Originally posted January 28, 2013

This time I flew to Milano, where I slept, and then I woke up early to take a train to Bologna, to visit the Ospedale Santa Ursula Malpighi, chaired by Prof. Giuseppe Martorana. It is the second biggest hospital in Italy and I was impressed to know that the department of urology had 73 beds!

There they had prepared a surgical session with 5 patients, we did 4 vaporizations and one GreenLEP (GreenLight Enucleation of the prostate) in a record time. We worked in two operating rooms simultaneously, and as I was finishing one operation they were preparing the next patient, so I worked non stop all morning. Quite an experience, and all cases went really well.

This way the urology department could ascertain the versatility of the GreenLight Laser for the treatment of BPH, with the different variants, vaporization, vapo-enucleation and enucleation followed by morcellation.

Then I gave a brief talk to the residents of the department on this laser. Dr. Martorana invited me to participate in a congress with live surgery in his department later this year.

I went to have some delicious pasta and then I returned by train to Milano to take the flight to Madrid. A great experience!

Originally posted January 25, 2013

This time I went to Rome to perform a surgical demonstration with the GreenLight XPS laser at the
Policlínico Universitario Tor Vergata, the urology department is chaired by Prof. Vespasiani. Dr. Roberto Miano accompanied me, he has a lot of interest in becoming a GreenLight surgeon.

I performed three cases in three patients with Benign Prostatic Hyperplasia. An anatomic vaporization, a vapo-enucleation (enucleating the middle lobe) and an En-bloc GreenLight enucleation of the prostate (GreenLEP), in which we used a morcellator to extract the tissue for histological analisys.

The session generated a lot of interest and there were many urologists and residents watching. Two days later Dr. Miano informed me that patients had fared very well.

I slept in Rome and the following morning I went to Hospital Villa Claudia to perform another surgical demonstration to Dr. Roberto Giulanelli, and we had also the visit of Dr. Tonino Lagana. I did two operations on two patients with BPH who had recurred after a previous TURP (Transurethral resection of the prostate). One anatomic vaporization case and one vapo-enucleation that went very well.

It is always a pleasure to go to Italy. After finishing the session I returned to Madrid to try and rest a little during the weekend. Due to my trip to Bulgaria the previous week, this has been a 15 day non stop working week...

Originally posted January 22, 2013

My first trip of 2013 has been to Sofia, to participate in another surgical session in which we performed 15 GreenLEP procedures (GreenLight Laser Enucleation of the prostate) in four days. I was happy to hear that all patients from the previous session were doing well.

Several patients had advanced BPH (Benign prostatic hyperplasia) with big prostates and bladder stones. In such cases we first pulverize the stone with Holmium laser and then we perform the GreenLight Enucleation procedure.

The new Vmax blades for the Piranha morcellator have changed our lives, morcellation time has been reduced to more than half, now procedures are much faster.

It started snowing and everything turned white... winter is tough in Bulgaria.

Originally posted January 13, 2013

Today I got the news that the abstract we sent to the AUA (American Urological Association) Annual Congress for this year has been accepted. It is another paper from the IGLU (International GreenLight Laser Users Group) that includes our experience with the GreenLight XPS 180 watt laser from the year 2010 at the Instituto de Cirugía Urológica Avanzada, in Madrid.

Originally posted December 16, 2012

Again I travelled to Sofia for another surgical session. I departed on Sunday with the intention of operating the same day, but the plane broke down and I had to spend the whole day at the airport... finally I got a new flight and managed to reach sofia after a true horrible day at several airports...

The two following days we operated patients at Hill Clinic, some with very big prostates, with the help of the wonderful urologists at Hill, Dr. Kocev, Dr. Botzevski, and Dr. Georgiev. The combination of the "en bloc" enucleation technique and the new Vmax blades for the Piranha morcellator allows us to operate big glands in a reduced time.

This prostate weighed approximagely 170 grams and it only took 17 minutes to morcellate it. To me this represents a true step forward in enucleative surgery for the treatment of BPH.

The session went very well and then I returned to Madrid. Christmas holidays are approaching and I feel like resting a little!

Originally posted December 12, 2012

Yesterday afternoon, the mythic 12-12-12, we received the visit of two italian urologists, Dr. Claudio Dadone and Dr. Oscar Fenice at Clínica CEMTRO in Madrid. The GreenLight laser is generating a great interest in Italy!

Also we were joined by Dr. Julio Fernández del Álamo, from the Hospital of Torrrejón in Madrid, who is very interested in learning the enucleation technique. Julio works with Dr. Luis Llanes, my partner at ICUA in Madrid, an expert in the endourological treatment of stones and head of department of this hospital.

We performed two surgeries, an anatomical vaporization and a GreenLEP (GreenLight Enucleation of the prostate), that went very well. Then we went for dinner to el Corral de la Morería, a Flamenco restaurant, we had a great time!!!

Originally posted December 11, 2012

This time I went to Modena via Milán. I rented a car to drive to Modena and I slept there to start in the morning with a new surgical session with Dr. Giovanni Ferrari at Hesperia Hospital. In this occasion we were joined by Dr. Lorenci and Dr Malossini, from the Ospedale di Trento,  who came to see the operations.

We did four operations that went really well, one of them was relatively more difficult, a man with a huge prostate. We did a GreenLEP procedure (GreenLight Enucleation) and we extracted 160 grams of tissue with the Piranha Morcellator from Wolf. I then had to return driving to Milan and took a plane back to Madrid.

Dr. Ferrari told me the next day that all patients were feeling well!

Originally posted December 7, 2012

This time I was invited to participate at the congress "Innovations and Classics in Endourology and Imaging" that took place in Mannheim, Germany.

My role at the congress was to perform a GreenLight Enucleation of the prostate (GreenLEP) procedure, that was transmitted to the main auditorium at the Rosengarten Congress Center.

The patient they selected was very complex. Had a huge prostate and bladder stones, but everything went very well. The transmission time was reduced, but I could demonstrate the basis of the GreenLEP technique, specially useful in big glands.

It was a great honor to operate in the hospital where Dr. Peter Alken developed percutaneous renal surgery, I had a great time.

Originally posted November 30, 2012

This time I went to the University hospital in Brest, France, to participate in a meeting of urologists who are trainers of other urologists in the GreenLight Laser use for the surgical treatment of BPH in Europe.

The objective of the meeting was to unify criteria as well as to share ideas and knowledge. The meeting was hosted by Prof. Fournier, who told us about his experience and who showed us the technique for continous intraoperative monitorization of laser vaporization with transrectal ultrasound.

Dr. Fournier came to visit me in Madrid in September 2009, and already then we commented the importance of transrectal ultrasound (TRUS) as a quality control of the procedure. I normally use TRUS before the procedure and at the end of it, or intraoperatively if I find it necessary, but only punctually.

Prof. Fournier has developed in these years a very ingenuous way to use a standard TRUS device to monitor the operation continuously in a very simple way. I loved the idea and I think it would be most useful for surgeons learning the procedure.

This way the surgeon has two views, the endoscopic view and the ultrasound monitoring in the same screen, very interesting.

I contributed presenting the different technical variations I use with the GreenLight laser, the anatomic vaporization with capsular localization, the vapo-enucleation and the GreenLEP (GreenLight enucleation procedure). I believe both approaches are compatible.

A very interesting meeting in the company of my colleagues, also passionate for prostatic laser surgery.

Originally posted November 21, 2012

Today I went to the Spanish National Television - RTVE, to participate in the program "La Mañana de la 1", with the famous Mariló Montero.

As always, it is a lot of fun to participate, and I had a great time. We spoke a little bit about pelvic floor problems and we demonstrated the new 3D laparoscopic system from Storz, that allows us to operate with 3D vision inside the abdomen, using a dummy patient.

Here below, the full video.

Saber vivir - Vejiga y próstata

• Saber vivir - Vejiga y próstata

Originally posted November 17, 2012

Again we had a two-day surgical session at the Hill Clinic in Sofia, Bulgaria.

In this session we operated 10 patients in two days with the GreenLEP technique (GreenLight Enucleation of the Prostate). The technique has been improving and now we can start the procedure with an apical dissection, liberating the external sphincter from the apex of the adenoma, which protects it much better, and the surgical time is greatly reduced.

In this occasion, we had the visit of Dr. Andrés Sempere. He trained as I did at the Hospital de La Princesa in Madrid, he just left as a certified urologist when I became a first year resident. Dr. Sempere is going to start working in Dubai soon, and he wanted to learn this enucleation technique. We had a great time!

Originally posted November 15, 2012

In this ocassion I went to Bari, Italy, to help Prof. Arcangelo Pagliarulo and Dr. Gaetano de Rienzo, from the huge Policlinico Hospital, to learn the new techniques for anatomic vaporization and GreenLight Enucleation of the prostate.

The Policlínico is like a city, full of healthcare buildings, very impressive. We did nine surgeries in two days, and we had time enough to discuss every technical aspect of these operations.

Then I had to go to Bulgaria, but as the flight connection was difficult, I flew to Rome, from there to Athens in Greece, slept at the airport hotel and then departed to Sofia in the morning. A little tough schedule!

Originally posted November 12, 2012

I am happy because I have established an agreement for collaboration with Dr. Giovanni Ferrari, by which I will operate with him in Modena, Italy, every month.

Yesterday we did three GreenLight vapo-enucleations in illustrious patients with big prostates that underwent really well. I am happy to collaborate with Dr. Ferrari, he is a top urologist and a very charming man.

I bought at the airport on my way back some italian cheese and Módena vinegar, of course... and I have to return via Lisbon, a tough schedule, but I was happy.

Originally posted November 9, 2012

I arrived in Torino to participate at the congress Technology & Training in Endourology, organised at the Ospedale Cottolengo by Prof. Cesare Scoffone.

My contribution was to perform an anatomic vaporization of the prostate with the GreenLight laser that would be transmitted live to the congress main room filled up with italian endourologists. The patient I had to operate had a catheter, and I could do a good job while I demonstrated the technical aspects of the operation as didactically as possible.

In the room, Dr. Naspro and Dr. Fasolis asked me questions and relayed the questions that other colleagues in the audience wanted to ask.

Then I did a talk to demonstrate other techniques with GreenLight laser, the vapo-enucleation and the En Bloc GreenLEP (GreenLight Enucleation of the Prostate).

That night we went to the readers circle in Torino, situated in a beautiful palace in the center of the city, and we enjoyed the congress' gala dinner, that was amazing. Prof. Scoffone addressed us during the dinner. He is a genuine man, a great urologist that works with illusion to contribute positively to improve the quality of endourology in his country. The truth is that this generous attitude always moves me and makes me proud of belonging to this wonderful specialty. It has been a great congress.

Then I came back to Madrid to rest for the remainder of the weekend.

Originally posted November 9, 2012

This time I travelled to Milano in Italy to introduct Dr. Epifanio Scardino to the technique of anatomic vaporization of the prostate for the treatment of Benign Prostatic Hyperplasia with the GreenLight laser at the Casa di Cura San Camillo.

The session went very well and Dr. Scardino seemed to me to be a charming man, we had a great time together.

Then I departed to Torino, where I had to participate at the congress Technology and Training in Endourology, where I had to contribute by doing a live surgical demonstration and a talk on GreenLight laser new surgical techniques.

Originally posted November 8, 2012

Today we had a surgical session at Clinica CEMTRO in which we operated four patients suffering from BPH with GreenLight laser, and Dr. Ehabsayeddr Elmallah, from Taiba Hospital, Kuwait came to visit us in the operating room.

We had a chance to comment basic science and all the technical aspects of this kind of operation and I showed him all the tips and tricks and approaches we use in these cases. Soon I will go with him to Kuwait to help him with launch his laser unit.

Originally posted November 1, 2012

This time I travelled to Dubai, at the United Arab Emirates, to give a conference at the first annual congress of the Emirati Urological Society. I spoke about surgery for benign prostatic hyperplasia with the GreenLight laser. The title of my presentation was "Exploring the boundaries of GreenLight for the treatment of BPH" and I tried to explain that not only GreenLight has a brilliant present (the european and american urological associations recognize it as a standard option of treatment for BPH), and that there are now two published meta-analysis that back this up (level of evidence 1), but also that the new techniques I have developed, the anatomic PVP, the vapo-enucleation of the middle lobe, and the GreenLEP procedure (GreenLight Enucleation of the prostate), the future looks even better.

I worked hard in this talk, and it was very welcomed by the public. The following day I had to moderate a session on minimally invasive treatment of urinary stones, very interesting. Dubai is an impressive city, with big buildings and constant activity... luckily it was not too hot as now it is winter over there. I had a great time and then I returned home. It is a long journey.

Originally posted October 30, 2012

This week, as every month, we had a surgical session with Dr. Richard Gaston. He came to Madrid to operate with Dr. Estefanía Romero and myself two patients with prostate cancer at Clínica CEMTRO.

Dr. Gastón performs more than 500 laparoscopic radical prostatectomy every year, with excellent oncological results (e.g. curing the cancer) as well as functional results (preservation of urinary continence and erectile function).

Originally posted October 27, 2012

The EAU 8th South Eastern European Meeting took place this year in Sofia, and we presented our experience with GreenLEP (GreenLight Enucleation of the Prostate) that we have acumulated during the last years at the Hill Clinic in Sofia.

In order to see it you have to notice that we stuck an ipad on the poster, so that urologists could see the video of the technique. It was sensational!

In the photo below, with the other authors of the poster, the urologists from Hill Clinic.

Then we started the surgical session, as every month. This time we had 15 GreenLight enucleations in 3 days, that went really well. In this session we registered all surgical times and data because we were trying the new Vmax blades for the Piranha Morcellator, from Richard Wolf.

We are very impressed to see the amazing efficiency of morcellation that these blades provide. We managed to morcellate 10 grams of tissue for every minute of morcellation surgical time. It is espectacular, we sent an abstract for the EAU with the data.

In this photo, all the specimens we obtained during the three days, that were sent for histological evaluation.

At last I returned to Madrid, very happy. Operating so many patients in such a short time is always a wonderful learning experience, and the enucleation technique keeps sophisticating itself, becoming more simple, faster and safer.