Lessons Learned From A Single Center's Early Aquablation Experience
Amanda Sherman, MD, Luke Sebel, MD PhD, Evyn Keating, BA, Jessica Mandeville, MD, Arthur P. Mourtzinos, MD MBA.
Lahey Hospital and Medical Center, Burlington, MA, USA.
Introduction: Urology has long been a field in pursuit of technologies to care for patients in safer, more efficient ways. Incorporating a new procedure into practice is a time-consuming and intimidating prospect but is a necessary skill through a physician's career. This describes our system's initial experience with performing aquablation.Methods: This prospective study was conducted at a single site of an academic center. Baseline patient demographics, comorbidities, prior treatment history, prostate sizing, PSA, and urodynamic diagnoses were collected. Intraoperatively, times were recorded for each phase of the procedure, with the surgeon notifying record keepers when each portion began and ended. Significant intraoperative and postoperative events (up to 30d) were logged. Unpaired Student's t-test was performed using SPSS to determine significance of findings between the first and last 10 cases in our dataset, with a p-value of <0.05 considered statistically significant.Results: Average gland size in the first 10 cases was smaller than the last 10 cases (69.6±32.4g, 94.9±32.9g p=0.1), with 11/35 (31.4%) measured as greater than or equal to 110g. Transrectal ultrasound (TRUS) positioning took 6.9±6.4 min initially, down to 4.1±3.6min in the last 10 cases (p=.247). The cystoscope to TRUS adjustment demonstrated a similar trend: 13.9±7.9min to 5.9±2.2min (p=0.006). Mean time to contour the prostate remained within 40 seconds (p=0.77), and total operative time was not noted to be significantly different (63.8±20 to 73.1±32.4 p=.45). Postoperative complications occurred in 4/35 (11.4%) patients, with one event classified as Clavien-Dindo (CD) 4.Conclusion: Our data represent a single surgeon experience, demonstrating lessons from the aquablation learning curve. Faster cystoscope to TRUS adjustment likely stems from more facile equipment handling with repetition, as was the trend with TRUS positioning- a similar type of task. Bipolar resection and hemostasis were the lengthiest portions of the final 10 cases, which may be reflective of increased resident involvement in the latter half of the 35 operations. Data collection is ongoing to examine this in greater detail. 
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