Advice
The technology
The technology
The PLASMA system (Olympus Medical) is a bipolar electrosurgery system, designed for use when surgical intervention is needed for prostatic enlargement. It consists of an Olympus high frequency generator (430 kHz plus or minus 20%), a resectoscope (which incorporates the PLASMA active working element and electrode), an endoscope, an inner and outer sheath, a light guide cable and a saline high‑frequency cable. The active and return electrode are contained within the resectoscope at the operation site. This means a patient return electrode is not needed because PLASMA uses saline irrigation fluid to conduct electrical current within the resectoscope. The surgeon uses an endoscopic image to guide the electrode assembly through the urethra to the prostate. The electrodes are available in different sizes and shape (described as loop, button and roller). This review focuses on the button electrode. The button electrode hovers over the surface of the prostate and is used to vaporise prostatic tissue.
Innovations
In common with other bipolar systems, the PLASMA system uses saline for irrigation instead of glycine, which is used in the monopolar transurethral resection of the prostate system. Using saline avoids transurethral resection syndrome, a serious adverse event. The button electrode is intended to offer more efficient vaporisation by removing tissue at a faster rate than other electrodes, such as loop and roller. Continuous haemostasis is provided during the procedure, which minimises bleeding. As tissue is vapourised and no individual chips are resected, the endoscopic view remains clear and unobstructed throughout the procedure.
Current care pathway
Surgery is only offered to people with voiding lower urinary tract symptoms caused by an enlarged prostate if symptoms are severe, or if drug treatment and conservative management options have been unsuccessful or are not appropriate. The current surgical options are monopolar or bipolar transurethral resection of the prostate (TURP), monopolar transurethral vaporisation of the prostate, or holmium laser enucleation of the prostate, which is only offered at specialist centres. GreenLight XPS is also recommended as a treatment option for benign prostatic hyperplasia by photoselective vaporisation of prostatic tissue. For people with a prostate estimated to be smaller than 30 g, transurethral incision of the prostate may be used as an alternative to other types of surgery. Open prostatectomy is only offered to people with prostates estimated to be larger than 80 g. Minimally invasive surgical therapies are also used in clinical practice, such as prostatic urethral lift, water vapour therapy, prostatic urethral temporary implant and prostate artery embolism.
The following publications have been identified as relevant to this care pathway:
Population, setting and intended user
The PLASMA bipolar electrosurgery system is intended to be used in adults with lower urinary tract symptoms, which happen because of benign prostatic hyperplasia. Surgery for benign prostatic hyperplasia is offered when symptoms are severe or if conservative treatment and drug interventions have been unsuccessful or are inappropriate. Procedures are commonly done in an inpatient setting, after which a hospital stay is normally needed, though day case is also achievable. Minimal training is needed for clinicians who are proficient in TURP to implement and safely use the PLASMA system.
Costs
Technology costs
The cost for TUVP or TURP using the PLASMA system with button electrode is estimated as £988, including consumables and length of stay. Costs are based on values taken from NICE's medical technologies guidance on the PLASMA system for transurethral resection and haemostasis of the prostate.
Costs of standard care
The typical cost of a TURP procedure using the PLASMA system for resection and haemostasis is estimated as £972. This includes consumables and length of stay. Costs are based on values taken from NICE's medical technologies guidance on the PLASMA system for transurethral resection and haemostasis of the prostate.
Resource consequences
The company has indicated that 114 NHS centres were using the PLASMA system in 2020, although this use would also include the loop and roller electrodes. Hospitals that do not currently have the Olympus infrastructure in place would need to purchase the specific equipment needed to use the system including the Olympus generator, endoscope, working element, light guide cable and saline cable. Advice from clinical experts suggests that minimal training would be needed for clinicians to implement and safely use the PLASMA system.