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House of Assembly - Fifty-Second Parliament, Second Session (52-2)
2013-02-07 Daily Xml
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DA VINCI SURGICAL ROBOT

The Hon. R.B. SUCH (Fisher) (11:47): I move:

That this house commends the state government for its longstanding support for the Da Vinci surgical robot at the Royal Adelaide Hospital and requests the government purchase the new model that is now available.

I should declare a conflict of interest. I had the experience of this robot several years ago and it was a very friendly machine. The machine at the Royal Adelaide Hospital was kindly donated by Gordon Pickard through the Pickard Foundation in 2004. First of all, that gift was very generous because you are talking about a machine worth close to $3 million. Gordon himself had prostate cancer. It is not a private matter; he has gone public on it. He was operated on by the same type of machine at a hospital in Melbourne.

As a result of that, and because he was so convinced by it and the fact that he could return to work quickly, he generously provided a machine for the public hospital. What is significant about Gordon's donation, apart from being generous—I know some people say, 'Look, he's got money'; yes, you can have money but you do not have to be generous, you do not have to give it to anyone else—is that he particularly wanted it available to everyone who needed it, and I will explain in a moment what it can do. In other words, he did not want it to be exclusively for people who are rich or well off.

Without going into it too much, Gordon's family came from I think what you can euphemistically call 'Struggle Street'. He has a strong commitment to helping people generally and he did not want the machine limited purely to rich people.

That machine was donated 10 years ago next year. I know several surgeons there, and one has performed over 1,000 prostatectomies on that machine. It can do other things; the beauty of that machine—and I am not an agent for the company—is that you have very little bleeding because it puts gas into your system as it operates so that you do not bleed. So, you do not need a blood transfusion.

The machine is controlled remotely by a surgeon who directs it to cut, operate and do all the things that are necessary to remove an organ, etc. Whilst it is being used primarily for prostatectomies, it can be and has been used for other forms of surgery. The bottom line is that the model, according to the company that makes it, cannot be supported beyond the end of this year; they will not be making spare parts for that machine. The situation is that the machine needs to be replaced and, at approximately $3 million, they are not cheap.

Some people have said, 'Let's ask someone to donate another one.' I think it is asking a lot of an individual, a foundation or anyone else to donate surgical equipment to a hospital. In saying that, if they are prepared to do so, that is fine. I think it is important that, however we do it, we also ensure that the machine is available to everyone and not just to a select few.

The new machine, which has smaller robotic arms and is more flexible, can do a whole lot more. The current machine can do throat surgery, so you have no external cutting. The machine saves on bed stays. It costs quite a bit of money to operate, as you have to have a technician there—you do not want the robot going on strike halfway through an operation—in addition to the purchase cost.

To the credit of the Hon. Lea Stevens, who was minister at the time, she authorised this machine for the Royal Adelaide Hospital, accepting Gordon's donation, and then the government picked up the operating costs. Ironically, the person who wrote the cabinet brief supporting the machine's installation and operating budget had the operation himself on that machine a year or two after it was installed.

The new model can do very delicate, fine surgery. You still have surgeons who like the old-fashioned scalpel, but increasingly I think you will see a greater use of robotic surgery, just as you are seeing more robotic machines in factories, etc. The machine does not shake or get tired; it provides greater precision and enables the surgeon to operate with greater accuracy. That is very important in certain operations, otherwise, as you would understand, you can get significant nerve damage.

The new model would be able to do a lot more sophisticated surgery in terms of kidney operations, the removal of small tumours, and so on. With the operation I had with the robot, you end up with four tiny little scars across your midsection; it is amazing. That machine stitches you up internally and externally as well. It is a brilliant piece of technology which was designed for surgery on the battlefield or in outer space (which does happen) because you do not need to be anywhere near the machine in order to operate; the surgeon could be in Melbourne and operate it.

It is fantastic technology, but it is not cheap to buy or maintain. I know the government have publicly indicated that there is some manoeuvring going on behind the scenes but, as I said at the start, I urge the government that, if there is to be another donation—and I do not know for sure that there will be—there has to be a condition that something like this is available for everyone and not just for the select few.

Some people have said, 'Why isn't the government spending money on this when most people who have the operation are men? Isn't that discriminatory?' I am all for having the best technology for men and women. I notice the government is upgrading mammography equipment, because women tell me that when they have a mammogram, some of the old equipment is uncomfortable and unpleasant, and the new digital equipment is a lot more comfortable and probably more accurate, as well. I am all for that, and I think the government is spending something close to $20 million with support from the commonwealth to upgrade that equipment for mammography. I think that is great.

So, my plea to the government is: time is running out in terms of the machine. It needs to be replaced. I would like to see a definite commitment outcome in the very near future because, as I say, I know of just one surgeon who has done over 1,000 operations. There are a lot of people out there who want to see this machine on offer again. Not surprisingly, a lot of the greatest supporters of men's health are actually women, because they care about the men in their life, whether it is their husband, father, uncle or sons.

So, I put this motion. I would urge the Minister for Health to help—pardon the pun—stitch up an arrangement so that we can have the Da Vinci available, and if it is going to be in a private hospital, then on the condition that it is available to the general public.

I and a lot of others in the community want to see a definite commitment in the very near future that this wonderful piece of technology will continue to be available, not just for surgery on men but also throat cancers, kidney cancers, gynae cancers and all sorts of things. It will not be long before this sort of machine, if we get the new model, will be able to do a whole range of sophisticated surgery with minimal impact on the patient and shorter bed stays. I commend this motion to the house.

Dr CLOSE (Port Adelaide) (11:57): I move to amend the motion as follows:

That this house commends the state government for its long standing support for the Da Vinci surgical robot at the Royal Adelaide Hospital, and notes that the state government is currently considering the options available for replacing the current model.

The SPEAKER: Could the member for Port Adelaide supply me with the text?

Dr CLOSE: I am pleased to speak to this amendment, having a personal interest in this machine. A close friend's life was probably saved by the Da Vinci robot, and ever since he went through that experience I have been fascinated by this extraordinary machine.

Just to give some background, the current Da Vinci robot used at the Royal Adelaide Hospital was donated to the state in 2004 by the Pickard Foundation. It is a sophisticated robotic platform designed to expand the surgeon's capabilities and offer a minimally invasive option for major surgery. It is an alternative to other laparoscopic techniques or open operations.

This machine has been used to perform over 3,000 major procedures with minimal morbidity. The overwhelming majority of cases have resulted in a hospital stay of 23 hours. The majority of the procedures the machine has been used for are urological; however, a number of gynaecological and laryngeal procedures have also been performed, significantly reducing lengths of stay for the patient. Also, following ear, nose and throat surgery, the need for tracheotomy and post-operative care in the intensive care unit has been reduced.

A large percentage of the patients treated using the machine are private patients. For example, at 1 June 2012, of the 594 patients that had been treated with the machine in 2011-12, 255 were private patients, or 43 per cent. The company that manufactures the robot has indicated that it will be unable to support the current machine beyond 2013. The cost of replacing it will be in excess of $3 million, with an annual maintenance cost of $300,000. In addition, it costs $6,000 in consumables each time the machine is used.

As this amendment to the motion states, the state government is currently exploring the options available for replacing the existing model. One possibility would be the establishment of a private partnership which the Department for Health and Ageing is considering. Any recommendations will necessarily be made within the context of SA Health's current financial situation and considered alongside other clinical equipment requirements.

Debate adjourned on motion of Mr Goldsworthy.

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