Surgical demonstration in Zaragoza

Today I woke up early and took the high speed train to reach Zaragoza in time to reach the  Hospital Viamed Montecanal to demonstrate the use of the GreenLight XPS laser to Dr. Jorge Rioja and his uncle, Dr. Carlos Rioja, as they have recently adopted this technology.

They had programmed three surgical cases. I demonstrated the anatomic vaporization technique, the vapo-enucleation technique and the GreenLight Enucleation of the prostate (GreenLEP).

All cases went really well and I really enjoyed the company of my friends, sharing tips and tricks in this  very nice new hospital in Zaragoza.

Visitors from USA to witness the placement of the UROLIFT system

This time we received visitors from the american company Neotract, to watch how we performed the treatment of two patients suffering of BPH (benign prostate hyperplasia) with the UROLIFT system.

This UROLIFT system is very ingenious and technologically sophisticated and allows to treat patients with mild or moderate BPH symptoms in a minimally invasive fashion, improving their symptoms without altering their ability to ejaculate. This is common in other forms of surgical treatment of BPH.

The technique consists in introducing a sophisticated cystoscope in the urethra of the patient under sedation.

The device introduces a needle in the prostate that releases a titanium filament that is fixed outside the prostate capsule.

Another filament is deployed in the inside of the urethra and a suture joins both filaments compressing the prostatic tissue, to widen the urethral lumen and allow for the easier passage of urine.

Normally four of these are placed, and this allows the patient to improve his urinary symptoms and many times, to abandon the medical treatment they were having.

In the published clinical studies, patients improve significantly, and this improvement is maintained during at least three years.

I think it is a very reasonable option for young men with BPH symptoms that want to improve their urinary symptoms without losing the ability to ejaculate.

New surgical session at Modena with four italian visitors

Again I traveled to Modena to operate with Dr. Giovanni Ferrari (in the photo with me) at the Ospedale Hesperia.

This time we had a surgical session with three patients and we received the visit of Dr. Francesco Vacirca, from Sicily, Dr. Giancarlo Carloni and Dr. Riccardo Lombi, from Perugia and Dr. Livio Bilotta, from Tivoli.

I performed three different operations with the GreenLight laser, an anatomic vaporization, a vapo-enucleation and a complete enucleation or GreenLEP (GreenLight Enucleation of the Prostate) of a patient with a very big prostate gland.

All the cases went really well and then I returned to Madrid in the afternoon.

Interview in the health related Spanish magazine "Gente Saludable"

This month I was interviewed by this Spanish magazine.

Celebration of the fourth anniversary of Hill Clinic and 300 enucleations

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

In this occasion we celebrated the fourth anniversary of the clinic. I started to collaborate with them three years ago and since then we perform the GreenLEP (GreenLight laser enucleation of the prostate) technique to treat the clinic's patients suffering from Benign Prostatic Hyperplasia.

To celebrate the event, Hill organised several activities and an open doors day where for the first time in Bulgaria we could show the GreenLight SIM, a computerized simulation of GreenLight laser vaporization of the prostate, a tool for urologists to train themselves before treating a real patient.

For me it has been a great experience to collaborate with Hill Clinic all these years, it has allowed me to develop this technique progressively, perfect it, introducing minute improvements as I got to understand how to make this procedure faster and safer. Interestingly, we reached 300 Enucleations the day of the 4th anniversary, we did 43 in 2010, 75 in 2011, 103 in 2012 and 79 up to now in 2013.

This weekend, as it is usual, we performed 14 operations in three days that went really well.

These are the specimens of prostatic tissue that we sent to the pathologist for histological analysis. This technique allows to extract all the adenomatous tissue independently of the prostate size and to analyze it.

Also the technique has improved a lot with the new Vmax blades of the Piranha morcellator, that allow for an extremely fast morcellation. In this extract from the intraoperative data of two of the cases we did this weekend we can see the prostatic volume as estimated by abdominal ultrasound, the weight of the tissue extracted (137 g and 73 g), the energy used, the firing time of the laser at 80 w and 40 w settings, the active morcellation time and the total morcellation time. It is impressive to be able to extract adenomatous tissue in such a short time (137 grams in 14 minutes and 26 seconds and 73 grams in four minutes and 5 seconds of real time), as it allows us to perform most cases in under one hour.

I am really convinced that any urologist who sees the work we do will agree that there is no justification nowadays to keep performing open prostatectomy.

The truth is that there I feel great, with my friends and colleagues from Buglaria. I really believe that we form an elite team of laser prostatectomy at the top level. In the photo from left to right, Dr. Botsevski, the nurse Ms. Petia, Dr. Kotsev, Mr. Lubo and Dr. Georgiev, all of them great professionals.

More visitors to our operating room

Today we had programmed three GreenLEP operations. We received the visit of two representatives from Germany and USA of the surgical instrument manufacturer Richard Wolf.

They also came interested in seeing the GreenLEP procedures (GreenLight Laser Enucleation of the Prostate). Normally we use their surgical instruments to perform this operation.

I am specially happy with the Piranha morcellator, with the new rotational blades Vmax, that allows us to extract the prostatic adenomatous tissue once we have enucleated it from its capsule and pushed it into the bladder.



Our surgical procedure time has been reduced much since we use them, because we achieve a very fast morcellation of 10 grams per minute during the morcellation phase, that is really impressive. Typically, to enucleate a 100 gram prostate we would need 40-45 minutes for the enucleation step, 5 minutes to change the instruments and start the morcellation and 10 minutes to finish. This is a true leap forward if we compare this with previous enucleations, where to morcellate 100 grams  of tissue we had to work for about 40 minutes.

In this occasion I also showed them the pre and postoperative transrectal ultrasound picture, that shows the beauty and value of this surgical technique.

Important visitor to my operating room

Today we received the visit of Mr. Mike Kujak, the general manager of American Medical Systems, the company producing the GreenLight laser in the US, as well as many other medical devices for the treatment of pelvic health problems.

He came to Madrid interested to see in person the GreenLEP (GreenLight laser enucleation of the prostate) technique that I have developed, as well as the anatomic vaporization technique. The postoperative ultrasound of the prostate we enucleated showed a perfect job! It was impressive. We probably removed 90 grams of tissue and the cavity was perfect!

After we finished the two procedures we went out for dinner in Madrid. I have to say that despite my close relationship with this company for many years it is the first time I see a CEO "coming down to the kitchen"to see first hand how their products are used. I was very positively surprised by this attitude. He left a comment in our visitor book.

Later on our Pathologist confirmed we had extracted 90 grams of tissue.

Surgery in Gran Canaria with Dr. Juarez del Dago

This weekend I went to Gran Canaria with Dr. Juarez. He invited me to operate with him a patient with a large prostate gland. We performed a GreenLEP technique at the Clínica San Roque in Gran Canaria. Everything went very well and I was happy to know that the patient had left the following morning.


Dr. juarez pioneered the application of GreenLight laser for the treatment of BPH at the Canary Islands. We have operated a lot together and we are very good friends.

Surgical session at the University Hospital Miguel Servet in Zaragoza

Today I took the AVE (the famous spanish high speed train), and at 300 km/h I reached Zaragoza and went to the University Hospital Miguel Servet to meet Dr. Rodriguez Vela, the head of department.

They had prepared two patients with big prostates to see the new GreenLight XPS laser in action. I demonstrated the anatomic vaporization technique and the vapo-enucleation technique (lateral lobe vaporization, localization of the capsule and enucleation of the middle lobe)

In both cases the result was very good, and I think they enjoyed seeing how one can easily localize the capsule and perform a radical vaporization of the adenoma that mimics what we did with open prostatectomy. I am convinced this is the future of the surgery of BPH. I had a great time with my friends in Zaragoza, I hope to return soon.

Then I came back to madrid, tonight I will depart to Gran Canaria, tomorrow I will operate there with my good friend Dr. Juarez del Dago.