4.1 The company claimed that using GreenLight XPS would reduce hospital length of stay and increase NHS efficiency because it can be done as a day‑case procedure. The company also claimed that using the GreenLight XPS system could lead to cost savings by avoiding adverse events and hospital readmissions.
4.2 All experts noted that training was needed to use the GreenLight XPS system. Although TURP is part of the core curriculum of urological surgical training, experts commented that the GreenLight XPS procedure is less challenging to learn than TURP, and 1 expert stated that it was also less challenging to learn than HoLEP. Experts highlighted that the company provides a mentorship programme, training courses and simulator technology; 1 expert indicated that 25 mentored cases would be enough to gain adequate expertise in the technique.
4.3 The company also claimed that GreenLight XPS may be used for high-risk patients for whom surgical intervention for BPH is unsuitable, such as those with a higher risk of bleeding or at a higher risk of anaesthetic complications.
4.4 Based on expert advice and limited published evidence, the committee concluded that using GreenLight XPS would allow more procedures to be done on a day-case basis. The committee noted that in the GOLIATH study, 70% of the UK cohort had a 'time to stable health' of less than 24 hours (defined as being able to void without a catheter or the time to discharge), suggesting these procedures can be done as day cases. In addition, day-case rates of up to 80% had been achieved in a single UK centre. In contrast, experts advised that less than 10% of TURP procedures could be done as day cases because of longer catheterisation times and the need for irrigation.
4.5 The committee was advised that the British Association of Day Surgery has recommended that within the next 5 years, over 90% of urological surgeries should be done as day-case procedures. Experts advised that although people living alone may not be suitable for day-case treatment, the presence of a post-operative urinary catheter should not necessarily be a barrier to discharge. Urinary catheters can safely be removed in the community by community nurses, at GP surgeries or, in some cases, by the patients themselves.
4.6 The committee noted that an in increase in day-case treatment rates as a result of adopting GreenLight XPS would necessitate planning for service redesign. It was advised by the experts that this had already been achieved in a number of UK centres and is associated with significant potential staff and cost efficiencies compared with inpatient treatment. Examples of service redesign to facilitate day-case treatment that were highlighted include 23-hour patient hotels, 5-day wards and morning surgery to allow discharge by the end of the day.