In this occasion I flew to San José to join an international experts committee where we discuss how should new lasers for the treatment of BPH evolve.
This committee is composed by Dr. Benjamin Choi (USA), Mayo Clinic Professor emeritus Dr. Reza Malek (USA), Dr. Mahmood Hai (USA), Dr. Karl Kemberling (USA) and Dr. Henry Woo (Australia), who could not be in this photo. It is always fascinating to think about the future of surgery of BPH and these are very interesting meetings.
When I arrived at Torino I went for dinner with Prof. Cesare M. Scoffone, an international expert in percutaneous renal surgery with a great interest in endourology.
We enjoyed a wonderful time tasting the local fish. The next morning we woke up early to go to the theatres of the Ospedale Cottolengo, where he had programmed four cases. I did three vaporizations and one prostate enucleation and I was delighted with Prof. Scoffone's reaction. He was amazed with the technology and the evolution of the surgical technique.
I also had the privilege of listening to Prof. Scoffone presenting his experience in percutaneous renal surgery and combined intrarenal surgery (double access to the kidney, both ureteroscopically and percutaneously). I talked to him about my colleague at ICUA, Dr. Luis Llanes, who is the newly appointed head of department of urology at the new hospital in Torrejón Madrid, a great expert in the same techniques and we thought to invite Prof. Scoffone soon to operate with us.
Finally I came back to Madrid, a little tired after 23 surgeries in the last six days.
After landing in Rome I took a taxi to go to the Policlinico Umberto Primo, Dipartimento Bracci, to operate two patients in the urological department of Prof. Gentile.
The session was shorter than usual, but also very interesting.
From Rome I flew again to Torino for the last day of this long italo-bulgarian roadshow.
This time we had a busy surgical program me at Hill Clinic in Sofia. We operated 10 patients in two days, all of them with big, bulgarian prostates.
We did 9 enucleations and one vaporization. I still learn a lot with this sessions, every prostate is different and facing the challenge of making surgeries safer, faster, more efficient, patient after patient, makes me learn and evolve. There were two patients with prostates specially big, with 150 and 220 grams, that went very well.
I was interviewed for bulgarian TV.
On Saturday night I went to a restaurant where I could see the folk group Asen & Milena. A wonderful and totally recommendable music.
After the surgical session in Rome, I flew to Torino and from there I was taken to Cuneo. There I had dinner with the urologists from the Ospedale de la Santa Croce and we enjoyed the cucina piamontesa in a restaurant just in front of the hospital.
The next day we had a busy session with four patients, accompanied by Dr. Arena and Dr. Dadone. They had already experience with the GreenLight HPS 120 watt laser and they were impressed by both the technological advances, with the 180 watt new laser, as well as by the advances in surgical technique. They loved to see how it is possible to perform a full vaporization of the adenoma with the anatomic PVP technique. I also showed how it is possible to enucleate a median lobe in prostates with huge median lobes. We had a great time.
In this occasion I had the privilege to operate at the Ospedale Fatebenefrateli isla tiberina in Rome, Italy, with Prof. Amici. This is the oldest hospital in Rome, surrounded by the Tiber river, wonderful. Under the hospital they discovered archeological ruins of a roman villa and they are exposed for visitors, fascinating.
We did a surgical session with three patients that went really well. I could demonstrate the anatomic PVP technique with excellent results. Later they told me that patients had all fared very well. Dr. Amici expressed his interest in inviting me to operate in Rome more often. I love Rome!
Again we received in Madrid the visit of two italian urologists who came to witness a surgical session at Clinica CEMTRO.
Prof. Mutto y Dr. Romagnoli watched two operations that fared excellently well. That night I went to bed early as I had to fly to Rome early in the morning.
This thursday I flew to Leipzig in Germany to participate in a course on the treatment of benign prostatic hyperplasia with the GreenLight laser organized by the Universitätsklinikum of Leipzig and the Universitätspital of Basel, Switzerland. There I lectured with Professors Alexander Bachmann, Oliver Reich, Frank Schiefelbein and Jens-Uwe Stolzenburg, Who hosted the meeting at his hospital in Leipzig.
I first lectured on basic science, explaining laser physics and their relevance for the GreenLight surgeon. Then we divided the participants in groups and I was in charge with Prof. Schiefelbein to discuss advanced techniques, the anatomic vaporization of the prostate and the GreenLEP (GreenLight enucleation of the prostate) procedure.
Then I performed a surgical operation precisely demonstrating the principle of anatomic vaporization, with the presence in the operating room of many german colleagues.
Professor Jens-Uwe Stolzenburg is a world famous urological laparoscopist, an exceptional surgeon, a wonderful person and a great host.
After the meeting I had a chance to visit the Porsche factory in Leipzig, with Dr. Bachmann and Dr. Reich and a professional pilot drove us fast in an spectacular Porsche Panamera...
Then I returned to Madrid and to try and enjoy the bank holiday.
Today I spent the morning with my colleagues at the Hospital Gregorio Marañón, the biggest public hospital in Madrid. I had been invited to show the GreenLight XPS 180 watt anatomic vaporization of the prostate. It is always nice to meet my friends again.
I did the first case of the morning, a patient with a moderately large prostate, where I showed them the way of identifying the prostate capsule to achieve a radical vaporization of the adenoma. Everything went smooth and nice.
Dr. Carlos Hernández performed the second case. He had previous experience with GreenLight and it was easy for him to reproduce the technique. He was very satisfied with the possibilities this new laser offers and surprised to see the radicality and elegance of the technique.
Dr. Hernández has always been in the avant gardé of technology and modern techniques in urology, pioneered many techniques in our country, specially laparoscopy and is a loved and respected reference for us spanish urologists. I had a great time with him and the urologists of his department. It is always a pleasure to share my experience and surgical tips with my colleagues.
This year the European Congress took place in Paris. In this ocasion my contribution for the congress was to participate in a observed advanced techniques observation session on GreenLight vaporization of the prostate in which we showed other colleagues how to operate with this laser with a computerized surgical simulator.
The simulator is fantastic, as it allows urologists without experience with GreenLight to train for hours before operating on patients. This way, their understanding of the technique improves a lot and any mistake is committed in a computer, rather than in a patient.
A very interesting session with my friends, Dr. Oliver Reich, Shiefelbein and Alivizatos.
Again we received the visit of some italian urologists, and Dr. Miguel Angel García, from Salamanca. In this occasion I did two vaporizations and one enucleation with the GreenLigth XPS laser in a patient with a big prostate, all operations were uneventful and successful.
A very interesting session. I love to see the reaction of my colleagues when they come to visit, they leave convinced that this laser, well used, can work wonders on the treatment of BPH patients.
Again I travelled to Sofia, for another surgical weekend. I worked hard at the Hill Clinic and then returned to Madrid.
I am always happy to know about the patients operated in previous sessions, and the feedback is fantastic, the results of GreenLEP (GreenLight Enucleation) are very good.
In this visit the marketing department of the clinic took some photos and gave me some for the blog.
In this photo during an operation at Hill Clinic. It is a very fast and efficient surgical room, it is a pleasure to work there.
In this photo with some members of the Hill Clinic team, with Drs Kocev and Georgiev in my right hand side and Dr. Bocevsky (with a white gown in my left hand side). With a blue head cover, Petia, a wonderful nurse who is really good and helps me during the operations.
Today I traveled to Bergamo, Italy, to help Dr. Deiana and Naspro with their first cases with the GreenLight XPS laser at the Ospedali Riuniti di Bergamo.
In the photo with Dr. Naspro this morning. We had very interesting discussions about the use of different types of lasers for the treatment of BPH...
Again I flew to Italy to participate in a surgical session at the Ospedale San Antonio in Padova, Italy. I did two operations with Dr. Del Bianco, on two patients with prostatic sizes of 80 cc and 70 cc, that went very well.
They have a fantastic urological surgical center, with three operating rooms only for urology.
A tough day, I departed Madrid at 6 am and returned at 12 pm... very tired!
Today we had another surgical session with Dr. Gaston at the Clínica CEMTRO in Madrid.
He is an exceptional laparoscopist and his anatomical knowledge of the prostate and his surgical resources are unparalleled. Helping him operate is a true privilege. I had a great time operating with him and with Dr. Estefanía Romero. The surgeries were a true surgical masterclass.
He has also mentioned his intention to invite me to participate in a GreenLight laser training workshop he wants to organize in Bordeaux. It will be an enormous pleasure to collaborate with him in whatever he needs.
I spent this weekend in Sofia, Bulgaria, where I did a surgical marathon of laser prostatectomies at the Hill Clinic. It was very cold, and Sofia was covered with snow. This was the view from the doctors resting room at the clinic.
All surgeries went very well. The GreenLEP technique detaches the adenoma from the capsule in one piece and we push it into the bladder and later we aspirate it out with a special device called morcellator. This technique has progressively evolved and is now very structured and reproducible. I am thinking this is the moment to start working on a video that describes the steps of this wonderful technique so I can publish it here.
On thursday I left early in the morning to Italy, to perform a surgical demonstration with the GreenLight XPS 180 watt at the Civil Hospital of Treviso. There I was with Prof. Maccatrozzo, Dr. Merlo and Dr. Paolo Guaitoli, who came all the way from Udine to watch the surgeries (the last two doctors in the photo below).
I had a first patient with a monster prostate with a huge median lobe and I had to perform a hybrid technique. At first I could not enter the bladder with the laser cystoscope due to the humungous median lobe. I vaporized the lateral lobes using 600.000 joules and then I found the capsular plane on top of the veru montanum to progressively enucleate the median lobe until it was hanging from a small pedicle at the bladder neck. Then I used a bipolar resectoscope to resect the median lobe, in a totally bloodless fashion, and when we weighted the prostate chips, 70 grams! We checked with intraoperative transrectal ultrasound that we had removed the whole adenoma... a difficult case, but we managed it safely. The second patient had a smaller prostate and we did a good job too. I really enjoyed the session.
Then I went to the airport, where I had to wait to leave to Sofia, Bulgaria, because the airport had been closed due to heavy snowing. Finally I got there at 2 am...
Today we had a surgical session with three operations with the GreenLight XPS laser for the treatment of benign prostatic hyperplasia (BPH). We received the visit from four italian urologists interested in this type of laser. The operations went very well and we had a chance to talk in depth about the basic science and the different properties of various wavelengths.
Soon the new book "Pelvic Pain", edited by Mary Montenegro, will be available. We have contributed with a chapter on myofascial syndrome in patients with chronic pelvic pain.
This thursday night I flew to Edinburgh to participate in the Celtic Urology Network Meeting, that brought together urologists from Scotland, Wales and Ireland, in an update session on the treatment of Benign Prostatic Hyperplasia (BPH).
I really liked to reach Edinburgh, a wonderful city. That night I had dinner with my friend Dr. Andy Thomas, and I got ready in the morning for my talk later that day.
I could only take this photo of the attendees. I spoke about the anatomic photoselective vaporization of the prostate as well as the GreenLEP (GreenLight Enucleation of the Prostate). I had a great time.
Then I returned to Madrid to spend the weekend, I could not enjoy Edinburgh enough, but I really look forward to coming back some day.
Urologist. HoLEP and robotic surgery specialist. Head of Urology at Clínica CEMTRO, Madrid. I have operated in over 50 countries and performed more than 10,000 laser procedures.
