The PLASMA system for transurethral resection and haemostasis of the prostate

2.1 The PLASMA system (Olympus Medical) consists of an Olympus high frequency (430 kHz plus or minus 20%) generator, a resectoscope (which incorporates the PLASMA active working element and electrode), a telescope, 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. A loop electrode is used to repeatedly cut out small chippings to create a wider channel through the prostate (generator set to cut) and a roller or button electrode is used to promote haemostasis (generator set to coagulate). Electrodes are available in different sizes. A urethral urinary catheter is inserted at the end of the procedure.

2.2 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 (mTURP) system. Using saline avoids transurethral resection syndrome, a serious adverse event. The PLASMA system has a range of electrodes. Of these, only the loop electrode for resection and the roller or button electrodes for haemostasis are in the scope of this guidance.

2.3 The PLASMA system is a bipolar electrosurgery system designed for use when surgical resection and haemostasis is indicated to treat symptomatic benign prostatic hyperplasia.

2.4 The relevant NICE Pathway described in the decision problem for this technology is the NICE Pathway on managing lower urinary tract symptoms in men.

2.5 The typical cost for a PLASMA procedure for resection and haemostasis is estimated as £972. This includes consumables and length of stay.