Doctors tackle prostate surgery backlog with new world record

Surgeons at Guy’s and St Thomas’ have successfully used a pioneering robotic technique to treat more men with enlarged prostates in one day than anywhere in the world.

Guy’s Hospital is the first NHS centre in central London to offer Aquablation Therapy to help men who have a non-cancerous, enlarged prostate. The surgical team at the central London hospital performed the Aquablation procedure on 10 patients in one day – the most of any hospital in the world.

Aquablation is a heat-free robotic system which uses advanced surgical mapping to create a bespoke surgical plan, water and real-time imaging to remove overgrown prostate tissue. It is used on men who have benign enlarged prostates. While in mild cases this can be treated with medication, bigger prostates may require surgery to manage obstructive urinary symptoms.

Having an enlarged prostate can make men feel they need to pee more often but they find it difficult to empty their bladder completely. Some men have to have a catheter inserted into their bladder while waiting for treatment, which can affect their quality of life.

Guy’s and St Thomas’ is one of the UK’s leading centres for treating patients with very large prostates and patients are referred to it from across London and beyond.

Conventional surgical treatment for treating benign, enlarged prostates would be using a laser technology known as HoLEP (Holmium Laser Enucleation of Prostate). However this procedure can take up to three hours for one patient, is highly specialised and can be challenging to perform if the prostate is very big.

Aquablation can be done more quickly, with the average procedure taking around 40 minutes. As the system is robotic, it is also more precise and standardised. The outcomes for patients are more predictable and most patients should be able to leave hospital in the following day or two.

Unlike more conventional treatments, Aquablation also improves the preservation of sexual function and urinary continence.

Aquablation was first used in Guy’s Hospital in July 2022 and since then surgeons there have successfully treated more than 30 men with it.

Retired dentist John Wade, 69, was one of the first Aquablation patients at Guy’s Hospital, following previous prostate surgery which didn’t fully resolve his issue.

John, from Norwich in Norfolk, said: “My surgeon was wonderful. He explained over the phone about Aquablation and said he could get me on the list.

“I turned up on the Sunday, had the treatment and stayed in hospital for 24 hours before I was discharged. My recovery has been good and my quality of life has improved.

“This procedure was so much ‘kinder’ to me physically than the one I had had previously. This is medicine moving forwards – it was first class.”

Rick Popert and Jonathan Noël, consultant urological surgeons at Guy’s and St Thomas’, along with their surgical teams have been operating using Aquablation to help tackle a backlog of patients waiting for treatment.

For the latest surgeries, using the efficient High Intensity Theatre (HIT) list technique pioneered at Guy’s and St Thomas’, Mr Popert and Mr Noël’s team operated on 10 patients with one Aquabeam robotic system. This was done across two operating theatres and using three teams of theatre staff.

Mr Popert said: “I’m delighted that John has made good progress. Aquablation offers lots of improvements for people like John who have enlarged prostates.

“Using this technique we can do twice the number of patients we’re able to do with more conventional surgery, and it’s easier and quicker to train more surgeons to be able to do it. This enables us to offer more patients better surgery.

“I am immensely proud of the incredible effort from the whole operating team, in which we used unconventional anaesthetic and surgical techniques to address one of the biggest problems that faces the NHS - surgical waiting lists - and it was delivered with military precision. The theatre teams at Guy’s and St Thomas’ are the Rogue Heroes of the NHS, and our motto should be ‘Who Shares Wins’.

“These HIT List techniques, adequately resourced and supported, can be applied to all surgical specialties. They could be used throughout the NHS as a blue print to help tackle the rising tide of surgical waiting lists.”

This was the 20^th HIT list undertaken at Guy’s and St Thomas’. More than 370 patients have been operated on across nine surgical specialties. The innovation and organisation of this system was developed by Dr Imran Ahmad, consultant anaesthetist and deputy clinical director for anaesthesia and theatres at Guy’s and St Thomas’.

Dr Ahmad said: “Initially we developed the HIT list model for short duration, rapid turnaround surgical cases, which has been very successful. More recently we have expanded the criteria to more complex surgery like the Aquablation cases. We were very excited to combine the innovation of HIT lists with the cutting edge technology of Aquablation prostate surgery and operate on a record number of patients in one day.”

What does the HIT list involve?

• Increasing the number of anaesthetic, surgical and theatre staff in order to minimise the turnaround time between cases, making more time available for the surgeon to operate. In some cases this has been over 95% of the day;
• Using two theatres and three teams, the surgeon can go between cases without having to wait for the patient – this allows for many more cases to be done in the same time period;
• Several multidisciplinary meetings led by Dr Ahmad are required for each HIT list to select suitable cases, patients and team members and to plan the equipment and order of the lists – they include managers, administration staff, therapists, nurses, pharmacists, anaesthetists and surgeons.

About Aquablation Therapy

Innovative heat-free robotic benign prostatic hypertrophy (BPH) Therapy

Analysis of four clinical studies (including a multi-centre, randomised control trial)* of 425 patients with prostates from 20-150ml showed:

• 99.5% of men had continence preservation
• 100%of men maintained erectile function preservation
• 91.2% of men had ejaculatory function preservation

[* Meta analysis of 4 studies with 425 patients vs standard of care (Eltermen e al 2021); Multi-centre randomised controlled trial of 181 people (Gilling et al. 2018);  Multi-centre single-arm study (Zorn et al. 2021). ]