Live surgery at the Escandinavian Urology Congress in Aahrus, Denmark

This thursday I traveled to Denmark to participate in the Congress of the Scandinavian Urological Association (NUF 2007). I was invited to perform a Greenlight HPS laser prostatectomy in a patient with Benign Prostatic Hyperplasia (BPH). The operation was broadcasted live from the prestigious Skejby Hospital to a conference room with 130 urologists from Norway, Finland, Sweden and Denmark. The congress welcomed 400 urologists and 400 scandinavian nurses, all of them blond and with beautiful blue eyes... (no comments...;-)

The hospital is impressive, it only has two floors, but it is massive. Nurses travel in small motorbikes around the hospital. It is really something different.

When I arrived to Billund Airport, I was picked up and driven to the hotel where the congress was taking place. Another impressive place, with beautiful architecture. I felt as if I was inside the Death Star from Star Wars.... (see photo).

Then we went out to a dinner organised by the congress at the "Old city" in Aahrus. A wonderful place with old fashioned Danish houses populated by actors... really beautiful.

There I had the chance to see two old friends, Ola Bratt, an expert in prostate cancer from Sweden and Henning Olsen, a pediatric urologist working at Skejby Hospital. I was really happy to see them. We shared many experiences while we all worked at the European Society of Residents in Urology 10 years ago...

The 80 watt Greenlight PV - KTP laser is very popular, but apparently they use very little amounts of energy (80-90.000 joules) in each prostate, and thus, they do a minimal channel prostatectomy. I am convinced this can only work in the short term. Patients improve after sugery, but I am afraid they have a higher risk of needing a reoperation in the future.

The live surgery went really well. The case was ideal for a surgical demonstration, a 45 gram prostate. The audience saw how I used 275.000 joules to perform the operation and how the operation resembled a complete TURP. I showed them my tips and tricks and they all saw the fantastic end result. During the operation, I answered questions from the audience... I think we all had a good time. The feedback after the session was very positive, I think many urologists changed a few concepts in their minds, and saw a different operation to what they were used to...

Then we did a second case, without the cameras, because they had prepared two cases just in case one of the patients got ill and could not be operated that day. Both cases were unevenful. It has been a great experience, and a great honour to operate in one of the best hospitals in Europe.

After the session, I rushed to the airport as I had to reach Madrid on Friday. I had to travel to Gran Canaria on Saturday, I had an appointment with my friends there...

Symposium on HIFU for prostate Cancer

Yesterday we celebrated a symposium on HIFU (High Intensity Focused Ultrasound) in hotel Hesperia Finisterre, in La Coruña, during the Annual meeting of the Spanish Urological Association. The panelists were Dr. Sebastian Rogenhofer, from Regensburg, Germany (in the center of the image), Dr. Ander Astobieta, from Bilbado and me.


I presented the scientific basis of the treatment of prostate cancer with HIFU (High Intensity Focused Ultrasound) and I also explained the training system for new users. Dr. Astobieta, from Bilbao, summarized the spanish experience and Dr. Rogenhofer commented on the results in his Hospital in Regensburg, Germany after 11 years using this technology.

Spanish Urological Association Annual Meeting in La Coruña

Yesterday I flew to La Coruña, in Galicia, the North-West region of Spain situated on top of portugal. I have come to the Annual meeting of the Spanish Urological Association to present two papers, the only two papers on Greenlight HPS laser treatment of BPH in this congress.

The congress center is situated in the "Paseo Marítimo", one of the most beautiful areas of La Coruña, facing the sea.

The first paper is a video presentation on the new Greenlight HPS laser, that I have presented only a couple of hours ago, with very good reception from my colleagues. It seems it is very didactic. My colleagues specially liked a short video of a transrectal ultrasound monitorization of the procedure, an idea I took from Dr. Gil Vernet, for the production of this video.

Tomorrow I will present a poster detailing my initial experience with this new laser.

Then, at 7.00 pm I will give a conference on the basic science behind HIFU (High Intensity Focused Ultrasound) for the treatment of prostate cancer.

It is nice to come to the National Congress, in part because it is always celebrated before the summer, and I relate it with the proximity of the summer holidays... and I realise it has been a tough year and that I really want August to come soon, so I can rest. But it can only be a brief thought, because there is still much to do.... Denmark, Ireland, Saudi Arabia, maybe the Canary Islands, London, and all before the end of the month...

A new paper

After the international experts meeting we held last year in Madrid, the consensus we reached on how to perform the PVP procedure will be published soon in Prostate Cancer and Prostatic Diseases. We have received the proof for review and this is how it looks like.


This year we will meet again in Madrid in July. We will try to reach a similar consensus with the new Greenlight HPS laser. As this laser is more powerful, the surgical technique is different and it becomes necessary to produce new surgical and training recommendations. I will host 9-10 top international experts for three days and we will perform surgeries, meet to discuss the technical points and recommendations and also we will publish our conclusions.

Terrible heat in Seville

Today I have operated in Seville. The objective was to demonstrate the PVP (Photoselective vaporization of the prostate) technique to various urologists from the Hospital Esperanza de Triana, in Seville, Spain. I took the high-speed train yesterday night, so we could start early in the morning. I have operated four patients and it has been a very interesting session, as two of them were reoperated several years after having had a TURP (Transurethral resection of the prostate). They will be able to compare both patient's experiences: having a TURP and having a Greenlight laser PVP - it would be interesting to know what they think and which they prefer...

After finishing the second operation I gave a brief talk on the basics of Greenlight laser surgery and the new features of this new high powered HPS laser. Then we went back to sugery.
It is seriously hot in Seville, today we had 36º Celsius... aaaggh. All my colleagues were very impressed by the technique and wanting to start offering it to their patients.

Surgery in Valencia

This Saturday I travelled to Valencia to operate a high risk surgical patient with a 120 gram prostate that was causing him serious problems. We used the old 80 watt KTP laser, that is slower than the new high power (120 watt) HPS laser, but the operation was a success. Valencia is celebrating the America's Cup, and you can tell it is a big event... I was able to reach Madrid on time for lunch - a late lunch at 3.30 pm, as we like to have it over here on Saturday and Sunday...

Article in European Urology Today

Today I have received the official newspaper of the European Urological Association. They have published an article I wrote in conjunction with Mr. Gordon Muir, from Kings College Hospital, London, with our personal view on the new high powered Greenligth HPS laser. This newspaper is sent to all members of teh European Association of Urology.

Surgical Saturday in the Canary Islands

This Saturday I travelled early to Gran Canaria to operate with Dr. Francisco Juarez, in the Santa Catalina Hospital of Las Palmas. Dr. Juarez has pioneered the HPS laser prostatectomy in the Canary Islands and he owns the first high powered greenlight laser (120 watts) in these islands. I am mentoring him in the technique.

After the first surgical session a couple of weeks ago, he had prepared an intense surgical list, we did 4 consecutive operations with the HPS laser. We operated two patients in the morning and then we had some time to rest and have a proper lunch in an Italian restaurant nearby. Then we continued in the afternoon and evening... all patients did very well and we had a good time together. The anaesthetists could not believe that at last there was a surgical option to open prostatectomy and TURP that does not cause bleeding, and they really were shocked when we told them that all patients would be home the next morning...


The we went out for dinner. After a brief sleep, I rushed to the airport to return to Madrid to spend the sunday at home. I still have some Jet lag after the AUA in anaheim...

From London to the AUA congress in Anaheim, California

This May 17th I travelled to London, where I stayed with Gordon Muir, one of the best HPS laser experts in the world. I was invited to participate with an interview in a new DVD that is being produced on laser prostatectomy with the HPS laser... this DVD apparently will be distributed to GPs and urologists around Europe.

The we travelled to Los Angeles, where we went to the American Urological Association Annual congress. We used the oportunity of flying together to work in a couple of editorial projects we are co-editing during the journey.

This year I was not presenting any scientific paper nor giving any talk, but I had important meetings with experts in HPS laser prostatectomy from all over the world. After the success of the KTP laser experts meeting held last year in Madrid (soon the conclusions of this meeting will be published in the Journal Prostate Cancer and Prostatic Diseases), I will soon organize a second meeting, this time to discuss the new HPS laser. We will try to reach a consensus on how this laser should be used and how the operation should be performed and more importantly, how urologists and residents should be trained. We also will try to publish the conclusions of this meeting.

During the congress I also had the opportunity of attending the scientific sessions and participating in some courses. The AUA is a good meeting to learn and to keep updated. The congress center was just in front of Disneyland. My hotel was inside the park and every morning I had breakfast with Minnie, Lilo and Stich. I really missed my daughters...

Surgery in Sevilla

This morning I had to wake up early to reach the airport in time to catch the Iberia plane to Seville. As always, the plane had a problem and we had to step out of the plane and wait for a replacement. So I had to wait and wait until I finally got to Seville.

There I went to the Infanta Luisa hospital, where I have operated a patient with Dr. Felipe Ros. When we finished, we went to have lunch and enjoyed the "Salmorejo", a tipical plate from Seville. And finally we went to "Popular TV", where Dr. Ros is the director of a TV program on health and well being and he has interviewed me. It was very interesting as we managed to show some video footage from the operation.

I came back home in the AVE (High Speed Train), in only two hours and a half. The landscape was extremely beautiful, you could feel the magic of the Spring season. I think I will rather not to fly to Sevilla again.

Surgeries in TEKNON, Barcelona

This Tuesday we had the festivity of San Isidro in Madrid. This is the time of the year when all the bullfighting starts. I used the oportunity to fly to Barcelona to operate with Dr. Gil Vernet at the TEKNON medical center. We did two cases and then I got back to Madrid in the air shuttle, that was deserted... This medical center still uses the Greenlight KTP 80 watt laser, and it feels strange to go back to it, now being used to the new 120 watt HPS unit... it is so easy to get used to the good stuff...

Visitors from La Coruña

This thursday we received two visitors from La Coruña. We had three HPS laser prostatectomies in our list, and we all enjoyed a very interesting training session. One of the prostates was relatively big, with 130 grams, and a big median lobe. They were impressed by the ability of this laser to reproduce the same job one could get with the TURP, but with much less risk. They also enjoyed the anterior start technique (it can be seen in the screen, the photo was taken when I was creating the anterior initial channel).

Full length Greenlight HPS prostatectomy video

This video shows a Greenlight HPS endoscopic prostatectomy. It is a fast movie, compressing a 50 minute full lenght procedure into 10 minutes of video. It shows the "anterior start" strategy and discusses its benefits. I guess it will be more interesting for urologists, but some patients might also want to see how the procedure is performed.

Holmium laser for stone treatment

This friday we asked Dr. Ibarluzea, from Bilbao, to help us with a very complex case. A patient with a single kidney full of stones. He had progressive renal insuficiency and kidney infections. Dr Ibarluzea is a stone expert and he said this was the most difficult case he had ever seen.

Dr. Llanes is the director of our stone unit, and he is also an expert in minimally invasive stone surgery (PCNL, percutaneous nephrolithotomy and ureteroscopy). We all had a hard time sorting out this case...



I bring this video up here to show how lasers have other applications in urology apart from prostate surgery. This laser allows to treat patients with stones in the urinary tract. We used a "stonelight" 15 watt holmium laser, from AMS.

Sorry, the video is in Spanish...

Visitors from AMS in theatre

This thursday I operated in Madrid, and I had some visitors, this time from AMS (Americal Medical Systems), the manufacturer of the HPS laser. They wanted to see a PVP (photoselective vaporization of the prostate) for the treatment of benign prostatic hyperplasia. The case I had scheduled was very difficult, it was a masssive prostate with an immense median lobe, so I had to be very systematic and slowly I managed to get a fantastic postoperative result. Then I gave them two lectures on basic science and clinical aspects of this technique. My voice was still not perfect, but I managed...

From Barcelona to the Canary Islands

This tuesday I took a flight to Barcelona, to help Dr. Guillermo Batlle to perform his first case with the 80 watt KTP laser at the Delfos Medical Center in Barcelona. It was a 60 gram prostate that seemed to be a little bigger endoscopically... The surgery was uneventful and I was satisfied with the result. Then I rushed to the airport back to Madrid. I had to connect with a flight to Gran Canaria. I landed only 20 minutes before departure time and it was a miracle but I got into the plane in time. Dr. Juarez and his wife, Loli, picked me up and took me out for dinner and the next morning we started operating with his brand new HPS laser. We had three patients scheduled, two big prostates and one smaller, all of them were successful.


Dr. Juarez and Loli are not only married but also work together and have a very wide experience in endoscopic surgery and andrology, so they learned the technique very fast and they are such nice people that I really enjoyed this trip. I returned to Madrid and went to bed very late, and totally croaky.... too many planes are bad for your health.

Visitors from the Canary Islands

This Friday I received in Madrid the visit of Dr. Juarez and his wife, who came from the Canary Islands to see the new Greenlight HPS in action. The surgical session was specially interesting because we operated two patients, one of them was a 50 gram prostate, very straight forward. The second case was a 220 gram prostate that needed 1.100.000 joules and a suprapubic trocar to enhance irrigation. We managed to do a good job in 2 hours and 45 minutes... the patient went home the next day, happy. Dr. Juarez is going to start using this HPS laser in the Canary Islands next week. I plan to jump there to give him a hand with the first cases. I did not take photographs, but I will in the Canary Islands...

Interview on Spanish TV on HIFU + Greenlight

This is a recent interview in the Spanish National TV most popular health program "Saber Vivir". They asked me about the characteristics of the HIFU (High Intensity Focused Ultrasound) + Greenlight HPS laser combination to treat prostate cancer. This interview took place during a press round we made with the company of Dr. Andreas Blana, from the University of Regensburg in Germany, who came to Madrid to help us with some of our cases.



This minimally invasive prostate cancer treatment is gaining popularity in Europe due to its efficacy and low risk. Patients can go home in less than 24 hours and they go back to their normal life very fast. It has a low risk of incontinence and the rate of potency postoperatively is 50%. Very good for a prostate cancer treatment.

Visitors from Denmark

Yesterday we received four visitors from Denmark interested in the PVP technique with the new HPS laser system. First I did a small talk introducing the basic concepts and theoretical concepts of the Greenlight laser. Then we went to the surgical theatre where I did two PVPs. I did not join them to the Flamenco Show this time...



Both patients were fine and today came to see me to my clinic. They were both happy, feeling well and could not believe how well they are feeling only some hours after surgery...

Masterclass with Dr. Gaston

This Saturday we received Dr. Gastón, from Bordeaux, in the company of Monique, his mithycal nurse, to perform three radical prostatectomies in patients with prostate cancer. He regularly visits us to operate with Dr. Castillón (the director of the laparoscopy unit at the ICUA) once a month.

It was a very interesting session because we operated relatively difficult cases that Dr. Gaston was able to solve elegantly. Dr. Gaston liked very much the new hospital where we have started to operate (Sanatorio del Rosario) in Madrid. Then we took them to the airport as they had to return to Bordeaux. We used our new high definition laparoscopy tower from OLYMPUS, that we have just adquired, with 5 mm videolaparoscopes. State of the art technology that allows operating with the best possible image quality.

We move!!!

Today we moved to a new hospital, the "Sanatorio de Nuestra Señora del Rosario". We leave the "Hospital San José" where we have been carrying out most of our surgical activity to start operating at the new hospital this week.

It has been a pleasure to work in San José for the last few years, where we have shared our activity with fantastic professionals. We will miss all the medical, nursing and administrative staff at San José, we have shared many moments of hard work and many intense and happy moments.

The "Rosario" hospital is one of the classic private hospitals in the "Barrio de Salamanca" in the Center of Madrid. Although an old hospital, it has kept the pace with medical innovation and it offers fantastic technology and state of the art services. Some of the best surgeons in Madrid work here, some of them are good old friends of mine. I worked there for many years as the surgical assistant of Dr. Hidalgo Pascual (Head of the Department of General Surgery of the famous "Hospital 12 de Octubre" from Madrid) and of Dr. Pereira Sanz (Head of the department of Urology of the "Hospital de La Princesa"), during the years of my specialisation. I learned a great deal from them.

In the "Rosario" Hospital we can continue our surgical activities in the best possible environment. For us it is very important that it is also very well equipped for training activities, and it is very close to the ICUA....

Interesting images

Recently, reviewing a patient in my clinic, I could compare the ultrasound appeareance of a prostate before and after PVP with the Greenlight HPS. I thought it was interesting enough to offer it here. This first image shows the preoperative image obtained with a 7 mHz transrectal ultrasound probe. This was approximately a 50 gram prostate.

And this is the postoperative image on transrectal ultrasound a month after the operation. This is a transversal image, where a wide prostatic cavity can be seen, similar to what we obtained with the classic trasurethral resection of the prostate.

And this is the longitudinal view. The prostate with a central cavity in the right hand side and the bladder in the left hand side.

I am extremely satisfied with the results we get with this laser. It is a quantum leap in the treatment of BPH, not only because it is safe and comfortable for patients (nobody doubts nowadays that it is safe, and that the side effect profile is better than classic surgical options), but because of it's efficacy. Many urologists still think that TURP is the best treatment in terms of efficacy, but I think that once you learn to master PVP properly, and that takes some time, to gather the appropriate experience, you can have exactly the same efficacy, with much lower morbidity. I hope to be able to prove this when I publish my results, but in the meantime, every urologist wanting to see this with his own eyes is invited to come to my theatre to watch it!!

Surgery in Toledo

Yesterday I drove to Toledo, a city just one hour away from Madrid, to show the new 120 watt Greenlight HPS laser to two colleagues from Toledo. They already had performed 30 cases with the 80 watt laser and were interested in upgrading to the new system.

They scheduled a patient with a big prostate, they estimated to be bigger than 100 cc. I needed 90 minutes and I delivered 550.000 joules. It was a tricky case because the camera system was not very good and the image ketp on saturating with the high intensity of the light. We lowered the light source intensity and managed to see a little bit better. The operation was uneventful and my colleagues were happy to see such a big prostate treated in a reasonable surgical time and with a fantastic result.

After my weekend in San Sebastian with my family, my camera was full of photos and I could only take this shot of the color of the urine postoperatively.

I am now starting every procedure with the 120 watt setting, before I would start with 80 watts until a tunnel was made and I was certain that the fibre would not contact with the tissue. Fibres do not like direct contact with tissue, and if you do contact and pressure against the tissue, the reflection of the energy on to the fibre will crack it. Interestingly, the fibre tolerates very nicely to work in near contact. Although this fibre can be used 3 mm apart from the tissue, I have the impression that performance is even better when you work in near contact and with a very slow sweeping speed. I got these tips from Dr. Carson Wong, and I must say it seems to work OK!!!

Then I went back to Madrid, I will spend the Easter days at home with my family. Being at home is a real pleasure!!!