annual report 2019/20 - slhd.nsw.gov.au

Annual Report 2019/20

Surgical Robotics Program Sydney Local Health District

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CONTENTS

1. EXECUTIVE SUMMARY ................................................................................................................................... 3

2. INTRODUCTION .............................................................................................................................................. 4

2.1 Purpose of report ........................................................................................................................................... 4

2.2 Funding arrangements ................................................................................................................................. 4

3. GOVERNANCE ............................................................................................................................................... 4

3.1 Surgical Robotics Steering Committee....................................................................................................... 4

3.2 Staffing ............................................................................................................................................................ 5

4. PROGRAM ACTIVITY ...................................................................................................................................... 7

4.1 Overview ........................................................................................................................................................ 7

4.2 da Vinci Xi Surgical System ......................................................................................................................... 9

4.3 MAKO Robotic System ............................................................................................................................... 19

5. RESEARCH ..................................................................................................................................................... 21

5.1 Research in development ......................................................................................................................... 21

5.2 Research in progress (ethics completed)................................................................................................ 21

5.3 Publications ................................................................................................................................................. 21

5.4 Conference presentation and posters ..................................................................................................... 22

6. CREDENTIALING ........................................................................................................................................... 22

6.1 Medical staff with approved scope of practice ..................................................................................... 22

6.2 Auditing ........................................................................................................................................................ 23

6.3 Credentialing Collaboration ...................................................................................................................... 24

7. SURGICAL AND ROBOTICS TRAINING INSTITUTE (RTI) ............................................................................... 24

7.1 Overview ...................................................................................................................................................... 24

7.2 Training and Courses .................................................................................................................................. 24

7.3 Animal Welfare ............................................................................................................................................ 25

8. ROBOTICS CONFERENCES .......................................................................................................................... 26

8.1 Sydney Robotics Summit 2020 – Postponed to 2021............................................................................... 26

8.2 World Robotics Symposium – Australian Program .................................................................................. 26

8.3 National Research Think Tank: Robotic Surgery in the Public Sector ................................................... 27

9. FUTURE PLANS ............................................................................................................................................... 27

9.1 National collaborations .............................................................................................................................. 27

9.2 Sydney Robotics Summit 2021................................................................................................................... 27

10. CONCLUSION ............................................................................................................................................... 27

11. APPENDIX ..................................................................................................................................................... 29

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1. Executive Summary

The purpose of this report is to provide a summary of the provision of the surgical robotics program at Royal Prince Hospital (RPA) within Sydney Local Health District (SLHD) for the financial year period 2019/20.

With the first robotic-assisted surgery (RAS) case undertaken at RPA in August 2016, this report covers the fourth financial year of operation for the program.

The surgical robotics program at RPA is one of the broadest multi-specialty public programs in Australia and is truly unique in that it is governed by a comprehensive research framework whereby every patient undergoing RAS is enrolled in a research study. The use of RAS on the campus is also strongly embedded in ongoing education and training.

Currently there are 5 surgical specialties utilising the da Vinci Xi Surgical System at RPA including benign gynaecology, cardiothoracic, colorectal, urology and upper GI, who did their first case in 2019/20. In addition, the Stryker MAKO Robotic System is being used by orthopaedics in the Institute of Rheumatology and Orthopaedics (IRO) at RPA.

In 2019/20, a total of 233 RAS procedures were completed at RPA including 125 taking place on the da Vinci Xi and 108 on the MAKO system. This resulted in an average monthly RAS caseload of approximately 19 patients. The unprecedented global COVID-19 pandemic had a significant impact on the 2019/20 program activity with a reduction in the cases able to be performed from April through to June 2020.

The robotic research program continued with the 6 active surgical specialties contributing to 11 prospective databases. There are currently 11 active specialty specific research studies another 4 in advanced stages of development. In addition, the team completed 6 publications and 3 presentations in 2019/20. A highlight for this financial year was the commencement of two new research studies, the RoboMitral and PNUT studies.

Credentialing for both senior and junior medical staff was maintained and approved throughout the financial year. As at June 2020, there were 6 proctors, 19 senior medical staff with an additional 5 having interim clinical privileges, 5 junior medical staff able to operate on the console and 8 able to assist at the bedside credentialed at RPA across the 6 specialties involved in the surgical robotics program.

The ongoing importance of education and training on the campus remained with the RPA Surgical & Robotics Training Institute (RTI) delivering 80 courses to a total of 112 participants in 2019/20 including surgeons, surgical fellows and theatre nurses. The COVID-19 pandemic also had a considerable impact on the facility, with the final course for the financial year run on 26 March thus decreasing the overall activity expected for the year.

Significant planning and preparation had been put in place to run the first national Research Think Tank on robotic surgery in the public sector on Friday 27 March 2020 and for the third Sydney Robotics Summit to be held at the Sydney Masonic Centre on Friday 12 and Saturday 13 June 2020. However, these were postponed in response to the COVID-19 pandemic. It is anticipated these will be either re-formatted to a virtual program or rescheduled at a later date in 2020/21.

In summary, the surgical robotics program continued to run successfully in 2019/20, despite the unanticipated challenges related to COVID-19, and is an ongoing credit to the dedication and commitment of the many medical, nursing, allied health and research teams involved. In particular, this report would like to specifically acknowledge the considerable contribution made by Dr Rob Ogle in establishing and supporting the surgical robotics program in benign gynaecology. He was also an important member of the Steering Committee and will be significantly missed. Vale Dr Ogle.

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2. Introduction

2.1 Purpose of report

The purpose of this report is to provide a summary of the surgical robotics program at Royal Prince Hospital (RPA) within Sydney Local Health District (SLHD) for the financial year period 2019/20.

With the first robotic-assisted surgery (RAS) case undertaken at RPA in August 2016, this report covers the fourth financial year of operation for the program.

2.2 Funding arrangements

Purchase of the latest generation da Vinci Xi Surgical System in December 2015, which was the first within a public hospital in Australia, was made possible through a generous bequest from the late Mrs Shirley Woolley.

The funding for the program is overseen by the New Technology and Specialised Services Committee of NSW Health with the program at RPA currently funded through the standardized activity based funding (ABF) system allocated through National Weighted Activity Units (NWAU) per case. There are currently no specific Diagnostic Related Groups (DRGs) for RAS however a coding flag was introduced in June 2017.

3. Governance

3.1 Surgical Robotics Steering Committee

The surgical robotics program is overseen by the RPA Institute of Academic Surgery (IAS) as one of the key programs within its ‘Innovation, Value and Thought’ portfolio.

The overarching committee responsible for this program is the Surgical Robotics Program Steering Committee which commenced in December 2015 and is co-chaired by Dr Teresa Anderson, Chief Executive SLHD, and Professor Paul Bannon, Co-Chair of the RPA Institute of Academic Surgery. The committee meets monthly and has representation from Heads of Department and key staff across all clinical departments and areas involved in the delivery of the program.

There are three working groups that report to the steering committee and cover the core functional areas of the program including research, operations, and training and credentialing. The Research Working Group meets bi-monthly and is chaired by Professor Michael Solomon, Co-Chair of the RPA Institute of Academic Surgery. The Operations Working Group meets as required and is chaired by Associate Professor Paul Stalley, Program Director of Surgical Services SLHD. The Training and Credentialing Working Group meets quarterly and is chaired by Dr Kim Hill, Executive Director Medical Services SLHD.

The governance structure is outlined in Figure 1.

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Figure 1. Surgical robotics program governance structure

3.2 Staffing

The delivery of the surgical robotics program at RPA would not be possible without the ongoing commitment and dedication of the many clinical teams and individual staff involved. Their contribution to ensuring the highest level of care is provided to our patients is greatly appreciated.

In particular, this report would like to specifically acknowledge the considerable contribution made by Dr Rob Ogle in establishing and supporting the surgical robotics program in benign gynaecology. He was also an important member of the Steering Committee and will be significantly missed. Vale Dr Ogle.

The list of key staff involved in the program are outlined in Table 1.

Table 1. Staff involved in the surgical robotics program at RPA in 2019/20 Management

Dr Teresa Anderson Chief Executive and Co-Chair, Surgical Robotics Steering Committee

Dr Tim Sinclair Executive Director Operations SLHD Mr Nobby Alcala General Manager RPA

Prof Paul Bannon Co-Chair IAS and Co-Chair, Surgical Robotics Steering Committee

Prof Michael Solomon Co-Chair IAS and Chair, Robotic Research Working Group

A/Prof Ruban Thanigasalam Robotics Research Lead; Associate Professor of Robotic Surgery

Dr Scott Leslie Robotics Research Lead; Senior Lecturer of Robotic Surgery

A/Prof Paul Stalley Program Director Surgical Services SLHD and Chair, Robotics Operations Working Group

Dr Peter Lee Deputy Director JL Theatres RPA

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Ms Stella Pillai Nurse Manager JL Theatres RPA Ms Kathryn Taaffe Clinical Nurse Consultant

Dr Kim Hill Executive Director Medical Services SLHD and Chair, Training and Credentialing Working Group

Ms Kate McBride Executive Director IAS Prof Jane Young Executive Director Research IAS and SOuRCe Dr Daniel Steffens Deputy Director SOuRCe Ms Lucy Mackenzie Manager Surgical Partnerships IAS Mr Trevor McGowan Ms Rosa Fung

Facility Coordinator IAS

Mr Trent Cameron Facility Coordinator RTI Benign Gynaecology Dr Rob Ogle Clinical Director Women and Babies SLHD Dr Sofia Smirnova Head of Department A/Prof Michael Cooper Benign gynaecologist Dr Trevor Tejada-Berges Proctor and gynae-oncologist Dr Anthony Marren Benign gynaecologist Dr Vivian Yang Benign gynaecologist Prof Nesrin Varol Benign gynaecologist Ms Milorose Felipe Clinical Nurse Consultant Dr Russell Duncan Surgical RMO Cardiothoracic Prof Paul Bannon Head of Department Prof Tristan Yan Cardiothoracic surgeon Dr Christopher Cao Cardiothoracic surgeon Ms Lisa Turner Clinical Nurse Consultant Ms Lorna Beattie Clinical Nurse Consultant Dr Nicholas McNamara Surgical RMO Dr James Farag Surgical RMO Ms Sarah McLennan Cardiac Surgery Case Manager Ms Andrea Scholes Thoracic Case Manager Colorectal A/Prof Chris Byrne Head of Department Dr Peter Lee Colorectal surgeon Dr Kirk Austin Colorectal surgeon Dr Kheng- Seong Ng Colorectal Fellow Orthopaedics Dr Mark Horsley Head of Department Dr Brett Fritsch Orthopaedic surgeon Dr Sanjeev Gupta Orthopaedic surgeon Dr Richard Boyle Orthopaedic surgeon Dr Maurice Guzman Orthopaedic surgeon Dr Daniel Franks Orthopaedic surgeon Ms Catrin Hill Clinical Nurse Consultant

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Urology Dr David Eisinger Head of Department RPA A/Prof Lewis Chan Head of Department CRGH A/Prof Ruban Thanigasalam Urologist and Robotics Research Lead CRGH Dr Scott Leslie Urologist and Robotics Research Lead RPA Dr Arthur Vasilaras Urologist RPA Dr Andre Lalak Urologist CRGH Dr Paul Sved Urologist RPA Dr Jeremy Fallot Urology Robotic Research Fellow Dr Wenjie Zhong Surgical RMO Dr Jonathan Kam Surgical RMO Dr Nicholas Walker Surgical RMO Dr David Habashy Surgical RMO Ms Virginia Ip Clinical Nurse Consultant RPA Ms Beth Whittaker Clinical Nurse Consultant CRGH Upper Gastrointestinal Series (UGI) Dr Jerome Laurence Upper gastrointestinal, hepatobiliary and transplant surgeon A/Prof Charbel Sandroussi Upper gastrointestinal, hepatobiliary and transplant surgeon Dr David Yeo Upper gastrointestinal, hepatobiliary and transplant surgeon Research Team Dr Daniel Steffens Deputy Director, SOuRCe Ms Christina Stanislaus Robotic Research Officer, SOuRCe Mr Sascha Karunaratne Orthopaedic Research Officer, SOuRCe Ms Dana Georgevsky Benign Gynaecology Research Officer Ms Clare Toms Upper Gastrointestinal Research Officer/ Data Manager

4. Program Activity

4.1 Overview

Research is a core component of the comprehensive governance framework surrounding RAS at RPA. This approach determines that every patient being operated on robotically must be enrolled in a research study enabling a strong contribution to be made to the existing knowledge regarding the strengths, limitations, costs and benefits of RAS across a range of surgical procedures, as well as all procedure specific ethical requirements.

Currently there are 5 surgical specialties utilising the da Vinci Xi Surgical System at RPA including benign gynaecology, cardiothoracic, colorectal, upper gastrointestinal and urology. In addition, the Stryker MAKO Robotic System is being used by orthopaedics.

Overall 632 RAS cases have been performed at RPA with 233 of these being completed during the 2019/20 financial year with 125 taking place on the da Vinci Xi and 108 on the MAKO. This resulted in an average monthly RAS caseload of approximately 19 patients (Figure 2).

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May-17Jun-17Jul-17


May-18Jun-18Jul-18


May-19Jun-19Jul-19


May-20Jun-20

Figure 2. Monthly number of cases performed at RPAH (N=632)

Da Vinci MAKO

2016/17 FY N=53

2017/18 FY N=136

2018/19 FY N=210

2019/20 FY N=233

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Despite the impact of COVID-19, most of the surgical specialties increased their caseload in 2019/20 compared to the previous financial year with the exception of urology. In the 2019/20, orthopaedics performed the most number of robotic cases (n=108) with colorectal and upper gastrointestinal performing the least amount of cases (n=2) (Figure 3).

4.2 da Vinci Xi Surgical System

The da Vinci Xi Surgical System was purchased in December 2015 with the first ethics approval obtained and first case performed by cardiothoracic in February and August 2016, respectively. The 5 active specialties using the da Vinci system are currently recruiting patients to 11 different research studies or databases.

Overall, 393 procedures have been performed at RPA using the da Vinci Xi Surgical System, with 124 undertaken in 2019/20 (Figure 2).

4.2.1 Cardiothoracic

There are currently three cardiothoracic robotic research protocols including:

• Robotic-Assisted Coronary Artery Bypass Grafting (RoboCab)

• Robotic-Assisted Lung Resection (RoboLung)

• Robotic-Assisted Mitral Valve (RoboMitral)

Overall, 60 patients have received cardiothoracic robotic surgery at RPA, with 23 of these procedures performed in 2019/20.

Description of research studies/databases

The 3 cardiothoracic robotic research projects are described in Table 2A-C. Note that the RoboCab study is currently on hold due to a challenge with the available instrumentation (stabilizer) in the da Vinci Xi system. This is a significant challenge within the current research protocol of the RoboCab study, as the progression to a phase 3 trial is impractical. This is being investigated by Intuitive Surgical.

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68

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40

60

80

100

120

2018/19

2019/20

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2019/20

2018/19

2019/20

2018/19

2019/20

2018/19

2019/20

2018/19

2019/20

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Orthopaedics Urology Colorectal Benign Gynae Cardiothoracic UGI

Figure 3. RAS activity by surgical specialty

UKA TKA THA ROSE Sling PNUT Colorectal Benign Gynae Cab Lung UGI

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Table 2A. Description of the RoboCab study Study Title: Robotic-Assisted Coronary Artery Bypass Grafting (RoboCab) Study HREC and SSA ref Number: X16-0003, HREC/16/RPAH/011 and SSA/16/RPAH/328

General Aim:

• Prospective data collection and periodic analysis of outcomes to enable a safe, step-wise progression through the procedural learning curve • Analysis of the procedural learning curve • Analysis of cost-effectiveness outcomes • Analysis of quality of life outcomes

Design: Prospective cohort study

Main endpoints: • Procedural learning curve • Cost effectiveness outcomes • Quality of life outcomes

Sample size: 31 Status: Paused Estimated Completion date: Paused - January 2019

Table 2B. Description of the RoboLung Database Study Title: Robotic-Assisted Lung Resection (RoboLung) HREC and SSA ref Number: X18-0014, HREC/18/RPAH/12 and SSA/18/RPAH/148 General Aim: Collect information about patients undergoing robotic-assisted lung resection Design: Prospective database

Main endpoints: • Assess patient outcomes and recovery • Provide quality control within our department • Set a national Standard for outcomes

Sample size: Ongoing Status: Recruiting Estimated Completion date: Ongoing

Table 2C. Description of the RoboMitral Database Study Title: Robotic-Assisted Mitral Valve Surgery (RoboMitral) HREC and SSA ref Number: X18-0294, HREC/18/RPAH/401 and 2019/STE16330 General Aim: Collect information about patients undergoing robotic-assisted mitral valve Design: Prospective database

Main endpoints: • Assess patient outcomes and recovery • Quality of life and health utilisation


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Characteristics of the study population

The characteristics of the participants included in the RoboCab, RoboLung and RoboMitral projects are described on Table 3. Overall, most participants included were male (60%) with a mean age of 61.5 years. The majority of robotic procedures were elective (75%), public patients (87%).

Table 3. Characteristics of the study population

Variables RoboCab RoboLung RoboMitral Overall Cardiothoracic

Overall (N=31)

2019/20 (N=0)

Overall (N=27)

2019/20 (N=21)

Overall (N=2)

2019/20 (N=2)

Overall (N=60)

2019/20 (N=23)

Gender, Male 25 (81%) - 9 (33%) 7 (33%) 2 (100%) 2 (100%) 36 (60%) 9 (39%) Age (years) 64 ± 7.7 - 61 ± 20.4 64 ± 20.4 63.0 ± 17.0 63.0 ± 17.0 61.5 ± 15.4 62.4 ± 20.3 Insurance, Public 26 (84%) - 25 (93%) 19 (90%) 1 (50%) 1 (50%) 52 (87%) 20 (87%) Country of Birth, Australia

14 (45%) - 15 (56%) 11 (52%) 1 (50%) 1 (50%) 30 (50%) 12 (52%)

Admission, Elective 16 (52%) - 27 (100%) 21 (100%) 2 (100%) 2 (100%) 45 (75%) 23 (100%)

Data presented as N (%) or mean ± SD.

Operating time and length of stay

The overall operating time was approximately 6 hours, with patients in the RoboCab study staying in hospital for 7.2 days, patients in the RoboLung study staying in hospital for 3.5 days and patients in the RoboMitral study staying in for 4.2 days. Table 4 presents this data for all patients undergoing cardiothoracic robotic surgery.

Table 4. Operating time and length of stay for patients undergoing cardiothoracic robotic surgery

Variables RoboCab RoboLung RoboMitral Overall Cardiothoracic

Overall (N=31)

2019/20 (N=0)

Overall (N=27)

2019/20 (N=21)

Overall (N=2)

2019/20 (N=2)

Overall (N=60)

2019/20 (N=23)

Console time (hours) 2.1 ± 0.6 - 1.4 ± 0.8 1.5 ± 0.9 2.3 ± 0.3 2.3 ± 0.3 1.8 ± 0.8 1.6 ± 0.9 Docking Time (mins) 11.2 ±

6.8 - 9.5 ± 6.2 9.7 ± 4.4 8.5 ± 3.5 8.5 ± 3.5 10.4 ± 6.5 8.9 ±4.2

Surgery Time (hours) 5.0 ± 2.5 - 2.8 ± 1.2 2.9 ± 1.3 4.4 ±0.1 4.4 ±0.1 3.9 ± 2.2 3.0 ±1.3 Operating time (hours) 7.3 ± 1.7 - 4.0 ± 1.4 4.3 ± 1.5 6.6 ± 0.4 6.6 ± 0.4 5.8 ± 2.2 4.5 ± 1.5

Length of stay (days) 7.2 ± 3.1 - 3.5 ± 3.0 3.7 ± 3.4 4.2 ± 4.9 4.2 ± 4.9 4.1 ± 2.9 3.8 ± 3.5 Data presented as mean ± SD.

Patient reported outcomes

All patients treated within the surgical robotics program are requested to report their outcomes through a range of questionnaires that cover quality of life (using the SF-36V2 tool), work and care responsibilities, health service utilization, assistance required at home, financial issues and paid/unpaid activities.

Overall, the completion rate was from 98% at the pre-operative period to 49% at six months post-operative. The completion rate for the three cardiothoracic robotic projects is outlined on Table 5.

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Table 5. Patient Reported Outcomes

Variables RoboCab RoboLung RoboMitral Overall Cardiothoracic Due Received Due Received Due Received Due Received

Pre-Operative 31 31 (100%) 27 26 (96%) 2 2 (100%) 60 59 (98%) 6 Weeks Post-Operative 31 24 (77%) 25 13 (52%) 2 2 (100%) 58 39 (67%)

6 Months Post-Operative 31 18 (58%) 17 5 (29%) 1 1 (100%) 49 24 (49%)

Data presented as N (%).

4.2.2 Colorectal

The colorectal department received ethics approval for their RAS study titled Robotic Assisted Rectal Resection (RARR) in March 2017 and performed the first case in November 2017.

Overall, Colorectal has completed 26 RAS cases with two of these undertaken in 2019/20. Currently there are three colorectal surgeons utilising the Da Vinci Xi robot. In 2019/20, the colorectal team with the support from the Robotics Working Group party amended the current protocol to expand the indications to allow for further procedures to be included. This is expected to increase the number of surgeries performed at RPAH in 2020/21 financial year.


The description of the colorectal robotic databse is outlined in Table 6.

Table 6. Description of the Robotic Assisted Rectal Resection (RARR) Database

Study Title: Robotic-Assisted Rectal Resection: The Creation of a Prospective Database (RARR-Data)

HREC and SSA ref Number: X17-0093, HREC/17/RPAH/137 and SSA/17/RPAH/279 General Aim: To analyse and compare short term surgical outcomes Design: Prospective database

Main endpoints: • To create a database of patient characteristics and in-hospital outcomes of

patients suitable for robotic assisted rectal resection • Analyse and compare short term in-hospital outcomes



Overall, most participants undergoing colorectal RAS were males (57%) with a mean age of 61 years. Most procedures were elective with the majority being public patients (93%). A detailed description of the colorectal RAS population is outlined in Table 7.

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Table 7. Characteristics of the study population Variables Overall (N=26) 2019/20 (N=2) Gender, Male 13 (57%) 1 (50%) Age (years) 61.0 ± 14.3 51.0 ± 37.5 Insurance, Public 23 (89%) 2 (100%) Country of Birth, Australia 10 (38%) 1 (50%)

Admission, Elective 23 (96%) 2 (100%) Data presented as N (%) or mean ± SD.


Of the 2 robotic rectal resections performed in 2019/20, the mean console time was 3.9 hours, docking time was 20 minutes, surgical time 6.2 hours, and total operating time was 8.1 hours. The mean length of hospital stay for was 5.9 days (Table 8).

Table 8. Operating time and length of stay for patients undergoing robotic rectal resection Variables Overall (N=26) 2019/20 (N=2) Console time (hours) 3.9 ± 1.3 3.9 ± 1.8 Docking Time (mins) 12.3 ± 7.5 20.0 ± 14.1 Surgery Time (hours) 6.9 ± 1.6 6.2 ± 2.5 Operating time (hours) 8.1 ± 1.5 8.1 ± 2.6 Length of stay (days) 5.9 ± 20.6 5.9 ± 3.5

Data presented as mean ± SD.


The rate of data collected from patients regarding their reported outcomes was 100% preoperatively, decreasing to 89% at 6 weeks post-operatively and to 72% at 6 months post-operatively (Table 9).

Table 9. Patient Reported Outcomes Variables Due Received Pre-Operative 26 26 (100%) 6 Weeks Post-Operative 26 23 (89%)* 6 Months Post-Operative 25 18 (72%)*

Data presented as N (%).*Missing information from 1 patients due to in-hospital death

4.2.3 Benign Gynaecology

Benign gynaecology received ethics approval in May 2016 and site specific approval in May 2017, with the first RAS case being performed in October 2017. To date, 75 benign gynaecological procedures have been performed at RPA by 3 surgeons with 29 of these being undertaken in 2019/20.

Due to issues identified by the Data, Safety and Monitoring Board (DSMB) during their initial 30 case review, which included lack of protocol adherence and data collection, the protocol was temporarily suspended in June 2018 until the issues identified could be rectified. Following a number of steps that were put in place, the protocol was officially recommenced in April 2019. In June 2020 the team conducted their one year post-

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suspension review and the Robotics Working Group and the Ethics Committee were satisfied with the programs progress to date.


The description of the benign gynaecology database is presented in Table 10.

Table 10. Description of the RSBG study

Study Title: Robotic surgery for benign gynaecology: the initial experience from an Australian tertiary unit (RSBG)

HREC and SSA ref Number: X16-0223, HREC/16/RPAH/274 and SSA/17/RPAH/219

General Aim: To determine the surgical outcomes, complications and costs of the introduction of robotic surgery for benign gynaecology

Design: Prospective observational study

Main endpoints:

• Clinical safety • Learning curve • Quality of life • Health economics • Cost effectiveness

Sample size: 90 Status: Recruiting Estimated Completion date:

December 2019


Overall, the mean age of the female patients was 39 years with most being from Australia (60%). Table 11 describes the characteristics of the patients that underwent RAS within benign gynaecology.

Table 11. Characteristics of the study population Variables Overall (N=75) 2019/20 (N=29) Gender, Male 0 (0%) 0 (0%) Age (years) 39.2 ± 11.2 35.5 ± 6.8 Insurance, Public 37 (49%) 15 (52%) Country of Birth, Australia 45 (60%) 16 (55%) Admission, Elective 75 (100%) 29 (100%)



The overall operation time for patients was 3.2 hours with patients staying in hospital on average for 1.5 days. For the 2019/20 cohort, the mean length of hospital stay increased slightly to 1.7 days. Table 12 outlines the surgical outcomes for all patients.

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Table 12. Operating time and length of stay Variables Overall (N=75) 2019/20 (N=29) Console time (hours) 1.5 ± 0.9 1.5 ± 1.0 Docking Time (mins) 7.6 ± 3.6 7.5 ± 3.7 Surgery Time (hours) 2.4 ± 1.1 2.3 ± 1.3 Operating time (hours) 3.2 ±1.2 3.1 ± 1.4 Length of stay (days) 1.5 ±1.3 1.7 ± 1.5



Completion rate for the patient reported outcomes is outlined in Table 13. The follow-up rate was 95% pre-operatively, decreasing to 69% at 6 weeks and 63% at 6 months post-operatively.

Table 13. Patient Reported Outcomes Variables Due Received Pre-Operative 75 71 (95%) 6 Weeks Post-Operative 74 51 (69%) 6 Months Post-Operative 67 42 (63%)


4.2.4 Urology

Urology was the second department to utilize the da Vinci Xi robot at RPA. The study received ethics approval in June 2016 and the first procedure was performed in October 2016. Overall, urology has performed 230 cases with 68 undertaken in 2019/20. Currently there are 5 surgeons performing robotic radical prostatectomy and partial nephrectomy at RPA.

Urology has three active research studies including:

(i) Robotic and open surgery for prostate cancer: a prospective, multicentre, comparative study of functional and oncological outcomes (ROSE)

(ii) Randomised study assessing urinary continence following robotic radical prostatectomy with or without an intraoperative retropubic vascularised fascial sling (ROBOSling)

The ROBOSling trial was the first full-scale robotic randomised controlled trial initiated at RPA.

(iii) Early unclamping versus regular clamping in robot assisted partial nephrectomy: a multicenter, prospective, randomised controlled clinical trial looking at functional and oncological outcomes (PNUT).

To date 184 patients have been enrolled in the ROSE study, 32 the ROBOSling trial and 14 the PNUT trial.


A description of the 3 urological studies is outlined within Table 14A-C.

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Table 14A. Description of the ROSE study

Study Title: Robotic and open surgery for prostate cancer: a prospective, multicentre, comparative study of functional and oncological outcomes (ROSE)

HREC and SSA ref Number: X16-0294, HREC/16/RPAH/377 and SSA/16/RPAH/565, SSA/16/CRGH/254

General Aim: To assess pre-operative and post-operative oncological, urinary and sexual functional and quality of life outcomes following Robot-Assisted Radical Prostatectomy (RARP) compared to Open Radical Prostatectomy (ORP).

Design: Prospective cohort study

Main endpoints: • Oncological outcomes • Urinary and sexual function • Quality of life

Sample size: 562 Status: Recruiting Estimated Completion date: January 2021

Table 14B. Description of the ROBOSling Trial

Study Title: Randomised study assessing urinary continence following robotic radical prostatectomy with or without an intraoperative retropubic vascularised fascial sling (ROBOSling)

HREC and SSA ref Number: X17-0339, HREC/17/RPAH518 and SSA/18/RPAH/633

General Aim: To determine if early and late post-operative continence is improved by performing a RoboSling procedure concurrently with RARP in men undergoing treatment for localised prostate cancer

Design: Randomized controlled trial Main endpoints: Urinary continence at 3 months postoperative Sample size: 120 Status: Recruiting Estimated Completion date: January 2021

Table 14C. Description of the PNUT Trial

Study Title: Early unclamping versus regular clamping in robot assisted partial nephrectomy: a multicentre, prospective, randomised controlled clinical trial looking at functional and oncological outcomes (PNUT)


General Aim: To assess the change in differential kidney function as demonstrated by DTPA nuclear renography and change in estimated glomerular filtration rate (eGFR) using early unclamping compared to regular clamping in RAPN

Design: Randomised controlled trial Main endpoints: Postoperative functional kidney recovery Sample size: 118 Status: Recruiting Estimated Completion date: December 2021

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Characteristics of the study population*

Overall, the mean age of the male patients was 64 years with most being born overseas (69%). Table 15 describes the characteristics of the patients that underwent RAS within urology.


Variables ROSE PNUT ROBOSLING Overall Urology

Overall (N=184)

2019/20 (N=38)

Overall (N=14)

2019/20 (N=8)

Overall (N=32)

2019/20 (N=22)

Overall (N=230)

2019/20 (N=68)

Gender, Male 184 (100%) 38 (100%) 8 (57%) 5 (63%) 32 (100%) 22 (100%) 224 (97%) 65 (96%) Age (years) 64 ± 7.5 66 ± 6.4 65 ± 11.2 69 ± 8.6 64 ± 6.9 64 ± 6.1 64 ± 7.8 65 ± 6.7 Insurance, Public 158 (88%) 36 (95%) 14 (100%) 8 (100%) 29 (91%) 20 (91%) 201 (87%) 63 (94%)

Country of Birth, Australia

48 (26%) 10 (26%) 6 (43%) 4 (50%) 17 (53%) 12 (55%) 71 (31%) 26 38%)

Admission, Elective 184 (100%) 38 (100%) 14 (100%) 8 (100%) 32 (100%) 22 (100%) 230 (100%) 68 (100%)



Overall robotic docking time was 5.9 minutes with an operation time of 5.2 hours. Patients undergoing robotic radical prostatectomy stay in hospital for 2.2 days on average, compared to 3.2 days for patients undergoing partial nephrectomy and 3.0 days for radical prostatectomy in the ROBOSling RCT study (Table 15).

4.2.5 Upper Gastrointestinal (UGI)

The UGI department received ethics and site specific approval in November 2017, with the first RAS case being performed in December 2019. To date, two UGI procedures have been performed at RPA by one surgeon.


The description of the Upper Gastrointestinal Series database is presented in Table 16.

Table 16. Description of the UGI study

Study Title: Robotic hepatobiliary and oesophagogastric surgery: A prospective database of clinical and oncological outcomes (RUGI)


General Aim: To determine clinical an oncological outcome, support quality improvement activities and feasibility.

Design: Prospective observational study

Main endpoints: • Clinical safety • Learning curve • Cost effectiveness

Sample size: Ongoing

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Status: Recruiting Estimated Completion date: Ongoing


Overall, the mean age of the male patients was 65 years with all patients being from Australia (100%). Table 17 describes the characteristics of the patients that underwent RAS within the upper gastrointestinal program.

Table 17. Characteristics of the study population Variables Overall (N=2) 2019/20 (N=2) Gender, Male 65.0 ± 1.0 65.0 ± 1.0 Age (years) 65.0 ± 1.0 65.0 ± 1.0 Insurance, Public 2 (100%) 2 (100%) Country of Birth, Australia 2 (100%) 2 (100%) Admission, Elective 2 (100%) 2 (100%)



The overall operation time for patients was 4.2 hours with patients staying in hospital on average for 3.0 days. Table 18 outlines the surgical outcomes for all patients.

Table 18. Operating time and length of stay Variables Overall (N=2) 2019/20 (N=2) Console time (hours) 1.6 ± 0.4 1.6 ± 0.4 Docking Time (mins) 9.0 ± 1.4 9.0 ± 1.4 Surgery Time (hours) 2.9 ± 0.8 2.9 ± 0.8 Operating time (hours) 4.2 ± 0.5 4.2 ± 0.5 Length of stay (days) 3.0 ± 3.0 3.0 ± 3.0



Completion rate for the patient reported outcomes is outlined in Table 19. The follow-up rate was 100% pre-operatively, 100% at 6 weeks and 50% at 6 months post-operatively.

Table 19. Patient Reported Outcomes Variables Due Received Pre-Operative 2 2(100%) 6 Weeks Post-Operative 2 2 (100%) 6 Months Post-Operative 2 1 (50%)


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4.3 MAKO Robotic System

The MAKO Robotic System was purchased in December 2016 with ethics approval received in February and the first case performed in April 2017. At the initial stage, the MAKO robot was only able to perform unicompartmental knee arthroplasty (UKA) and total hip arthroplasty (THA), with total knee arthroplasty (TKA) starting in October 2018 after the purchase of the MAKO’s specific software program. Currently there are 6 orthopaedic surgeons utilising the MAKO robot at the Institute of Rheumatology & Orthopaedics (IRO) based at RPA.

4.3.1 Orthopaedics

A total of 238 knee arthroplasties have been performed using the MAKO robot with 108 procedures performed in 2019/20. Overall, 177 (74%) were total knee arthroplasties, 59 (25%) were unicompartimental knee arthroplasties and 2 (1%) were total hip arthroplasties.

Currently the orthopaedic department has 2 main databases that collects patient characteristics, surgical outcomes (Lower Limb Robotic Arthroplasty [LOAD Database]) and patient reported outcomes (Patient Reported Outcomes in Lower Limb Robotic Arthroplasty [PRO-LOAD]).


A description of the LOAD and PRO-LOAD databases are outlined in Tables 18A-B. The PRO-LOAD database commenced in late 2018, therefore patient reported outcomes of the initial 31 patients that underwent unicompartmental knee arthroplasty are not reported.

Table 18A. Description of the LOAD Database Study Title: Lower Limb Arthroplasty Database (LOAD) HREC and SSA ref Number: LNR/17/RPAH/80 & LNRSSA/17/RPAH/155 General Aim: To collate clinical information following lower limb arthroplasty procedures Design: Prospective database Main endpoints: Surgical outcomes Sample size: Ongoing Status: Recruiting Estimated Completion date: Ongoing

Table 18B. Description of the PRO-LOAD Database

Study Title: Patient reported outcomes in lower limb robotic arthroplasty: A prospective cohort study database (PRO-LOAD)

HREC and SSA ref Number: HREC/18/RPAH/19 & SSA/18/RPAH/420

General Aim: To evaluate patient reported outcomes following lower limb robotic arthroplasty procedures.

Design: Prospective database Main endpoints: Patient reported outcomes Sample size: Ongoing Status: Recruiting Estimated Completion date: Ongoing

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Overall, most of the patients were female (58%) presenting with a mean age of 67 years. All procedures were elective with the majority being public patients (81%). A detailed description of the orthopaedic RAS population is outlined in Table 19.


Variables TKA UKA THA Overall Orthopaedic

Overall (N=177)

2019/20 (N=89)

Overall (N=59)

2019/20 (N=17)

Overall (N=2)

2019/20 (N=2)

Overall (N=238)

2019/20 (N=108)

Gender, Female

100 (56.5%)

54 (60.7%)

37 (62.7%)

9 (52.9%) 2 (100%) 2 (100%) 139 (58.4%)

65 (60.2%)

Age (years)

68.1 ± 9.4 68.6 ± 8.9 63.9 ± 10.2

62.4 ± 10.3

42.5 ± 3.2 42.5 ± 3.2 66.8 ± 9.9 67.1 ± 9.9

Insurance, Public

148 (83.6%)

74 (83.2%)

43 (72.9%)

10 (58.8%)

1 (50.0%) 1 (50.0%) 192 (80.7%)

85 (78.7%)

Country of Birth, Australia

80 (45.2%)

34 (38.2%)

30 (50.9%)

8 (47.1%) 1 (50.0%) 1 (50.0%) 111 (46.6%)

43 (39.8%)

Admission, Elective

177 (100%)

89 (100%) 59 (100%) 17 (100%) 2 (100%) 2 (100%) 238 (100%)

108 (100%)


The mean operating time was 2.2 hours for patients that underwent total knee arthroplasty, 1.8 hours for patients undergoing UKA and 2.8 hours for patients undergoing THA. Patients that underwent THA stayed longer in hospital (mean of 6.7 days) than patients that underwent UKA (mean of 3.8 days). No conversions to conventional arthroplasty occurred, however 2 TKA patients returned to theatre due to issues with prosthesis implantation though the reporting period (Table 20).

Table 20. Operating time and length of stay


Overall (N=177)

2019/20 (N=89)

Overall (N=59)

2019/20 (N=17)

Overall (N=2)

2019/20 (N=2)

Overall (N=238)

2019/20 (N=238)

Operating time (hours)

2.2 ± 0.8 2.3 ± 0.9 1.8 ± 0.3 1.9 ± 0.4 2.8 ± 0.0 2.8 ± 0.0 2.1 ± 0.7 2.2 ± 0.8

Length of stay (days)

5.3 ± 1.9 5.3 ± 1.8 3.8 ± 1.0 3.9 ± 1.0 6.7 ± 0.7 6.7 ± 0.7 4.9 ± 1.8 5.1 ± 1.8

Return to theatre 2 (1.1%) 2 (2.2%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 2 (0.8%) 2 (0.8%)

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Overall, most patients completed their patient reported outcome questionnaires. With completion rates ranging from 100% (preoperatively) to 64% (6 months post-operatively) (Table 21).

Table 21. Patient Reported Outcomes


Overall (N=177)

2019/20 (N=89)

Overall (N=28)*

2019/20 (N=17)*

Overall (N=2)

2019/20 (N=2)

Overall (N=207)*

2019/20 (N=99)*

Pre-operative

176 (99.4%) 89 (100%) 28 (100%) 17 (100%) 2

(100%) 2 (100%) 206 (99.5%) 108 (100%)

6 Weeks Post-Operative

137 (80.1%) Out of

171

67 (79.8%)

Out of 84

24 (88.9%)

Out of 27

15 (88.2%)

Out of 17

2 (50.0%) Out of 2

2 (50.0%) Out of 2

163 (81.5%)

Out of 200

84 (81.6%) Out of 103

6 Months Post-Operative

96 (65.3%) Out of

147

39 (65.0%)

Out of 60

15 (65.2%)

Out of 23

7 (53.8%) Out of 13

1 (100%)

Out of 1

1 (100%) Out of 1

112 (65.5%)

Out of 171

47 (63.5%) Out of 74

*PRO-LOAD commenced in late 2018, as such n=31 UKA were not enrolled into patient-reported outcome follow-up.

5. Research

5.1 Research in development

• Robotic-assisted, kinematic alignment (RASKAL) – Comparing individual and combined effectiveness of robotic-assisted and kinematic alignment in total knee arthroplasty when compared to computer-assisted surgery and mechanical alignment.

• Predictors of PROMs in Robotics – Evaluating the clinical and patient characteristics that lead to significant improvements in patients undergoing robotic arthroplasty.

• Understanding surgical team learning curve in robotic-assisted surgery - investigate the learning curve of the multidisciplinary RAS team using time-based metrics within the operating theatre, and associations with surgical and patient reported outcomes.

• Robotic-assisted colorectal surgery: the creation of a prospective database (update of current study)

5.2 Research in progress (ethics completed)

• Cost of robotic-assisted knee arthroplasty – Cost analysis comparing in-hospital cost between computer-navigated arthroplasty and robotic-assisted knee arthroplasty.

• Robotic-assisted arthroplasty learning curve – Evaluating the factors influencing the learning curve for surgeons performing robotic-assisted arthroplasties.

• Quality of life outcomes for patients undergoing robotic-assisted surgery • Cost of robotic-assisted surgery in the public sector: Hope or Hype?

5.3 Publications

• McBride, K. E., D. Steffens, K. Duncan, P. G. Bannon and M. J. Solomon (2019). Knowledge and attitudes of theatre staff prior to the implementation of robotic-assisted surgery in the public sector. PLOS ONE 14(3): e0213840.

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• Fernando, H., C. Garcia, T. Hossack, N. Ahmadi, R. Thanigasalam, D. Gillatt, S. Leslie, N. Doeuk, I. Smith and H. H. Woo (2019). Incidence, Predictive Factors and Preventive Measures for Inguinal Hernia following Robotic and Laparoscopic Radical Prostatectomy: A Systematic Review. The Journal of Urology 201(6): 1072-1079.

• Figueroa, F., Wakelin, E., Twiggs, J., Fritsch, B. (2019). Comparison between navigated reported position and postoperative computed tomography to evaluate accuracy in a robotic navigation system in total knee arthroplasty. Knee. 26(4): 869-875.

• Kam, J., N. Gore, R. Lai, H. Fernando, J. Boulas, D. Eisinger, P. Sved, A. Vasilaras, G. Watson and S. Leslie (2020). Identifying the pathological predictors of PSMA avidity-comparison of preoperative locoregional ga-68 PSMA PET-CT results with radical prostatectomy histopathology. The Journal of Urology 203(Supplement 4): e951-e951.

• Lam, D., S. Warrier, N. Ahmadi, S. Leslie and R. Rindani (2020). Value of Indocyanine Green Angiography to Guide Wound Management and Prevent Necrosis in a Robotic Surgical Procedure. Journal of Endourology Case Reports.

• Yao, J., J. Laurence, A. Hameed, T. Lee, R. Allen, H. Pleass, L. Yuen, V. Lam, S. Leslie and L. Kim (2020). How to do it: a robotic kidney autotransplant. ANZ Journal of Surgery.

• Daniel Steffens, Kathryn Wales, Clare Toms, David Yeo, Charbel Sandroussi, Ashish Jiwane. What surgical approach would provide better outcomes in children and adolescents undergoing cholecystectomy?: results of a systematic review and meta-analysis (2020). Annals of Pediatric Surgery.

5.4 Conference presentation and posters

• KE McBride, D Steffens, C Stanislaus, M Solomon, T Anderson, R Thanigasalam, S Leslie, PG Bannon. Detailed cost of robotic-assisted surgery in the Australian public health sector: from implementation to a multi-specialty caseload [Poster: RACS ASC]

• S Kim, J Fallot, C Stanislaus, D Steffens G Mak, A Virk, S Jackson, R Thanigasalam, S Leslie. Robotic Enucleation of Prostate for Benign Prostatic Hyperplasia, a Trans-vesical approach [Video Abstract: ICS 2020]

• S Kim, J Fallot, D Steffens, L Chan, C Stanislaus, S Leslie, R Thanigasalam. Anatomical factors influencing early recovery of urinary continence following robot-assisted radical prostatectomy. [Video Abstract: ICS 2020]

6. Credentialing

Credentialing is another core component of the comprehensive governance framework surrounding RAS at RPA. The procedures established for both senior and junior medical staff seeking to have surgical robotics included in their scope of practice have been well defined and ensures that all staff sufficiently satisfy the criteria for them to be safely and competently involved in the surgical robotics program.

6.1 Medical staff with approved scope of practice

As at June 2020, there were 6 proctors, 19 senior medical staff credentialed, 5 senior medical staff with interim clinical privileges, 5 junior medical staff able to operate on the console and 8 junior medical staff able to assist at the bedside credentialed at RPA across the six specialties involved in the surgical robotics program. Full details of these staff are outlined in Table 22.

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Table 22. List of senior and junior medical staff with approved surgical robotics scope of practice

Staff Level Cardiothoracic Urology Gynaecology Colorectal Orthopaedics Upper GI

Proctors Tristan Yan Feb-19

Scott Leslie Apr-16 Ruban Thanigasalam Jul-16 Andre Lalak Feb-17

Scott Leslie Apr-16 Trevor Tejada-Berges Nov-16 Vivian Yang Jun-19

Scott Leslie Apr-16

(Not required) Scott Leslie Apr-16

Senior medical staff

Tristan Yan Feb-19 Christopher Cao Mar-19

Scott Leslie Apr-16 Ruban Thanigasalam Jul-16 Paul Sved Oct-16 Andre Lalak Feb-17 Arthur Vasilaras Feb-18

Trevor Tejada-Berges Nov-16 Vivian Yang Oct-17 Michael Cooper Oct-17

Kirk Austin Dec-17 Peter Lee Feb-18 Chris Byrne Mar-19

Brett Fritsch Mar-17 Sanjeev Gupta Jul-18 Maurice Guzman Feb-19 Richard Boyle Feb-19 Mark Horsley Feb-19

Jerome Laurence Dec-19

Senior medical staff - interim privileges

Anthony Marren Feb-18 Nesrin Varol Aug-19

Daniel Franks Sep-19

David Yeo Jul-18 David Martin Feb-19

Junior medical staff – console under supervision

Hilary Fernando Jan-19 Jonathan Kam Aug-19 Jeremy Fallot Nov-19 Wenjie Zhong Jun-20

Russell Duncan Oct-19

Junior medical staff – assist at bedside

James Farag Apr-19 Nicholas McNamara June-20

Jonathan Kam Dec-18 Nicholas Walker May-19 Jeremy Fallot Oct-19 Wenjie Zhong Feb-20 David Habashy Feb-20

Russell Duncan Feb-19

6.2 Auditing

The Training and Credentialing Working Group had planned in March 2020 to review the logbooks of all credentialed senior medical staff (included cases from both RPA and undertaken elsewhere) with a requirement that all staff undertake a minimum of 20 RAS cases annually. As a result of COVID-19, this process has been delayed and it is planned the annual audit will take place in the first half of 2020/21 financial year.

The review undertaken in May 2019 recommending continuation of all surgeon clinical privileges was endorsed by the Medical and Dental Appointments Advisory Committee in August 2019 and approved by the Chief Executive.

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6.3 Credentialing Collaboration

The IAS and Executive Director of Medical Services, Dr Kim Hill, provided advice to Executive staff at Royal Melbourne Hospital and Royal Brisbane and Women’s Hospital during this period on the credentialing pathways established at RPA, which has further strengthened the collaboration between public hospitals in how to best manage the governance within this area.

7. Surgical and Robotics Training Institute (RTI)

7.1 Overview

The RPA Surgical and Robotics Training Institute (RTI) was established in March 2017 and is the only officially designated training facility for da Vinci robotic surgery in the southern hemisphere. A unique partnership was formed between SLHD, Device Technologies, Intuitive Surgical, and the University of Sydney to establish the facility bringing together clinical care, research, training and state of the art medical technology.

7.2 Training and Courses

In 2019/20 the RTI delivered 80 courses to a total of 112 participants trained including surgeons and surgical fellows (Table 23). Surgeons trained at the RTI practice locally and internationally, many having travelled interstate as well as internationally from New Zealand and South-East Asian countries including Singapore and Vietnam.

The RTI was issued with an anatomy license (under the umbrella of the existing IAS license) by NSW Health and SLHD Public Health Unit early in 2019. The facility ran a total of 7 cadaveric workshops in 2019/20 with 23 surgeons being trained.

Due to workplace safety and travel restrictions set in place resulting from the COVID-19 pandemic, the final course for the 2019/20 financial year was run on 26 March 2020 thus decreasing the overall courses run for the year, reflected in Table 23 and Figure 4.

Table 23. Overview of RTI training delivered Courses Participants Basic Training (by specialty) Gynaecology 19 19 Colorectal 14 14 Urology 10 10 General 7 7 Upper GI 4 4 Cardiothoracic 3 3 ENT 2 2 Surgical Fellows 7 14 Sub-total basic training 66 73 Advanced Training Inanimate Workshop (Cadaveric) 7 23 Advanced Training 4 10 Introductory Course 2 6 Feasibility Study 1 0 Sub-total Advanced Training/Other 14 39 Grand Total 80 112

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Figure 4. Total participants trained and courses delivered in the RTI by financial year

Three main types of courses are run at the RTI: Basic Training, Advanced Training and Introductory Courses. Starting with the basic training course, this commences surgeons on the pathway to developing technical and clinical skill in using the da Vinci robot. Surgeons can then advance with a progressive, surgeon-led education series focused on clinical application, advanced techniques and procedure refinement. The surgeons leading these courses are often internationally recognized as leaders in their field.

Basic Training focuses on basic techniques including retraction of tissue in the abdominal, pelvic and thoracic cavity, dissection of vessels and lymph nodes, dissection of the uterine broad ligament, resection of the uterine body and lateral leaflets of the suspensory ligaments to surgically access the ureters. The training also includes basic tissue handling skills and suturing drills, organ to organ anastomosis, intercorporeal anastomosis as well as a simulated hernia repair.

Advanced Training teaches participants the clinical application of the surgical robot to prepare for procedures. This includes the skills learned in basic training, procedure and system setup, patient positioning, surgical approach with the technology, clinical application for specific procedures and use of advanced instruments and technology during surgery.

Introductory Courses are designed to provide consultant level surgeons with an introductory educational experience with the surgical robot. The objective of these courses is to evaluate the feasibility and value of surgical robots in specialties where robots are not commonly used, such as gastrointestinal and thoracic surgical specialties and are not a substitute for the more involved Basic Training Course. Surgeons working in specialties where robot use is becoming usual practice such as gynaecology and urology would be required to complete a Basic Training Course

7.3 Animal Welfare

Animal welfare is the utmost priority of the RTI and a team of veterinary staff are dedicated to the care of all animals housed in the RTI. The training protocol is approved and governed by the SLHD Animal Ethics Committee. The training protocol has been renewed this year for 2020/21.

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8. Robotics Conferences 8.1 Sydney Robotics Summit 2020 (postponed)

The Sydney Robotics Summit 2020 was due to be held on 12 and 13 June at the Sydney Masonic Centre but was unfortunately postponed in early March due to COVID-19. The program was being held in collaboration with the internationally recognised surgical robotics group, Society of Robotics Surgery (SORS).

The program was advertised through surgical societies, previous SRS attendees and internal distribution channels with an estimated 300 delegates planning to attend across the two days. This program was going to be our largest SRS with six specialties and over 35 speakers confirmed. In addition, 10 major sponsors were confirmed with another nine interested in being involved in the conference prior to the official postponement demonstrating the outstanding industry support for the event.

The two day program had three plenary sessions and seven specialty programs. Plenary sessions included the future of robotic surgery, nightmares in robotic surgery and robotic training.

The specialty and program leads were:

1. Cardiothoracic: Dr Christopher Cao and Professor Tristan Yan 2. Colorectal: Dr Peter Lee 3. Gynaecology and Gynae Oncology: Dr Michael Cooper and Dr Trevor Tejada-Berges 4. Head & Neck/ ENT: Dr Hubert Low 5. Nursing: Mr Kevin Ancog 6. Orthopaedics: Dr Brett Fritsch 7. Upper GI: Dr David Yeo 8. Urology: Associate Professor Ruban Thanigasalam and Dr Scott Leslie

An impressive list of international speakers had confirmed including:

1. Dr Craig Rogers (USA) – Urology 2. General Zhang (China) – Urology 3. Dr Vipul Patel (USA) – Urology 4. David Bouchier-Hayes (UK) – Urology 5. Sebastian Beley (France) – Urology 6. Dr Justin Collins (UK) – Urology 7. Prof Yoon Suk Lee (South Korea) – Colorectal 8. Dr Chinnusamy Palanivelu (India) – Upper GI 9. Dr James Ngu (Singapore) –– Colorectal 10. Dr Susan Lau (Canada) – Gynaecology

8.2 World Robotics Symposium – Australian Program

The Society of Robotic Surgery (SORS) were due to hold a program in August but due to COVID-19 they moved their program to a virtual online format from 31 July to 2 August 2020.

Conference convener, Dr Vipul Patel asked SRS conveners; Associate Professor Ruban Thanigasalam and Dr Scott Leslie to coordinate and deliver the Australian section of the program, which will be urology focused and held on Saturday 1 August 2020. Planning for this virtual program has been undertaken during the 2019/20 financial year.

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Robotic urological surgeons from around Australia, including a number of speakers from the planned SRS2020 program will be presenting at the virtual conference via ZOOM. The full day will include discussions, presentations and semi-live surgical cases.

8.3 National Research Think Tank: Robotic Surgery in the Public Sector

The IAS developed a one day research forum focused on RAS in the public sector, which was to be held on the RPA campus on Friday 27 March 2020. The program included exploring the latest research within specialty areas, the current research being undertaken across public hospital sites, and most importantly identifying priority areas for potential collaboration. Representatives from 11 different public hospitals across Australia were planning to attend including from states WA, SA, NSW, VIC and QLD. It was anticipated this would include approximately 70 delegates of surgeons, senior administrators and researchers.

Unfortunately due to COVID-19, the Think Tank was postponed and plans are being developed to pivot this event toward a more regular online collaboration. Despite the disappointment of the event being postponed, it was still a productive exercise in communicating and establishing connections with many of the leaders in robotic surgery within public hospitals across Australia and certainly the enthusiasm for holding the event was encouraging.

9. Future Plans

9.1 National collaborations

Several collaborations with other Australian centres are in the initial stages of planning including with Royal Brisbane and Women’s hospital, which will include combining our program wide datasets to investigate the uptake, surgical outcomes and cost of robotic-assisted surgery in the Australian public sector.

Furthermore, there is support to convert the Research Think Tank into a quarterly ZOOM forum for public hospitals across Australia to collaborate on research opportunities and to discuss commonly experienced challenges.

In addition, contribution to the IAS webinar series and podcasts being developed will also assist in establishing further collaborations within this program.

9.2 Sydney Robotics Summit 2021

The Sydney Robotics Summit 2021 program will be held on Friday 11 and Saturday 12 June 2021. The program will resemble the same program which was developed to be run in 2020 but at this stage will not include any international faculty attending in person with online platforms to be utilised.

10. Conclusion

The surgical robotics program at RPA is one of the broadest multi-specialty public programs in Australia and is truly unique in that it is governed by a comprehensive research framework whereby every patient undergoing RAS is enrolled in a research study. The use of RAS on the campus is also strongly embedded in ongoing education and training.

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The success of the program is due to the vision and support of SLHD and RPA senior management, the dedication and commitment of the IAS and surgical academics, and the skill of the many medical, nursing, allied health and research teams involved.

The development and future direction of the program will focus on the incorporation of further surgical procedures, and the opportunities for national and international collaboration. Certainly the current program is a model for how other surgical technology can be introduced into the public sector.

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11. Appendix

annual report 2019/20 - slhd.nsw.gov.au

Documents