Live surgery in Bilbao

Yesterday started the I Symposium Internacional de Cirugía Robótica y Nuevas Tecnologías en Urología, organised by the prestigious urologists group Urología Clínica, from Bilbao. This congress, mainly devoted to robotic surgery, also has a session on lasers for benign prostatic hyperplasia. The panel of experts invited is espectacular, with urologists as Cathelineau, Gastón, Lugnani, Murat, Piechaud, Wilson. I was invited to participate performing a live surgery in a patient with BPH with the new Greenlight HPS (High Performance System) laser in the Virgen Blanca Hospital in Bilbao, while the attendees were in the conference hall at the Museo Marítimo de Bilbao, in a beautiful part of the city. The hospital was equipped with a system to retransmit video and audio to the congress hall.

The patient I operated had a 70 gram prostate with a humungus median lobe, a slightly difficult case, with the intention to show the audience a real life case, rather than a selected and easy BPH case, so they could evaluate the real ability of this laser to deal with real life prostates...
During surgery, Dr. Carlos Hernández, the moderator of the session, asked me questions about the technique, the surgical strategy and the features of the new HPS system.

Surgery was smooth and beautiful, there was no problem at all. I delivered 525.000 joules in 80 minutes. Some colleagues commented they were impressed not to see a single drop of blood. Today I will do a presentation in the congress hall and then I have to split because I have to fly to Venice, where I will attend another medical meeting this weekend.

More visitors from Portugal

Today we received the visit of four urologists from Porto, Portugal, that will soon start operating patients suffering from Benign Prostatic Hyperplasia with the new Greenlight HPS. We only had one case scheduled, but it was a relatively difficult one. A patient with a huge prostate with a very big median lobe. I must say it has been the most challenging case I have had in some time.

Finally, the result was very satisfactory. The median lobe was completely gone and there was a huge cavity. The patient will leave tomorrow morning. I have used 800.000 Joules in approximaetely two hours of surgery... The normal plan for those who come to visit us is to see operations on smaller glands, but I think it was a good experience. Even when a case is difficult, the patient is totally safe and it is possible to negotiate any challenging situation presenting during surgery without much trouble.

Visitors from Portugal

Today we welcomed visitors in the OR. Two urologists from Portugal that wanted to learn to perform PVP (Photoselective vaporization of the prostate) with the new HPS laser system.

When we receive visitors we always comment the theoretical aspects of this technique, we watch videos, animations and discuss some data. Then we go to the OR, where I operate one or various patients, and we have a chance to comment the technique step by step and clarify any doubt on the procedure.

In this ocassion we operated a very big prostate, that was uneventful... At the end, the session was intense but very interesting, we shared many opinions and ideas.

Return to India

Again I have come to India, to participate in a workshop on greenlight HPS laser treatment of BPH. I was invited to attend this workshop at the Jaslok Hospital, in Mumbai. It is the best surigal hospital in town and it will adopt the treatment of benign prostate hyperplasia with the new Greenlight HPS. I am happy to come to India, I love this country and I have also made some friends that I like to visit.

My role in this meeting was to present my experience with the technique, and its advantages over other treatment options. I had 30 minutes to explain my experience, what advantages this laser has over the 80 watt Greenlight PV (KTP laser) and above all, why I think this is the best option on earth to treat BPH. After the presentation, there was a discussion and it was a lively one.

Then we went to theater, where I performed three consecutive operations that were completely uneventful. This time we did not see a drop of blod. They were easy cases, 50, 40 and 20 grams, very easy.

Tomorrow we will operate four patients and this time I will help urologists in this hospital with their first cases. After the operations tomorrow, I will get the plane back to Madrid, that departs at 02.30 a.m. !!!

Visitors from Vitoria

Today we received visitors from Vitoria, two urologists and a group of nurses interested in witnessing the technique and the details of how a PVP with the new Greenlight HPS laser is performed. We had a patient with a relatively big prostate with a median lobe that needed three laser fibres. He had a huge median lobe and it took a little more than usual to complete the operation. After finishing, we sat down for a while to discuss the technical aspects of the operation. I showed them presentations and videos to ensure that they get all the tips and tricks!!!

Riyadh, part II

I am now at the airport waiting to embark back to Madrid after four intense days in Saudi Arabia.


The third day of my stay we did two PVPs that were uneventful. This was the most relaxed day. After sleeping and working at the hotel room for a while I had the chance to visit the Kingdom Tower, the emblematic building in Riyadh, and it is really impressive. From the bridge one can see the city, immense, built on the desert. Unfortunately my camera was retained on my way up, so I can only offer this one (see the brigde of the tower in the upper left corner of the photo?).


The fourth day we were planning to operate four patients, but two of them did not show up. The first case was a 70 gram prostate and the second was again a very big prostate maybe as big as 150 grams (the patient did not have a preoperative ultrasound, so we estimated the size endoscopically). Everything was uneventful and I had a chance to show some tips and tricks on how to tackle these relatively big glands. This time, the head of the department of Urology at the King Faisal Hospital came to theatre, and he showed a lot of interest. During the operations we had a chance to comment the subtleties of PVP with the new Greenlight HPS.


It has been an intense week, with nine surgeries in four days, but it has been really interesting to visit this hospital and get to know his urologists, great surgeons and better persons. After the success of this sessions I have receive new invitations to help train urologists in Jedda and other Saudi cities.

Operations in Riyadh, Saudi Arabia

I have already been in Riyadh for two days. I travelled the whole day on Friday and I had a welcoming dinner in a fantastic morrocan restaurant.... a good start for a very intense trip with a lot of work ahead.

I have been invited to the King Faisal Specialist Hospital & Research Centre to perform a number of surgical operations (PVPs - Photoselective Vaporization of the Prostate) in patients suffering from Benign Prostatic Hyperplasia with the new Greenlight HPS. The hospital wants to evaluate the technique and it has organised four days of surgery. This is a top-level tertiary hospital that is devoted to treating very complex cases coming from the whole kingdom of Saudi Arabia. Here is where the members of the Saudi Royal Family come for medical care. It is equipped with the latest technology and it is truly a healthcare city.... it is an impressive hospital.


A good part of the sanitary personnel is non-saudi, and comes from more than 80 different countries, which makes this hospital a really exceptional place. I must admit I am very impressed to see the quality of healthcare here, the outstanding level of doctors and the technology available.

Each day I have been asigned to treat the patients of one of the consultants of the department. The objective is to show them the technical tips and tricks and to allow them to witness the surgery and evaluate the results in their own patients.


The first day I operated two cases, a 40-50 gram prostate and an 85 gram prostate with a big median lobe. Both cases were uneventful. Today I saw the patients in the morning and both were feeling fine and have been already discharged.


This morning we operated a small prostate and a bladder tumour in a high risk patient and then they offered me to operate a patient with a huge 200 gram prostate, that also was satisfactory, although it was probably the most difficult case they can offer to a visiting surgeon... I suppose they found it interesting to see the performance of the HPS laser in huge prostates. After the surgical session we had some lunch at the urology department and then I did a talk on the Greenlight Laser, that was followed by a discussion.


Tomorrow and the day after tomorrow there are more patients programmed, so there is still a lot to do... Tonight we will go to a typical Saudi Restaurant, and believe me, the food is very good here ,-)

HIFU in Bilbao

Yesterday I travelled to Bilbao, where I visited Dr. Astobieta and Dr. Ibarluzea, that had scheduled a session of HIFU (High Intensity Focused Ultrasound) treatments for two patients diagnosed of prostate cancer. We are good friends and we share the passion for minimally invasive technologies and we had a chance to discuss the latests news in Urology and our recent experiences.

I have been invited to participate in an international meeting they organise the 1st of March, in principle to lecture on the new Greenlight HPS, and if possible, to perform a live surgical operation.

I then came back to Madrid, and attended the inauguration of the new headquarters of IML (Instituto Médico Láser), by my friends, the Surgeon Dr. Moreno Moraga and his wife, also a plastic surgeon, Dr. Josefina Royo. They have the biggest laser and technological unit in Europe and they devote their efforts to applying state of the art technology in the treatment of cutaneous diseases, varicoise veins, obesity and so on. They are growing fast and they are offering technological treatments in other areas, as plastic surgery, ophtalmology and dentistry. We will soon collaborate offering laser treatments of urological conditions.

Visitors from Belgium

Today I had scheduled a surgical session in Madrid and we received the visit of Dr. Philip Ameye and Ben Van Kleinebrugel, from the University Hospital from Leuven, Belgium. I performed three laser prostatectomies with the new 120 watt Greenlight HPS, and they came to theatre to witness these operations first hand. They already have experience with the 80 watt Greenlight PV system, but they wanted to see the new HPS in action, as they are evaluating the possibility of purchasing one.
I explained them my ideas on this operation and how should one handle this new laser.

I performed three operations from 9.30 am to 2.30 pm, all uneventful, and we went out for lunch to celebrate their visit. We had fun and we also learned a lot. I always learn from the opinions and comments from other coleagues - these are top class urologists performing state of the art surgery in Leuven, Belgium.

I got an invitation to operate in Belgium in March. It seems there is a Urology Professor that is interested in this technique but that would like to see with his own eyes not only some operations, but also the postoperative recovery of his own patients. So I will do some surgeries there to allow them to ascertain if Photoselective Vaporization of the Prostate keeps up with its wonderful reputation.

Surgical Session in Barcelona

Today I took a flight to Barcelona, to participate in a surgical session of Photoselective Vaporization of the Prostate with the 80 watt KTP laser at Teknon Hospital in Barcelona.

We have operated two patients and both surgeries were uneventful. I then had to wait at the airport for a couple of hours before returning to Madrid. As we are in Christmas, there are less shuttle flights and I had to wait for longer than usual.

Both Madrid and Barcelona were extremely quiet, almost everybody is on holiday for Christmas, and that makes it more difficult to work!!!

Later I checked my mail and I had an invitation to travel to Saudi Arabia during the first week of February, to participate in the training of urologists from Riyadh and Al Khobar city in the use of the new Greenlight HPS laser...


This is the last entry of the year in this blog, and I would like to take the opportunity to wish you all a happy and successful 2007!!!

Conference in Cairo, Egypt

Today I returned to Madrid after spending a week in Egypt, where I was invited to the 41st Annual Congress of the Egyptian Urological Association to talk about my experience with PVP - Photoselective Vaporization of the Prostate with the Greenlight Laser.

I also had a chance to spend some days in Luxor with my family, and from there we went to Cairo, where the congress was being celebrated. Egypt is a beautiful country, and we enjoyed visiting the temples of Karnak, Luxor, the Nile and the exotic atmosphere of this amazing country.

After Luxor, we went to Cairo, I had to participate in two important events. The first one, a press round to launch this technique in Egypt, where I participated actively. After the press round, the beautiful Nile TV channel presenter interviewed me and we not only talked about the Greenlight laser, but also about prostate cancer and urinary incontinence.

That night I participated in the official presentation of the Greenlight System to the urologists attending the congress, and the programme included the participation of Mr. Martin Hill (EMEA Distributor Manager of AMS/Laserscope), Prof. Mostafa El Hilali, an eminent Egyptian Urologist that lives and works in Canada, and Dr. Yarkin Kamil Yakupoglu, from Turkey. We all spent about 20 minutes discussing the Greenlight system and after the scientific session we enjoyed a very nice Egyptian dinner.

Martin Hill, Dr. Kamil and me just before the start of the scientific session.


The next day I had a chance to visit El Cairo, and I enjoyed enormously visiting the Pyramids and the Museum of Cairo. The Pyramids are overwhelming.


I was most impressed by the mummy of Ramses II. I think going all the way to Cairo is worth it just to look at him, flesh and bones, after 3300 years.... he is still looks great, doesn't he?



And finally, I did my contribution to the congress itself, with the conference "Greenlight PVP", and with an impressive attendance...

After my talk, I had the chance to discuss this technique with surgeons from Jordan, Kuwait and other Middle east countries.

I was interviewed by the magazine HME that was distributed to all attendees. I am transcribing it below.


It has been a fantastic experience. I have enjoyed Egypt, and I recommend everyone to visit this wonderful country. The Egyptians are very kind people and the country is espectacular.

I was happy to receive an invitation to come back soon, maybe in February, to contribute to the training of the two first users of the Greenlight laser in Egypt.

HPS in action in a big prostate

This is a video of a Greenlight HPS Photoselective Vaporization of the Prostate in a man with a 130 g prostate. These prostates are very big and usually are treated with an open prostatectomy. I used a suprapubic trocar, a 5 mm tube that is inserted into the bladder under the belly button, to enhance irrigation and improve visibility. The patient was sent to the room after his operation and the trocar entry site only needed a sticker to close. He was operated at 3.00 pm and was discharged the following morning, without a catheter and very happy.

Training in Sweden

Yesterday I travelled to Stockholm, Sweden. I then took a taxi to Västeras. I have been invited to train two urologists from the Public Hospital in Västeras in the use of the new 120 watt Greelight HPS. I had dinner with Dr. Botan Hawas, head of the department of urology and an extremely pleasant man, and we had a chance to discuss the characteristics of this technique thoroughly.

This morning we started at 8 am and we have operated three patients. The first patient was a relatively easy case with a small prostate and he has been the first patient to be operated with the HPS in Scandinavia.


Then we did an 80 gram prostate with a very prominent median lobe, very interesting and with a big educational value. Finally we operated a patient with an advanced prostate cancer that was catheterised. We will do two more cases tomorrow before I return to Madrid.

The hospitals in Sweden are very different from Spanish hospitals, they have a very pleasant decoration, with large living rooms where patients and doctors can sit down to have a coffee. This must make patients feel at home during their hospital stay!!

Visitor from Saudi Arabia

Last week was intense. I had a visitor in Madrid, Dr. Khalid Al Othman, from Hospital King Faisal Specialist Hospital & Research Centre, Jedda, Saudi Arabia. There is a growing interest for the Greenlight HPS system in his country and he came to visit with the objective of learning as much as possible about this laser, as they plan to implement this technology in their department. We started the training programme with four operations on Tuesday. I had scheduled four cases with prostatic sizes of 160, 106, 90 y 45 grams so we had a chance to comment the technical details of the operation. Dr. Al Othman was trained in Canada and Germany, and he was very focused in listening and seeing everything, and I learnt a great deal with his comments and questions... Then on wednesday I picked him up early to go to the airport, we travelled to Barcelona where I had scheduled a surgical session with the famous Gil Vernet family of urologists. We are good friends and I have been going to Barcelona to operate with them regularly. We have decided to strengthen this collaboration in the future. We performed a Greenlight PVP with the 80 watt laser, and it was a good oportunity for Dr. Al Othman to realise the differences between the 120 watt HPS and the 80 watt Greenlight.


We also had a chance to discuss thoroughly urethral stenosis treatment, one of the passions of Dr. Gil Vernet, a true expert in this field.

We returned to Madrid later that night because we had a very intense session the next morning. On thursday I had scheduled 5 patients, this time prostatic sizes were smaller, 130, 80, 60, 45 and 9 grams, and the session was uneventful. Again the conversations with Dr. Al Othman were enjoyable, he is a sharp urologist and he was able to grasp the subtleties of PVP, he could see almost every kind of patient and he learned all the surgical tips and tricks. In one of the operations in a patient with a 130 gram prostate I used a suprapubic trocar to enhance irrigation, and I delivered 800.000 joules. I recorded this operation and I hope to be able to offer it here soon.

I have been invited to travel to Saudi Arabia soon to help Saudi urologists to learn the technique with the new HPS greenlight Laser. I look forward to that.

Conference in Leuven, Belgium

This weekend I took a flight to Leuven in Belgium. I was invited to the International Symposium State of the Art in Urology organised by Professor Van Poppel at the University Hospital K.U. Leuven. The title of my lecture was "Why PVP rather than TURP or other MITs" - or why do I think that PVP is better than transurethral resection of the prostate and much better than TUMT (Transurethral microwave termotherapy) and TUNA (Transurethral needle ablation of the prostate). I had a chance to talk about my experience with the new HPS laser.

This time I was able to stay for the whole congress and the truth is that the programme was of the highest quality, all the speakers were international experts and I have really enjoyed it. The panel of experts was impressive Piechaud (robotic prostatectomy), Possover (laparoscopic neuronavigation), Van Velthoven (laparoscopic cystectomy), Stolzenburg (laparoscopic radical prostatectomy), Dasgupta (robotic surgery), Marberger (ablative kidney cancer energies), Emberton (HIFU), Langley (Brachytherapy), Kirkali (EORTC), Janetschek (centinel node in prostate cancer), Tombal (new agents in prostate cancer), etc...

Two urologists of the University Hospital in Leuven have confirmed that they would like to come to Madrid in January to see some PVP cases with the HPS laser.

Leuven is a university city full of students driving bicicles, and the atmosphere is very nice, the city is really beautiful.

Visitors from India

Today I had the pleasure of welcoming two Indian Doctors. The prestigious Urologist Shailesh Raina and Col. Manesh Sadhuram Masand from Jaslok Hospital from Mumbai, India. They want to be the first buyers of an HPS laser in India, and they wanted to see some Greenlight HPS Photoselective Vaporization of the Prostate procedures.


We have programmed four patients this morning, with prostates weighing 150, 80, 60 and 50 grams, the last of the cases was an obstructive prostate cancer. We have managed to operate all patients from 9 am to 3 pm, and all surgeries were uneventful. I think they liked what they saw and I guess they will decide to go for it.

Tonight I will take them to a Flamenco Show. They have to see some of our culture before they return to India... Olé!!!

Experts meeting in London

This friday I travelled to London to meet Mr. Gordon Muir and Prof. Alex Bachmann (in the Photo) to finish the article on technical recommendations on PVP (Photoselective vaporization of the prostate) with the 80 Watt Greenlight PV laser. This article also includes recommendations on how to train urologists to perform this operation correctly. We started this article during our experts summit in Madrid in July. We have used the opportunity to start a second paper on the complications observed with this technique (of course less important than those observed with the classic transurethral resection of the prostate) and how to avoid them. Christine Mckillop, a professional medical writer specialised in Urology is helping us to maintain order and focus, as it is not always easy to reach the consensus among five international experts... She is always taking notes and drawings, and as the time was short, we decided to keep on working during our lunch....

Trip to Lyon, France, HIFU for Prostate Cancer

This thursday I took a plane to Lyon, to visit Dr. Murat and Dr. Gelet, both world experts in the treatment of localised prostate cancer with HIFU (High Intensity Focused Ultrasound). I went to theatre to witness two HIFU cases, one for a primary prostate cancer (recently diagnosed), and the second one was a patient who was treated with radiotherapy and this treatment failed, and recurred to HIFU as a salvage treatment.
Next tuesday we will perform our first case in Madrid, we will have the first permanent HIFU device installed in Spain and we will offer this treatment option to our patients, and the possibility of getting trained to those urologists who want to learn. It is an impressive technology, that allows prostate cancer to be treated with minimal discomfort and with a lower risk of complications or secuelae.

This video shows how the technique is performed.