Impressive early results – project evaluates robotic-assisted hernia repairs

The first complete review of data from a project analysing robotic hernia repair shows that not only does this approach have a number of significant benefits for patients, it is also an efficient use of health care resources.

The ‘High volume day-case robotic inguinal hernia project’ is a quality improvement project being conducted at Sydney Adventist Hospital (the San). Commencing in July this year, the project is assessing the feasibility and cost-effectiveness of robotic short-stay hernia repair in a high-volume robotic surgery centre. 

With robotic hernia repair – compared with other methods of repairing hernias – patients can generally expect less pain, fewer complications, a shorter stay in hospital, and a quicker return to work and normal activities. 

"These outcomes are well documented," said A/Prof Stephen Pillinger, Head of Robotic Colorectal Surgery at the San, and Principle Investigator for this project. “Despite these benefits, 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. The purpose of this 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. This is the first time a project of this nature has been done in Australia.” 

Early findings

“We’ve been able to look at the early results from the first three months of the project and the results are outstanding,” said A/Prof Pillinger.  Patients are doing extremely well; most have little pain from the start, and close to zero pain at 28 days post-op. Most patients are very quickly getting back to their normal activities – much quicker than with other methods of hernia repair.”

The San was the first hospital in Australia to introduce a zero-extra-cost model for robotic surgery, and this policy applies for the lifetime of the robotic hernia repair project. “It is important to note there is no added costs for patients with the robotic approach to inguinal hernia repair,” said A/Prof Pillinger. “The project also clearly shows that robotic hernia repair is very acceptable as day-case surgery: 97% of patients are going home the same day. And even in this early phase of the project, efficiencies in the operating theatres are also being undertaken which is one of the objectives of the study.”

Patient experience

Rob* suffered for a number of years with a hernia in his right groin. “I had a lump a few centimetres in size sticking out of my groin and it was very painful. Sometimes I had to walk along with my hand in my pocket to press on the hernia to hold it in, and it was a bit embarrassing.”

“I’d been to the GP a couple of times over the years and he had referred me to have the hernia operation. But I’m self-employed, and taking time off work at the bakery to get this done was very difficult. It was another 12-18 months down the track when I went back to the GP. By then it was super painful and I knew I had to get something done as soon as possible.”

The GP referred Rob to a Sydney Adventist Hospital specialist, who talked through all the options of the various approaches to hernia repair surgery. “I heard about this project. I was keen to get the hernia fixed, and happy to take part in the [robotics] project,” Rob said. As it turned out, scans revealed that Rob not only had the large hernia in the right groin, he also had a hernia in the left groin, and both needed repair.

“I went into hospital at 6.30am to have the surgery, and was home by 6pm that night. I was up walking around before leaving hospital. The next morning I had a bit of pain when I rolled over, but otherwise fine. By day five I felt well enough to go into the bakery for a short time – not to work, just to check on things. Honestly, if I’d known a few years ago that this type of surgery was around, I’d have had it done then. I had surgery in August and six weeks later I was back to playing golf.”

While there is significant interest around robotic hernia repair, not every patient is suitable for robotic surgery. Each patient will be carefully assessed, and their hernia surgery will be done using the most appropriate approach for their individual needs. The project will analyse the outcomes of 200 patients, with results expected to be published mid-2024.

“The six surgeons currently involved in this project strongly feel that robotics is the best approach for hernia repair for patients," said A/Prof 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. Even at this early stage, the results are very encouraging." 

*Patient’s full name withheld for privacy.