New surgical session at Hill Clinic in Bulgaria

Again I travelled to Sofia, to operate at Hill Clinic.

This time we performed 13 procedures in 2 days, and everything went very well. The GreenLEP procedure is so refined and mature that it is very fast, very safe and the results are extremely good and predictable.

We have worked so much during the last four years that things have simplified significantly. This is a photo of the sterile table where we prepare the necessary instruments. A 26 F laser cystoscope with a 30º lens, some dilators, a nephroscope or morcescope (as we use it for morcellation), the new Vmax blade for morcellation (really important) and the Piranha morcellator, from Wolf, that is not in the photo.

After performing enucleative laser surgery for the treatment of BPH, one understands how superior this technique is to vaporization or transurethral resection, and it is extremely safe!

New surgical course in Modena, Italy

Again I travelled to Modena, to Hesperia Hospital, to operate with Dr. Ferrari.

This time we received the visit of three italian urologists, Dr. Timossi, Dr. Canovaro and Dr. Gianella, who witnessed the operations. I demonstrated the GreenLEP technique (GreenLight Enucleation of the Prostate) as well as the vapo-enucleation technique, as we only had patients with big prostates today.

Fortunately we could use the new Vmax blades from the Piranha morcellator, manufactured by Richard Wolf, that allows a super-fast extraction of prostatic tissue from the bladder, cutting down the surgical time!

At the end of the session I drove to Bologna Airport to travel to Sofia sleeping at Istanbul airport... a little tired, but very happy.

Visitor from Chile

Today we received the visit in our surgical room of Dr. Eduardo Reyes, urologist from Hospital DIPRECA, from Santiago de Chile, who came to witness two laser enucleations for BPH.

Dr. Reyes is going to be in Madrid in a rotation for three months, and will attend our operations during this time at Clínica CEMTRO.

Live surgery at Auguste-Viktoria-Klinikum in Berlin

This time I went to Berlin invited to perform a live surgery that would be transmitted to the audience of the congress at Auguste-Victoria-Klinikum.

This Hospital has been the most active center in Europe in Holmium laser enucleation of the prostate, and his recently retired head of department, Dr. Kuntz, an enthusiastic advocate of laser prostatectomy for many years, very respected all over the world.

Getting ready for the operation and the TV transmission

It has been a great honor for me to have been invited to operate there. My role was to demonstrate the GreenLEP technique (Green Laser Enucleation of the Prostate), but the patient's prostate was so small that I decided to use a mixed technique, vaporizing anterior and laterally and enucleating the middle lobe. Then I showed a video of the GreenLEP technique.

During the operation I communicated with the audience in the congress

I got a tweet from one of the attendees at the congress:

Everything went very well, then I returned to Madrid to rest during the weekend, after two full weeks non stop.

New session in Sofia, Bulgaria, with Dr. Ruban Thanigasalam

This time I went to operate to the Hill Clinic and we welcomed Dr. Ruban Thanigasalam, urologist from Australia who was already visiting us in Madrid at Clinica CEMTRO. Ruban is finishing a two year rotation in a Paris Hospital and is about to return to Australia to work.

The objective was to witness enough GreenLEP (Green Laser Enucleation of the Prostate) operations to understand this technique's complexities and we did 9 cases, a very fruitful session. There is yet another urologist convinced of the advantages of GreenLEP for the treatment of BPH.

More and more urologists express their interest to join us in Sofia to see this technique. In principle we plan to do another session on December 13-15th and another one in January 30-31st.

Conference in Berlin - GreenLight laser german users group meeting.

This time I participated at the annual meeting of the German GreenLight Users Group.

I was invited to give a talk on my experience and ideas about the use of the GreenLight laser for the treatment of BPH and the role of the new techniques I developed, anatomic vaporization, vapo-enucleation and GreenLEP (Green Laser Enucleation of the Prostate).

These techniques are generating a great interest worldwide and more and more urologists are interested in learning them as they allow to obtain improved results in patients with bigger prostates, with minimal risk.

There were many questions at the end, many urologists find hard to believe that these techniques are easy to learn and perform, until they visit us to see them, they feel the enthusiasm and then they learn them.

Surgical session at Ev. Krankenhaus Hospital, Witten, Germany

This time I went to the Ev. Krankenhaus Hospital, in Witten, Germany, to perform a surgical demonstration of GreenLEP and Anatomic Vaporization. The head of the urology department, Dr. Wiedeman was a very kind host of the session.

I performed two operations that went very well. Dr. Wiedeman has an extensive experience with the GreenLight laser and is convinced as I am that TURP (Transurethral resection of the prostate) is obsolete.

Dr. Schattka also came to see this session and when we finished the second surgery we took this photo with Dr. Wiedeman and his nurse, who helped us really well.

Then I took a flight to Berlin, as I was invited to participate in the Annual Meeting of the German GreenLight users.

Surgical session at Ammerland Klinik, Westerstede, Germany

This time I flew to Hamburg and from there I drove to Westerstede, to operate at the Ammerland Klinik, the public hospital in the region, with Dr. Schattka.

At the hospital this morning, prior to starting the surgical session of laser treatment of BPH

The plan was to teach him to perform the new techniques, anatomical vaporization with capsular localization and GreenLEP, Green laser enucleation of the prostate for the treatment of Benign Prostatic Hyperplasia (BPH).

Checking the instruments gently provided by Richard Wolf for this session

I performed three operations that went very well. As always, urologists who watch these techniques are highly impressed and they are convinced that this is the way forward in surgical treatment of BPH.

Performing a GreenLEP at Ammerland Klinik

Then I drove again to Dortmund, to participate in another surgical session tomorrow morning.

Australian visitor to learn GreenLEP

Again we had a visitor at the operating room at Clínica CEMTRO. Dr. Jimmy Lam came all the way from down under to see some procedures.

Dr. Jimmy Lam is a very experienced urologist in the surgical treatment of BPH with GreenLight laser. He came interested in learning the new techniques, anatomic vaporization, vapo-enucleation and Green Laser Enucleation of the Prostate. Surgeries went very well and patients were discharged the following morning.

Participation in Spanish National TV

Again I participated in the National TV program "La Mañana de la 1" at RTVE.  This time we talked about problems related with urine. I could talk a little about BPH and laser treatment. It is always good fun to go to this TV show.

Saber vivir - Problemas de orina

• Saber vivir - Problemas de orina

New surgical session at Hill Clinic in Sofia, Bulgaria

Again I travelled to Bulgaria to operate at Hill Clinic. In this occasion we had a long session with 18 pacients scheduled over a few days.

I did 17 GreenLEP procedures (GreenLight Enucleation of the prostate) that went very well.

These were the specimens for histological analysis from the patients we operated. More than 1 kg of prostate tissue!

It is really wonderful to be able to work at Hill Clinic. The team works like a clock and we work hard but very happy. We are also very satisfied with the results of GreenLEP!

This tuesday I flew to Gran Canaria to operate a patient with Dr. Juarez del Dago. We are friends from a long time ago and regularly either I go to Gran Canaria or he comes to Madrid to operate together. This time we operated a patient with a big prostate, we performed a GreenLEP (GreenLight Enucleation of the prostate together that went very well).

Then I returned to Madrid that same day.

Visitors from Australia and Asturias

Today we had a surgical session scheduled at Clinica CEMTRO and we received the visit of two urologists. One of them Australian (originally from Sri-Lanka), Dr. Ruban Thani-Gasalam, who is finishing a two year fellowship at the Hospital Sant Josef in Paris, with our friend and excellent laparoscopist Hervé Baumert. We also received the visit of a Spanish urologist, Dr. Abel Mateos, from Gijón, Asturias, who had a lot of interest in seeing us work and is considering starting to do laser prostatectomy.

I performed two cases of GreenLight Enucleation in two patients who suffered Benign prostatic hyperplasia. One of them was a patient submitted previously to a TURP, but he had too much residual BPH tissue that caused hematuria and problems with micturition. Both cases went really well and we had a wonderful afternoon together.

I love to see the reaction of urologists watching this technique, they are impressed by seeing the anatomy of the prostate in a way they never did before, by the simplicity of this "en bloc" technique and by the quality of the dissection and preservation of the sphincter. We also commented the importance of the improved morcellation with the Piranha system and the new Vmax blades that cut down the surgical time. The second case was completed in just 35 minutes!

Live surgical demonstration at the Annual Congress of the Società Italiana di Urologia

This time I was invited to perform a GreenLight anatomic vaporization of the prostate at the Congress of the Italian Urological Society, at the Azienda Ospitaliera S. Orsola-Malpighi, in Bologna.

From this hospital, all surgical operations in the live surgery program were transmitted via satellite to the congress center in Riccione, a seaside italian city one hour away from Bologna by car.

They selected a patient with a small prostate with a lot of prostatic calcifications that usually form in the periphery of the adenomatous tissue, that make the procedure a little more complicated.

Despite this, everything went very well, and I could show how to access the prostatic capsule to guarantee a full vaporization of the BPH tissue. In Riccione there were many urologists in the plenary room of the congress watching the procedure. I would have liked to be able to demonstrate this technique in a bigger prostate, as it is more informative, but I did my best to make the most of this case.

In the surgical room next to mine, I met my colleague and ex-older resident from my residence at the Hospital de la Princesa, Dr. Manuel Fernández Arjona, who was also demonstrating the UROLIFT system for the treatment of BPH. I really enjoyed seeing him after such a long time and we had a chance to catch up while we waited to start our procedures. Then we returned to Madrid, as we both have to work tomorrow!

Online webinar in Spanish on BPH

Tomorrow morning I will participate in a live webinar (or web seminar) on Benign Prostatic Hyperplasia in collaboration with Post55. If you have interest in learning on BPH, please join us live registering first in this web site with interesting contents for men over 55.

Te recordamos que para asistir a la videoconferencia del Doctor D. Fernando Gómez Sanchasobre "Nuevos Avances en el tratamiento prostático" tienes que estar inscrito en Post55. Si no tienes aún usuario puedes darte de alta haciendo clic aquí. Unos minutos antes del comienzo de la sesión llegará un enlace a tu correo electrónico para que puedas acceder a la misma. ¡¡Te esperamos!!
Socios colaboradores:
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Surgical session at Hill Clinic in Sofia, Bulgaria, with visitors from France

After Modena y flew to Sofia, Bulgaria, as I do every month, to operate at the Hill Clinic. Again they had prepared a surgical weekend.

This time we received the visit of two prestigious french urologists, who came to learn the GreenLEP technique (GreenLight Enucleation of the prostate) for the treatment of Benign prostate hyperplasia.

Dr. Vincent Misrai, from Institute Pasteur in Toulouse and Dr. Jean Baptist Roche, from Clinique Saint Agustin, Bordeaux. They are both charming and they have a genuine interest for urology and despite their extensive experience, they want to keep learning. It is always refreshing to treat people like this.

I performed 10 operations in two days that they witnessed with much interest. We had a great time and I think it was a very unique learning experience. They went home very happy and with new ideas on the advanced use of GreenLight laser to treat BPH.

Hill Clinic is the center is the most experienced center in the world in this kind of surgery and my advice to any urologist wanting to learn this technique is to come and visit us during one of this sessions.

Again I went to Modena, this time driving from Ponte San Pietro, to operate at Ospedale Hesperia with dr. Ferrari. He had organized another training session for italian urologists as it is becoming custom now.

This time we did two surgeries that went very well and we received the visit of Dr. Mauricio Candidi, from Tivoli, Danilo Patti, from Rome and Fabiano Palmieri, from Ravena.

We had a good time together and I finished early, and that allowed me to rest in Modena. I have to travel early to Bulgaria tomorrow and I have a lot of work this weekend...

Surgeries at Ponte San Pietro

Again I visited the Hospital at Ponte San Pietro, near Milano, to work with Dr. Fenice. He has offered me to come to operate regularly the most difficult cases of BPH with the GreenLight laser and from now on it will be an ongoing collaboration.

This time I did two GreenLEP procedures (GreenLight enucleation of the prostate), that went very well. During the operation the blood loss is minimal, and this is how the urinary catheter looked like after the operation. A tube conducts saline solution to the bladder, and the other tube brings it out, but there is no blood at all. Great!

The following day Dr. Fenice told me that the patients were doing well and were going home. From now on, the Hospital at Ponte San Pietro will be another regular place of work for me. I am very happy.

Interview in Bulgarian TV

During my previous trip to Bulgaria I was interviewed for the most prestigious TV program on health in Bulgaria. Today I got it and I include it here.



The goal of the interview, to clarify things after Angelina Jolie was submitted to a bilateral mastectomy for carrying a defective form of the BRCA1 gene.

Right after that happened, the London Based urologist Roger Kirby told the press that after sequencing the BRCA2 gene in a man with a non aggressive form of prostate cancer, he found a mutation in the gene. This mutation decided him to recommend radical surgery for his prostate tumor that normally would not be treated. This was very polemic and hence, the interview.

I tried to clarify that some people carry a mutated form of these genes that does carry out the normal function of suppression of tumor growth. Men who carry these defective forms of the gene have a higher risk of prostate cancer and usually also more aggressive, but it is not justified to carry out preventive surgery in all carriers. It is more logical to watch them closely and if the tumor arises treat them aggressively.

Live surgery at the AURO Congress

I woke very early to catch a flight to Rome at 6.00 am. I was picked up at the airport to drive to L'aquila to participate at the UROLEAGUE Congress from the Association of Italian Urologists (AURO) that took place at the Hospital San Salvatore, chaired by Prof. Di Clemente.

The surgical schedule was very interesting, with the participation of great italian urologists. I was the only foreign urologist invited to operate.

With Prof. Di Clemente

I had to do two procedures one after the first, an anatomic vaporization with GreenLight laser of a trilobulated 80 cc adenoma, and a GreenLEP procedure (GreenLight Enucleation of the Prostate) in a prostate bigger than 100 cc.

Both cases went very well, and were retransmitted to the congress venue, in a nearby hotel. Dr. Mutto moderated the session and he relayed questions from the floor during the operation. Both were successful.

During the operations I noticed my mobile vibrating in my pocket, and later I found out that it was a message from one of my colleagues that was cheering me during the live procedure! Interesting times we live in...

Visitor from Sydney Australia

Today we received in our surgical theatre at Clínica CEMTRO the visit of Dr. Thomas Dean, urologist from Sydney, Australia.

He was very interested to see a GreenLEP procedure (GreenLight Enucleation of the Prostate). I performed a case,  a patient with a prostate bigger than 100 cc, that went very well.

The enucleation itself took 40 minutes and the morcellation took other 15. A very beautiful case. I think he went away happy and impressed by the technique. If I can, I will take him to the Flamenco show tomorrow ;-)

In the meantime, in the surgical theatre just beside mine, Dr. Guillén was retransmitting a Master Class to more than 300 hospitals in all the world using the Google Glass. He performed a chondrocyte transplant using his cable free endoscope and using surgical instruments developed at Clínica CEMTRO.

Invitation to operate at Clinique Saint Agustin, Bordeaux, France

This time I visited the prestigious Clinique Saint Agustin in Bordeaux, France

This clinic is the most important center in Europe in laparoscopic urology. There they perform 5000 laparoscopic procedures and more than 1000 robotic surgeries per year. Dr. Gaston, Dr. Piechaud and their colleagues are very well known worldwide for their specialization in laparoscopy and specially in robotic radical prostatectomy.

Dr. Richard Gaston ready to start a robotic laparoscopic prostatectomy with one of the two robots available at St. Agustin

Dr. Gastón has collaborated with us for the last 7 years and comes to operate every month to Clínica CEMTRO, we are very good friends.

The reason for this invitation was that the urologists at Saint Agustin wanted to learn to perform Holmium laser enucleation of the prostate in patients with big prostates, e.g. high volume benign prostatic hyperplasia.

They prepared five patients that we operated in two days, and I had the occasion to demonstrate the details of this technique. All patients had big glands, some also had big and multiple bladder calculi (stones) that we could fragment seamlessly with this Holmium laser. We also tried the Storz morcellator, that has improved recently and the Piranha system with the Vmax blades, my favourite morcellator.

All surgeries went very well and patients recovered extremely fast. My french colleagues were very happy to see this and I think they were convinced that it is perfectly possible to treat big prostate adenomas with laser enucleation. Also they could ascertain its superiority to the laparoscopic approach they were using up to now, as patients can be discharged the next day as opposed to three days after the laparoscopic operation.

With Dr. Piechaud during the surgical session

I really enjoyed collaborating with these great urologists, true living legends of urology, and help to light their enthusiasm for laser prostatectomy. It was a great honor to help them and I returned to Madrid very happy after this session.

Surgeries with Dr. Gaston at ICUA - Clinica CEMTRO

Again we had Dr. Gaston with us to operate at Clinica CEMTRO.

Dr. Gaston is an international expert in urooncology and laparoscopy who works at Clinique Saint Augstin in Bordeaux. He has been collaborating with us in Madrid for seven years.

In the surgical session, he was assisted by Monique, her nurse from Bordeaux and Dr. Estefania Romero, our expert laparoscopist at ICUA.

This time we tried the VIKING system for 3D laparoscopic high definition visualization.

Dr. Gaston invited me to visit their department in Bordeaux next week to help them with their fist cases of laser prostatectomy.