Holmium laser for stone treatment

This friday we asked Dr. Ibarluzea, from Bilbao, to help us with a very complex case. A patient with a single kidney full of stones. He had progressive renal insuficiency and kidney infections. Dr Ibarluzea is a stone expert and he said this was the most difficult case he had ever seen.

Dr. Llanes is the director of our stone unit, and he is also an expert in minimally invasive stone surgery (PCNL, percutaneous nephrolithotomy and ureteroscopy). We all had a hard time sorting out this case...



I bring this video up here to show how lasers have other applications in urology apart from prostate surgery. This laser allows to treat patients with stones in the urinary tract. We used a "stonelight" 15 watt holmium laser, from AMS.

Sorry, the video is in Spanish...

Visitors from AMS in theatre

This thursday I operated in Madrid, and I had some visitors, this time from AMS (Americal Medical Systems), the manufacturer of the HPS laser. They wanted to see a PVP (photoselective vaporization of the prostate) for the treatment of benign prostatic hyperplasia. The case I had scheduled was very difficult, it was a masssive prostate with an immense median lobe, so I had to be very systematic and slowly I managed to get a fantastic postoperative result. Then I gave them two lectures on basic science and clinical aspects of this technique. My voice was still not perfect, but I managed...

From Barcelona to the Canary Islands

This tuesday I took a flight to Barcelona, to help Dr. Guillermo Batlle to perform his first case with the 80 watt KTP laser at the Delfos Medical Center in Barcelona. It was a 60 gram prostate that seemed to be a little bigger endoscopically... The surgery was uneventful and I was satisfied with the result. Then I rushed to the airport back to Madrid. I had to connect with a flight to Gran Canaria. I landed only 20 minutes before departure time and it was a miracle but I got into the plane in time. Dr. Juarez and his wife, Loli, picked me up and took me out for dinner and the next morning we started operating with his brand new HPS laser. We had three patients scheduled, two big prostates and one smaller, all of them were successful.


Dr. Juarez and Loli are not only married but also work together and have a very wide experience in endoscopic surgery and andrology, so they learned the technique very fast and they are such nice people that I really enjoyed this trip. I returned to Madrid and went to bed very late, and totally croaky.... too many planes are bad for your health.

Visitors from the Canary Islands

This Friday I received in Madrid the visit of Dr. Juarez and his wife, who came from the Canary Islands to see the new Greenlight HPS in action. The surgical session was specially interesting because we operated two patients, one of them was a 50 gram prostate, very straight forward. The second case was a 220 gram prostate that needed 1.100.000 joules and a suprapubic trocar to enhance irrigation. We managed to do a good job in 2 hours and 45 minutes... the patient went home the next day, happy. Dr. Juarez is going to start using this HPS laser in the Canary Islands next week. I plan to jump there to give him a hand with the first cases. I did not take photographs, but I will in the Canary Islands...

Interview on Spanish TV on HIFU + Greenlight

This is a recent interview in the Spanish National TV most popular health program "Saber Vivir". They asked me about the characteristics of the HIFU (High Intensity Focused Ultrasound) + Greenlight HPS laser combination to treat prostate cancer. This interview took place during a press round we made with the company of Dr. Andreas Blana, from the University of Regensburg in Germany, who came to Madrid to help us with some of our cases.



This minimally invasive prostate cancer treatment is gaining popularity in Europe due to its efficacy and low risk. Patients can go home in less than 24 hours and they go back to their normal life very fast. It has a low risk of incontinence and the rate of potency postoperatively is 50%. Very good for a prostate cancer treatment.

Visitors from Denmark

Yesterday we received four visitors from Denmark interested in the PVP technique with the new HPS laser system. First I did a small talk introducing the basic concepts and theoretical concepts of the Greenlight laser. Then we went to the surgical theatre where I did two PVPs. I did not join them to the Flamenco Show this time...



Both patients were fine and today came to see me to my clinic. They were both happy, feeling well and could not believe how well they are feeling only some hours after surgery...

Masterclass with Dr. Gaston

This Saturday we received Dr. Gastón, from Bordeaux, in the company of Monique, his mithycal nurse, to perform three radical prostatectomies in patients with prostate cancer. He regularly visits us to operate with Dr. Castillón (the director of the laparoscopy unit at the ICUA) once a month.

It was a very interesting session because we operated relatively difficult cases that Dr. Gaston was able to solve elegantly. Dr. Gaston liked very much the new hospital where we have started to operate (Sanatorio del Rosario) in Madrid. Then we took them to the airport as they had to return to Bordeaux. We used our new high definition laparoscopy tower from OLYMPUS, that we have just adquired, with 5 mm videolaparoscopes. State of the art technology that allows operating with the best possible image quality.

We move!!!

Today we moved to a new hospital, the "Sanatorio de Nuestra Señora del Rosario". We leave the "Hospital San José" where we have been carrying out most of our surgical activity to start operating at the new hospital this week.

It has been a pleasure to work in San José for the last few years, where we have shared our activity with fantastic professionals. We will miss all the medical, nursing and administrative staff at San José, we have shared many moments of hard work and many intense and happy moments.

The "Rosario" hospital is one of the classic private hospitals in the "Barrio de Salamanca" in the Center of Madrid. Although an old hospital, it has kept the pace with medical innovation and it offers fantastic technology and state of the art services. Some of the best surgeons in Madrid work here, some of them are good old friends of mine. I worked there for many years as the surgical assistant of Dr. Hidalgo Pascual (Head of the Department of General Surgery of the famous "Hospital 12 de Octubre" from Madrid) and of Dr. Pereira Sanz (Head of the department of Urology of the "Hospital de La Princesa"), during the years of my specialisation. I learned a great deal from them.

In the "Rosario" Hospital we can continue our surgical activities in the best possible environment. For us it is very important that it is also very well equipped for training activities, and it is very close to the ICUA....

Interesting images

Recently, reviewing a patient in my clinic, I could compare the ultrasound appeareance of a prostate before and after PVP with the Greenlight HPS. I thought it was interesting enough to offer it here. This first image shows the preoperative image obtained with a 7 mHz transrectal ultrasound probe. This was approximately a 50 gram prostate.

And this is the postoperative image on transrectal ultrasound a month after the operation. This is a transversal image, where a wide prostatic cavity can be seen, similar to what we obtained with the classic trasurethral resection of the prostate.

And this is the longitudinal view. The prostate with a central cavity in the right hand side and the bladder in the left hand side.

I am extremely satisfied with the results we get with this laser. It is a quantum leap in the treatment of BPH, not only because it is safe and comfortable for patients (nobody doubts nowadays that it is safe, and that the side effect profile is better than classic surgical options), but because of it's efficacy. Many urologists still think that TURP is the best treatment in terms of efficacy, but I think that once you learn to master PVP properly, and that takes some time, to gather the appropriate experience, you can have exactly the same efficacy, with much lower morbidity. I hope to be able to prove this when I publish my results, but in the meantime, every urologist wanting to see this with his own eyes is invited to come to my theatre to watch it!!

Surgery in Toledo

Yesterday I drove to Toledo, a city just one hour away from Madrid, to show the new 120 watt Greenlight HPS laser to two colleagues from Toledo. They already had performed 30 cases with the 80 watt laser and were interested in upgrading to the new system.

They scheduled a patient with a big prostate, they estimated to be bigger than 100 cc. I needed 90 minutes and I delivered 550.000 joules. It was a tricky case because the camera system was not very good and the image ketp on saturating with the high intensity of the light. We lowered the light source intensity and managed to see a little bit better. The operation was uneventful and my colleagues were happy to see such a big prostate treated in a reasonable surgical time and with a fantastic result.

After my weekend in San Sebastian with my family, my camera was full of photos and I could only take this shot of the color of the urine postoperatively.

I am now starting every procedure with the 120 watt setting, before I would start with 80 watts until a tunnel was made and I was certain that the fibre would not contact with the tissue. Fibres do not like direct contact with tissue, and if you do contact and pressure against the tissue, the reflection of the energy on to the fibre will crack it. Interestingly, the fibre tolerates very nicely to work in near contact. Although this fibre can be used 3 mm apart from the tissue, I have the impression that performance is even better when you work in near contact and with a very slow sweeping speed. I got these tips from Dr. Carson Wong, and I must say it seems to work OK!!!

Then I went back to Madrid, I will spend the Easter days at home with my family. Being at home is a real pleasure!!!