Surgical Session with Dr. Richard Gaston

This week, as every month, we had a surgical session with Dr. Richard Gaston. He came to Madrid to operate with Dr. Estefanía Romero and myself two patients with prostate cancer at Clínica CEMTRO.

Dr. Gastón performs more than 500 laparoscopic radical prostatectomy every year, with excellent oncological results (e.g. curing the cancer) as well as functional results (preservation of urinary continence and erectile function).

EAU 8th South Eastern European Meeting and surgeries in Sofia

The EAU 8th South Eastern European Meeting took place this year in Sofia, and we presented our experience with GreenLEP (GreenLight Enucleation of the Prostate) that we have acumulated during the last years at the Hill Clinic in Sofia.

In order to see it you have to notice that we stuck an ipad on the poster, so that urologists could see the video of the technique. It was sensational!

In the photo below, with the other authors of the poster, the urologists from Hill Clinic.

Then we started the surgical session, as every month. This time we had 15 GreenLight enucleations in 3 days, that went really well. In this session we registered all surgical times and data because we were trying the new Vmax blades for the Piranha Morcellator, from Richard Wolf.

We are very impressed to see the amazing efficiency of morcellation that these blades provide. We managed to morcellate 10 grams of tissue for every minute of morcellation surgical time. It is espectacular, we sent an abstract for the EAU with the data.

In this photo, all the specimens we obtained during the three days, that were sent for histological evaluation.

At last I returned to Madrid, very happy. Operating so many patients in such a short time is always a wonderful learning experience, and the enucleation technique keeps sophisticating itself, becoming more simple, faster and safer.

Surgeries in Milano

Again I travelled to Milan to perform another surgical demonstration at the Istituto Clínico Città Studi, with Dr. Marco Raber.

I performed two operations with the GreenLight laser. An anatomic vaporization and a partial enucleation, that went very well. The second case was a patient with a massive prostate.

From Milano I went to Sofia stopping in Viena, as I lost the direct flight....

Visitors from Lebanon

Today we received the visit of two urologists from Lebanon who came interested in seeing the operations we had programmed for the day.

I performed three operations with the GreenLight XPS laser showing all the technical variations, the anatomic vaporization, the vapo-enucleation (middle lobe enucleation) and the GreenLEP (GreenLight laser "En bloc" enucleation of the prostate).

The truth is that these options allow me to offer my patients an optimal result, with minimal risk and very satisfactory. They left very happy with what they had seen and learnt.

Transperineal biopsy with RMN-US fusion course at Guys Hospital London and Ginsburg study group meeting

This week I went to London, to participate in a course on transperineal prostatic biopsy organized by  Mr. Rick Popert at Guy's Hospital in London.

Very interesting, a move is taking place in the UK and Germany from the transrectal biopsy of the prostate for the diagnosis of prostate cancer (a simple procedure that can have serious infection complications) towards the transperineal biopsy, with a near zero risk of serious infection and allowing much better targeting based on MRI image fusion with Ultrasound and with a higher diagnostic yield.

The new 3 Tesla MRI is providing a much better diagnostic study of the prostate and there is now technology that allows to import the images from the MRI study into a special Ultrasound device, and the FUSION of both images allows to direct the biopsies to the suspect areas in the MRI. It allows to be sure that the suspect areas are properly targeted.

To me this approach seems totally logical and it improves diagnosis and reduces the risks. It is going to be extremely useful for those cases where we consider no treatment (active monitoring), to increase the diagnostic precision in cases with prior negative biopsies and to indicate which patients are suitable for focal treatments with cryosurgery and HIFU.

We have been doing transperineal biopsies for some time in Madrid, in patients with prior negative biopsies and we are happy to see that we were in the right track. Clinica CEMTRO has acquired a new 3 Tesla MRI that will be active soon, and I hope to be able to offer this type of transperineal biopsy targeted with MRI-US fusion to my patients very briefly.

The following day I participated at the meeting of the Ginsburg study group for transperineal biopsy with MRI-US fusion, and from now on I will contribute to the investigations of the group on this type of biopsy.

Surgery in Rome

Right after my visit to Milán, I went to the Azienda Ospedaliera San Giovanni Addolorata in Rome.

There Dr. Gianluca D'Elia welcomed me to perform a GreenLight XPS laser surgical operation. He runs a minimally invasive surgical unit with emphasis in Robotic surgery.

I showed them the technique for capsular localization, that they had never seen. Unfortunately we did not have time to operate the second patient that was programmed that day. I rushed back to Madrid to rest during the weekend.

Surgeries in Milano, Italy

This time I travelled to Milano, with Dr. Marco Raber, who has decided to incorporate the GreenLight technology to be able to offer his patients the 180 watt laser prostatectomy.

In the morning we performed three operations that went very well. I showed him the maneuvers to localize the capsule and allow to perform a radical removal of the adenomatous tissue. Soon I will return with him to demonstrate other techniques, as the GreenLight Enucleation.

Surgeries in Beirut, Lebanon

Again I travelled to Lebanon to help Dr. Mohamad Aluuan, head of the urology department at the Central Military Hospital of Beirut, to learn to operate patients with benign prostatic hyperplasia with the new laser GreenLight XPS 180 watts.

It was a tough schedule, as I got there at 3 am and slept only some hours before starting a long surgical session. We operated six patients, one of them with a 150 gram prostate, and then that night I returned to Madrid.

It was a very nice session and the head of the military healthcare of Lebanon offered me a beautiful plaque of the Lebanese army as a reminder of my stay there.

In the photo, with Toni Abboud, Dr. Mohamad Aluuan and Bassem Zarif, at the end of the surgical session.

Dr Gaston performs laparoscopic 3D operations in Madrid

As every month, Dr. Richard Gastón visited us from Bordeaux, and came to Clínica CEMTRO to operate patients with localised prostate cancer with us. This time we performed several laparoscopic radical prostatectomies using the new laparoscopic videolaparoscope from Karl Storz, a system that provides high definition (HD) and three dimensional view (3D) inside the patient's abdomen.

This was the first time this system was used in a private center in Madrid. It uses a special laparoscopic camera that allows the surgeons, through the use of special 3D glasses, to have a vision in three dimensions (3D) and High Definition (HD) of the interior of the abdomen of the patient. It is an important development because it allows to be more precise with the movements and facilitates enormously the complex laparoscopic manouvers, as intracorporeal suturing.

The operations went really well, and we were all convinced that this visualization system in 3D and HD facilitates laparoscopic surgery enormously and it is a big advantage in our daily work and logically will result in faster and safer operations for patients.