Information for GPs
How your patients may be involved in this Quality Improvement Project
Robotic-assisted surgery is a well-established minimally-invasive surgical approach used in Australia for the past 20 years*, and at Sydney Adventist Hospital (the San) for more than 10 years. The San is proud to be holding the first Quality Improvement Project to assess the feasibility and cost-effectiveness of robotic-assisted short-stay hernia repair in a high-volume robotic surgery centre, and your patients can give consent for the use of their clinical data as part of this project.
Hernia repair is one of the most common surgical procedures performed – using either open incision, laparoscopic or robot-assisted techniques. To date, the laparoscopic approach has been regarded as the ‘gold standard’ for minimally-invasive inguinal hernia repairs. Even though robot-assisted hernia repairs also achieve excellent results, the robotic approach has sometimes been perceived less cost efficient.
"The established dogma is that the robotics approach is too expensive for inguinal hernia repairs, however there is a lack of really good evidence to support that view," said Dr Stephen Pillinger, Consultant Robotic Colorectal Surgeon at the San, and Principal Investigator. "This project will look to evaluate the benefits of experience at every level – surgeons, anaesthetists and theatre staff – in a very experienced robotic surgical unit which can do high-volume day-case hernia repairs efficiently, economically, and with benefits to the patients. I don’t believe a project of this nature has been done anywhere in the world – certainly not with specific data published in Australia."
While robotics initially had a strong urological focus in prostate surgery, with newer technology the fastest growth in robotics in recent years has been seen in general surgery, colorectal surgery and gynaecology.
"Robotics is a very accepted and sought after technology now," said Dr Pillinger. "It is the next evolution in surgical care and, with it, minimally-invasive surgery keeps getting better and better."
Quality Improvement Project Overview
With robot-assisted hernia repair, patients can generally expect less pain, fewer complications, shorter stay in hospital, and a quicker return to work and normal activities. "These outcomes are well documented," said Dr Pillinger. "The motivation behind setting up this quality improvement project is to prove we can run a high-volume robotic inguinal hernia service that is beneficial for our patients as well as being efficient and economical."
The project commenced in late July 2023 at the San, and the aim is to analyse data from up to 200 patients during the project. The first complete review of the data will be done at three months, with interim results expected at six months and published data after 12 months.
Every patient referred to a surgeon at the San will be carefully assessed by their surgeon, and their hernia surgery will be done via the most clinically appropriate approach for their individual needs. If robotic surgery is determined to be the most appropriate approach, patients can then agree to have data routinely collected as part of their surgical intervention analysed in this Quality Improvement Project, with the aim to improve outcomes for our patients.
For the purposes of this project, there are three groups of hernia patients that may be suitable for inclusion:
- Patients who have had no prior lower abdominal surgery, previous repair, recurrence or pelvic radiotherapy
- Patients who have had previous inguinal hernia repair with recurrence
- Patients who have had previous abdominal surgery and have complex or large incisional hernias that require component separation/abdominal wall reconstruction.
Initially, the project will focus on data from patients who have not had previous lower abdominal surgery or treatment. "We’re restricting the project to simple hernias for the first three months, while we standardise protocols and procedures," said Dr Pillinger. "It is expected that data from other patients will then be incorporated into the project as it progresses."
"While we expect there will be significant interest from patients, not every patient is suitable for robotic surgery," said Ms Catherine Murphy, Perioperative Redesign Project Manager at the San. "However every patient will be carefully assessed, and their hernia surgery will be done via the most appropriate approach for their individual needs."
During this project, the San will allocate dedicated robotic hernia theatre lists, with theatre personnel experienced in robotics. "If you do large numbers of robotic cases one after the other it becomes very efficient, rather than alternating between robotic cases and laparoscopic or open cases," said Dr Pillinger. "We’re aiming to establish a service that is very efficient and works well for the patient, the theatres and the hospital."
Six surgeons very experienced in robotic surgery are participating in the Quality Improvement Project: Dr Stephen Pillinger, Dr Walid Barto, A/Prof Craig Lynch, Dr Christos Apostolou, Dr Assad Zahid and Prof Jaswinder Samra.
"The surgeons involved in this project strongly feel that robotics is the best approach for hernia repair for patients," said Dr Pillinger. "Until now there hasn’t been the hard data to back this up, and that’s one of the things we hope to achieve with this project."
This project was reviewed by the AHCL Research Office and approved by the AHCL Director of Research as a QI project in accordance with the NHMRC Ethical Considerations in Quality Assurance and Evaluation Activities (March 2014) and the Health Privacy Principles #10 and 11. No ethical risks were determined with the project.