PROCEPT HYDROS
Photo: PROCEPT BioRobotics (NASDAQ: PRCT)
- imaging
- integrated next-generation ultrasound plus digital cystoscopy on dual HD touchscreens
- therapy
- Aquablation — heat-free waterjet resection of obstructive prostate tissue
- planning
- FirstAssist AI, trained on a library of prior Aquablation procedures, identifies anatomy on ultrasound and suggests a plan; the surgeon defines the final plan
- handpiece
- single-use handpiece ships pre-assembled with a digital scope, removing cystoscope reprocessing between cases
- fda hydros
- K240200, 2024-08-20; also K251082 and K260723
- fda de novo
- AquaBeam, DEN170024, 2017-12-21
- install base us
- 816
- total or time min
- 33
- resection time min
- 4
- install base global
- 1036
Who's exposed
Jobs in the threat radius
- transurethral resection of the prostate (TURP) surgeon
- HoLEP / laser enucleation subspecialist urologist
- sterile processing technician (cystoscope reprocessing)
- urology operating room surgical technologist
Deployment status
As of June 30, 2026 PROCEPT had an install base of 1,036 AquaBeam and HYDROS systems globally, 816 of them in the United States — up from 595 US systems a year earlier and 765 at the end of Q1 2026. The curve is still in its steep section. The company delivered 65 US systems in Q2 2026, 14 of which were replacements. Procedure volume ran above 13,100 US cases in the quarter, roughly 21% higher year over year, and PROCEPT raised full-year US guidance to 54,000-56,000 procedures against revenue guidance of $390-410 million; Q2 revenue was $94.5 million, up 19%. Handpieces sold as a share of US procedures was about 98%, so installed systems are being used, not parked. On regulatory history: the predecessor AquaBeam cleared a De Novo in December 2017, HYDROS received 510(k) clearance on August 20, 2024, and the system is CE-marked, though PROCEPT has never published the CE date. Internationally the UK became the first market outside the US in March 2026; international revenue was $11.1 million in Q2, up 15%, with no OUS procedure count or install base disclosed. The EAU carries a Strong recommendation for Aquablation in 30-80 mL prostates, and the AUA strengthened its recommendation in its 2026 guideline update — a claim we can currently only source to PROCEPT's characterization, because the AUA guideline text is member-gated.
When this hits the labor market
Start with what this machine does not do: it does not replace the urologist. The surgeon defines the plan; the AI only suggests one. What it replaces is the skill premium. 1-3 years: roughly 400,000 BPH surgeries happen in the US each year, about 300,000 of them resective, across roughly 2,700 hospitals. PROCEPT's stated go-to-market is not a raid on UroLift and Rezum but a hospital-by-hospital conversion of the urologists who already do resective cases. Backing out from full-year guidance, Aquablation is now at roughly 13-14% of all US BPH surgery and close to a fifth of resective cases. The mechanism sits between two numbers: TURP spends 27 minutes on resection, Aquablation spends 4. Double the gland and Aquablation's resection goes from 4 minutes to 8, while manual technique scales hard with prostate size. 3-5 years: the learning-curve collapse matters more than the clock. One study of HoLEP found complication rates only stabilizing after about 350 procedures, with improvement continuing past 200; PROCEPT's own filings cite a training program that a third of surgeons failed to complete. On the Aquablation side, CUSUM analysis puts stable performance at roughly 12-21 cases. A capability that used to cost hundreds of operations to acquire now costs twenty. That does not put urologists out of work; it makes the word 'experienced' worth much less in this one procedure. The counter-evidence belongs on the record too: complications and symptom relief do appear experience-flat, but hemoglobin drop and ejaculatory-function preservation are still influenced by the surgeon's learning curve, and real-world NHS data puts Aquablation's mean operative time at 61.8 minutes against 33 in the trial. The only complete block of non-surgeon labor we can verify this machine deletes belongs to sterile processing: the HYDROS handpiece ships with the digital scope pre-assembled, so there is no cystoscope to reprocess between cases.
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Twenty-seven minutes become four
Surgical robots are the hardest category in this catalog to write honestly, because they almost never replace the surgeon. Da Vinci did not reduce the number of surgeons. Neither did Mako. HYDROS earns its own entry because what it removes can be named precisely: not the person, but the expensive part of the person.
The comparison comes from the 2018 double-blind randomized trial against TURP. Total operative time was effectively the same — 33 minutes versus 36. Resection time was not: 4 minutes versus 27. Those 27 minutes are a surgeon shaving tissue with a wire loop under limited visualization, and they are the only place in the operation where experience cashes out. A heat-free waterjet executing a pre-defined plan now does that part.
The sharper figure is what happens when the gland gets bigger. Take average prostate volume from 54 mL to 107 mL and Aquablation’s actual resection time goes from 4 minutes to 8, with total operative time moving 33 to 37. Manual technique has no such property. The bigger the gland, the longer, harder and more surgeon-dependent the case.
From three hundred cases to twenty
PROCEPT’s SEC filings are more careful than its press releases and, for our purposes, more useful. The filings say Aquablation is “relatively simple to learn” and delivers “resection independent of surgeon experience.” The same document itemizes the incumbent’s barrier to entry: reoperation rates 1.2 times higher for surgeons who had done 172 or fewer TURPs versus those past 402; 120 procedures before a surgeon reaches optimal outcomes with PVP; a laser enucleation training program that a third of surgeons failed to finish.
The independent literature puts numbers on both ends. One 2025 series found HoLEP complication rates stabilizing only after about 350 procedures, with improvement continuing beyond 200. On the Aquablation side, a CUSUM analysis found setup and ablation time plateauing after 14 cases, coagulation time after 21, and stable performance overall at roughly 12 to 21. Three hundred versus twenty is not a difference in proficiency. It is the difference between a craft you commit a decade of your career to and a workflow you learn in a month.
That is the skill premium, and it is what this machine takes. The surgeon still operates. The surgeon still plans. FirstAssist AI only outlines anatomy on the ultrasound and proposes a plan. But “I have done eight hundred of these, so I am safer” has much less room to be true here than it did.
The parts that complicate it
PROCEPT’s own wording shifts depending on the audience, and that is worth recording. The SEC version says resection is independent of surgeon experience. The press releases say outcomes are. Four hundred words below the marketing claim, the product page’s legal disclaimer says outcomes may depend on patient characteristics, disease characteristics and/or surgeon experience. Three different claims, one company, same set of materials.
The independent evidence does not line up neatly behind the strongest version either. An international multicenter study found complication rates and three-month symptom relief genuinely flat across experience levels — but hemoglobin drop and ejaculatory-function preservation were both still influenced by the learning curve. Bleeding control and the function-sparing part of planning still reward skill. Separately, a single NHS trust compared 436 procedures and put Aquablation’s mean operative time at 61.8 minutes, nearly double the trial figure; the same paper notes that Aquablation was the only procedure producing a financial surplus largely because its robotic-assisted classification attracts a higher tariff, not because it is intrinsically cheaper.
We publish all of that because the only asset this catalog has is being checkable. The machine is doing something real — compressing a craft that took three hundred cases into an operation that takes twenty. It is not clearing surgeons out of the room. And the only full block of labor we can prove it deletes belongs to the sterile processing department, where the pre-assembled single-use scope ends cystoscope reprocessing between cases.
Why we are adding it now
Because outside Intuitive, PROCEPT is the only surgical robotics company that publishes its install base and its procedure count every quarter. 816 US systems. More than 13,100 procedures in a single quarter. $495,000 average selling price for a new system, $3,550 for the handpiece. Those are numbers filed with a regulator, not claimed on a trade show floor. Most of the surgical entries in this catalog rest on manufacturer statements. This one does not have to.