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.