Surgical Session in Barcelona

Today I took a flight to Barcelona, to participate in a surgical session of Photoselective Vaporization of the Prostate with the 80 watt KTP laser at Teknon Hospital in Barcelona.

We have operated two patients and both surgeries were uneventful. I then had to wait at the airport for a couple of hours before returning to Madrid. As we are in Christmas, there are less shuttle flights and I had to wait for longer than usual.

Both Madrid and Barcelona were extremely quiet, almost everybody is on holiday for Christmas, and that makes it more difficult to work!!!

Later I checked my mail and I had an invitation to travel to Saudi Arabia during the first week of February, to participate in the training of urologists from Riyadh and Al Khobar city in the use of the new Greenlight HPS laser...


This is the last entry of the year in this blog, and I would like to take the opportunity to wish you all a happy and successful 2007!!!

Conference in Cairo, Egypt

Today I returned to Madrid after spending a week in Egypt, where I was invited to the 41st Annual Congress of the Egyptian Urological Association to talk about my experience with PVP - Photoselective Vaporization of the Prostate with the Greenlight Laser.

I also had a chance to spend some days in Luxor with my family, and from there we went to Cairo, where the congress was being celebrated. Egypt is a beautiful country, and we enjoyed visiting the temples of Karnak, Luxor, the Nile and the exotic atmosphere of this amazing country.

After Luxor, we went to Cairo, I had to participate in two important events. The first one, a press round to launch this technique in Egypt, where I participated actively. After the press round, the beautiful Nile TV channel presenter interviewed me and we not only talked about the Greenlight laser, but also about prostate cancer and urinary incontinence.

That night I participated in the official presentation of the Greenlight System to the urologists attending the congress, and the programme included the participation of Mr. Martin Hill (EMEA Distributor Manager of AMS/Laserscope), Prof. Mostafa El Hilali, an eminent Egyptian Urologist that lives and works in Canada, and Dr. Yarkin Kamil Yakupoglu, from Turkey. We all spent about 20 minutes discussing the Greenlight system and after the scientific session we enjoyed a very nice Egyptian dinner.

Martin Hill, Dr. Kamil and me just before the start of the scientific session.


The next day I had a chance to visit El Cairo, and I enjoyed enormously visiting the Pyramids and the Museum of Cairo. The Pyramids are overwhelming.


I was most impressed by the mummy of Ramses II. I think going all the way to Cairo is worth it just to look at him, flesh and bones, after 3300 years.... he is still looks great, doesn't he?



And finally, I did my contribution to the congress itself, with the conference "Greenlight PVP", and with an impressive attendance...

After my talk, I had the chance to discuss this technique with surgeons from Jordan, Kuwait and other Middle east countries.

I was interviewed by the magazine HME that was distributed to all attendees. I am transcribing it below.


It has been a fantastic experience. I have enjoyed Egypt, and I recommend everyone to visit this wonderful country. The Egyptians are very kind people and the country is espectacular.

I was happy to receive an invitation to come back soon, maybe in February, to contribute to the training of the two first users of the Greenlight laser in Egypt.

HPS in action in a big prostate

This is a video of a Greenlight HPS Photoselective Vaporization of the Prostate in a man with a 130 g prostate. These prostates are very big and usually are treated with an open prostatectomy. I used a suprapubic trocar, a 5 mm tube that is inserted into the bladder under the belly button, to enhance irrigation and improve visibility. The patient was sent to the room after his operation and the trocar entry site only needed a sticker to close. He was operated at 3.00 pm and was discharged the following morning, without a catheter and very happy.

Training in Sweden

Yesterday I travelled to Stockholm, Sweden. I then took a taxi to Västeras. I have been invited to train two urologists from the Public Hospital in Västeras in the use of the new 120 watt Greelight HPS. I had dinner with Dr. Botan Hawas, head of the department of urology and an extremely pleasant man, and we had a chance to discuss the characteristics of this technique thoroughly.

This morning we started at 8 am and we have operated three patients. The first patient was a relatively easy case with a small prostate and he has been the first patient to be operated with the HPS in Scandinavia.


Then we did an 80 gram prostate with a very prominent median lobe, very interesting and with a big educational value. Finally we operated a patient with an advanced prostate cancer that was catheterised. We will do two more cases tomorrow before I return to Madrid.

The hospitals in Sweden are very different from Spanish hospitals, they have a very pleasant decoration, with large living rooms where patients and doctors can sit down to have a coffee. This must make patients feel at home during their hospital stay!!

Visitor from Saudi Arabia

Last week was intense. I had a visitor in Madrid, Dr. Khalid Al Othman, from Hospital King Faisal Specialist Hospital & Research Centre, Jedda, Saudi Arabia. There is a growing interest for the Greenlight HPS system in his country and he came to visit with the objective of learning as much as possible about this laser, as they plan to implement this technology in their department. We started the training programme with four operations on Tuesday. I had scheduled four cases with prostatic sizes of 160, 106, 90 y 45 grams so we had a chance to comment the technical details of the operation. Dr. Al Othman was trained in Canada and Germany, and he was very focused in listening and seeing everything, and I learnt a great deal with his comments and questions... Then on wednesday I picked him up early to go to the airport, we travelled to Barcelona where I had scheduled a surgical session with the famous Gil Vernet family of urologists. We are good friends and I have been going to Barcelona to operate with them regularly. We have decided to strengthen this collaboration in the future. We performed a Greenlight PVP with the 80 watt laser, and it was a good oportunity for Dr. Al Othman to realise the differences between the 120 watt HPS and the 80 watt Greenlight.


We also had a chance to discuss thoroughly urethral stenosis treatment, one of the passions of Dr. Gil Vernet, a true expert in this field.

We returned to Madrid later that night because we had a very intense session the next morning. On thursday I had scheduled 5 patients, this time prostatic sizes were smaller, 130, 80, 60, 45 and 9 grams, and the session was uneventful. Again the conversations with Dr. Al Othman were enjoyable, he is a sharp urologist and he was able to grasp the subtleties of PVP, he could see almost every kind of patient and he learned all the surgical tips and tricks. In one of the operations in a patient with a 130 gram prostate I used a suprapubic trocar to enhance irrigation, and I delivered 800.000 joules. I recorded this operation and I hope to be able to offer it here soon.

I have been invited to travel to Saudi Arabia soon to help Saudi urologists to learn the technique with the new HPS greenlight Laser. I look forward to that.

Conference in Leuven, Belgium

This weekend I took a flight to Leuven in Belgium. I was invited to the International Symposium State of the Art in Urology organised by Professor Van Poppel at the University Hospital K.U. Leuven. The title of my lecture was "Why PVP rather than TURP or other MITs" - or why do I think that PVP is better than transurethral resection of the prostate and much better than TUMT (Transurethral microwave termotherapy) and TUNA (Transurethral needle ablation of the prostate). I had a chance to talk about my experience with the new HPS laser.

This time I was able to stay for the whole congress and the truth is that the programme was of the highest quality, all the speakers were international experts and I have really enjoyed it. The panel of experts was impressive Piechaud (robotic prostatectomy), Possover (laparoscopic neuronavigation), Van Velthoven (laparoscopic cystectomy), Stolzenburg (laparoscopic radical prostatectomy), Dasgupta (robotic surgery), Marberger (ablative kidney cancer energies), Emberton (HIFU), Langley (Brachytherapy), Kirkali (EORTC), Janetschek (centinel node in prostate cancer), Tombal (new agents in prostate cancer), etc...

Two urologists of the University Hospital in Leuven have confirmed that they would like to come to Madrid in January to see some PVP cases with the HPS laser.

Leuven is a university city full of students driving bicicles, and the atmosphere is very nice, the city is really beautiful.

Visitors from India

Today I had the pleasure of welcoming two Indian Doctors. The prestigious Urologist Shailesh Raina and Col. Manesh Sadhuram Masand from Jaslok Hospital from Mumbai, India. They want to be the first buyers of an HPS laser in India, and they wanted to see some Greenlight HPS Photoselective Vaporization of the Prostate procedures.


We have programmed four patients this morning, with prostates weighing 150, 80, 60 and 50 grams, the last of the cases was an obstructive prostate cancer. We have managed to operate all patients from 9 am to 3 pm, and all surgeries were uneventful. I think they liked what they saw and I guess they will decide to go for it.

Tonight I will take them to a Flamenco Show. They have to see some of our culture before they return to India... Olé!!!

Experts meeting in London

This friday I travelled to London to meet Mr. Gordon Muir and Prof. Alex Bachmann (in the Photo) to finish the article on technical recommendations on PVP (Photoselective vaporization of the prostate) with the 80 Watt Greenlight PV laser. This article also includes recommendations on how to train urologists to perform this operation correctly. We started this article during our experts summit in Madrid in July. We have used the opportunity to start a second paper on the complications observed with this technique (of course less important than those observed with the classic transurethral resection of the prostate) and how to avoid them. Christine Mckillop, a professional medical writer specialised in Urology is helping us to maintain order and focus, as it is not always easy to reach the consensus among five international experts... She is always taking notes and drawings, and as the time was short, we decided to keep on working during our lunch....

Trip to Lyon, France, HIFU for Prostate Cancer

This thursday I took a plane to Lyon, to visit Dr. Murat and Dr. Gelet, both world experts in the treatment of localised prostate cancer with HIFU (High Intensity Focused Ultrasound). I went to theatre to witness two HIFU cases, one for a primary prostate cancer (recently diagnosed), and the second one was a patient who was treated with radiotherapy and this treatment failed, and recurred to HIFU as a salvage treatment.
Next tuesday we will perform our first case in Madrid, we will have the first permanent HIFU device installed in Spain and we will offer this treatment option to our patients, and the possibility of getting trained to those urologists who want to learn. It is an impressive technology, that allows prostate cancer to be treated with minimal discomfort and with a lower risk of complications or secuelae.

This video shows how the technique is performed.

Surgeries in Castellón

This morning I woke up early to travel to Valencia. From there I took a car to go to Castellón, where I was invited to mentor a group of urologists. I did three PVPs in the morning session. The National Health Service in Castellón is starting to use PVP. After I finished, I went back to Valencia and from there back to Madrid and from there I took a plane to Lyon, France. Tomorrow I will wake up early again to participate in a course on HIFU (High Intensity Focused Ultrasound) for prostate cancer.

Masterclass with Prof. Gastón

This saturday we had the privilege of hosting Dr. Gastón in Madrid. In this ocassion he came with the legendary Monique, his nurse, that is able to assist him and do the instrumentation as a scrub nurse at the same time. They have operated together for 20 years and they are maybe the best example of surgical excellence in urology. Watching them operate is like watching a ballet as they perform an impecable operation. He did three radical prostatectomies while we watched. I picked them up at the airport at 9 am and at 5.30 pm he had finished and had time to relax in the way back to the airport and Bordeaux.

Invitation to Egypt

Yesterday I received an invitation to participate in the Annual Course of the Egyptian Urological Association. This is one of the most prestigious congresses celebrated in the African continent. Egyptian Urology has produced a number of world class surgeons and urology gurus... I will lecture on Greenlight Photoselective Vaporization of the prostate. A nice challenge and a wonderful trip!

International Course at Fundació Puigvert

This morning I had to wake up early to take a plane to Barcelona, to participate at the Annual International Course organised by the prestigious Fundació Puigvert. My role was to moderate a live surgical session where Dr. Montlleó performed a Photoselective Vaporization of the Prostate with the 80 Watt KTP laser. After the training sessions I conducted at Puigvert, and after having operated 15 patients, she was able to perform a wonderful operation. We took the opportunity and we discussed in depth the advantages of this technique over conventional surgery in the treatment of BPH.



This has been an impressive course, world class surgeons were invited and the best technical resources were available. The conference room was totally silent, because there were two simultaneous operations being retransmitted and the attendees had the option of chosing what surgery and comments to listen. Also, to appreciate the surgeon's point of view in robotic operations, all attendees wore 3D goggles. An espectacular course!!!

Trip to Valencia to operate a colleague

Yesterday I went to Valencia to operate a colleague. A urologist and friend of mine who I mentored on the technique of Photoselective Vaporization of the Prostate. He has had a chance to experience the results of this operation in his own patients, and he asked me to fly to Valencia to operate him, and I did with pleasure. He has phoned today to tell me that he spent the night home after the operation, and that he is voiding well, will totally clear urine... It is a great honour to be asked by a colleague and friend to operate him.

Greenlight HPS

This video shows an endoscopic prostatectomy in a patient with a 60 gram prostate with the new 120 watt HPS grenlight laser. This laser has the same wavelenght than the 80 watt Greenlight KTP laser (532 nm), but is much more powerful. It vaporizes tissue at a higher rate and thus operative time is reduced. The Greenlight KTP laser is a wonderful tool, this new laser will be specially useful to treat bigger prostates.
This is a TRUS image of the prostate preoperatively.

And this is the postoperative aspect of the prostate. There is a huge central cavity showing that all BPH tissue has been removed.

European School of Urology Course in Albufeira, Portugal

This morning I participated at the ESU Course on minimally invasive treatments in urology, that took place during the Annual Congress of the Portuguese Urological Association. This has been my first contribution as a faculty member of the European School of Urology.

My task was to discuss the current status of minimally invasive treatments of benign prostatic hyperplasia. I have analized these options, as well as their pros and cons (TUMT, TUNA, ILC, intraprostatic Botox, TEAP, WIT, HoLap, HoLep, and so on). I also discussed in detail my experience with the Greenlight laser, and showed my experience with the new HPS laser. The meeting has been really interesting and many urologists showed up for the course. After our lectures, we had a relatively long and lively discussion.

The chairman of the session, Prof. Morgia, from Italy, in the left hand side of the photo below, spoke about the minimally invasive treatment of prostate cancer, including cryosurgery, High Intensity Focused Ultrasound (HIFU) and brachytherapy. Prof. Dimitri Pushkar, from Moscow, in the center of the photograph, spoke about urinary incontinence, he has a vast experience in lower urinary tract reconstruction in the female. He has operated more than 2000 urinary fistulas (!).

After the session, I only had time to enjoy lunch by the sea with my good friend Dr. Reis Santos, from Lisbon, and I had to rush to the airport, on my way back to Madrid.

Conference in Ireland

Yesterday I travelled to Ireland, I did a stop in Glasgow and from there I took a plane to Killarney, where the Annual Congress of the Irish Society of Urology is taking place. I was invited to lecture on my experience with the Greenlight KTP laser in the treatment of Benign Prostatic Hyperplasia.




The congress took place at the Great Southern Hotel, at Killarney, a relatively remote place within Ireland. Unfortunately I did not have much time to visit the place as I have been at the scientific sessions.



It was fortunate though that I had a chance to see the famous cup "Sam McGuire" that is about 100 years old, and every year it is kept by the team winning the amateur ligue of Gaelic Football (an Irish old sport where the ball can be touched with the hands). This is also famous in Australia, with slightly different rules... One of the winners took it with him to the hotel and it was a great honour to be able to see and touch it. As I did not have my camera with me, I took a photo with my mobile...


It was also very interesting to see some good friends here, Dr. Killian Walsh and Dr. Bouchier-Hayes, and to have a chance to talk and meet prestigious local urologists and share our points of view... There are four centers in the country that offer Greenlight PV to their BPH patients. The Irish are very hospitalary and charming people....

Holidays are over

After a whole month resting in a quiet town in the north of Spain, I am back to work and with a lot of work. This wednesday I was invited to Valencia to operate a patient. The operation was uneventful and I got back home late due to Iberia's famous delays.... It is quite difficult to go back to work after enjoying the summer rest... Anyway, the year ahead looks very exciting and I guess it is just postvacational lazyness.

Surgery in Vienna

Today I have operated at the Urology department of the General Hospital in Vienna, invited by Prof. Marberger. This hospital is the biggest I have seen in my life. Apparently every day there are 70.000 people coming in and out the hospital, it has 50 surgical theatres and it employes 250 anaesthetists.... it is unbelievable, I had never seen anything like this. It is a huge place, a true health city.
The urology department is going to adopt the greenlight PVP (Photoselective vaporization of the prostate) technique, and I was invited to demonstrate the technique. I have operated three patients, two with relatively small prostates and one with a big gland and a huge median lobe. All three patients did really well. We also had time to talk slowly about the technical and scientifical issues about this technique. Tonight we will go out to dinner and although we thought we would operate also tomorrow, the session has been cancelled, apparently patients have suddenly decided they wanted to go on holiday... It is really hot in Vienna (35 degrees celsius), and they seem to have escaped heading north.
It was a great honour to be invited to operate at one of the best urology centers in the world, we will celebrate tonight dining in Vienna.

Second day in South Africa

This is my second day in South Africa. I visited Hospital Donald Gordon in Johannesburg, where we did three PVPs (photoselective vaporization of the prostate). The objective was to train two local urologists in this technique. As always, I started the first operation and then they took the initiative. All operations were uneventful and the outcome was satisfactory (so I am told, all patients did well postoperatively). Then I went to the airport to take a plane back to Madrid. This time my stay in South Africa was extremely short, there is no doubt I will try to come back...

Mentoring in South Africa

Again I went to Southafrica, this time to mentor two teams in Johannesburg. They are the first surgeons to offer the Greenlight PVP procedure in Africa. We went to Linkinsfield Park Hospital in Johannesburg to operate three patients.


I had the enormous honour of operating the first patient to be subjected to a PVP in the African continent... I shared this honour with Dr. Kevin Fisher, who finished the operation. After this first case, I helped Dr. Fisher to perform two operations that were very successful.

We will have dinner together tonight and tomorrow we will conduct a similar session in another hospital. Today the session was successful and everyone who saw the technique, anaesthetists, nurses, other surgeons, were very impressed by this technique.

In the news - Greenlight HPS

This clip appeared in the news after the presentation of the HPS greenlight laser in Madrid and the world experts summit.

We are on TV

This video was broadcasted by "Madrid Directo", a programme of the regional TV, TeleMadrid. It focuses in patient's experience of PVP. We operated him in the afternoon and he was discharged the morning after, so happy. Yesterday he phoned from the beach to say he was feeling great!!

Presentation of the HPS to the press and world experts summit

This weekend we presented the new HPS system to the Spanish press. We did it using the opportunity of the visit to Madrid of four renowned international experts in Greenlight Photoselective Vaporization of the prostate: Mr. Gordon Muir, from King's College Hospital, London; Dr. Shahin Tabatabei, from Massachussets General Hospital; Dr. Benjamin Choi, from Presbysterian Hospital, New York and Dr. Alex Bachmann, from the Basel University Hospital, Switzerland.


We all have a very broad experience in this operation, among the five of us, we have a combined experience of 3000 patients. The objective of their visit was to meet to carry out a surgical session where we would operate one patient each and use the opportunity to discuss technical aspects, strategies and tips and tricks of this surgical intervention. We wanted to share our points of view and reach a consensus on the best way of doing things. All surgeries were splendid and all patients recovered fast and went home very happy.


This saturday we gathered at the Institute of Advanced Urological Surgery in Madrid to establish a consensus on how this operation must be carried out, what to do and what to avoid, what are our recommendations on training residents and urologists, etc... We reached some conclusions that will be published in the form of one or two papers in an international Journal. It was a real pleasure to host these wonderful people and eminent urologists in Madrid. We have all enjoyed the opportunity to share our knowledge, and we think the papers that will come out of this meeting will be of great help as a guide for those urologists wanting to offer this treatment to their patients.