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Operative time comparison of aquablation, greenlight PVP, ThuLEP, GreenLEP, and HoLEP

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Abstract

Introduction

The BPH surgical armamentarium is composed of a rapidly expanding number of technologies and techniques. These include greenlight photovaporization of the prostate (PVP), greenlight enucleation of the prostate (GreenLEP), holmium laser enucleation of the prostate (HoLEP), thulium laser enucleation of the prostate (ThuLEP) and, more recently, the aquablation procedure. To the best of our knowledge, no direct comparison in operative time has been performed.

Methods

Data for this study were pooled from five sources. For aquablation, patient-level data from four studies of the aquablation procedure were provided by the device manufacturer as well as from a high-volume commercial user. PVP, GreenLEP, HoLEP, and ThuLEP were performed by high-volume, experienced experts. Endpoints included total operative time, resection time, and proportion of total operative time for resection. General linear models were used to evaluate the relationship between prostate volume (or other continuous predictors) and procedure time.

Results

Total procedure time was related to prostate size. Except for the small prostate size range (size < 40 cc), at any given prostate volume, procedure time was highest for PVP, intermediate for LEPs, and lowest for Aquablation. The relationship between procedure time and prostate size (i.e., slope of the fitted lines) was 0.16 min/g for aquablation, 0.32 min/g, 0.28 min/g and 0.32 min/g for GreenLEP, HoLEP and ThuLEP, respectively, and 0.63 min/g for PVP.

Conclusion

In our analysis of pooled data of multi-surgical techniques and technologies, aquablation provided the lowest operative time across all prostate volumes. PVP had the longest procedure time for prostates > 40 cc.

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Funding

WATER, WATER II, OPEN WATER, and FRANCAIS WATER clinical studies were funded by PROCEPT BioRobotics.

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Authors and Affiliations

  1. Faculty of Medicine, McGill University, Montreal, Canada

    David-Dan Nguyen

  2. Department of Urology, Clinique Pasteur, Toulouse, France

    Vincent Misraï

  3. Department of Urology, Asklepios Hospital Harburg, Hamburg, Germany

    Thorsten Bach

  4. Division of Urology, University of Montreal Hospital Center, Université de Montréal, Montreal, Canada

    Naeem Bhojani & Kevin C. Zorn

  5. Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA

    James E. Lingeman

  6. Division of Urology, University Health Network, University of Toronto, Toronto, Canada

    Dean S. Elterman

Authors
  1. David-Dan Nguyen
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  2. Vincent Misraï
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  3. Thorsten Bach
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  4. Naeem Bhojani
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  5. James E. Lingeman
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  6. Dean S. Elterman
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  7. Kevin C. Zorn
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Contributions

D-DN: protocol/project development, data analysis, manuscript writing. VM: data collection, manuscript editing. TB: data collection, manuscript editing. NB: manuscript editing. JEL: data collection, manuscript editing. DSE: manuscript editing. KCZ: protocol/project development, data collection, data management, manuscript editing.

Corresponding author

Correspondence to Kevin C. Zorn.

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Conflict of interest

Consultants and proctors for Boston Scientific for greenlight: KZ, DE, VM. Investigators and consultants for PROCEPT BioRobotics: VM, TB, NB, KZ. DDN were supported by a summer scholarship from the Endourological Society.

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This research involves humans.

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Nguyen, DD., Misraï, V., Bach, T. et al. Operative time comparison of aquablation, greenlight PVP, ThuLEP, GreenLEP, and HoLEP. World J Urol 38, 3227–3233 (2020). https://doi.org/10.1007/s00345-020-03137-8

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  • DOI: https://doi.org/10.1007/s00345-020-03137-8

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