Same-day hospital discharge after bowel cancer surgery becomes an Australian first

A patient at Royal Perth Hospital (RPH) has become part of what is believed to be an Australian first, leaving hospital just hours after undergoing surgery to remove a malignant bowel tumour.

The milestone was achieved earlier this month through RPH’s new same-day discharge program for colectomy patients, following the introduction of the hospital’s Da Vinci Xi surgical robot.

RPH consultant colorectal surgeon Associate Professor Abraham Jacob used the advanced robotic system to perform the procedure on a woman in her 70s, who was able to return home on the same day despite having several high-risk factors.

“It means that patients who have bowel surgery go home the same day, which hasn’t been done anywhere else in Australia, as far as I am aware,” A/Professor Jacob said.

The patient was supported after discharge by the RPH Home Hospital Team, which provided close monitoring and ongoing clinical oversight.

“Blood tests were arranged at home, the nurses checked on her incision sites and dressings and one of our registrars checked in by phone every day until all the boxes were ticked and she was able to be discharged from care,” A/Professor Jacob explained. “She will then follow up in the clinic once the pathology results arrive.”

Same-day discharge colectomy programs were first introduced in the United States during the COVID-19 pandemic, as hospitals looked for ways to reduce inpatient stays, increase bed availability and minimise infection risks.

The approach has gained further momentum as advances in robotic surgery have made minimally invasive procedures more accessible, particularly for patients where traditional keyhole surgery can be more challenging.

With obesity rates increasing, laparoscopic surgery can become more technically difficult in larger patients, and robotic technology offers an alternative that can improve precision and access.

“It’s minimally invasive and because the camera is a 3D camera, it allows us to feel like we actually have our hands inside the patient,” A/Professor Jacob added. “That adds a lot of advantage to access difficult areas and you’re not anchoring instruments on the patient, so you cause less trauma on the abdominal wall.”

The introduction of same-day hospital discharge follows the hospital’s first robotic colorectal procedure in April, performed by fellow RPH Consultant Colorectal Surgeon Dr Ruben Rajan.

Dr Rajan completed a right hemicolectomy using the hospital’s Da Vinci Xi robot, removing part of the bowel and reconnecting the remaining healthy sections.

“We completed a right hemicolectomy and everything has gone really well,” Dr Rajan said. “This is an operation where we remove a portion of the bowel and make a connection between the two good ends of bowel – it’s typically done for cancer or benign diseases of the colon.”

Robotic surgery provides surgeons with enhanced vision through 4K, 3D imaging, while articulating instruments allow greater movement and access around difficult angles. For patients, the benefits include reduced post-operative pain, faster mobilisation and earlier discharge. Surgeons can also complete bowel joins inside the abdomen rather than externally, supporting a quicker recovery pathway.

Robotic surgery has historically been more widely used in urological procedures, including prostatectomy and nephrectomies. Evidence is now also growing for its use in more complex procedures, including liver and pancreas surgery. The technology is enabling surgeons to perform increasingly complex operations through minimally invasive techniques, resulting in smaller incisions, shorter hospital stays and earlier returns to normal activities.

The RPH Research Foundation is providing $5 million over the next 10 years to support the Da Vinci Surgical Robot, with the East Metropolitan Health Service (EMHS) funding the remaining costs.

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