V02-01: Prostate Aquablation: A Novel Image-Guided Robot-Assisted Prostate Ablation using Water-Jet Hydrodis

V02-01: Prostate Aquablation: A Novel Image-Guided Robot-Assisted Prostate Ablation using Water-Jet Hydrodissection



Aquablation is a new surgical procedure designed to treat LUTS due to BPH. The surgical technique combines intra-procedural ultrasound image guidance and robotics for a controlled resection of the prostate utilizing a heat-free waterjet. We present a video detailing the definitive method of performing Aquablation using the techniques developed and refined as part the Phase III WATER Study comparing Aquablation with TURP.


The AquaBeam System (PROCEPT BioRobotics, Redwood Shores, CA) is an image-guided robotic system delivering Aquablation, a precise waterjet therapy for the targeted heat-free removal of prostate tissue. Utilizing real-time transrectal ultrasound imaging as well as an integrated cystoscope, the AquaBeam handpiece is positioned along the length of the prostate. Using ultrasound guidance, the surgeon plans the depth and angle of the tissue resection in the transverse view, and in the sagittal view, draws a treatment contour that conforms to the shape of the adenoma while sparing the bladder neck and verumontanum. The AquaBeam System automatically translates the markers into the defined resection volume. Once surgical mapping is complete, the surgeon initiates the Aquablation treatment using a foot pedal. The console pump delivers a high-velocity waterjet orthogonally to the length of the handpiece at various flow rates based on the required depth of penetration. The AQUABEAM System enables a precise and controlled resection of the prostate in accordance with the surgeon&[prime]s planned contour and the average resection time is less than 5 minutes. Cautery can be used for hemostasis; however, hemostasis can also be achieved by positioning the balloon of a Foley catheter inside the prostatic cavity or at the bladder neck to tamponade the bleeding, thus eliminating the need for cautery.


Over 300 patients have been treated using Aquablation in early clinical research as well as the Phase III WATER Study. The results of the Phase I and Phase II study have been previously presented, demonstrating that Aquablation appears to be safe and effective. The 6-month results from the WATER Study, a prospective randomized double-blind clinical trial comparing Aquablation to standard TURP, demonstrated superiority compared to TURP in the primary safety endpoint and non-inferiority compared to TURP in the primary efficacy endpoint.


This video demonstrates the procedure of Prostate Aquablation, a novel, safe and effective technique for treating BPH.

Funding: Procept Biorobotics