Trip to Mexico (I): Mexico D.F. - Hospital Angeles Lomas

This Sunday I flew to Mexico DF. I planned to participate in a coupe of workshops in this city and then travel to Guadalajara to perform a live surgery that will be transmitted to the World Congress of Endourology that takes place in Cancún. It is a week long trip and I am very happy to be invited to such an important congress.

The first workshop took place in the Hospital Angeles Lomas. I did a talk on Greenlight laser treatment of Benign Prostatic Hyperplasia and then I performed a surgical procedure.

It was a delightful session and I had the pleasure of meeting there my old friends Dr. López Cueto, from Puerto Vallarta, the pioneer user of the Greenlight laser in Mexico, and with Dr. Francisco Barrios, also an early adopter of this technology.

I first gave a talk on Greenlight laser for the treatment of BPH.

Then we went to the surgical room to perform a procedure that was retransmitted to the meeting room. Dr. Barrios was with me in theatre and Dr. López Cueto was the moderator from the meeting room.

After the operation, we gave certifications to those attending the session and we went together for dinner.

I was impressed by the quality of this Hospital and by the human warmth of these mexican doctors.

Surgical session in Cabueñes and meeting with the press

Today I visited the Hospital in Cabueñes, Asturias. I went to see my colleagues and friends Dr. Muruamendiaraz, Cuervo and Tamargo. They pioneered this treatment modality in Asturias some years ago, and organised a surgical session and a press round.



The cases were difficult, huge prostates, purely Asturian. I had a hard time completing them, but I could manage them satisfactorily at the end, we had time to discuss the Greenlight laser with the press.

These are some links related to the pressround output...

http://www.elcomerciodigital.com/gijon/20071018/gijon/cabuenes-pedira-salud-incorporacion-20071018.html
http://www.lne.es/secciones/noticia.jsp?pRef=1794_35_568351__Gijon-Laser-verde-para-prostata

http://tv.lne.es/index.php?detector=2310&UserID=8037120181496261193121940000703500&VideoId=3546


Then we went to have lunch at 5 pm, and after that there was no need for dinner....

Weekend in Gran Canaria

Wednesday morning I departed to Gran Canaria (one of the Canary Islands) with my family. On thursday, we operated in the Clínica Santa Catalina with Dr. Juarez, the Director of the Gabinete de Urología y Andrología in Gran Canaria. Dr. Juarez had scheduled three operations with the new Greenlight HPS, two big prostates and a smaller one, that were uneventful.



We had a great time together, discussing the new technical aspects and all the tips and tricks I recently learned. The truth is that on top of collaborating professionally we have become very good friends and we will spend the rest of the weekend together with the family in Gran Canaria.

Surgery in Sevilla

This Tuesday I took the high speed train to Seville to help a colleague with a difficult case. A patient with a huge prostate.

It was kind of weird to see that in the contiguous theatre a group of urologists struggled with an open prostatectomy in a patient with BPH... I was suprised to see how in the same moment in history, in the same place, a patient received the classic treatment and another patient the modern Greenlight laser treatment. Our patient left home the morning after and the other patient will have to stay at least 5 days in hospital, and will leave anemic, after having endured the postoperative recovery of open surgery....

The operation went fine, although it was a long one (I delivered 800.000 Joules) and then I took the train back to Madrid.

Athens

After finishing my friday morning surgical list (I did two laser cases, one of them had a huge 220 g prostate) I took the plane to Athens, where I had to meet my colleagues from the IGLU (International Greelight Users) Group. We had a lot to talk about. We are working on a paper pooling our prospective experience with the Greenlight HPS laser, and also a supplement describing the technique and recommendations of use and training, that will be published in European Urology.




We used the opportunity that the congress on Innovations & EBM in Urology was being celebrated there and that Gordon Muir, Alex Bachmann and Jean de la Rossette were already there, because they were presenting data on this laser in the symposium. Oliver Reich and I travelled to see them all there. The place was really beautiful, and very close to athens.


I had a ticket to return on saturday, but the meeting took longer than anticipated and I changed the flight to Sunday. I used the opportunity to work with Gordon Muir in a paper on surgical technique we are preparing together.

Visitor from Portugal

Today I had programmed some operations in Madrid, and we received the visit from Dr. Fino Correia, from Portugal. I did two Greenlight HPS laser prostatectomies, on a 60 gram and then a 220 gram prostate in an 81 year old high risk patient. We had time enough to discuss every aspect about the technique, and I shared all my surgical tricks with him.

We had a great time, and both operations went fine. I then drove to the airport as I am leaving today to Athens, to a meeting. I found out that my plane is delayed, so I started writing this entry of the blog.

I managed to enucleate a fragment from the median lobe of the prostate and extract it with a
Boston Scientific's Zero Tip big stone extraction basket, in order to show Dr. Correia the fine line of coagulated tissue that this laser produces. I took the photo with my mobile, and it is not perfectly clear, but it is easy to see how little damage this laser causes to the prostate, and how it coagulates just enough to avoid bleeding, but not more than that.

Morning in Barcelona

Today I woke up earlier than my alarm clock. I could not sleep any more, so I decided to go to the airport taking my time and listening to nice music. We had programmed a training session with Dr. Batlle in Barcelona. As I travel quite a lot in aeroplanes, I followed Gordon Muir's advice and bought a pair of noise-cancelling headphones that are amazing, they virtually supress the background noise in the airplane. I have an iPod and I listen to relaxing music while I think and watch the sky... I specially love to see Barcelona waking up from the air, it is really special.

We have operated an anticoagulated patient with an 80 gram prostate together, everything went fine. I slept all the way back to Madrid in the aeroplane...

Montecelo Hospital in Pontevedra

After sleeping at the Parador de Pontevedra, I went to the Montecelo Hospital in Pontevedra, with Dr. Meirás and Dr. Lobato, to perform a demonstration of the new Greenlight HPS in action. I only did one case, because they wanted to see how to operate a huge prostate.


The case was very successful, but it was long and relatively difficult. I used a suprapubic drainage trocar to improve visibility during the operation. I then left to the airport and returned to Madrid.

Monday in Manresa

This monday I took a flight to Barcelona, and then drove from the airport to Manresa. It was a holiday in Barcelona, so there was no traffic. There we did two operations with an 80 Watt laser.

Both cases were uneventful and I drove back to the airport, as I had to take a plane to Pontevedra, where I had to do some surgery the day after.

Two important invitations

Yesterday I received an Email from Dr. Jean de la Rossette inviting me to participate in a symposium that will take place during the European Association of Urology Annual Meeting, that will take place in March 26th-29th.


Then I got another one from Dr. Jorge Gutierrez, President of the World Congress of Endourology, that will take place in Cancún, Mexico. He invites me to participate, apart from the live surgery that I will have to do there, in an instructional course on laser treatment of BPH, with Dr. Mostafa Elhilali (Canada), Richard David (USA) and Ken Nakagawa (Japan).

New training session in Barcelona

This time I went to Barcelona to visit the Centro Médico Delfos, to help Dr. Batlle with two cases we had to operate with an 80 watt Greenlight PV system. The truth is that although one gets used to the best tools quickly - I am referring to the 120 watt laser - and that it has been a while since I did a case with the 80 watt PV system, I enjoyed it. The 80 watt laser is also a very good laser for small and medium sized prostates. Also, we had good fun, as we had time enough to discuss the sutile technical details of the operation, the ones that make the difference...

Surgeries in Plasencia, Spain

I spent the day in Plasencia to perform two surgeries with the new Greenlight HPS. The group of urologists who bought this new unit wanted to learn the technique. It was a long day, a three hour drive to get there and then back, and we started late.

Surgeries in La Coruña

Yesterday I flew to La Coruña, to participate in a surgical session at the Hospital San Rafael. This hospital is considering the purchase of a Greenlight HPS to operate patients with BPH and wanted to evaluate it with their own eyes. This morning I did three operations, everythin ran smoothly. Then I returned to Madrid, I have a lot to do this week.

It has been very nice to operate again after the summer holidays. I enjoy coming to La Coruña, it is very pretty.

Holidays are over

My holidays are over. What a pleasure to rest, sleep, relax, read, oxygenate my brain and evaluate my life from a different perspective... My American brother in law, Wade Hatler (have a look at his website, it is really worth it) recommended a very interesting book, Ray Kurzweil's, "The Singularity is Near", that has made me understand that the advances in medicine will be exponential in the next years and that technology will evolve very fast to provide better treatments. I am even more convinced than I was that we as doctors have to look forward now and try to learn new techniques and keep updated to the minute. He also recommended "The Shangri-La Diet", written by Seth Roberts, a whole new theory on why we get fat and lose weight, that has made me decide (at last) to start losing weight.

But now it is time to go back to work. I am looking forward to it. I foresee a very intense and interesting year.

When I arrived to Madrid I found I have received several invitations to perform live surgeries and conferences in several international congresses before the end of the year, India, Mexico, Belgium...

I have also found out that our paper with recommendations on the PVP technique has been selected as a key article by www.urosource.com, one of the most relevant urological websites in Europe.

This year will also be interesting because we will try to incorporate new very exciting technologies that are being evaluated by the ICUA... 

Training session in El Cairo, Egypt

The 31st of July I took off to El Cairo, to help starting a Greenlight HPS laser unit in the most prestigious urological hospital in this city. It is devoted to Urology and Nephrology and the panel of urologists working here is impressive.

The distributor of this laser in Egypt, Heart Mission Egypt, prepared this fantastic cake to celebrate the occasion, a great idea indeed.

The organization of the session was really good, I managed to do 5 operations during the day to demonstrate the technique and all were highly impressed by the absence of bleeding and the excellent endoscopic result at the end of the operations.

Then we went to have some Kebab for dinner, and to smoke the "shisha". We finished late and I slept like a baby in the plane back to Madrid.

This is the last training activity before my holidays. I will spend the month of August on holiday with my family.

It has been an exciting and intense year. I will try to get a good rest, I suspect the coming year will also be very intense.

Surgical demonstration in Manresa

This Monday I woke up early to travel to Barcelona, and from there to Manresa, to the Hospital San Joan de Deu, to make a demonstration of the high power Greenlight HPS at work.

The hospital is considering to offer this technique to its patients, but they needed to see it with their own eyes...

So I was asked to operate four patients with prostates weighing 40, 100, 75 and 70 grams, and all of the operations were uneventful and satisfactory. They were positively impressed. As always, on my return to Madrid, Iberia provided another delay, and I got home relatively late. Tomorrow I will do the last clinic before my holidays and I will depart to EL CAIRO, my last trip before I leave on holiday.

New surgical session in Gran Canaria

This thursday I took an early flight to Gran Canaria. Again I operated with Dr. Juarez four patients. All the operations went fine and we had fun spending the day together in theatre. This is the good thing of laser surgery, it is very relaxed, not only for the patient, but also for the surgeon.

It is relatively sad to get to Gran Canaria and have to leave right away. In this time of the year one feels like staying there... so I had no choice but to wake up early again on Friday to return to Madrid. I had scheduled a full day operating list, with some minor operations, a PVP of a large prostate and a Cryosurgery of a recurrent prostate cancer after radiotherapy.

Dr. Juarez gave me a print of a newspaper published recently in the Canary Islands covering the first installation of an HPS laser in the region.

Invitation to operate in Cancún, Mexico.

Today I received an invitation to participate in the World Congress of Endourology in Cancún, Mexico, in October. I will perform a Greenlight HPS prostatectomy live, that will be transmitted to the congress venue, for all the urologists attending the congress to see...

It is an immense honour. Operating live in the World Congress of Endourology is for a urologist as competing in a final of the Olympiad for a sportsman. I am delighted with the invitation. From all of the urologists in the world they could have chosen to invite, they chose me.

Triple surgical session in La Coruña

This Monday I travelled to La Coruña, in the North-West of Spain to participate in three surgical sessions with the new High Power Greenlight HPS laser. We conducted two surgical sessions, Monday afternoon and Tuesday morning at the Abente y Lago Hospital, training two prestigious colleagues from La Coruña. We did six operations in total. All cases were very satisfactory. This hospital belongs to the Juan Canalejo Healthcare complex, and they mainly do short stay surgery here.

On Tuesday afternoon we went to the Modelo Hospital in La Coruña, where we performed another operation, that was also uneventful. The truth is that it is a great pleasure and honor to help my colleagues to perform their first steps with the greenlight, specially when they are such outstanding pupils, and learn so fast.

Anyone reading this blog might ask what moves me to travel so much and to train so many urologists, today here, tomorrow there, always on the move.... it is really a big effort, and something must justify this huge effort.

Well, what really moves me to do this is that I learn a great deal in these training sessions. First, because I am training seasoned urologists, who know a lot and have seen a lot. They share their views with me. I learn much from them and ultimately they become good friends. Secondly, each prostate is different (I have not seen two prostates that are exactly the same), and the fact that we review once and again the basic concepts of endoscopic laser surgery, and that I explain thousands of times why hold the scope this way, or how fast to rotate the fiber, or what is the ideal working distance, how to approach a median lobe, how to avoid and handle complications, etc... helps me reflect and understand more deeply and grasp the immense amount of details that one should know to perfom this operation with excellence.

This technique is evolving constantly, getting better and better. We learn day by day how to make it better and safer. It will change the current worldwide panorama of the surgical treatment of BPH (Benign Prostatic Hyperplasia). In my opinion, classic surgical techniques, open prostatectomy and TURP (Transurethral resection of the prostate) are obsolete, but they are being performed and offered to patients in hospitals worldwide, and many patients still suffer the secondary effects and complications, sometimes very severe, of these classic operations.

It is a true adventure to be able to play a part in this movie... operating so much, in so many theatres, having the opportunity to interact with urologists, nurses, patients all over Spain and the rest of the World is really a privilege and an enriching activity. More importantly, this enables me to learn more and to be able to offer my patients a better operation, safer and more close to perfection.

Masterclass with Dr. Gastón

Today we have operated two patients with prostate cancer with Dr. Gastón and Dr. Piechaud, from Bordeaux, France, in the new Hospital Pardo de Aravaca, in Madrid.



Dr. Gastón visits us regularly, he invented the technique of laparoscopic radical prostatectomy. Dr. Piechaud is another international expert in laparoscopic surgery, with a special interest in robotic surgery.