Author: Dr Finn McLennan Battleday
Department of General Surgery, Bay of Plenty Health Te Whatu Ora

The General Surgeons Australia (GSA) Annual Scientific Meeting (ASM) held in the Gold Coast this year showcased an exciting conference with many highlights. It underscored the significant strides in hernia surgery and demonstrated the collaborative spirit thriving within our Pacific surgical community.

A standout theme was the advancement in hernia surgery—with the field on the cusp of a transformative era—particularly with regard to the development of new robotic systems. These advancements not only signal a competitive market, but also promise to make robotic surgery more accessible, potentially improving outcomes for both surgeons and patients.

Several of these new robotic systems have impressive demonstrations of capabilities in hernia surgery. Attendees had hands-on opportunities to test and evaluate the operability of these devices. What stood out was not just the technological sophistication, but also the user-friendly nature of these systems, making them accessible to surgeons with varying levels of robotic surgery experience.

While the potential benefits of these robotic systems in hernia surgery continue to be pursued in the literature, they offer appreciable improvements in ergonomics and handling from a surgeon’s perspective. Less physical strain and improved optics are two factors that are anecdotally appreciable and were exciting to discuss with colleagues. The positive outcomes from the operator perspective could include: increased longevity for surgical practice, reduced career-impacting strain, and the laying of a foundation for improvement in surgical outcomes.

Parallel to the discussions on robotic technology was the growing adaptability in the use of surgical mesh. The conference also brought to light the innovative concept of using mesh prophylactically in high-risk patients, potentially preventing hernia development following abdominal surgeries. This forward-thinking approach can reduce the burden of hernia disease and its recurrence throughout the Pacific region.

One stimulating conversation with a hernia specialist included a discussion on the potential of a two-surgeon approach in complex hernia repairs involving mesh. This collaborative method—particularly in the context of performing different linear modules of an operation—reflects a broader movement towards team-based surgery. This is increasingly being recognised as beneficial for challenging surgical scenarios. By combining expertise, surgeons can ensure a higher standard of care, address intraoperative challenges effectively, and contribute to a learning environment that benefits all involved, including Trainees.

Within the delegation, Pasifika colleagues and nine recipients of the 2023 GSA Pacific Island Travel Grants from Fiji, Tonga, Solomon Islands, and Papua New Guinea attended in-person, as well as surgeons and accredited surgical Trainees from Aotearoa New Zealand. The GSA ASM provided a platform for discussions about the unique challenges faced by these groups. Surgeons from Aotearoa New Zealand, Australia, and the Pacific Islands shared insights and experiences—highlighting the necessity of culturally competent healthcare.

The discourse was not limited to identifying issues but extended towards actionable strategies to improve access and outcomes for Indigenous patients. Aotearoa New Zealand’s surgeons and Trainees often bridge two surgical environments, balancing between advanced surgical settings and the unique healthcare challenges of their Indigenous populations. In relation to service delivery in hernia, the use of robotic systems utility of mesh, including its prophylactic application, is a phase we are prepared for, but resource restraints hinder progress in the public sector.

This exchange of knowledge and techniques underlined a key aspect of modern surgical practice—adaptability. Surgeons practicing in tertiary centres with access to robotic equipment were able to share their experiences with those working in the challenging and resource-constrained settings of remote island communities.

The Aotearoa New Zealand contingent, with their experience in both urban and rural settings, provided valuable insights into adaptable surgical practices. This drew down to an area within surgical training with scope to build the training experience and develop the Pacific partnership further. Enter the mutual benefits of cross-regional collaboration.

The opportunity to experience six months to a year of surgical training in an exchange with Fijian surgical trainees has considerable benefit. Minimally invasive work is becoming more common and open operating can become a focus for Trainees wanting to gain more experience in such techniques.

The discussions at the conference went beyond the sharing of knowledge. A program such as this, under supervision from RACS accredited Fellows in Fiji and both Australia and Aotearoa New Zealand would offer integrated cultural competence and mutual training benefits.