RAMIO New Zealand: First Robotic Oesophago-Gastric Surgery Programme Launched in NZMJ

The Dawn of Robotic Precision in New Zealand Surgery

New Zealand has taken a significant step forward in surgical innovation with the launch of the country's first Robotic Assisted Minimally Invasive Oesophago-Gastric (RAMIO) programme. Published in the New Zealand Medical Journal (NZMJ) on February 13, 2026, this milestone details the successful implementation at North Shore Hospital, a tertiary centre under Health New Zealand – Te Whatu Ora Waitematā. 101 0 This development marks the evolution from traditional open surgeries to advanced robotic techniques, promising better outcomes for patients battling complex upper gastrointestinal cancers.

Oesophago-gastric surgery addresses conditions affecting the oesophagus (the tube connecting the throat to the stomach) and stomach, primarily cancers that demand precise resections to remove tumours while preserving function. The introduction of RAMIO combines robotic precision with minimally invasive approaches, reducing trauma compared to large incisions in conventional methods. This programme's launch underscores New Zealand's commitment to adopting global best practices in a resource-conscious public health system.

Led by surgeons with specialised training, including senior author Suheelan Kulasegaran, who holds formal certifications in oesophago-gastric and robotic surgery, the initiative builds on a prior minimally invasive oesophagectomy (MIO) programme. This stepwise progression ensures patient safety through rigorous auditing and protocolised care. 101

Oesophageal and Gastric Cancer Burden in Aotearoa

Oesophageal cancer remains a formidable challenge in New Zealand, with approximately 330 new diagnoses annually and around 251 deaths, reflecting low survival rates of about 17-20%. 69 61 Incidence is rising, particularly among Māori and Pacific populations, exacerbated by factors like smoking, obesity, and gastro-oesophageal reflux disease (GORD). Gastric cancer, though less common, adds to the caseload, with surgeries often involving gastrectomy or oesophagectomy.

Traditional open oesophagectomy, the gold standard for curative treatment, involves large thoracic and abdominal incisions, leading to prolonged recovery, high complication rates (up to 50%), including pneumonia, anastomotic leaks, and cardiac issues. These procedures demand multidisciplinary teams, including oncologists, radiologists, and intensivists, highlighting the need for advanced techniques like RAMIO to improve accessibility and equity in remote areas like the North Island.

Statistics from Te Aho o Te Kahu indicate cancer diagnoses will surge to over 45,000 by 2044, pressuring surgical capacity. Innovations like RAMIO could alleviate this by shortening hospital stays and reducing intensive care unit (ICU) demands. 66

Demystifying RAMIO: Technology Meets Surgical Expertise

RAMIO stands for Robotic-Assisted Minimally Invasive Oesophagectomy, a technique using systems like the da Vinci Surgical System. Surgeons operate from a console, controlling robotic arms equipped with 3D high-definition cameras and wristed instruments offering seven degrees of freedom—far surpassing human hands.

The procedure unfolds in phases: the abdominal phase mobilises the stomach to create a conduit replacing the oesophagus, performed robotically for precision around vessels and lymph nodes; the thoracic phase, often thoracoscopic, accesses the chest cavity. Neoadjuvant chemotherapy precedes surgery to shrink tumours, followed by adjuvant therapy if needed.

Step-by-step: 1) Patient preparation with multidisciplinary assessment; 2) Robotic docking and port placement; 3) Lymphadenectomy and tumour resection; 4) Anastomosis (reconnection); 5) Comprehensive post-op monitoring. This contrasts with open surgery's blunt dissection, minimising tissue damage. 101

North Shore Hospital's Trailblazing RAMIO Programme

At North Shore Hospital in Auckland, the RAMIO programme emerged from an established MIO framework. James Z Jin, MBChB PhD candidate at the University of Auckland, alongside Yazmin Johari, Michael Rodgers, and Suheelan Kulasegaran, documented the launch in NZMJ. 101 83 As New Zealand's first public system RAMIO on a funded patient, it sets a precedent for nationwide rollout.

Implementation involved meticulous planning: proctoring, simulation training, and quality audits tracking failure-to-rescue rates. The hospital's general surgical unit adapted swiftly, leveraging Te Whatu Ora's support.Read the full NZMJ publication.

A Landmark First Case: Patient Outcomes

The inaugural RAMIO treated a 74-year-old man with locally advanced distal oesophageal adenocarcinoma post-four neoadjuvant chemotherapy cycles. Theatre time totalled 515 minutes, with robotic abdominal and thoracoscopic thoracic phases.

Post-op: 4-day ICU stay, transient delirium, and rapid atrial fibrillation (septic workup negative). No conduit necrosis or leak. Histopathology: ypT2N2 (residual tumour, 4/19 positive nodes), clear margins—all oncological benchmarks met. Discharged day 7, adjuvant chemotherapy followed. 101

This case exemplifies RAMIO's feasibility in public settings, mirroring global successes.

Evidence-Based Benefits of RAMIO Over Traditional Methods

Meta-analyses show RAMIO reduces pneumonia (8.6% vs 15.2%), overall complications, and operative blood loss, with higher lymph node yields (critical for staging). 91 93 Ergonomics prevent surgeon fatigue, enabling complex dissections in high-BMI patients.

• Shorter ICU/hospital stays
• Improved resection margins
• Equivalent long-term oncological outcomes
• Better quality of life recovery

Compared to open surgery, minimally invasive variants like RAMIO halve pulmonary complications. 97 PubMed abstract.

Navigating Challenges in RAMIO Adoption

High costs, training needs, and limited robots (eight da Vinci systems nationwide, mostly private) pose hurdles. 57 North Shore overcame via phased rollout: MIO first, then robotic abdominal.

Solutions include RACS robot courses, simulation, and proctoring. Institutional buy-in ensures sustainability. 70

Higher Education's Pivotal Role in Robotic Surgery Training

Universities like Auckland drive progress; James Z Jin's PhD exemplifies research integration. 84 Medical schools need tailored curricula: online modules, VR simulation, dual-console mentoring.Craft your academic CV for surgical research roles.

RACS offers linear training; Auckland's mechatronics research advances devices. 71 73 For aspiring robotic surgeons, explore research jobs in higher ed.

Research Frontiers and Publication Impact

The NZMJ paper catalyses local studies on RAMIO outcomes, building on global IDEAL framework reviews. 4 Metrics like lymph node yield and failure-to-rescue will benchmark progress. University collaborations could yield RCTs, enhancing NZ's research profile.

Stakeholder Perspectives and Systemic Impacts

Surgeons praise ergonomics; patients gain faster recovery. Te Whatu Ora eyes expansion, potentially reducing private-public disparities. Māori health advocates stress equitable access.Discover NZ academic opportunities.

Economically, shorter stays offset robot amortisation long-term.

Photo by Matthew Stephenson on Unsplash

Future Horizons for RAMIO in New Zealand

With proctoring scaling, RAMIO could standardise oesophago-gastric care. Integration with AI imaging and trials like Ferronova's fluorescence-guided surgery loom. 32

For professionals, rate your professors, seek higher ed jobs, or career advice. This launch heralds a precise, patient-centric era.