New course on Robotic Radical Cystectomy at ORSI and OLV Hospital in Aalst, Belgium

Again I went to Belgium to participate in an advanced course on robotic radical cystectomy and intracorporeal urinary diversion at ORSI.

I had the privilege in this course of performing two robotic radical cystectomies with an intracorporeal diversion and I also went to the operating room to witness a case at the OLV hospital in Aalst.

I am very grateful to Dr. Mottrie for everything I have learned in these courses with him, but I have to say that I have received a lot from Dr. Giorgio Gandaglia, from the Hospital San Rafaele in Milan, who is spending six months working at the OLV hospital in Aalst, and who has taught me a great deal.

For many hears I have devoted myself to teach other colleagues, specially in the use of lasers for the treatment of prostate disease. My experience as a surgical teacher helps me value the generosity of those who teach what they know without limits, and Giorgio Gandaglia is a great teacher. I think he will become no doubt one of the leading urologists in europe in a few years!

New robotic surgical session with Dr. Richard Gaston

This weekend we had again a surgical session with Dr. Richard Gastón at Clínica CEMTRO. Dr. Gaston is now a member of our team at ICUA and he comes every month from Bordeaux to operate with us in Madrid.

Robotic surgery requires a lot of preparation and a precise coordination among our nurses at ICUA, the anesthetists, hospital nurses, and other personnel, to allow for an uneventful and smooth work.

Vanesa Cuadros, our chief nurse ensures that every detail is looked after and also makes sure that all the clinical information about the patient, his PSA, the result of the digital rectal examination, the information obtained in the biopsy or the transperineal MRI-US fusion mapping, the preoperative MRI are clearly looked at prior to the operation so it can be planned to the detail.

Our nurses, Sandra and Nuria are in charge or organizing all the surgical material necessary for any eventuality. They also assist us during the robotic procedures.

It is fantastic to be able to work in a team full of enthusiasm and will to perform an excellent job!

Live surgery during the Annual Congress of the Italian Society of Urology

This time I travelled to Italy to participate at the congress of the SIU, this time performing a live surgical procedure that was broadcasted to the main auditorium of the congress that was held in Riccione.

With the possibilities offered by modern technology, the operation was performed far from the congress venue, at the Hospital in Carpi, where Dr. Verrini, the head of the urology department was hosting this live surgery session.

My role was to perform an anatomic vaporization in a patient with a relatively big prostate with 80-90 cc.

They told me the main auditorium was full. ¡Everything went very well!

Surgical workshop to demonstrate GreenLEP in Delft, The Netherlands

This time I travelled to The Netherlands to visit the Hospital Reiner de Graaf, in Delft.

There I was kindly hosted by Dr. John Van Der Hoeven who was there with other Dutch colleagues for a surgical session on "En Bloc" GreenLight enucleation of the prostate.

First I gave a talk at the clinical session of the urology department and then we went to the operating room, where they had prepared three patients. Two of them had very large prostate glands.

The session went very well, although two of the cases were a little more difficult than usual. In one of the cases I showed the anatomic vaporization technique. The attending urologists were very impressed with the possibilities of the GreenLight laser with these new techniques for the treatment of benign prostatic hyperplasia.

I spent the weekend in Amsterdam, and I had a chance to visit the exhibition Body works, where they show "artistic" anatomic preparations of plastinated human bodies. It is amazing, I recommend it thoroughly.

This was a plastinated dissection of the urinary tract and the main vessels in a female subject. Fascinating!

Surgeries in Sofia, Bulgaria, to try the new Auriga XL system

This time I flew to Sofia to operate at the Hill Clinic, and to try the new 50 w Holmium laser Auriga XL.

In Madrid we have a 100 w Holmium laser from Lumenis, and I was curious to try it. I had heard that it allowed to perform endoscopic enucleation for the treatment of BPH, but that it maybe was a little slower than the 100 W lumenis laser.

I played with the output parameters of energy and frequency until I did with the settings that provided the tissue effect I like for the en bloc enucleation technique, and the truth is that we could work wonderfully with this laser, and we did not perceive any difference in the time we needed to complete a procedure as compared with GreenLight and Holmium 100 w.

The more I try different lasers the more I believe that despite the technical differences among different lasers, the most important factor is the experience of the surgeon. If the surgeon understands laser physics and knows the anatomy of the prostate well enough, there shouldn't be very significant differences among lasers. At the end, patients recover equally well, do not bleed much, and are very happy with their operation, irrespective of the wavelength. I do believe that Holmium and Thulium are technically more demanding for the surgeon (more difficult to use).

I also think that GreenLight en bloc enucleation is the most beautiful procedure, it allows visualizing the anatomy much better and it is extremely elegant and efficacious.

I got this from the staff at the Hill Clinic, a photo that summarizes the international visitors who came to learn to use the GreenLight laser during the last three years. Watching this gets to my heart, so much work, so many friends!

Experts meeting in London

From Brussels I flew to London to participate in an experts meeting summoned by the company Boston Scientific.

This company recently acquired American Medical Systems (the male products part, including the GreenLight laser), as well as the German laser manufacturer Starmedtec.

Now Boston offers three kinds of laser for BPH, the GreenLight XPS system, a 50 watt Holmium system (Auriga XL) and a Thulium laser (Vela XL).

Boston Scientific had summoned international experts in the use of lasers of different kinds, and it was very refreshing to sit down all together in one table and discuss openly the pros and cons of different kinds of lasers.

I realized that my experience is quite unique, as I have worked a lot with all three wavelengths and the majority of my colleagues specialize in one wavelength only. A very interesting meeting.