American Urological Association Annual Congress in Atlanta

Tomorrow will be the last day of the AUA Annual congress. This is the most important urological meeting in the world, and every year new tendencies and technologies are presented. I try to visit the USA every year, because here is where important new treatments and trends are presented. It has been a hard congress, because apart from attending scientific sessions, I had a lot of work.
Laserscope invited me to do two presentations on advanced concepts in Photoselective Vaporization of the Prostate. I also had the honour of being invited to participate in an informative session addressed to laserscope's investors, with Dr. Collins and Dr. Malloy, two world class surgeons and expert users of the GreenLight laser. I exposed my views on this technique and its future and I explained how fast it is being adopted by urological surgeons in Europe. There is a webcast available at laserscope's website, if anyone is interested to hear it).
Apart from that, I presented a poster on my experience with this technique in the congress. My contribution was to prove that as the surgeon gets more experience with Photoselective Vaporization of the Prostate, postoperative complications, although not serious, are reduced and also the energy used and the operative time diminish with experience.


It has been a tough but very interesting congress. I had the oportunity to try extensively the new higher power GreenLight laser, the brand new HPS system (High Performance System), and I have been able to confirm that it is an instrument far better than the KTP Greenlight laser we have been using, specially because it will make operating larger prostates much easier. After this initial experience, I have been invited to present it at the National Urological Congress in Spain, that will take place in Seville the 10th of July. Then we will take the HPS system to Madrid, where we will be able to start using it.
With 120 watts power and a colimated beam, a pedal to vaporize and another pedal to coagulate, operating with it will probably feel as driving a Ferrari. This coupled with its safety, will make the best ever existing laser for BPH...


Tomorrow I will attend the take home messages session at the congress and I will fly back to Madrid. I am desperate to see my daughters...

A dream come true: The new Greenlight HPS in Madrid !!!

Laserscope, the manufacturer of the Greenlight laser system, has announced the launch of a new device that improves the previous Greenlight laser. The new Greenlight HPS (High Performance System) improves the performance, allowing to operate patients in a shorter time. Being more powerful (up to 120 watts, from the previous 80 watts), it vaporizes tissue more efficiently. It will be a leap forward because it will allow to operate patients with bigger glands easily. It also has other advantages for surgeons and hospitals...
We had a system that had revolutionised surgery for Benign Prostatic Hyperplasia, but now we see a dream come true, we will have the definitive tool. It is great news for all patients and urologists around the world!!!
Laserscope has communicated me that the Institute of Advanced Urological Surgery from Madrid will be one of the 6 centers of the world to have access to this new system prior to it's big scale commercialisation. I will be one of the few first lucky surgeons to use this wonderful new laser!!!!
I will update this information in this blog as I get more details.

Double training session in Barcelona

Yesterday I went to Barcelona to participate in two consecutive training sessions. One took place in the Puigvert Foundation, where we operated two patients. I spent the night in Barcelona because we started a very complex case at TEKNON, a high risk cardiac patient that was operated uneventfully. Then I flew back to Madrid to prepare my case. I leave to Atlanta this thursday to participate at the American Urological Association Annual Meeting.

Puigvert Foundation II

I visited Puigvert Foundation today, in Barcelona, to participate as a mentor in a surgical teaching session. We operated two patients with the GreenLight PV technique (Photoselective Vaporization of the Prostate). We had the chance to try two new prototypes of cystoscope from a company specialised in the design of surgical instruments, so the session was specially interesting. Some surgeons very used to TURP (Transurethral resection of the prostate) need to adapt to this new technique, because the scope is handled with the left hand unlike the resectoscope for TURP. Also, the laser fiber has to be rotated in a sweeping motion that is different from the in-out excursions of the resection cutting loop. The manufacturers of endoscopes try to make this adaptation easier for surgeons adopting PVP. In an case, I thought these prototypes have a long way to improve to fulfil that goal...
I then came back to Madrid, I have to operate this saturday, my workload is increasing and most weeks I am operating 5-10 patients now.

New training session in Barcelona

Today I jumped to Barcelona to participate in a teaching session at the prestigious TEKNON hospital in Barcelona. In this ocasion we treated two patients with relatively small glands, so everything was uneventful. Today I will sleep in Barcelona, tomorrow I will participate in another session at Fundació Puigvert. My wife is here with me, so we will try to dine at Sergi Arola's restaurant at the Hotel Arts... his "patatas bravas" (hot potatos) have a reputation over here...

Virtual reality laparoscopy simulator

Today we have installed at the Institute of Advanced Urological Surgery (ICUA) a virtual reality simulator for laparoscopic surgery, with the help of Ethicon Endosurgery. Our institution cooperates closely with the European School of Urologic Laparoscopy (EELU), directed by Dr. Castillón, our laparoscopy expert.


This simulator is an amazing tool. It consists of a small robot connected to a computer that allows the surgeon to simulate a real surgery. It also allows to develop laparoscopic skills and familiarize with different instruments. The robot gives tactile feedback to the instruments, so when you use the simulator, you can feel the resistance opposed by tissues exactly as you would feel it in real surgery. The modules for intracorporal suturing are outstanding. The objective of these simulators is allowing the surgeon to train BEFORE engaging in mentored surgeries on patients. The European School will allow local urologists to use it by appointment.

Training session in Madrid

Today I had the pleasure of hosting Dr. Pedro López Cueto, from Puerto Vallarta, in Mexico. He is going to pioneer PVP in his country, being the first mexican urologist to adopt Greenlight PVP.
He came over to Madrid driving all the way down from Paris. We met at the EAU congress and he had a strong interest to come and see a PVP procedure performed by an expert. We spent some time together discussing the basics of lasers and their interaction with tissue, and the specific technical aspects of the Greenlight PVP procedure. We had one patient scheduled, who had a 110 gram prostate. So he had a chance to see a difficult case. We discussed all the tips and tricks and he was amazed of seeing a fantastic result in a patient with a relatively big prostate. The patient was discharged later that day and we went to have dinner together. We had four additional cases scheduled the following day, but unfortunately he had to go back to his country. I enjoyed very much his company and I can see he will become an important man in his country. He mentioned he would try to invite me to participate and perform a live PVP at the National Congress in Mexico in November.

European Association of Urology Congress, Paris

This month I attended the European Association of Urology Congress, in Paris. The most important urology meeting in Europe. It is always exciting to go and witness the recent advances in urology. There were a number of papers on Greenlight PVP, all very positive. I did not have time (I am quite busy, as you know) to prepare a paper for this congress, but I will do so at the American Urological Association - AUA Congress that will take place in Atlanta next month. I have also been invited by laserscope to lecture during the pre-congress and congress. I also participated in a meeting of the Multimedia office of the European Association of Urology, as a member of this office. And as faculty member of the European School of Urology, I directed a course on Multimedia and Urology. My presentation can be seen online in webcast format at : http://webcasts.prous.com/eau2006/article.asp?AID=242&CID=YY&CLID=2

Puigvert Foundation

This thursday I took a plane to Barcelona to help the urologists from the prestigious Puigvert Foundation to perform their first cases of Greenlight Photoselective Vaporization of the Prostate. This Puigvert Foundation is one of the most prestigious urological centres in europe, and they have decided to embrace Greenlight PV.
The surgical session was uneventful and I really enjoyed it. We operated three patients with relatively small prostates. One of them was a high risk patient. I then found out that the immediate postoperative recovery was very good, and that all patients were sent home without a catheter. All urologists that see this procedure live for the first time are amazed by the great advantage of operating patients with BPH without blood loss and by the extraordinary endoscopic result. I then went to the airport and took a flight to Paris, to participate at the Europan Urological Association annual congress.

South Africa Roadshow - Durban

At last we arrived at Durban. This time we took it easy as there was only one lecture scheduled. Durban is also a very attractive city from South Africa. I had the chance to walk in the beach for some time. The lecture had a great impact and most urologists working in Durban attended. PVP (Greenlight Photovaporization of the Prostate) has generated a great interest in South Africa, because while in countries as Denmark, where PVP is being performed in 14 out of 17 urology departments in that country, in South Africa this laser has just started its distribution by a prestigious company in South Africa, TecMed. These urologists were really anxious to get to know more about this technique they have read so much about. The discussion was very intense and the interest was really high.

So, this is the end of my trip to South Africa. I am very happy that I had a chance to get to know this wonderful country, and also because I have contributed to make PVP better known by my South African colleagues. I am sure also South African patients will start to benefit from it soon. I will return to Johannesburg tomorrow, where I will stay another day prior to returning to Madrid this Sunday. On Monday I will fly to Barcelona, where I will mentor the urologists from Fundació Puigvert, another very prestigious urology center that has decided to adopt PVP. That same day I will fly to Paris, to participate in the European Urological Association congress, where I am chairing a course of the European School of Urology.

South Africa has impressed me deeply. After drinking the waters of the zambeze, I think I will never be able to quench the thirst for Africa. I will never forget the night I spent with the lions, their flashy eyes and their overwhelming roars...

South Africa Roadshow - Cape Town

We took a morning flight to Cape Town. The most turistic city of South Africa. One could say Cape Town is like Marbella in Spain. The Weather was splendid, but we did not have much time to visit the city. Just after arriving to Cape Town, we went to the University Hospital, where the urology staff attended my lecture, that was followed by an animated discussion. It seems that public hospitals will take some time before adopting this technique, mainly because of lack of funds to invest in new technologies. One of the questions asked by these urologists was that with PVP there is no tissue that can be sent to the pathologist for histological analysis. I explained that if a tumor is suspected, then biopsies are indicated prior to PVP. Also I told them that when we decide to treat a patient with drugs, there is no tissue for histology...
Then we rushed out of there because at 6.30 pm we had another lecture where all urologists in private practice in the city were invited.Again I observed the same effect in the urologists attending this lecture, they were fascinated by PVP. When we were finishing the lecture we started hearing explosions outside, and when we went out to find out, a fantastic fireworks show had started. A good end for this lecture.... Tomorrow we will travel to Durban, to participate in the last lecture scheduled in this hectic roadshow.

South Africa Roadshow - Johannesburg

After the first lecture in Pretoria, we travelled by car to Johannesburg, where we had to meet a very prestigious urologist interested in this technique and later on that evening we had a new lecture scheduled where all the urologists from Johannesburg were invited.
The lecture was a success, when urologists used to do TURP (transurethral resection of the prostate) see the data, the results and the videos of PVP, they realise how superior PVP is. Seeing that one can get the same endoscopic result without the risk of bleeding, impotence and incontinence, they are convinced that this is the way to go. We had a lively discussion, and after this intense meeting, it looks like several hospitals in Johannesburg will be offering this technique to their patients very soon.

South Africa Roadshow - Pretoria

After the meeting in London, my wife and I travelled to South Africa invited by TecMed, the new distributor of the Greenlight laser in this country. My task is to lecture in Pretoria, Johanesburg, Cape Town and Durban, during the launch of Greenlight PVP in this country.
Just after landing, a driver picked us up and took us to the Welgevonden game park, a private park where we would be welcomed. The idea was to participate in a game drive prior to the roadshow and the tough task of lecturing everyday in a different city. We would sleep in the park before leaving for Pretoria.
I was so lucky to see a group of lions (a wonderful male lion and three female lions) an elephant, rhinos and other animals during the daytime. But the most amazing experience took place during the night. We took the car, and used very potent torches to localize the animals at great distance. The light is reflected by the animals' retinas and shines allowing us to locate them. We witnessed three female lions chasing a zebra in front of our car. Luckily, the cebra escaped, and the three female lions and the male later came about and roared loudly just by our car. These cars are not closed, and I swear it was impressive to have those big lions roaring just a couple of meters away from us. An experience I will never forget.
TecMed CEO, Mike Milford, drove the car. He is in love with Africa, its nature and its animals, and his enthusiasm is contagious. An african saying "if you drink from the Zambeze river, you will always thirst his water and this thirst will never be quenched" will surely prove to be true with me. I am sure I will do my best to come back to this wonderful country.
We spent the night in wonderful bungalows with a wonderful view. There is a small lake in front of them and many animals came to drink water. I woke up at 5 am and sat in the terrace to enjoy the sunrise, with the lions roaring in the distance. Maybe this time they managed to kill their pray.
Then we travelled to Pretoria where the first lecture should take place.

We had approximately 30 people. South Africa only has 200 urologists, which seems a low number in comparison whit the 2000 urologists we have in Spain. The technique was very well received among the urologists present in the room, and some of them expressed their interest in adopting PVP as their preferred treatment of BPH.

Day Case Prostatectomy Workshop at King's College Hospital, London

Yesterday I went to the Day Surgery Unit at King's College Hospital in London, to participate in a Workshop on Day Case Prostatectomy using Greenlight PV.
Mr Gordon Muir (the smiling doctor with a yellow shirt) was the organiser of this meeting and he performed two live surgeries. Both interventions were transmited through a state of the art surgical video system. The Day Case Unit at King's is really outstanding. The goal of these units is to reduce hospital stays to a minimum, so patients are operated in the morning and sent home the same day, before 8 p.m..
The multidisciplinary approach, with specialised anaesthetists, motivated surgical and ward nurses and perfectly coordinated personnel allow to perform surgeries in the morning and sending the patient home later on the same day. It is a concept that is being pushed forward, as it reduces healthcare costs.
In the case of Benign Prostatic Hiperplasia (BPH), the advent of the KTP laser has allowed this operation to be performed in the morning and patients to go home before 8 p.m. All patients are operated under general anaesthesia, and that allows a faster recovery. We in Madrid favour spinal anaesthesia, that requires six hours of recovery, so although most of our patients go home at 9-10 pm, some of them feel they want to stay overnight and are discharged the next morning.
My contribution was to present two lectures on surgical alternatives to the treatment of BPH and it's comparison with Greenlight laser photoselective vaporization of the prostate.

So it was a very interesting session where I could appreciate how this operation is being performed in London, and the great enthusiasm among local urologists. The faculty of this meeting was impressive, with the assistance of Neil Barber and Killian Walsh, also pioneers in this technique. Killian is also an old friend. Gordon, Killian and I worked together at the European Society of Residents in Urology when we were specialising in Urology, many years ago.

Tonight I will travel from London to South Africa, where we will spend a week visiting different hospitals in Johanesburg, Cape Town, Durban and Pretoria.

PVP Workshop in Mumbai, India (2)

I am on my way to Madrid from Mumbai, and I take the opportunity to write this while I wait at Heathrow airport in London. Yesterday we operated four patients, and I assisted the urologists from Hospital Aly Khan in Mumbai,
Dr. Deepak Batura, Dr. Ashiq A. Raval y Dr. Percy Jal Chibber, while they performed a case. I then was asked to operate a very high risk patient. All surgeries were uneventful and satisfactory. We then went to visit the patients in the ward and spoke to the family members, who were very impressed to see how well the patients tolerated surgery and how clear the urine was...
Happy and tired, after finishing at 5 p.m., I enjoyed Dr. Ashiq A. Raval's Hospitality, he took me for a quick shopping sesion and he invited me to visit his family and for dinner. After enjoying his immense hospitality and his wonderful family's company, (and the very exotic flavours of the uncountable plates he laid on the table) I was taken to Mumbai's Airport. While I was waiting to embark, I met Lorna Kelly, a wonderful american woman who told me about her friendship and experiences with Mother Teresa, from Calcutta. It helped time pass quickly, as I was embarking at 02.40 a.m. I will get to Madrid at 10.30 a.m. and I hope to be able to reach home and sleep.... tomorrow I have surgeries scheduled in Madrid. This trip to Mumbai has been short but intense, and I wish I could return to India soon, and also bring my wife along with me. India is an amazing place.

PVP Workshop in Mumbai, India

Today I have participated in a workshop on Greenlight PVP (Photoselective Vaporization of the Prostate) for benign prostatic hyperplasia in Mumbai, India. I was invited by the prestigious Hospital Aly Khan, the hospital has purchased a KTP Greenlight Laser to be able to offer this technique to their patients. Mi role was to present the technique to a numerous group of local urologists and to contribute to the training of the urologists at this hospital.

The workshop commenced with a presentation on the technique in front of 70 attendees, followed by a vivid discussion with the audience and with the participation of various very prestigious Indian urologists.

In India there are approximately 1200 urologists, that cover a population of 1000.000.000 people. In Spain there are 2000 urologists to cover 46.000.000. One of the urologists who I will train tomorrow told me he had done over 15.000 TURPs (transurethral resection of the prostate (!!!!).

Mumbai is well known within India for its rapid adoption of new technologies, but this time Delhi pioneered in the adoption of this technique.

After the end of the session, I was given a commemorative gift. Then we went to the Surgical theatre and I have performed two PVPs with a live link to the meeting room, and the audience did not stop asking questions during both operations. The first patient had a 50 gram prostate, the second one had a bigger one, approximately 80-90 g. Both operations were uneventful. I am sure tomorrow both patients will be happy, without a catheter.

All the attendees agreed that the technique is a leap forward in BPH surgery, there was no blood loss at all during surgery and the endoscopic result was very convincing. The main problem for the generalised adoption of this technique in India is that the cost of a TURP for the patient is roughly 800 USD. The cost of one laser fibre is higher than that, so it is a relatively more expensive technique. All these patients could not afford the operation and have been operated free of any cost.

Invitation to the National Congress in Portugal

Today I received an invitation to participate in a session on minimally invasive surgery during the National Urology Congress in Portugal. This will be my first task as a member of the faculty of the European School of Urology. My lecture will be on "Minimally invasive treatment of BPH".

Meeting at King's College Hospital: final programme

Today I received the final programme of the meeting on Greenlight PV laser prostatectomy for the treatment of Benign Prostatic Enlargement that will take place at King's College Hospital in London in March 24th. Mr. Gordon Muir organises this meeting, he is a well known european expert in PVP. I have prepared two presentations. The Urology department at King's has been a pioneer in the adoption of this technique in Europe.

New urethral surgery training session

This wednesday I was invited to operate a patient with a complex urethral stricture to the Hospital Universitario de La Princesa, in Madrid.

He had a long urethral stenosis involving bulbar and penile urethra, and when we explored it surgically it affected all the length of the urethra. The operation was uneventful and we needed 4 hours to reconstruct it with a combination of free grafts taken from the inner side of the cheek (Barbagli's operation) and a long cutaneous flap from the penis (Orandi's operation). I was told that all the patients we have operated up to now are doing well. I am happy for them.



This week has been rather hectic. That same day we had to operate a patient with a kidney cancer and we performed a laparoscopic nephroureterectomy, and I havehad to operate 10 PVPs (Photoselective Vaporization of the Prostate) this week, and some of the patients had very big prostates. So I am kind of tired.

Although I still have much work to do on the presentations I will carry out in my forthcoming visits to India, London, South Africa and Paris, I am looking forward to them, so I can take a break. My wife will come along with me to London and South Africa, so we will also have a chance to enjoy some time together.