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House of Assembly - Fifty-Second Parliament, First Session (52-1)
2010-05-27 Daily Xml
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SURGICAL ROBOT

The Hon. R.B. SUCH (Fisher) (12:10): I move:

That this house requests the state government to purchase the latest model robot (the da Vinci Si) for use at the Royal Adelaide Hospital so that a wider range of intricate surgical procedures, with minimal patient impact, can be undertaken.

I do not know whether members are aware or know much about the da Vinci Si robot. I had the pleasure of being subjected to it about five years ago when I was diagnosed with prostate cancer, so I have taken an interest in the da Vinci Si robot. However, we have now reached the point where that model, which was installed approximately six years ago, will soon need to be upgraded. Unfortunately, it cannot be adapted to take the latest modifications. The minister has indicated to me that, from his advisers, he believes the current robot has four years life left in it. The surgeons who use it indicate to me that there is much less life in it than that. Of course, if the machine is replaced with a more modern model, it does not mean to say that the existing model could not be used for a range of surgeries. In fact, it is almost certainly being used right at this moment.

Members may recall that the reason we have the robot at the Royal Adelaide is as a result of the generosity of Gordon Pickard and, I think, one of the Cooper family and a few others. We are talking about a machine which sells for just under $2 million—not cheap. It was a very generous gesture on the part of Gordon Pickard. People might say, 'Well, he benefited from it.' He did not actually. He experienced the da Vinci Si robot at Epworth Hospital in Melbourne and he was so impressed, and I think thankful—and this is on the public record—that his cancer had been removed in good time and he is healthy as a result, that he donated one to the Royal Adelaide Hospital. One of the fantastic things about that donation is that it is in a public hospital where it is available to people irrespective of their financial means. It is not for the exclusive benefit of people who are affluent. Any person who needs that machine can have access, on a medical needs basis, at the Royal Adelaide.

Just briefly, the way it operates (pardon the pun) is that the surgeon watches a big screen—the surgeon is not next to the robot; he is in the same room generally, but does not have to be, he could be on the other side of the world—and controls the robot and its arms. It makes a small incision in the person, depending on the operation, and then the arms of the robot go inside and do whatever is required. One of the surgeons, Dr Peter Sutherland, has performed in excess of 800 operations alone using that machine. Apart from the reduced trauma—because people can walk out of hospital within a day or two after having the surgery because of its minimal impact, even though it is major surgery—the savings to the health system are considerable. Peter Sutherland alone has performed over 800 operations using the robot, and Dr Wells and other surgeons have also carried out surgery with it.

It has been used primarily for prostatectomies (the removal of the prostate), and it has been very successful in that regard. The new model, the da Vinci Si, is capable of doing things that the current model cannot easily do. For example, the new model can perform intricate throat cancer surgery and it can remove cancers from within the head, as I say, by going down the throat. Currently, some of those surgical procedures require the jaw to be broken, but with the robot that is not necessary. Just imagine the savings in time and trauma.

Likewise, with the new model robot now on offer people can have, rather than a major operation, literally with their throat cut, the cancer removed without the necessity for a major external cut to their throat or anywhere else. It can do gynaecological work, which is great, and it can do sophisticated kidney cancer surgery and major bladder surgery without the sort of impact that normally occurs with that type of surgery.

One of the great things about the robot is that there is very little bleeding. When the robot is working, it is actually pumping carbon dioxide into the body so that there is normally no need for a blood transfusion. Once again, the saving is enormous and the trauma reduction is also fantastic. The ear, nose and throat surgeons at the Royal Adelaide are doing excellent work with the current machine, but the new machine, which I am keen for the government to purchase, would give them the ability to carry out that work more expeditiously and with less impact.

The cost, as indicated—we checked with the manufacturer, and I am not an agent for them—is $1.7 million. Just going back on the history of it, Lea Stevens, who did a lot of good things as minister for health, supported the robot when it was purchased years ago. These things cost a lot of money to operate. You need a technician in case something goes wrong, but the arms and parts, and so on, for the robot are quite expensive. Ironically, Lea Stevens' adviser—and I will not say his surname—wrote the brief for cabinet, suggesting that it support the gift of Gordon Piccard; then, ironically, he was able to get the benefit of the robot down the track. He did not know at the time that he would be a beneficiary of the robot. It shows how fate can have its own reward.

The current machine is good. It still works, but the new model on offer will be able to do things a lot better. Not only will it be a cost saving but, more importantly in my opinion, there will be less trauma for people. The robot is fantastic, and it is the way of the future in terms of surgery; that is what the surgeons tell me—Professor Villis Marshall, who is head of surgery, and others—because there is no vibration or shaking. Most surgeons do not tend to shake (apart from that one on the television ad who is supposedly consuming drugs): they are normally pretty disciplined sort of people. With the robot, there is no vibration, no shaking and less nerve damage because the surgeon can see better, as the tissues and so on are magnified; so it is a plus-plus situation.

I know that money is always tight, but when the government is thinking of spending $400 million plus on a football oval, I would urge it to consider budgeting now to get the latest robot. The current robot can be still used at the Royal Adelaide or put in one of the other metropolitan hospitals, as it can still do good work, but the current one cannot be updated and nor can its parts be easily replaced over the short-term future.

I commend the motion to the house. I have met with the Minister for Health, and obviously he is looking at the business case. He did not make any commitment to purchase the latest model, but I am putting it before him, the parliament and the community as a worthwhile addition to the machine that already exists at the Royal Adelaide.

Mrs VLAHOS (Taylor) (12:20): I rise to amend the motion. I move:

That the house notes the state government is considering purchasing the latest model robot (the Da Vinci Si) for use at the Royal Adelaide Hospital so that a wider range of intricate surgical procedures with minimal patient impact can be undertaken.

This motion deletes the original paragraph and replaces it with the paragraph above. The Royal Adelaide Hospital currently has the only Da Vinci robot in South Australia. It was purchased in 2004-05, as the member for Fisher has noted, and generously donated by the Pickard Foundation. The robot is used to address a number of urological, gynaecological, ear, nose and throat and cardiothoracic procedures, but it does not generate sufficient income to cover the cost of ongoing maintenance and eventual replacement.

Nearly 1,000 men with prostate cancer have been treated with the robot-assisted approach over the past five years, and all surgeons involved are required to submit outcome data on these procedures. The results compare very favourably with those achieved elsewhere in the world. Men now require only a 23-hour stay in hospital, and may be able to return to work within two weeks after the procedure.

While the robot does deliver good surgical results, it is very expensive to operate and maintain, and other surgical methods deliver good outcomes for patients at less expense. The Royal Adelaide Hospital has a maintenance contract for the existing robot until 2013 but it is not anticipated that a proposal to replace the robot will be considered until closer to this date. Any decision to invest in a new model will be considered on the merits at the time and in consideration of what other biomedical equipment is required as a priority from within the allocated budget.

The Hon. R.B. SUCH (Fisher) (12:22): As I understand it the amended motion simply recognises that at an appropriate time the government will consider buying one, so I do not have a problem with the amendment.

Amendment carried; motion as amended carried.

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