Second meeting of the Iberoamerican Group of Laser in Urology

The second meeting of the GRILUR (Grupo Iberoamericano de Láser en Urología) took place in Lima, Perú. We gathered there to discuss advanced techniques with GreenLight laser. Dr. Jorge Saldaña, from Lima, organised the meeting, with great success.

I took the responsibility of performing five surgeries with the GreenLight laser, I did five GreenLEPs (GreenLight Enucleation of the Prostate), to be able to explain the step by step way to perform it to the attendees, who were very interested in starting this in their work centers. All the operations were uneventful, it is a mature technique, and very reproducible, and all the attendees understood the advantages and peculiarities of this technique over conventional vaporization.

All the group attending GRILUR 2011, after the surgical marathon. Dr. Alexis Alva, Dr. Daniel Porto, Dr. Cesar Quincot, Dr. Luciano Nuñez, Dr. Dario Soto, Dr. Marcelo Borghi, Dr. Jorge Saldaña, Dr. Javier Zeballos, Dr. Elvis Sueldo, Dr. Fernando Gomez Sancha, Dra. Saskia Suarez, Dr. Ricardo Yepes, Dr. Carlos Zuñiga.

The second day we discussed the future of GRILUR, up to now it was a meeting of friends interested in exchanging experiences and knowledge on the use of lasers in urology.

Dr. Saskia Suarez, Dr. Ricardo Yepes, from Ecuador, with ample experience in the use of the GreenLight Laser, are in charge of organising the next GRILUR meeting in Quito, Ecuador, in July 2012. On my left hand side, Dr. Jorge Saldaña, organiser of this year's meeting.

We decided to push the group forward, so every year we will cellebrate an annual meeting where we will offer live surgical demonstrations and scientific presentations to allow to compare different kinds of lasers used in urology, for the treatment of benign prostatic hyperplasia and urinary stone disease. If any spanish or southamerican urologist wants to join the group, please contact us at GRILUR@googlegroups.com.

Surgeries in Policlínica Guipuzkoa

Yesterday I took an early flight to San Sebastián, to go to Policlínica Guipuzkoa with my friends and great urologists Dr. Azparren and Dr. Madina. They are very experienced laser surgeons and wished to see the new GreenLight XPS in action.

We had a great time together and everything was uneventful. I returned to Madrid to pack, I have to fly to Lima now.

New published paper

I just received the paper we have had published at Urodinámica Aplicada, a prestigious journal of the SINUG (International Society of Neurourology and Urogynaecology). It is the result of our collaboration with Dr. Fernando Itza (pelvic pain expert), Dr. Daniel Zarza (neurofisiologist) and Lydia Serra (physiotherapist specialised in chronic pelvic pain) in the treatment of patients with Chronic Pelvic Pain Syndrome.

American Urological Association Annual Congress: Washington DC

This time the AUA congress took place in Washington DC.

In this occasion I had three things to do:
First, I participated in a course on advanced techniques with the new GreenLight XPS 180 watt laser, with Prof. Oliver Reich, from Munich.

Second, I participated in a Symposium on lower urinary tract symptoms due to bening prostatic hyperplasia, in front of more than 100 urologists from all over south america, with Dr. Mark Spearman, a very well known Guru of this subject from the UK.

And finally, we presented our work at the congress, a summary of the IGLU's (International GreenLight Users Group) experience with the new GreenLight XPS 180 watt laser.

Many dinners, meetings, courses, bumping into friends, new projects and ideas, the AUA congress is always fun and nice, and a good opportunity to update oneself.

Surgeries with Dr. Richard Gastón

As every month, Dr. Richard Gaston came with us to operate at Clinica CEMTRO. Dr. Gaston is maybe (and without maybe) the most experienced urological laparoscopist in the world. In this session we did three operations that were uneventful. Dr. Gastón is a true surgical master!

Visitors from Norway, Bulgaria and Spain

In this occasion we received the visit of Dr. Vyturys Svedas, from Norway, Dr. Anakievski, from Bulgaria and Dr. Ricardo Esteban. We did two cases, a normal vaporization and a GreenLEP procedure and then we went out for some flamenco. This time I forgot to take a photo for the blog ;-(

Surgical workshop in Navarra

This Thursday I flew early to go to the Hospital de Navarra, where they had prepared a scientific session with theoretical talks and live surgery on the treatment of benign prostatic hyperplasia with the new greenLight 180 watts. We had a great time and I had time to return to Madrid that day.

Surgeries in Bulgaria

Again I spent the weekend in Bulgaria, operating at the Hill Clinic in Sofia, with Dr. Iliya Kalchev.

We operated a lot over the weekend, and then we were invited to the National Bulgarian TV, where we were interviewed on the GreenLight Laser treatment for benign prostatic hyperplasia (BPH).

Interview in Bulgarian TV from Fernando Gómez Sancha on Vimeo.

Then on tuesday I returned to Madrid, as I had to operate in Clinica CEMTRO.

Surgeries in Gran Canaria

On thursday evening I flew to Gran Canaria to meet again my good friend Dr. Juarez, an expert in the treatment of benign prostatic hyperplasia with GreenLight laser. In this occasion I was going to accompany him in his first cases with the brand new GreenLight XPS 180 watt laser.

We performed two operations that underwent wonderfully well and then we went out for lunch together, to get an update in our respective lifes.

Then I came to Madrid in the afternoon, the following day I had to fly to Sofia for another surgical session at the Hill Clinic.

World Premiere of "There be Dragons"

This Wednesday I was fortunate to attend the World Premiere of the brand new movie "There be dragons", directed by Roland Joffé (director of "The Mission" and "The Killing Fields"), produced by my brother, Ignacio Gómez-Sancha. It is first released in Spain, and soon in the rest of Europe, America, and the rest of the world.

Olga Kurylenko, Roland Joffé and Ignacio, in the presentation of the Movie

I feel so proud of him and of the amazing job he has performed in the production of this movie that I decided to pay tribute to him from here.

During the las two years I have witnessed the hardships and the immense efforts that Ignacio and his family have endured in the production of this movie. The combined efforts and genius of the director, the actors and the rest of people involved in this project have given birth to a true work of art.

I recommend the movie wholeheartedly, regardless of your beliefs or inclinations, because I believe it will leave a footprint in you, as it has already done in me.

Ignacio has proven to me again that great achievements, those who are really worth it, are only reached with passion, dedication and effort without measure, with deep love and respect for one's job and devotion for his loved ones. Congratulations Ignacio!

European Association of Urology Congress - Vienna

This weekend I travelled to Vienna to participate in the European Association of Urology (EAU) Annual Congress. I participated in a Symposium on the surgical treatment of benign prostatic hyperplasia (BPH) with Drs. Alexander Bachmann (Switzerland), Oliver Reich (Germany) and Llorente (Spain). Very important data was presented on the results of a comparative study between transurethral resection of the prostate (TURP) and GreenLight HPS (120 watt) laser treatment carried out at the Fundación Hospital de Alcorcón from Madrid. Also we communicated the first worldwide results of the GreenLight XPS 180 watt laser from the IGLU (International GreenLight Users Grup), where I had collaborated with our results at the ICUA (Institute of Advanced Urological Surgery, in Madrid).

There was a lot of public and there was a great interest in the results of the new GreenLight XPS. I presented a comparison between the HPS laser and the XPS laser, to demonstrate the great advantages of this new laser. Although there is no voice-over, this short video shows the difference in efficiency of vaporization. The new laser is probably between 2-3 times faster than the HPS, and as the new Moxy fiber does not degrade during the procedure, it is possible to obtain a better performance with the energy used.


Comparison GreenLight HPS vs XPS from Fernando Gómez Sancha on Vimeo.

Then I returned early to Madrid, the following Monday I had to operate some patients.

Visitors from Israel

Today we were honoured to host Dr. Gabriel Gilon, from the Rabin Medical Center Bellinson, Tel Aviv, accompanied by Mr. Sam Goldberg. Both were very interested in seeing greenlight laser prostate operations. This afternoon they witnessed three operations that were really smooth and succesful. I explained to them the anatomic PVP technique, that ensures a complete removal of adenomatous tissue.

I think they were impressed and to celebrate the success of the day we went out for dinner and some flamenco!

Visit of Dr. Joao Pippi Salle

This weekend we received the visit of Dr. Pippi Salle, who came to Madrid to operate with us a one year old boy with a severe congenital malformation of the penis. He and Dr. Enrique de la Peña, the pediatric urologist of our team at the Institute of Advanced Urological Surgery, operated the boy with success at Hospital NISA Pardo de Aravaca, in Madrid.

Dr. Enrique de la Peña with Dr. Pippi Salle after the operation

Dr. Pippi Salle is one of the geniouses of current urology, he has described several surgical procedures and is one of the most respected pediatric urologists worldwide. He is originally from Brasil, but works in Toronto, Canadá.

Then, as we always do when we receive visitors, we took Dr. Pippi Salle to have dinner at Restaurante Botín, and then to the flamenco show at Casa Patas, that was magnificent!

Invitation to speak at the European Congress

I have received an invitation to speak on GreenLight Laser surgery for BPH at the European Association of Urology Annual Congress that will take place in Viena next month. I will be there to tell our experience with the new GreenLight XPS 180 watt laser!

Visitors from Morocco

This week we received visitors to Clínica CEMTRO, Dr. Saadallah khalid, Dr. Benjellorin Saad and Dr.  Fekkak Hamid, from Casablanca. I showed them the current technique for Greenlight vaporization of the prostate and they could clearly see the difference between the 120 watt GreenLight HPS system and the new 180 watt GreenLight XPS. We saw very interesting cases.

Then I took them to Casa Patas to see some flamenco, we had a great time!

More visitors... this time from Spain

This week we were honored by the visit of colleagues from Hospital Fundación Jimenez Díaz, Madrid, and Hospital Rio Hortega, Valladolid.

I showed them how the new GreenLight XPS allows to perform a good prostatectomy even in very large prostates.


The last case was quite impressive. The patient had a very big prostate and was a high risk surgical candidate. He had a giant intravesical median lobe. We applied a mixed technique, vaporizing first the anterior and lateral part of the adenoma with a Moxy fiber, that allows to work at 120 watts, vaporizing very fast. I took a lot of care in  preparing very well the area near the urinary sphincter, and then we proceeded to enucleate all the median lobe with a 2090 fiber, more resilient to mechanical force and ideal for enucleation. We worked at 80w-vap/40w-coag to enucleate the median lobe. After it floated freely in the bladder we extracted it with the Piranha morcellator from Wolf. I think we extracted about 60 grams of tissue... and at the end of the procedure we had used 500.000 joules. This mixed technique, using vaporization first and enucleation next is very interesting, because enucleating the median lobe after the vaporization of the lateral and anterior tissue is a piece of cake.

On the ohter hand, this type of technique would allow many surgeons who use GreenLight to face bigger prostates with better results, and it is not as difficult as the complete enucleation of the adenoma. Maybe also this initial preparation of the sphincter allows for a very low rate of sphincteric continence.


The following photos illustrate the completeness of the procedure.

Pre and postoperative transrectal ultrasound, longitudinal view

Pre and postoperative transrectal ultrasound, transverse view

New surgical session in Bilbao

Again I took a plane to go to Bilbao. We had programmed a session with two operations. Two patients with symptoms of benign prostatic hyperplasia (BPH) with two 80 cc prostates. We used the new GreenLight XPS 180 watt system. Both surgeries were uneventful.

Then I returned to Madrid rather early, to rest for the weekend.

Trip to Valladolid to learn to use the UROLIFT System

This afternoon I took the high speed train to Valladolid, to learn to use the new Urolift System to treat mild symptoms of benign prostate hyperplasia (BPH). I had known about this system before from my friend Dr. Henry Woo, from Australia, who was involved in the first trials in humans with this new system. It is also being evaluated at the Hospital del Rio Hortega, in Valladolid, and I was invited to see how Dr. Marcos Cepeda implanted this system in two patients.

It is a new concept for the treatment of lower urinary tract symptoms suggestive of BPH. It consists in applying two, four or six sutures with a special applicator, under local anesthesia + sedation into the prostate, and these compress the prostatic tissue opening the prostatic urethral lumen to facilitate micturition. The application was rather straightforward.

The main advantages of this system are: it is a minimally invasive system, with very low risk. It benefits younger patients, with smaller prostates, with moderate symptoms and it has the advantage of not altering ejaculation, a specially important issue in younger patients.

The disadvantages are for me that it is quite expensive and that there is a limited clinical experience published yet. My friend Dr. Woo tells me that it does not benefit all patients treated, but in those who benefit it is an elegant solution and long lasting, which prevents from having to receive medical treatment for years. He calls it "the surgical pill", precisely because it  is a minimally invasive intervention that can substitute medical treatment.

We sill see how it goes. It is available right now at the Institute of Advanced Urological Surgery in Madrid.

World Congress on Controversies in Urology, Paris, France

This weekend I went to Paris to participate in the IV World Congress on Controversies in Urology. I participated in a symposium on GreenLight Laser treatment for BPH.  It was very interesting and there was a lot of participation from the public. Paris was wonderful, as always, but it was freezing.

This photo shows us just before the symposium, with Drs Bachmann (Basel), Reich (Munich), Alivizatos (Athens) y Thomas (UK).

Then I returned to Madrid, I got a terrible cold in Paris ;-(