Surgeries in Lebanon

This time I came to Beirut to accompany Dr. Imad Ghantous at the Hôpital Libano-Français, in Zahle, a city near Beirut.

We had a very tough schedule, with six surgeries and a talk to the hospital doctors, as well as other urologists who came to see the session.

I explained the basic science, the interaction of laser with prostatic tissue, basic concepts that are very important and need to be clearly understood in order to work with this laser.

A tough day, but very successful, all operations went well. The following day I returned to Madrid, a long trip Beirut-Rome-Madrid. I am starting to feel that I need to rest this Christmas.

Surgeries at Ospedale San Antonio, Padova, Italy

Today I flew to Bergamo and drove towards Padova, where I performed two operations in two patients with benign prostatic hyperplasia, to demonstrate the new technique of anatomical vaporization of the prostate with the GreenLight XPS laser.

There I was hosted by the head of the department of urology, the kind Dottore Massimo del Bianco. We spent a very nice morning in the operating theatre, discussing pros and cons of this laser and the effect of the economic crisis in the Italian healthcare system. The operations were successful and I could demonstrate the benefits of this technique for the patients.

Then I departed to Rome, to connect to Beirut. A very tough trip, I arrived in Beirut after 3 am...

Surgical session in Sofia

Again I travelled to Bulgaria to operate patients with big prostates at the Hill Clinic in Sofia. It started snowing showing that Christmas and the end of the year is near. Everything comes to an end!

New paper on European Urology

Yesterday I saw in European Urology the new paper I have published with other international experts in laser treatment of BPH (Benign Prostatic Hyperplasia), analyzing the results obtained with the new GreenLight XPS 180 watt laser.

It is the analysis of the early experience with this laser, that is very satisfactory.

This is the first paper published with results of this new laser in the world, and it surely will be thoroughly cited.

Surgeries with Dr .Gaston, from Bordeaux, France

Today I woke up early to pick up Dr. Richard Gaston at the airport. He came to operate two patients with us, to perform two radical laparoscopic prostatectomies.

As always, we operated with him Dra. Romero, from our team at ICUA, and myself, with the added pleasure of receiving the visit of two local urologists. Dr. Gastón told me today that he will operate this year more than 500 patients at Clinique Saint Agustin. He is a true genius of surgery and his knowledge of the micro anatomy of the prostate is amazing.

He also commented that he wants to invite me to visit Bordeaux so I can show them our technique of laser treatment of BPH. 

Visit of Prof. Amici, from Rome

Today we received the visit of Prof. Amici, from the Ospedale Fatebenefratelli Isola Tiberina in Rome, Italy. I did two operations to show the anatomic vaporization concept, very interesting cases. The first patient had a 75 cc gram prostate with a big median lobe. I did a mixed technique, vaporizing lateral lobes and enucleating the median lobe into the bladder, and later morcellated it. The second patient had a smaller gland, about 40 cc, I did an anatomic vaporization down to capsule in 35 minutes.

I could demonstrate with intraoperative transrectal ultrasound how it is perfectly possible to perform a radical vaporization of the adenoma, with no bleeding, in a simple and fast way. I think he was convinced that this laser GreenLight XPS allows to perform a fantastic job with minimum morbidity. I think I will go to his hospital soon to help him perform his first cases.

Surgeries in Buenos Aires, Argentina

This weekend I went to Buenos Aires, where I was invited by my friends Edgardo Becher, Marcelo Borghi and Victor Chernobilsky, from the prestigious Centro de Urología de Buenos Aires.

The Centro de Urología is an ambulatory surgical center where they have already operated more than one thousand patients with the GreenLight Laser. The objective of my visit was to help them start with the GreenLEP (GreenLight Enucleation of the Prostate) technique, so that they can offer this to their patients, specially those with bigger prostates.

Dr. Borgi, happy after finalizing an enucleation procedure

It is a great pleasure to work with expert surgeons, they had no problems to grasp the technique, we only had to polish small but important details to do this kind of operation, that is technically more demanding than simple vaporization.

I had a great time with them, they are wonderful urologists and remarkable human beings, now even more friends.

Surgeries with Dr. Muchster

Today I flew to Rottenburg, Germany, to visit Dr. Muschter.

They asked me to visit him in his hospital in Rottenburg to evaluate him as a surgeon, to ensure that he can do a good job with the GreenLight laser, so he can be admitted for a randomized clinical trial, the "Goliath Study". This is a requisite in these randomized trials, that aim to demonstrate the true differences between treatments.

This trial is going to compare the results of conventional surgery with transurethral resection of the prostate (TURP) with those of Photoselective Vaporization of the Prostate (PVP) with the GreenLight Laser.

Prof. Muschter is one of the most active urologists in the laser field in the history of urology. I had a chat with him that was pure gold for me, I learnt a great deal from him and his vast experience with all kinds of lasers for many years.

Of course, he is a master surgeon as well. He also showed me his installations, that are impressive due to their functionality and equipment. It was a very nice day.

Then I came back to Madrid to rest during the weekend, after several weeks non-stop working!

Visitors from Italy, Canary Islands and Peru

Today we had programmed operations at Clínica CEMTRO and we received the visit of many urologists from Italy, Las Palmas de Gran Canaria, and of my friend, Dr. Jorge Saldaña, from Perú, who is touring across Spain and has taken the opportunity to pay a visit to see some operations.

Waiting for the patient to get ready

We operated three patients, two vaporizations and one enucleation, that went really well. Among the visiting urologists was Dr. Naspro, who has published extensively on laser prostatectomy and is an internationally known laser surgeon. He found very interesting the concept of anatomic vaporization, down to the capsule, and the new possibilities of GreenLight enucleation with a side firing fiber.

With Dr. Jorge Saldaña

Then we went to the flamenco show, as always, and we had a lot of fun!

Surgeries in Sofia, Bulgaria

Following with my collaboration with the Hill Clinic in Sofia, in this occasion we had two very busy days.

On Saturday I arrived a little later than planned from Athens, and we started to operate a little bit late. We had six operations scheduled for the day. On sunday we operated five more patients. We did ten GreenLEPs (GreenLight enucleations) and one vaporization, and all of them were fine. One of the patients had a 230 g prostate, and all the other patients had prostates over 100 g.

To me, operating in Hill is always very interesting, the cases they select for me are the more complex, bigger prostate glands. Operating complex case after complex case in this way is an excellent opportunity for me to keep learning small details, trying technical variations that allow me to mature and perfect even more the GreenLEP technique.

We received a visit from a local urology professor from Sofia and I showed him the GreenLEP technique. He left us very impressed with what he saw, being able to treat these patients with big prostates with such a minimally invasive way, such elegant procedure is always very surprising.

The fastest procedure took 40 minutes, we can do this procedure faster, safer and more satisfactorily. It was an intense weekend, but very interesting and productive. It is always a pleasure to go to Sofia.

San Luigi Hospital, Torino

From Belgrade I flew to Torino, Italy, where I had to visit Hospital San Luigi, to perform a demonstration of the GreenLight XPS 180 watt laser in action. I did two operations with the urologists of San Luigi. The Italian hospitals are very well equipped and in this one there is a lot of robotic laparoscopic procedures being carried out.

We had a problem with the visibility during the operation as we tried to use a three chip endoscopic camera. These are not ideal for GreenLight surgery, as the image gets too saturated.

Then we used a high definition camera that was amazingly good. I showed them the anatomic vaporization technique by with the prostatic capsule is localized to allow for a complete removal of the adenoma.

Then I left to Milan, where I tried to catch a flight to Sofia. Unfortunately I was late and I lost the flight, and I had to find an alternative option, fly to Athens, sleep there and then fly to Sofia early in the morning.

Surgeries in Belgrade, Serbia

I went to Belgrade, Serbia, to help in the presentation of the new GreenLight XPS 180 watt laser at the Dean's building of the University of Serbia.

The distributor company of Americal Medical Systems in Serbia, Medicon, donated a laser to the Clinical Center of Serbia, the most relevant urology department in the country, to allow the Serbian people to access to this treatment at the national health service.

I presented the technology and its advantages and then I performed two live procedures, that were transmitted to the room, full of local dignitaries, as the Serbian Minister of Health, or the ambassador of the United States in Serbia.

The session was very successful. I enjoyed thoroughly helping to introduce this marvelous technology in a country like this.

I also had a very nice moment when one of the patients I operated in my previous visit to Belgrade, a famous serbian actor who had a huge prostate gland, on whom I performed a GreenLight enucleation, a very difficult case, came to see me. He very kindly described how well he was feeling and how happy he was, he brought one of his movies for me and we spoke about his life in cinema, and commented on Emir Kusturiça, who directed him in multiple occasions, and who I love as a director.

Soon I will return to Serbia to train the urologists who are going to start using this laser.

Participation in "La Mañana" - Spanish National TV

Today I participated in the National TV program "La Mañana.

This time we speak about urinary tract infections. It is always nice to go to the TV and contribute to expand the public knowledge on urological disease.

Surgeries in University Hospital Infanta Leonor, in Madrid

Today I visited Hospital Infanta Leonor, in Madrid. I did three operations with the GreenLight XPS 180 watt laser in the morning session. I really liked this new hospital. It is a very modern and beautifully designed hospital.

The interest for GreenLight laser has reached public hospitals in Spain, where the low risk and short hospital stay that this laser allow for the treatment of patients with benign prostatic hyperplasia is becoming interesting.

Surgeries in Quito, Ecuador

I could reach Quito after a long trip. My plane from Avianca broke down while trying to take off, and the flight was cancelled, so I had to wait one day to travel. I was going to operate with Dr. Ricardo Yépez and Dr. Saskia Suarez, at Hospital Carlos Andrade Marín.

Con el Dr. Ricardo Yépez antes de entrar en el Hospital

I was very impressed by quality of the technical equipment available in the surgical rooms in this hospital. It seems the government is investing heavily in infrastructure and has pushed healthcare forward significantly.

The objective of this visit was twofold, the first objective was to help my colleagues to start with GreenLight Enucleation of the prostate. We operated two days and we went through step by step surgical technique and we could deepen in details and improve several important technical aspects.

Prostate enucleation is a complex technique and to be able to perform it properly it is important to have specific surgical instruments, an impeccable anesthetic technique, a properly trained surgical team and to pay great attention to detail. The clinical results are excellent and many of the patients we operated, not specially easy cases, went home the same day of the operation.

The second objective was to support Dr. Yépez and Dr. Suarez with the planification of the first international congress of the GRILUR (Grupo Iberoamericano de Láser en Urología) that will take place in this hospital in July 26th-29th, 2012, with special focus in the minimally invasive treatment of benign prostatic hyperplasia (BPH) as well as of urinary stones. It will be an important congress, with live surgeries and the participation of international experts. We had a good chance to comment on the current status of the organization of the meeting that aims to gather those spanish and american urologists interested in the use of lasers for the treatment of urinary tract diseases.

We also had a chance to travel to the east where we visited amazing places and I was able to enjoy my friend's hospitality.

Then I returned to Madrid. A long trip, but definitely worth it!

Surgical Session in Gran Canaria

This weekend I went again to Gran Canaria, to collaborate with my old friend, Dr. Juarez del Dago, in a surgical session with the new GreenLight XPS 180 watt laser. We operated several patients that went really well.

In the photo, Dr. Juarez and his marvelous nurse, Loly, getting ready for the operations.

Surgical Session with Dr. Rix

Today we had the pleasure of hosting Dr. Gerald Rix, an expert in the technique of Holmium Laser Enucleation of the prostate at Clinica CEMTRO in Madrid.

We commented the surgical technique at large and his convictions regarding this procedure. His advice was excellent and I carried out several procedures while he commented his ideas and tips and tricks. All surgeries were successful!

Dr. Rix interestingly speaks a perfect spanish as he was raised in Spain as a child. We had a great time and I am very grateful to him, he is a great teacher.

I am convinced that it is crucial that surgeons from different countries and hospitals share their knowledge, as this will improve our skills for the benefit of our patients.

XVIII Congress of the Canarian Society of Urology

In this chance I travelled to Gran Canaria to participate in the Congress of the Canarian Urology Society, to speak about lasers. The congress was organized by the Gabinete de Urología y Andrología, captained by Dr. Juarez del Dago in a wonderful hotel in Mogán.

The congress started with a non-urological talk on the Timple from Canarias, a string instrument that is very popular over here. Very interesting, we had Germán López, one of the best timplists in the world and a fantastic spanish artist. I did not know him, but now I am his fan. Here a video of the artist with his Timple... a wonderful instrument.



The level of the scientific sessions was very high as we had the luxury of having Dr. Richard Gaston who spoke about laparoscopy and also Dra. Estefanía Romero, from our team, that also presented on the surgical indication of Benign Prostatic Hiperplasia.

I spoke, as always, about lasers, and my participation was reflected in the congress daily newspaper as well as in a local newspaper Canarias 7.

As always, going to Canarias is wonderful, and I had a great time among friends. 

Surgeries in Naples, Italy

This wednesday I flew very early to Rome, and then to Naples, to visit Hospital Federico II.

There I met Professor Vincenzo Mirone and his team of urologists, that had prepared three patients so I could demonstrate the technique of anatomic vaporization of the prostate.

Dr. Mirone was the former president of the Italian Association of Urology and is currently its secretary general, he was very kind and we talked about the characteristics of GreenLight Laser and its interaction with prostatic tissue.

The three operations were successful and it was nice to see Naples on the way to the airport, it was a sunny and marvelous day. I had some time to try the local mozzarella, really good.

The return trip was tougher after such an early start. I arrived in Madrid around 12 pm, but happy.

Visitors from Vitoria-Gasteiz

Yesterday we had a surgical session at Clinica CEMTRO, where we operated several patients. This time we enjoyed the visit of a group of urologists from Hospital Santiago Apostol, from Vitoria-Gasteiz.

I could demonstrate to them a case of anatomical vaporization of the prostate and another case of Greenlight laser enucleation. We had a great time as they already have a big experience with the use of the GreenLight HPS 120 watt laser and are now going to start using the new GreenLight XPS 180 watt laser and we could share experiences and knowledge.

Surgery with Dr. Gastón at Clínica CEMTRO

The morning of the 8th I woke up early in Sofia to return to Madrid. And from the airport I went to Clinica CEMTRO where we operated with Dr. Richard Gaston in the morning.

Dr. Gaston is maybe the most important expert in the world in laparoscopic radical prostatectomy and has been a member of our team for five years, coming every month to operate with us to Clinica CEMTRO.

In this occasion Dr. Estefanía Romero and I helped him. Dr. Romero was trained in Bordeaux with Dr. Gaston.

I was impressed when Dr. Gaston decided not to leave a drain in the patient, a usual thing to do after a radical prostatectomy, and this allowed the patient to be discharged the following morning, because he was feeling perfectly well.

New surgical session in Sofia

The 6th and 7th I worked in Bulgaria, operating at the Hill Clinic of Sofia. We had a lot of patients and little time to operate them, so it was an intense surgical session, with patients with big and difficult prostates, but we could operate all of them successfully.

These two days were the last days of good weather in Sofia... I returned from there and it started to snow over Vitosha mountain.

Visitors from Sweden and Italy

In this occasion we had two days of surgery to demonstrate the techniques of Greenlight anatomic vaporization and Greenlight enucleation to our important visitors from Sweden and Italy.

I demonstrated how it is possible to ensure the full removal of the adenoma by the use of the Anatomic Vaporization technique in different types of prostates. Finally I performed a GreenLight Enucleation in a massive prostate, which was very difficult and demanding, but we managed to finish the procedure successfully by performing the morcellation of the adenoma inside the prostatic capsule.

We love to receive visitors and to share our knowledge with other colleagues!!!

Trip to Bérgamo

I took an early flight to Bergamo, Italy, to spend the day with Dr. Ivano Vavassori, one of the best surgeons in Europe in the treatment of BPH with laser. I witnessed four surgical procedures that he brilliantly completed. A good opportunity to compare the differences and pros and cons of Holmium laser enucleation and GreenLight laser enucleation, and to learn from a true master of surgery.

I am always impressed to see the surgeons that by working hard and passionately achieve perfection in the execution of surgical procedures. Dr. Vavassori is on top of that a delightful human being.

Roadshow in Perú

This month of August I travelled to Perú to participate in various courses with live surgical transmissions as well as to give some lectures.

I started in Lima with two days of surgeries (7 patients) at the Clínica San Borja, with Dr. Elvis Sueldo. We operated in Perú for the first time with the new GreenLight XPS 180 watt laser. I also could demonstrate the technique of endoscopic enucleation followed by morcellation (GreenLEP). I also did a presentation for the attendees, who were very impressed  by the anatomic vaporization technique (that localises the prostatic capsule to ensure full removal of the adenomatous tissue), as well as by the side firing enucleation technique.

There I met, apart from Dr. Elvis Sueldo, my good friends Dr. Daniel Porto and Javier Zeballos

Then I travelled to the wonderful city of Arequipa, where we also did two sessions of surgery (6 patients), demonstrating the technique. The operations were transmitted to a room full of urologists, other specialty doctors and nurses interested in learning about this technique.

In arequipa I also took part in the National Congress of the Peruvian Urological Association. I participated with a lecture on GreenLight Laser, stressing that both the AUA (American Urological Association) as the EAU (European Association of Urology) recommend GreenLight laser as a standard option for the surgical treatment of BPH in their Guidelines.

Then I had a chance to visit Machu Picchu for a couple of days... It is one of the most impressive places I have seen, it was my second visit and I liked it even more than the first. One feels overwhelmed up there, trying to understand what would the Incas have in their minds to dare to build an impossible city in the top of a mountain...

Then I returned to Lima, where we had to operate at the Police Hospital, where I did a prostatic vaporization and the enucleation of a big prostate.

The enucleation case was a patient with a very high PSA, near 30 ng/mL, with two previous negative biopsies and a volume over 100 grams. The surgery was smooth and we got plenty of tissue for histology.

Lastly, that same day I gave a talk at the Peruvian Society of Urology. This ended my participation in this wonderful roadshow in Perú. Now I will take my holidays until September!

Foreign visitors

Today we had the great honor of receiving the visit of two great urologists. Professor Lacoste, from France, and Professor Merhej, from Lebanon.

I did two procedures at Clinica CEMTRO where I could show them the technique of anatomic vaporization of the prostate, that consists in vaporizing the whole prostatic adenoma using two principles: One, capsular localization, that allows for a complete vaporization of the adenoma. Two, the use of intraoperative TRUS (Transrectal Ultrasound) monitoring of the procedure, a fantastic way of guaranteeing the completeness of the procedure.

I think both were satisfied with the new concepts. I always enjoy sharing my experience with my colleagues.

Talk in Gran Canaria

This Friday I came to Gran Canaria hosted by my friend and great urologist Dr. Juarez del Dago, that had organised a conference for medical practitioners on the treatment of BPH (benign prostatic hyperplasia) with the GreenLight Laser.

I was interviewed by the regional TV channel. I tried to explain how fast BPH surgery is changing worldwide, and how today the classic surgical approaches for the treatment of BPH, open surgery and TURP (transurethral resection of the prostate) are losing favor and are becoming obsolete. I also explained that the American Urological Association and European Association of Urology recognize this fact in their latest guidelines.