, always a wonderful experience. These surgical sessions are quite intensive but the learning value is very high. The bad part of it is taking the return flight, it is always late, and when it arrives to Madrid they take it to the parking lot which is usually very far away from the terminal..... I arrived at home at 12.00 pm and fell into bed. Tomorrow I have to operate in Madrid and I will travel to Chile this sunday.

New surgical Session in Valencia

After operating a urethral stricture in the Hospital de La Princesa in Madrid, I took a plane to Valencia, where we conducted a training session on PVP (Photoselective Vaporization of the prostate) for Benign Prostatic Hyperplasia. I trained four local urologists. We performed two interventions, a 40 gram prostate and an 80 gram prostate, that progressed smoothly. I then came back to Madrid by plane, tomorrow I have to operate more cases of PVP at my hospital, Hospital USP San José, in Madrid.

Urethral surgery masterclass

Today I have operated a very complex case of urethral stenosis at the Hospital de la Princesa in Madrid. As I commented in this blog before, I am invited to this hospital whenever there is a urethral stenosis case. This patient had a very long bulbar urethal stenosis. We have managed to reconstruct this with a double buccal mucosa free graft in a dorsal position. In this image, we have worked in two teams. I prepared the urethra and two surgeons took the grafts from the inside aspect of the cheek. I have had to rush off to the airport, as I had to operate in Valencia the same afternoon.
The surgery today was a success.

Invitation to perform a live surgery

Today I received a letter inviting me to perform a live surgery, a PVP (Photoselective vaporization of the prostate) during the 11th International Congress that will take place in Zaragoza.

Urolap 2005

Today I will attend the International Course on Laparoscopy - Urolap 2005, organised by La Paz Hospital. It is probably one of the best courses in the world in laparoscopy, due to the quality of its organization, the quality of the live surgeries and because all the current world experts are here. I have attended as a student, I did not want to miss it. During this course I have contacted Dr. Gastón, one of the three or four best laparoscopic urologists in the world, and he has accepted to come to Madrid for a teaching session in our surgical theatre. He will operate a patient in January in collaboration with Dr. Castillón, the head of the Laparoscopy unit at the Instituto de Cirugía Urológica Avanzada.

New surgical session in La Coruña

Today I travelled to the northwest of Spain, to La Coruña, to participate in a very difficult case. A patient with a prostate larger than 150 grams. I could not see any ultrasound of the patient before surgery, but his digital rectal examination revealed the pressence of a massive prostate. Endoscopically it was also huge, and very long (7 cm). Maybe the biggest case I have done (I operated a 200 gram prostate once, but it was easier to operate).
We finally managed to complete the operation without much trouble, I think the patient will do very well. We spent more than 3 hours in theatre, it gets long and one gets tired, but the result is very satisfactory. In cases like this the usual spinal anaesthetic is not enough, so the anaesthetist must perform a combined anaesthetic spinal + epidural, that allows for new bolus of local anaesthetic to be administered if the surgery is prolongued. This way patients are confortable during the procedure.
Then I returned to Madrid, I will operate three cases in Hospital USP San José. Two of them are high risk patients, one is very bothered with his bladder and the second one has been catheterised for months, he was not considered fit enough for surgery and his doctors told him he had to live with a catheter forever. Maybe the KTP laser prostatectomy will be their only chance to recover a normal life. (update November 16th.... all three cases went fine, all patients are happy and back home already).

Basic Laparoscopy Course in Madrid

Yesterday I participated as invited teacher at the Basic Laparoscopic Urology Course organised by Dr. Ignacio Castillón (upper photo), director of the Escuela Europea de Laparoscopia Urológica (European School of Laparoscopic Urology) in collaboration with the Instituto de Cirugía Urológica Avanzada (Institute of Advanced Urological Surgery).

The objective was to initiate in laparoscopy techniques to a group of eight urologists. Nowadays laparoscopic (keyhole) surgery is taking over open surgery and has important advantages for patients. Urologists have to learn these techniques in courses like this and aquire the surgical skills before they can apply these techniques to the treatment of their patients. .
The course took place in four different surgical theatres, perfectly equipped thanks to the generosity of Olympus and other sponsoring companies that provided laparoscopy surgical instruments. This initiative would have not been possible without the collaboration of the Hospital Clínico Veterinario, an ideal place for this kind of courses. The presence of other very experienced urologists as Dr. Estébanez, laparoscopist from San Sebastián, and Dr. Páez, head of the department of urology of the NHS Hospital of Fuenlabrada in Madrid, helped to ensure that the quality of the training was superb. The participants in the course thought the course was "excellent", as it showed in the evaluation forms we provided them at the end of the course. The Escuela Europea de Laparoscopia Urológica (European School of Laparoscopic Urology) organises basic laparoscopy courses and also more specialised courses as the one in Advanced Renal Surgery that will take place in February. Urologists interested in these courses can contact the school coordinator, Ana María Muñoz, her telephone number is +34914352844.

PVP workshop in Santiago de Compostela

Today I left Madrid early in the morning towards Santiago de Compostela. This time I have had a little free time and managed to walk around the "plaza del Obradoiro", in front of the Cathedral of Santiago. It is a beauty. This is how the pilgrims look like when they reach Santiago by foot from France. I have then gone to eat some octopus in a local restaurant.
At three pm I went walking to the hospital where I had to train two urologists in the technique of Photoselective Vaporization of the prostate.
We did two operations, one of the prostates was relatively big, weighing 75 grams. The second one was smaller, ideal for training. I had to rush to the airport thinking that I was late, but after boarding we had to disembark due to an aeroplane's motor breakdown. I am updating this blog from the airport and I do not know yet if I will have to sleep in Santiago or if I will be able to get home tonight. Tomorrow I have to participate as a teacher in the Basic Laparoscopy course organised by Dr. Castillón. An initiative of the European School of Urologic Laparoscopy in collaboration with the Institute of Advanced Urological Surgery, our institution.

Invitation to operate in Vienna

Yesterday I received an invitation to train the prostate specialists of the Urology Department of the University Hospital in Vienna. The head of the department is Prof. Marberger, one of the "fathers" of European Urology. Dr. Djavan is also an eminent urologist well known for his contributions to Benign Prostatic Hyperplasia. Dr. Marberger and I met recently at the International Urology Congress celebrated in Madrid. I think he was convinced by the efficacy and simplicity of Photoselective Vaporization of the Prostate. Apparently they have decided to adopt this technique and I am invited to a two day workshop in which I will lecture on the basic aspects of this technique and we will perform several surgeries. I will keep you posted in this blog.

Training seminar in Valencia

Today I jumped to valencia to participate in a training seminar. We performed a case of Benign Prostatic Hyperplasia with a high power (80 W) KTP laser, under spinal anaesthetic. I returned to Madrid the same day. This was a high risk patient that we managed to operate without losing a single drop of blood. It was a very satisfactory operation. As this photograph demonstrates, in this operation the patient is so safe that the anaesthetist only performs the spinal anaesthesia and then he can read the newspaper.

USP Interhospitalary Meeting on Urology

This weekend we have celebrated the USP interhospitalary meeting on urology. This is the first meeting gathering all urologists working at USP hospitals in Spain. The objective is to allow each urology department to present the new advances, as well as to establish a closer contact among the urologists working for this group of private hospitals, so that we can offer a better service to our patients. All presentations were excellent and all participants had put a lot of interest in this meeting. I really enjoyed during this meeting.

I have presented my experience with PVP (KTP laser photoselective vaporization of the prostate). I also presented a video where we performed a partial laparoscopic nephrectomy using a low power KTP laser. This is a possible future application of this laser we are investigating at the Hospital Clínico Veterinario, in Madrid.

New training session in Valencia

Today I operated in Madrid in the morning. I had a relatively young patient with a big prostate (120 grams). He had suffered several episodes of urinary retention and had to carry a urinary catheter. He wanted to avoid open surgery and its risks (including impotence, incontinence and so on).
I then travelled to Valencia to participate in a new training session. We operated a patient with a big prostate similar to the one I did this morning.

Then I went back to Madrid and visited the patient I operated this morning. He had managed to void and was happy without his catheter.

Training session in Valencia

Today I travelled to Valencia to participate in a training session. We had a very complex patient, with a huge 130 gram prostate. These big prostates can be operated, but they require a longer operating time and patience. This operation took 3 hours and we applied 750.000 joules. The prostate had an enormous median lobe that occupied the prostatic urethra and protruded inside the bladder. We managed to vaporize it and to leave a huge prostatic cavity. It was a very interesting case, big prostates are always a challenge but this one was special for its peculiar anatomy. Some urologists think that median lobes are difficult to treat with the KTP laser, but it is rather easy to vaporize them completely, you only need to know some simple tricks.


We also realised that irrigation can be improved with a suprapubic 5 mm laparoscopy trocar. I did not carry with me the Reuter trocar I use in these difficult cases (it is getting more difficult to get it into an aeroplane - it is a sharp metallic object). So this was a good idea, nowadays all hospitals have laparoscopy trocars. This enhances irrigation, the vision gets very clear and it is very useful to operate big prostates with a very small risk and good results. The patient gets a 5 mm wound in his lower abdomen, that is not much of a problem at all. I took the plane back to Madrid, we have a Bank Holiday and tomorrow I will get a chance to rest for a while. I have to return to Valencia this thursday to participate in another rather difficult case.