Originally posted June 22, 2013

Again I travelled to Sofia, Bulgaria to operate at Hill Clinic.

In this occasion we celebrated the fourth anniversary of the clinic. I started to collaborate with them three years ago and since then we perform the GreenLEP (GreenLight laser enucleation of the prostate) technique to treat the clinic's patients suffering from Benign Prostatic Hyperplasia.

To celebrate the event, Hill organised several activities and an open doors day where for the first time in Bulgaria we could show the GreenLight SIM, a computerized simulation of GreenLight laser vaporization of the prostate, a tool for urologists to train themselves before treating a real patient.

For me it has been a great experience to collaborate with Hill Clinic all these years, it has allowed me to develop this technique progressively, perfect it, introducing minute improvements as I got to understand how to make this procedure faster and safer. Interestingly, we reached 300 Enucleations the day of the 4th anniversary, we did 43 in 2010, 75 in 2011, 103 in 2012 and 79 up to now in 2013.

This weekend, as it is usual, we performed 14 operations in three days that went really well.

These are the specimens of prostatic tissue that we sent to the pathologist for histological analysis. This technique allows to extract all the adenomatous tissue independently of the prostate size and to analyze it.

Also the technique has improved a lot with the new Vmax blades of the Piranha morcellator, that allow for an extremely fast morcellation. In this extract from the intraoperative data of two of the cases we did this weekend we can see the prostatic volume as estimated by abdominal ultrasound, the weight of the tissue extracted (137 g and 73 g), the energy used, the firing time of the laser at 80 w and 40 w settings, the active morcellation time and the total morcellation time. It is impressive to be able to extract adenomatous tissue in such a short time (137 grams in 14 minutes and 26 seconds and 73 grams in four minutes and 5 seconds of real time), as it allows us to perform most cases in under one hour.

I am really convinced that any urologist who sees the work we do will agree that there is no justification nowadays to keep performing open prostatectomy.

The truth is that there I feel great, with my friends and colleagues from Buglaria. I really believe that we form an elite team of laser prostatectomy at the top level. In the photo from left to right, Dr. Botsevski, the nurse Ms. Petia, Dr. Kotsev, Mr. Lubo and Dr. Georgiev, all of them great professionals.

Originally posted June 20, 2013

Today we had programmed three GreenLEP operations. We received the visit of two representatives from Germany and USA of the surgical instrument manufacturer Richard Wolf.

They also came interested in seeing the GreenLEP procedures (GreenLight Laser Enucleation of the Prostate). Normally we use their surgical instruments to perform this operation.

I am specially happy with the Piranha morcellator, with the new rotational blades Vmax, that allows us to extract the prostatic adenomatous tissue once we have enucleated it from its capsule and pushed it into the bladder.



Our surgical procedure time has been reduced much since we use them, because we achieve a very fast morcellation of 10 grams per minute during the morcellation phase, that is really impressive. Typically, to enucleate a 100 gram prostate we would need 40-45 minutes for the enucleation step, 5 minutes to change the instruments and start the morcellation and 10 minutes to finish. This is a true leap forward if we compare this with previous enucleations, where to morcellate 100 grams  of tissue we had to work for about 40 minutes.

In this occasion I also showed them the pre and postoperative transrectal ultrasound picture, that shows the beauty and value of this surgical technique.

Originally posted June 18, 2013

Today we received the visit of Mr. Mike Kujak, the general manager of American Medical Systems, the company producing the GreenLight laser in the US, as well as many other medical devices for the treatment of pelvic health problems.

He came to Madrid interested to see in person the GreenLEP (GreenLight laser enucleation of the prostate) technique that I have developed, as well as the anatomic vaporization technique. The postoperative ultrasound of the prostate we enucleated showed a perfect job! It was impressive. We probably removed 90 grams of tissue and the cavity was perfect!

After we finished the two procedures we went out for dinner in Madrid. I have to say that despite my close relationship with this company for many years it is the first time I see a CEO "coming down to the kitchen"to see first hand how their products are used. I was very positively surprised by this attitude. He left a comment in our visitor book.

Later on our Pathologist confirmed we had extracted 90 grams of tissue.

Originally posted June 7, 2013

This weekend I went to Gran Canaria with Dr. Juarez. He invited me to operate with him a patient with a large prostate gland. We performed a GreenLEP technique at the Clínica San Roque in Gran Canaria. Everything went very well and I was happy to know that the patient had left the following morning.


Dr. juarez pioneered the application of GreenLight laser for the treatment of BPH at the Canary Islands. We have operated a lot together and we are very good friends.

Originally posted June 7, 2013

Today I took the AVE (the famous spanish high speed train), and at 300 km/h I reached Zaragoza and went to the University Hospital Miguel Servet to meet Dr. Rodriguez Vela, the head of department.

They had prepared two patients with big prostates to see the new GreenLight XPS laser in action. I demonstrated the anatomic vaporization technique and the vapo-enucleation technique (lateral lobe vaporization, localization of the capsule and enucleation of the middle lobe)

In both cases the result was very good, and I think they enjoyed seeing how one can easily localize the capsule and perform a radical vaporization of the adenoma that mimics what we did with open prostatectomy. I am convinced this is the future of the surgery of BPH. I had a great time with my friends in Zaragoza, I hope to return soon.

Then I came back to madrid, tonight I will depart to Gran Canaria, tomorrow I will operate there with my good friend Dr. Juarez del Dago.

Originally posted May 30, 2013

Again I went to the Hospital de Torrejón in Madrid with my nurse Vanesa to help the urology team captained by Dr. Luis Llanes, head of the department of urology and his colleagues with their learning process with Holmium laser enucleation.

We did two cases that went really well. It is a complex technique and the learning curve is long, but with very good results.

Originally posted May 29, 2013

Today we had a surgical session at Clínica CEMTRO and we received the visit of two urologists from France, very interested in the surgery of benign prostatic hyperplasia with the GreenLight laser, Dr. Vincent Misrai, from Toulouse and Dr. Sebastian Vincendeau, from Rennes.

I performed three operations and I could show them he GreenLEP procedure (GreenLight Laser Enucleation of the Prostate), one anatomical vaporization and one vapo-enucleation (enucleation of the middle lobe). They enjoyed the experience:

And these were the comments they wrote at the visitor book.

Originally posted May 24, 2013

Again I went to Sofia to operate at the Hill Clinic. I had to participate in a two day surgical session.

I am always happy to hear from my bulgarian colleagues that the patients from the previous session are doing well after their operations.

I am very happy with the evolution of the GreenLEP (GreenLight Enucleation of the Prostate) technique. During the last three years I have introduced small variations, changes in the steps I followed to detach the adenomatous tissue from the surgical capsule, that allow us to perform it more safely.

Originally posted May 22, 2013

The 21st I travelled at night to Milano, to depart to the Hospital in Lovere early in the morning. Lovere is a small city by a beautiful lake and surrounded by mountains. The hospitals attends patients from all the region.

There I met Dr. Rainieri and Dr. Paganelli, who had prepared three patients to operate with the GreenLight XPS laser. The views from the hospital are beautiful.

The session went very well, and Dr. Paganelli could do his first steps with GreenLight under my supervision. He had been working with the simulator the previous day, and I really think it is a wonderful tool for learning.

We had a nice session and enjoyed it, everything went very well.

Then I departed to Milano, to catch a flight to Bulgaria.

Originally posted May 17, 2013

I arrived in Borgosesia on Thursday afternoon to participate as invited professor at a course in minimally invasive urology.

The hospital is located between mountains, in a really wonderful place.

First I gave a 20 minute talk covering the different generations of GreenLight lasers and the advances in surgical technique, and I presented the anatomic vaporization, the vapo-enucleation and the GreenLEP (GreenLight enucleation of the prostate) procedure. Then we performed a simulator session that was used by all attendees at the course.

The simulator is a wonderful training tool, that reduces greatly the surgeon's learning curve and obviously benefits patients who have to be operated by a surgeon in training.

Then we went to dinner to a typical restaurant, to enjoy the "cucina piamontesa". I had no choice but to leave apart my recently started diet ;-)

The next day there were surgical sessions where the attendees could participate. I performed two interventions. A vapo-enucleation of a large prostate and a GreenLEP procedure in a patient who had two previous biopsies with inconclusive signs of prostate cancer. The GreenLEP procedure allows for the retrieval of the adenomatous tissue for histological analysis.

Both operations went pretty well, and as always I could see the surprise of my colleagues when they see the versatility of this laser and the beauty of these techniques. I had a lot of fun, enjoyed to see new techniques, as the single port radical prostatectomy performed by Dr. Vincenzo Ferrara, and I made new friends. Then I drove back to Malpensa to return to Madrid to rest for the weekend after three intense work days in Italy.

Originally posted May 16, 2013

Again I arrived at the Hospital at Ponte San Pietro to assist Dr. Oscar Fenice with his training in GreenLight XPS 180 watt laser prostatectomy for BPH.

In this occasion we operated three patients, two with relatively voluminous prostates and one with a smaller gland. Dr. Fenice had been training hard with the computerized simulator designed to teach this procedure and I was impressed to see the qualitative leap in his surgical skill in comparison with the first session we performed recently. Dr. Angelo Gritti, head of the department, was very impressed with the possibility to visualize the prostatic capsule in such a clean and clear way, despite the big size of the prostates.

When we finished the session, at lunchtime, I took a rented car and drove up north to Borgosesia. I had to participate in a training course in minimally invasive surgery. Unfortunately it was raining and I do not know why the roads in Italy are always so busy, but I enjoyed the changes in geography driving up north and the beauty of the fields and the mountains in the region.

The followind day Dr. Fenice contacted me very happy to tell me that all patients had passed water without a catheter and were leaving the hospital.

Originally posted May 15, 2013

This time I travelled to Ancona via Roma, in Italy. Frome there I reached the Civil Hospital of Porto Recanati to perform a surgical demonstration of the GreenLight XPS 180 watt laser for the treatment of benign prostatic hyperplasia.

There I met Dr. Enrico Caraceni, from Ospedale Generale di Zona a Civitanova Marche, Gabriele Mammana head of the department of urology of the Ospedale di Macerata and Doctor Emilio Sacco from Ospedale Policlinico Universitario Agostino Gemelli di Roma, who came to witness the three operations of the day.

It was interesting that we operated a young patient and we performed an ejaculation preserving technique, a relatively new technique that is offering very good results, and allows to improve urinary symptoms respecting the ejaculatory function of the patient.

The session went very well and that same evening I flew to Milan, as I had to operate at the Hospital in Porto Recanati.

Originally posted May 9, 2013

Again I travelled to Modena in Italy to operate at the Ospedale Hesperia with Dr. Giovanni Ferrari. This time I operated four patients with benign prostatic hyperplasia with the GreenLight XPS 180 watt laser.

This time we enjoyed the visit of Dr. Mario Fiorello from Policlinico Ospedaliero di Camposampiero, Padova, Dr. Motjaba Rahmati, from Ospedale ULSS no. 4 at Schio, Vincenza, Dr. Stefano Trovarelli and Dr. Fabio Mattei from the Casa di Cura Rugani, at Siena and Dr. Paolo Guido Dell'Orto, from Policlinico di Milano.

The course went very well, despite having to treat very complex cases, we did vaporizations and enucleations and had a great time. All cases went very well.

Originally posted May 7, 2013

This time I could not join the AUA Annual Meeting, but there our Australian colleagues in this study presented our multicentric experience with the GreenLight XPS laser for the treatment of patients with Benign Prostatic Hyperplasia.

Also, at this congress, Prof. Alexander Bachmann presented the results of the important study "Goliath"that compares GreenLight XPS 180 watt laser vaporization of the prostate with conventional transurethral resection of the prostate (TURP) for the treatment of BPH. Despite the TURP arm obtaining excellent results, probably the best ever published in a study, GreenLight vaporization showed to be equally efficacious with less postoperative complications, catheterisation time and hospitalization. It is a very rigorous study, methodologically sound, that finally demonstrates the superiority of GreenLight for BPH over conventional TURP.

Originally posted May 6, 2013

As it has happened almost monthly for the last 5 years, Dr. Richard Gaston joined us in Madrid at  Clínica CEMTRO to perform surgeries.

We operated several patients with a diagnosis of prostate cancer in which we performed a laparoscopic radical prostatectomy, with the collaboration of Dr. Estefanía Romero, from our team, the specialist in laparoscopy at ICUA. Dr. Romero was trained in Bordeaux with Dr. Gaston and performs all laparoscopic procedures in our center.

It is always a pleasure to receive the visit of Dr. Gaston in our center. He is a great expert and now a friend. Keeping this link with him on a regular base allows our patients to access the best world expert in the field, without needing to travel to Bordeaux in France where he works. For us it is a true privilege to collaborate with him and to keep on learning from him.

Originally posted April 30, 2013

Today I was invited to the National Spanish TV, to participate in the program "La Mañana de la 1" with the famous presenter Mariló Montero.

This time we spoke about prostate and about surgery of Benign Prostatic Hyperplasia. I explained conventional surgery and the advantages of surgery with the GreenLight laser, and also presented the new technique of GreenLight Enucleation of the prostate that I developed.

We discussed the role of surgical simulators for training of urologists in this technique and the importance of learning with virtual models prior to starting to operate on patients. I had a great time, as always.

Saber vivir - Problemas de orina y próstata.

• Saber vivir - Problemas de orina y próstata.

Originally posted April 25, 2013

This wednesday I travelled to Amsterdam to meet with Dr. Gordon H. Muir, from King's College Hospital, London, UK.  Prof. Alexander Bachmann, from Basel University Hospital, Switzerland.  Dr. Riddick, from Scotland. Prof. Georges Fournier, from the University Hospital in Brest, France and Dr. Brunken, from Germany.

All of them are experts in BPH surgery with the GreenLight laser and they engage actively in the training of other urologists, like me.

Mr. Muir, Prof. Fournier and Prof. Bachmann, in a break at our meeting.

We met to discuss the advances in the technique of GreenLight laser vaporization of the prostate and on how should the training be to optimize GreenLight laser use in ambulatory clinics, e.g. without hospitalisation.

We had a fruitful discussion and we hope to publish a couple of papers, one with recommendations on training and one on advanced surgical technique, that we hope to publish soon.

Dr. Riddick left on a shirt and Dr. Brunken by the picture on the wall

Originally posted April 23, 2013

Today we received the visit of the French Urologist Denis Chautard, who has an interest in laser surgery of BPH.

He witnessed two cases we performed today, an anatomic vaporization of the prostate and a GreenLEP procedure.

Both cases went really well, and I think Dr. Chautard was impressed with the techniques he saw today. We have prepared a visitors book and he wrote a comment after his visit that I reproduce below. French language is not my strongest talent, but I think it is a positive comment ;-)