Minimally Invasive Surgery for Benign Prostatic Obstruction

New Insights and Future Technical Standards

Enrique Rijo; Richard Hindley; Shahin Tabatabaei; Thorsten Bach


Curr Opin Urol. 2021;31(5):461-467. 

In This Article


Aquablation (AquaBeam System, PROCEPT BioRobotics, Redwood Shores, California, USA) is a image guided robot-assisted water-jet ablation of the prostate procedure, combining an integrated cystoscope with intra-operative TRUS images as an alternative to TURP.[15] It is feasible for the treatment of large prostates (80–150 mL),[16] representing a potential option in place of simple prostatectomy and endoscopic enucleation of the prostate.

Aquablation is performed under general or spinal anesthesia and usually involves an overnight stay.

A large international blinded randomized trial showed that aquablation had a similar level of efficacy compared to TURP and better ejaculatory function preservation;[15] similar results were found in patients with larger (80–150 cc) prostates in a prospective multicentre trial.[16] Bach et al. reported similar functional outcomes in clinical routine, as reported in RCTs.[17]

Aquablation is based on semi-autonomous, robot-executed tissue resection whose limits are automatically suggested by the computer.[18]

This procedure is one of the first robotic platforms in urology to incorporate a type of artificial intelligence and offer procedure automation, even though in the end it is the surgeon who defines the limits of the resection area of the procedure.[18,19] Therefore, the success of Aquablation depends more on the instruments than on the surgeon's skill, and not depending only on a surgeon's ability is a big step toward surgical standardization in the future.