Robotic Inguinal Hernia
Surgery Program

About the program

Inguinal hernia repair is one of the most commonly performed general surgical procedures, with simple procedures often performed as day cases. The gold standard is laparoscopic minimally invasive surgery. The procedure can also be done robotically with equally good results; however, a perception persists that this is a more expensive, less efficient method. Sydney Adventist Hospital has several of Sydney’s leading robotic general surgeons who perform inguinal hernia surgery both robotically and laparoscopically, and has recently launched a Quality Improvement Project aimed at testing this perception.

There are various groups of hernia patients that may be suitable for a robotic surgery approach. Your doctor will discuss with you the best treatment option for you based on your circumstances. Both laparoscopic and robotic surgery have been performed at the San for many years. Should robotic-assisted surgery be the best clinical decision for you, we would appreciate your approval to include data collected as part of your surgical intervention in this Quality Improvement Project.

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Begin your hernia repair journey

1. Speak to your GP

2. Choose a San doctor

3. Make an appointment

Meet our team of surgeons

Frequently Asked Questions

What is robotic hernia surgery?

Hernia surgery can be performed via a number of approaches: open incision, laparoscopic (keyhole), and robot-assisted surgery. A robotic surgical system has mechanical arms with surgical instruments and cameras attached, and the surgeon controls these via a computer console at the operating table. Robot-assisted surgery can provide greater precision and control of surgical instruments. It also provides three-dimensional, 10-fold magnification which enhances the surgeon’s view of the surgical area. With a robotic approach, patients can generally expect less pain, fewer complications, shorter stay in hospital, and a quicker return to work and normal activities.

Is robotic surgery experimental?

Robot-assisted surgery is not experimental, it has been widely used around the world for many years – including in Australia for 20 years. Sydney Adventist Hospital (the San) has a well-established robotic surgical centre, with a number of surgeons very experienced in robotic surgery, including the six surgeons participating in this project.

What is the purpose of this project?

Laparoscopic surgery and robotic surgery are both considered very good minimally-invasive ways of doing hernia surgery. There has been a perception that robotic surgery is too expensive, however to date there is a lack of data to test this perception. The purpose of this Quality Improvement Project is to see whether robot-assisted hernia surgery can be done both efficiently and economically.

I need hernia repair surgery. How can I find out if it can be done robotically?

Discuss this with your GP and your surgeon. Not every patient is suitable for robotic surgery. Every patient will be carefully assessed, and your hernia surgery will be done via the most appropriate approach for your individual needs.

If I do have robotic surgery, do I have to take part in this project?

You are completely free to choose to take part in this project or not. Discuss this with your GP and your surgeon. Your surgeon will carefully assess your own individual situation and discuss options with you. Your hernia surgery will be done via the most appropriate approach according to your particular needs. If robotic surgery is the most clinically appropriate approach for you, we ask that you consider approving the inclusion of data routinely collected as part of your surgical intervention in this Quality Improvement Project.

Is my type of hernia suitable to allow my inclusion in this project?

For the purpose 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.

Your doctor will discuss this with you in further detail.

How long will this project be happening?

The robotic hernia quality improvement project commenced on late July 2023, and the aim is to analyse data from 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.

Where is the project being conducted?

The project is only being conducted at Sydney Adventist Hospital (the San), in Wahroonga, NSW.

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.

A hernia forms when part of an organ or tissue protrudes through a weakened area or tear in surrounding tissue or a muscle wall. Hernias can be caused by many different factors, either alone or in combination, such as:

obesity
heavy lifting
pregnancy
coughing
genetic predisposition

Recognising hernia symptoms

The displacement of the tissue or organ can result in pain or discomfort and may also result in visible swelling under the skin and digestive issues. The most common types of hernias occur in the groin, around the stomach and in relation to the abdominal wall. The severity of symptoms varies depending on the size and location of the hernia and can be more noticeable during specific activities such as lifting or straining which exert force on the impacted area.

If a hernia is suspected, your doctor will conduct a physical examination to identify the location and severity. This would usually be followed by imaging tests such as ultrasound or CT to confirm the precise location and size to assist with treatment options.

Common hernia symptoms

Visible bulge, especially when standing or straining
Local discomfort/aching sensation
Pain with specific activities
Tenderness at the location when pressure is applied
Digestive symptoms
Change in bowel movements

Hernia treatment

Smaller or minor hernias may be monitored for a period of time while aggravating activities are avoided, to see if symptoms persist. For example, lifestyle changes such as weight loss or avoiding heavy lifting can also help to minimise symptoms and the condition. Support garments can also be used to provide pain relief while the hernia is monitored.

While not all hernias require surgery, this is the most typical outcome for many types of hernias such as abdominal wall hernias. Where hernia repair surgery is recommended, the common approach involves returning the protruding organ back into its proper position and reinforcing the weakened muscle or tear. Untreated hernias can lead to other medical issues so treatment by surgery is commonly recommended.

Once diagnosed, your doctor will discuss the hernia repair treatment options and then refer you to an appropriate hernia repair specialist.

Types of hernia surgery

The team of hernia repair specialists based at the San on Sydney’s North Shore undertake three main types of hernia surgery which each have different applications and considerations:

Open incision

May be preferred for complex hernias or where laparoscopic is not feasible; requires a larger incision than keyhole or robot-assisted and may have longer recover times.

Keyhole (laparoscopic)

Minimally invasive surgery with shorter recover times but may not be suitable for a complex hernia.

Robot-assisted

Minimally invasive surgery conducted with enhanced visualisation and technology; provided at the San with no additional hospital costs for patients than other types of surgery.

As individual needs differ and not all patients are suitable for particular types of hernia surgery, your doctor and hernia repair specialist will assess the best approach for your condition.

Robotic hernia surgery at the San

While the San’s hernia surgery team conduct all types of surgery, they have specific expertise in robotic hernia surgery. Widely used in surgery for more than 20 years, robotic assisted hernia surgery involves the use of a system with mechanical arms which have surgical instruments and cameras attached. With a three-dimensional view and enhanced magnification, the surgeon controls the system via a computer console. Using the robotic surgery approach, patients generally experience fewer complications and faster recovery times.

The San is home to some of Sydney’s best hernia surgeons with a well-established robotic surgery centre located at our North Shore hospital. The San is currently undertaking a Quality Improvement Project to test whether robotic assisted hernia surgery can be done both efficiently and economically. The project involves collecting clinical data as part of the surgical intervention, with the patient’s consent.

Why choose the San for your hernia surgery?

As a leading hernia repair hospital with a large number of highly qualified surgeons who specialise in hernia surgery, the San is well-equipped to offer all types of hernia surgery either with or without robotic assistance. In conjunction with your doctor, our specialist team will review and recommend the most suitable approach to your hernia repair, taking into account your individual circumstances.

Robotic Inguinal Hernia Surgery Program