When the first da Vinci S surgical robot was commissioned at The Wesley Hospital in Brisbane in 2010, robotic surgery in Australia was in its infancy, with limited access to the cutting-edge technology scattered across the country.

Internationally, the technology was being adopted more rapidly, especially in the United States where the robotic prostatectomy was pioneered in Detroit, Michigan.

Wesley urologists providing prostate cancer surgery were the first to use the robot when it arrived, performing the first robotic radical prostatectomy at the hospital in January 2010.

Since then, the Wesley has gone on to become the highest volume robotics centre in the country, and in 2018 achieved accreditation as a Centre of Excellence in Robotic Surgery following independent review by the Surgical Review Corporation (SRC).

The hospital is now home to three da Vinci surgical robots and offers robotic surgery across nine specialities, with more than 40 surgeons embracing the technology.

This year, the Wesley will mark it’s 10,000th surgical case assisted by the da Vinci robot and nearly 15 years since the beginning of its robotics program which has contributed to advancing and reimagining surgical care for its Queensland patients.

Wesley urologist, Dr Geoff Coughlin, saw robotic surgery for the first time twenty years ago while training in London and was immediately attracted to the level of precision the technology could bring to surgery.

He went on to complete two years of robotic surgery training in the United States, all the while hoping that one day the state-of-the-art technology might be available at home in Brisbane.

Fast forward and Dr Coughlin is now Australia’s most experienced and highest volume robotic prostatectomy surgeon, having performed more than 4,000 robotic operations.

“Immediately I was attracted to the opportunity robotics provided to do very complex surgery minimally invasively and with finesse that I don’t think can be matched with other operative techniques,” Dr Coughlin said.

“Minimally invasive surgery using the robot allows for complex surgery to be done with significant dexterity, generally making it safer and better surgery.

“The progression of robotics in urology has happened rapidly and today it’s rare for a patient to have open surgery in the work that we do,” he said.

Wesley colorectal surgeon, Dr Carina Chow, said the move to robotic surgery began more slowly in the colorectal space, but gained significant traction as evidence of the outcomes and advantages became evident.

Today, Dr Chow performs almost all of her cases with the da Vinci robot.

“When I started, there was no one doing robotic colorectal surgery in Australia and it was difficult to prove the benefits with so few runs on the board. In Queensland, we’ve always been minimally invasive pioneers in colorectal surgery, so it was also a challenge to consider changing what we were already doing very well,” Dr Chow said.

“However, there were still things that we were struggling to do laparoscopically, so in 2013, I went to Korea to train in robotic surgery, and commenced my first cases at The Wesley Hospital later that same year.

“Initially I used robotic surgery for selected cases only but as the technology, experience and availability grew, we were able to expand this to all aspects of colorectal surgery and are now able to do those difficult cases minimally invasively without conversion,” she said.

Robot-assisted surgery is a minimally invasive surgery performed through small incisions using high-definition, 3DHD cameras and specially designed articulating surgical tools.

For patients, it can offer a range of benefits including less pain, shorter hospital stays, reduced blood loss, and most significantly the opportunity in some cases to have minimally invasive major surgery.

“For surgeons, it means operating with more control and with greater finesse, and most importantly it can assist us to perform better and safer surgery,” Dr Coughlin said.

“The robot also makes it far easier to teach minimally invasive surgery to the next generation as well. Its technology creates the perfect teaching environment,” Dr Chow added.

“I like that fact that when assisted by the robot I can see every fibre of every tissue and I can perform an extremely accurate operation as a result,” she said.

In some cases, robotics has made surgery a possibility for patients who may have previously been considered ineligible.

“A lot of factors that made traditional surgery difficult are more manageable with robotics. For example, urology patients who may have previously been excluded are now becoming eligible for robotic surgery because those difficulties are less of a concern,” Dr Coughlin explained.   

“In my speciality, this can include patients with a small pelvis, large prostate or obesity, and with reduced blood loss, there is less concern about operating on patients with a cardiac history for example.”

With access to multiple robotic platforms at the Wesley, it can also mean more than one surgeon operating robotically in the same place, at the same time.

“The advantage of having three robots at a hospital like the Wesley where so many surgeons are robotically trained, is that you can have multiple consoles, and surgeons, operating together in the same room,” Dr Chow said.

“For example, for a patient with combined rectal and prostate cancer, I can operate with a urologist on another console. Or for a patient with locally advanced cancer, we can have multiple specialists involved.”

Looking ahead, both specialists agree, robotic surgery is the way of the future.

“It took me a while, but I’m definitely a convert now. Robotics is a no brainer, if you have access to the robot, you use the robot,” Dr Carina Chow said.

“Technology always improves where there is a need and that is what robotics has been doing, and where it’s heading. It’s seeing the areas where we have difficulty, and using technology to make it easier and possible,” she said.

Dr Geoff Coughlin agreed, saying, “I think the big advances to come over the next decade will include constant improvement of the robots we use, and I expect we’ll see them become even more dexterous and less invasive allowing us to operate from a single cut or port.”

“Robotics will continue to advance to make surgery safer, quicker, and better and that’s a great thing,” he said.

UnitingCare hospitals Group Executive, David Harper, said the program’s growth to reach 10,000 cases this year is a credit to the Wesley’s specialists and robotics teams.

“It’s important to highlight the multi-disciplinary team involved, who have embraced robotic technology and the opportunity to learn and continually improve. Their combined mix of skills and expertise underpins the success of the program and is the recipe for achieving accreditation as a Centre of Excellence,” David said.

“The expansion of our robotics program at the Wesley, and more recently across our UnitingCare group of hospitals, has opened the doors to a range of minimally invasive surgical options for our patients.

“Like so many in our industry, we’re excited about the future of robotics and what it will mean for those we care for.”

In the years since launching at The Wesley Hospital, UnitingCare has expanded access to robotic surgery across its network of hospitals, with da Vinci robots also available at St Andrew’s War Memorial Hospital and Buderim Private Hospital on the Sunshine Coast.

The group is also home to four Mako orthopaedic robots which are benefiting patients in Brisbane at The Wesley and St Andrew’s War Memorial Hospital, at Buderim Private Hospital and St Stephen’s Hospital in Hervey Bay.



First published by Catholic Health Australia in Health Matters Spring 2024.