HANSARD

 

NOVA SCOTIA HOUSE OF ASSEMBLY

 

 

STANDING COMMITTEE

 

ON

 

HEALTH

 

 

Tuesday, August 11, 2026

 

 

COMMITTEE ROOM

 

 

Surgical Advancements in Robotics

 

 

 

 

 

 

 

 

 

 

 

 

Printed and Published by Nova Scotia Hansard Reporting Services

 

 

HEALTH COMMITTEE

Danny MacGillivray (Chair)

Adegoke Fadare (Vice-Chair)

Julie Vanexan

Ryan Robicheau

Nick Hilton

Lisa Lachance

Rod Wilson

Hon. Iain Rankin

Hon. Becky Druhan

 

[Hon. Iain Rankin was replaced by Hon. Derek Mombourquette.]

 

 

 

In Attendance:

 

Genevieve Harvey

Acting Chief Legislative Counsel

 

Robin Dann

Legislative Committee Clerk

 

 

 

WITNESSES

 

IWK Health

Dr. Dafydd Davies, Chief, Pediatric Surgery

 

Nova Scotia Health Authority

Eileen MacGibbon, Vice President, Operations, Central Zone

Dr. Gail Darling, Physician, Thoracic Surgery

Dr. Greg Bailly, Physician, Urology

 

 

 

 

HALIFAX, TUESDAY, AUGUST 11, 2026

 

STANDING COMMITTEE ON HEALTH

 

1:00 P.M.

 

CHAIR

Danny MacGillivray

 

VICE-CHAIR

Adegoke Fadare

 

 

THE CHAIR (Danny MacGillivray): Good afternoon, everyone. I’d like to welcome you here. I call the meeting to order. This is the Standing Committee on Health. I am Danny MacGillivray, the MLA for Pictou Centre and the Chair of this committee. Today we’ll hear from IWK Health and the Nova Scotia Health Authority regarding Surgical Advancements in Robotics.

 

A reminder to please set your phones to silent. A reminder again that you don’t have to touch your microphone; the staff will take care of that. I’ll ask committee members to please introduce themselves, starting on my left.

 

[The committee members introduced themselves.]

 

THE CHAIR: For the purposes of Hansard, I’d also like to recognize the presence of Acting Chief Legislative Counsel Genevieve Harvey and Legislative Committee Clerk Robin Dann. Now I’ll ask the witnesses to please introduce themselves, starting on the left.

 

[The witnesses introduced themselves.]

 

THE CHAIR: I believe there are some opening remarks. We’ll start with Dr. Davies.

 

DR. DAFYDD DAVIES: Thank you for inviting me to share my insights about robotics in surgeries, specifically as it pertains to children and youth in Nova Scotia and the Maritime provinces. I’m a pediatric general and thoracic surgeon, and I’m the head of Pediatric Surgery, overseeing our 24 subspecialty surgeons at IWK Health.

 

For simplicity, I like to break robotics in surgery into two categories: navigational, where robots are used to guide surgeons to place implants in optimal positions or stay within certain boundaries, and manipulative, where a robot functions as an extension of surgeons’ hands to improve the movements of the patient. Both are rapidly expanding in use and new technologies. As I’ll describe below, we’ve already ventured into some navigational robotics and anticipate further growth in that area before we adopt more of the manipulative strategies.

 

The good and the bad in my job is that children are mostly healthy, so the volumes of operations that we perform can never match those of adults. What that means for emerging technologies is that biomedical companies can’t sell enough product to make return on their investment when they develop instruments sized for children. This slows our growth in our field; we’re often behind our adult-serving colleagues. Internationally, robotics is picking up steam for adolescent patients, but it has a long way to go when it comes to children and small infants.

 

I think the key considerations we must wrestle with when we look at the future of surgical robotics in Nova Scotia are the cost implications and the inevitable need to start building the foundations so we do not fall behind the rest of Canada and the world. Robotics will become part of surgery for all ages, whether we like it or not. We all must understand the massive cost differences. A common operation such as removing someone’s gallbladder goes from about $1,000 of disposable costs - that’s just the things we throw out at the end of surgery - to up to about $15,000 when done with a da Vinci robot. That’s not accounting for the upfront cost of buying the robot, training the staff, et cetera.

 

If you look at outcomes, there’s minimal benefit to that individual patient. However, if you want to have surgical teams skilled enough to take advantage of robotics for complex surgery, they need to be doing high volumes of the more basic things. While there are benefits to the surgeon and patients, robotic operations usually take longer to complete, especially with manipulative technology. In our current situation with growing wait-lists and limited resources, we will need to ensure close oversight and control of who is given access to the training as well as the robotic tools themselves. We must gradually adopt technologies to make the best strategic use of our resources to meet our goal of staying current without breaking the bank.

 

That being said, the technology is here to stay. New graduates will be trained to operate with robots and expect them to be available when they’re hired as surgeons. We will need to have active programs if we wish to recruit good surgeons and meet our future needs.

 

When it comes to IWK Health and the resource constraints we currently face, we are not actively using robotics in surgery. That being said, our robotics surgeons have done several cases on teenagers using the navigation system currently at the Halifax Infirmary. These were some of the first adolescent robotic scoliosis surgeries performed in Canada.

 

Over the next five to 10 years, the IWK hopes to implement navigational robotics for orthopaedics and neurosurgery routinely. We have a keen young surgeon taking it upon himself to gain experience and training, and we hope to further support that program. It will undoubtably have spillover benefits to neurosurgery and possibly other specialties as well.

 

Within the next 10 to 15 years, new surgeons coming out of training will be seeking careers where they can use the latest technology, including robotics, both in navigational and manipulative contexts. We’re going to be looking at those specialties closely to develop a robotics strategy that will guide our investments in the future.

 

Thank you for your time. I’m happy to answer any questions.

 

THE CHAIR: Thanks for that, Dr. Davies. I believe the other opening statement will come from Ms. MacGibbon.

 

EILEEN MACGIBBON: As the vice-president of operations for Nova Scotia Health Authority’s Central Zone, it is my absolute privilege to share our advancements in surgical robotics and our vision for further improvements on a provincial scale.

 

I’m joined today by some of our biggest champions for surgical robotics: Dr. Gail Darling, Central Zone head of surgery, thoracic surgeon, and co-chair of our steering committee for our new Nova Scotia Centre of Excellence in Robotic Surgery at the QEII; Dr. Greg Bailly, our head of urology and a urological surgeon who was instrumental in bringing our first surgical robot and the innovative prostate and kidney cancer treatments it supports to life; and our partner in care, Dr. Daffyd Davies, head of surgery for IWK Health, which partnered with us on Canada's first robotic-assisted surgery for pediatric scoliosis.

 

When our first robot was launched in 2019, we embraced its potential: greater precision, improved patient outcomes, efficiencies, undeniable recruitment advantages, and a catalyst for growth. To now share the rare distinction of operating eight robots across multiple specialties and bolstering training in our simulation lab is nothing short of amazing. Today we will reflect on the ground we have covered; share the measurable benefits robotics surgeries offer our patients, our teams, and our entire health system; and acknowledge the partnerships and generosity that have led us here.

 

Our efforts have not only established Nova Scotia as a provider of robotic-assisted surgeries but firmly positioned us as a respected leader in this innovative care. Our QEII teams led firsts for Atlantic Canada, including using robotics to assist with urological and gynecological cancer surgeries and being on the leading edge for brain and spinal surgery. They were the second in Canada to use the Mako system for partial and total knee replacement surgeries and are among the first using robotics to treat bladder and testes cancer. With the incredible support of the Dartmouth General Hospital Foundation, our team was the first to use the orthopaedic robot for a total hip replacement as well.

 

Making history and expanding our fleet is exciting, but first and foremost, these investments are about our patients. Robotics’ precision allows surgeons to target disease, preserving healthy tissue and supporting faster recoveries, shorter stays in hospital, and reduced blood loss, pain, and complications. Robotics amplify the gains from minimally invasive laparoscopic surgery in the 1990s to even greater precision and customized treatment for some of the most complex patient needs.

 

We are immensely proud to be leaders in this evolution. Nearly 4,000 patients have benefited from our programs and our tenfold increase in robotics surgeons, including patients with urological and gynecological cancers and cancers of the lungs, colon, liver, ear, nose, and throat. Many brain, spinal, and orthopaedic surgery patients are benefiting as well. I often hear from surgeons who see the difference robotics are making for their patients’ prognosis, recovery, and quality of life.

 

Our data clearly reveals return on our investments. Robotic surgery patients are going home sooner, not being readmitted as often, and seeking less follow-up care in our emergency departments. Our hospital stays are down by 3.3 days on average, our readmissions are down more than 30 percent, and post-operative emergency department visits are down too, which has returned 12,000 hours to care for other patients in our system.

 

We have come so far so fast with quality, safety, and data as our guideposts and with patients at the heart of each decision. We will continue to position Nova Scotia as a leader through our new Centre of Excellence. The QEII Health Sciences Centre Foundation has supported the robotics surgery program through $17 million in funding to date and has committed an additional $20 million to the Centre of Excellence over the next seven years. Our steering committee is in place, and working groups are focused on five provincial key strategies aligned with government’s Action for Health plan. From exploration to implementation, the Centre of Excellence will ensure a structured approach to expanding services here and across all of Nova Scotia to maintain positive returns and ensure that programs are sustainable from a quality and funding perspective.

 

A strong workforce is vital too, and we will keep building capacity among our teams and aim to establish Nova Scotia as a training centre for residents and other surgeons. We can directly attribute the recruitment and retention of nine surgeons to our robotics program so far, and with residents increasingly exposed to robotics and expecting to use these techniques post-fellowship, we must remain competitive. Leveraging our infrastructure and talent to serve as a training centre will help us attract top talent to the QEII, the Dartmouth General Hospital, and across all of Nova Scotia.

 

We wouldn’t be here without the support of government, our teams and partners, and our incredible foundations: the Dartmouth General Hospital Foundation and the donors who supported our first robotics program outside the QEII, and the QEII Health Sciences Centre Foundation and their donors, from individuals and businesses to visionary donors like the Orchid Women’s Health Initiative and countless more. They’ve helped us create a robust foundation to expand robotics to even more patients.

 

THE CHAIR: We’ll now move on to our question-and-answer period. Each caucus will get 20 minutes, plus a second round of approximately 10 minutes, as time allows. Questioning will wrap up at 2:50 p.m.

 

We’ll start with the NDP caucus. MLA Lachance.

 

LISA LACHANCE: I have a couple of numbers questions to get us started. How many surgeons in the province are actually trained to do robot-assisted surgeries, and how many robot-assisted surgeries occurred last year?

 

THE CHAIR: Dr. Darling.

 

DR. GAIL DARLING: The robotics surgery that has occurred has occurred in HRM, was either at the QEII or the Dartmouth General Hospital. There are surgeons in other jurisdictions who are trained, especially in urology, but also orthopaedic surgery. There are no general surgeons trained as yet to do robotics surgery.

 

In terms of the numbers, we have 31 surgeons currently in the HRM, mostly at the QEII, doing robotics surgery, and we’ve done about 3,900 robotic cases to date. Most of those are orthopaedic procedures done both at the QEII and at Dartmouth. We also have urology surgeries done at the QEII, as they were the first to get the robot.

 

Dr. Davies differentiated - what do you call it? (Interruption) Navigational versus manipulative. The manipulative part is the da Vinci robot, which is a soft-tissue robot. That’s what’s primarily used by urology, general surgery, and thoracic surgery. Urology has had use of the da Vinci robot since 2019. Also, gyne oncology has been using it since 2019, and a little bit for ENT surgery for base of tongue cancers. We got the second da Vinci last fall, and that allowed us to open it up to thoracic surgery, the general surgeons - superficially colorectal surgery - and the liver-pancreas surgeons.

 

LISA LACHANCE: If you don’t have the numbers here today, maybe the clerk could follow up in terms of - I’m curious about whether the number has been increasing. You said 3,900 to date.

 

Let me go for my next question. I’m curious how many last year, and is it increasing year over year?

 

THE CHAIR: Was that your question?

 

LISA LACHANCE: Yes.

 

THE CHAIR: Dr. Darling.

 

GAIL DARLING: It’s definitely increasing year over year. We’re looking up the exact numbers, but about 300 since January when we onboarded the colorectal surgeons, the thoracic surgeons, and the liver surgeons.

 

THE CHAIR: Order. MLA Lachance is ready to ask their next question. Just a reminder that the mics will turn on automatically. You don’t have to press any buttons.

 

MLA Lachance.

 

LISA LACHANCE: One of the areas that you mentioned that we have some capacity in is gynecological cancer surgeries. However, we know that Nova Scotians who need gynecological care wait three times longer than other Canadians; actually, the current worst surgical times in the province for Nova Scotians are for gynecology.

 

Is there a target time to increase gynecological cancer surgeries? What is that plan there?

 

[1:15 p.m.]

 

GAIL DARLING: We recognized their need when we got the second da Vinci. They were already using the first da Vinci for gynecologic cancers. When we got the second da Vinci - you know, I’m head of the Department of Surgery. Gynecology is not in my department, but I said, “They need it.” We said, “Okay, you’re going to use this new robotic also. We’re not going to just keep it for us.”

 

The gynecologists recognize the problem and have taken on a specific strategy for dealing with gynecologic cancers. They’re doing the high-risk cancers in Halifax and the lower-risk cancers are being done in the communities by gynecologists.

 

The robot has enabled our gynecologic oncology surgeons to provide minimally invasive surgery to women who would otherwise not be candidates for minimally invasive surgery. Minimally invasive - small incisions, cameras, and so on. Even some of these women could not have laparoscopic surgery and then they would have to have open surgery. So by kind of triaging it, they’ve been able to reduce the wait times.

 

LISA LACHANCE: I apologize for rushing through. We have a very short amount of time with you at the table.

 

Is there a target wait time for robot-assisted gynecological cancer surgeries? How often is that target being met?

 

GAIL DARLING: I cannot answer that specifically.

 

THE CHAIR: Ms. MacGibbon.

 

EILEEN MACGIBBON: I can provide that post - I absolutely can provide that to you by specialty area.

 

GAIL DARLING: I might note that when we look at their wait times overall - not specifically robotics but overall - their wait times have come down substantially. We gave them an extra OR day and we gave them extra robotic access. I’m not sure about the robot, but overall their wait times are within what they think is a target.

 

LISA LACHANCE: That’s helpful. I think from publicly available information, though, the worst surgical wait times in this province are for gynecology. That would seem to me to be an area where there should be greater emphasis and greater use of this.

 

I guess my question is: What is being done to decrease the wait times and ensure that women and gender-diverse Nova Scotians get the care they need in a timely fashion?

 

THE CHAIR: Dr. Bailly.

 

DR. GREG BAILLY: I’d just like to clarify something. I think it’s important to understand that gynecologic surgery is - there’s general gynecology and there’s oncology. There’s cancer, and those surgeries are being done, and the wait times are being monitored closely. Many of those are being done robotically or laparoscopically. That’s the emphasis of the robot that we have.

 

Access to health care for women with gynecologic problems is - I agree, it’s outside - the wait times are long, but that’s not the same population that is being directed toward the robotic surgery. It’s the gynecology cancers that are being directed for the robotic surgery. I think the big discrepancy in wait time is the non-cancer access to gynecologic care.

 

LISA LACHANCE: That’s helpful, but my understanding is that there’s no wait time data currently published for gynecological oncology. I do understand the distinction. This is one of the reasons why we think there should be a women’s health strategy: so that we are thinking about where the differences and the lacks are. If we’re focused on really important things like prostate and testes and urology cancers - important, but that doesn’t look at the needs of women and gender-diverse Nova Scotians.

 

I do want to talk a bit about more general gynecological care. In the spring, we heard from Cassidy Walker, who waited four long years in pain on the wait-list for care at the IWK. She eventually gave up on receiving care in our province and spent $60,000 out of province for an endometriosis diagnosis and surgery in Maine. The surgery she ended up having can be done using robot-assisted technology. To date, have the surgical robots in Nova Scotia been used to perform endometriosis surgery?

 

GAIL DARLING: Not to my knowledge.

 

LISA LACHANCE: Why is that?

 

GAIL DARLING: The robotics surgery is done by the gynecologists who are oncology surgeons, so cancer surgery only. I believe that endometriosis surgery would be done at the IWK. Is that not correct?

 

THE CHAIR: Dr. Davies.

 

DAFYDD DAVIES: As far as I know, Dr. Jim Bentley is the head of gynecology and obstetrics at the Nova Scotia Health Authority as well as the IWK. He would have more and better details about exactly what their strategy is. To my knowledge, they have focused, like Dr. Bailly suggested, the use of the robot specifically for oncology. I don’t know whether they’re planning to expand to endometriosis or not in the future.

 

LISA LACHANCE: You explained that there’s a steering committee and a strategy that’s located at the Centre of Excellence. I’m wondering how those strategies develop. If you look at the fact that the worst surgical wait times in the province are for gynecology, has the steering committee discussed making use of this technology to address some of the worst wait times we have in the province?

 

GAIL DARLING: I would say, first of all, the steering committee - the Centre of Excellence is on robotics, and we do have representation from the gynecologists. It’s definitely on the agenda.

 

I would say that endometriosis surgery can be done laparoscopically, which can be done at the IWK currently. I think that’s an important thing to note. Robotics surgery is a technique or a technology. The goal of any operation is “What do you want to achieve?” Then there’s how you’re going to do it. Robotics just offer one way of doing it. Laparoscopic surgery, for women who can have laparoscopic surgery, is just as good, in my opinion.

 

LISA LACHANCE: I appreciate that. What I’m trying to understand is how decisions are made. If it hasn’t been explicitly evaluated - women wait in pain when they’re waiting for endometriosis treatment and surgery. It is painful every day, every month. It affects people’s ability to go to school, to work, and to participate in family life. It’s very debilitating. Anything that we could do to lessen those wait times and lessen that experience of pain for Nova Scotians and get them back to their lives - we want people at work. We want people to be able to parent well. We want people to volunteer at church. Those are all things that people who are in pain can’t do.

 

Have there been discussions about better connecting the IWK folks who really focus on this with your steering committee? Is the head of gynecology or Dr. Davies on the steering committee at the Centre of Excellence?

 

EILEEN MACGIBBON: We do have representation from IWK Health for the obvious reasons related to gynecological surgery. I think it’s important to know - because you raise a very good point around how we would see the evolution of robotics as it relates to surgical access for gynecology patients in Nova Scotia. I think, as Dr. Bailly said, the gyne oncologists have prioritized those with cancer and high BMIs who are not candidates for laparoscopic surgery first. Relatively speaking, they are still in the earlier stages of using robotics surgery and expanding their access.

 

For us there’s no one thing that improves surgical access for patients in Nova Scotia. It’s a multi-faceted strategy. Robotics is just one. We are finding improvements and efficiency in the system that enable better access overall.

 

I know from talking with the gynecologists and the gyne oncologists that their desire is to do exactly as you are describing: move in that direction as we evolve the program and enable improved and increased capacity overall to their service and specialty.

 

LISA LACHANCE: I wanted to touch on, in terms of the orthopaedic surgeries, some of the wait times that currently still exist. When I look at the most recently available public data, we see that Nova Scotians - 50 percent of people get their first consult within 186 days of being referred. That means 50 percent get it after more than 186 days. The wait times of the 90th percentile are: in Dartmouth, it’s 488 days; in the Valley, it’s 575 days. Certainly you can see the difference. At the QEII, it’s 333 days. I can table this, but this is from the public website.

 

In terms of the regional discrepancies, what is the strategy taking into account to make sure that the benefits of robotics surgery are not just in the HRM?

 

GAIL DARLING: I could speak to the orthopaedic joint-replacement program in general. This is our biggest program. More patients need orthopaedic surgery than any other subspecialty in surgery.

 

A couple of things have happened that have allowed the QEII and Dartmouth to improve their numbers. One is that the government put in funding for new operating rooms. Dr. Bill Oxner, who is head of the division of orthopaedic surgery, strategized to make Dartmouth a centre of excellence for high-throughput, high-quality arthroplasty. He recruited several - three, I think - new orthopaedic surgeons who are at Dartmouth. We were able to utilize the government’s investment in OR time to do more orthopaedic joint replacements.

 

The other thing Dr. Oxner did was he - not him alone, but he and his team - developed what are called orthopaedic assessment clinics. Many patients who have joint problems - arthritic joints and so on - require assessment, but they don’t all need surgery. These assessment centres allow them to see more patients - in other words, reduce the wait time to consult and then to select the patients. They have their criteria to select the patients who will benefit from surgery. That has allowed us in the QEII and Dartmouth to reduce the wait times. I think we were number one in Canada on CIHI this week.

 

LISA LACHANCE: Thank you for that. My question was actually not what’s happening in the HRM. My question was actually: What’s the plan to even out those wait times in rural areas? For hip replacement at the Valley Regional Hospital, the consult wait time for the 50th percentile - again, 50 percent of people wait longer than this - is 362 days, which is a whole year of discomfort, pain, and an inability to do things like work, volunteer, or be part of community.

 

To your point, perhaps they don’t need surgery, but the whole point is that they’re waiting. That’s sort of the next question that needs to be answered. The surgery wait time at 50 percent is another 164 days. People are losing years of their lives, and often at a really transitional point in time. They might still be working, but maybe they’re close to retirement. This often forces people out of the workforce at this age.

 

To be specific, let’s take the Valley. What is the target in terms of decreasing the wait times for, let’s say, hip replacements at the Valley Regional Hospital - both consult and surgery, if needed?

 

GAIL DARLING: I can’t specifically give you a number for the target. I can say that the Nova Scotia Health Authority implemented the Ocean centralized referral system. A family doctor or any doctor could refer their patient in through the Ocean system. This is aimed at reducing the wait time for consultation. The patient has the option of accepting the first available provider, i.e. the soonest appointment, or choosing to wait for someone where they live or somewhere else. The government and the Nova Scotia Health Authority have funded that with the goal of reducing wait times - not just for joint replacement, but for all surgeries.

 

[1:30 p.m.]

 

What the Valley is actually doing in terms of what their target is, I don’t know. I’m sorry, I don’t know that answer.

 

THE CHAIR: MLA Lachance with one minute, 11 seconds remaining.

 

LISA LACHANCE: Who would be supporting, for instance, the Valley Regional Hospital in looking at those wait times and trying to address them? Whose role is that?

 

EILEEN MACGIBBON: I think it really is important to note that everything we do is strategy across all of the Nova Scotia Health Authority. That’s the benefit of having one structure - one organization reflecting health care across the entire province.

 

As Dr. Darling said, we have an ability now to have line of sight on wait times in all of our areas where we’re offering surgical services across all of our sites in Nova Scotia. We have clear awareness on where patients are in terms of their wait times. We also have a significant number of strategies under way to find efficiency and optimize the use of our operating rooms. We have lists of actions and strategies and tactical components of that work that demonstrate the improvement we’re making year over year.

 

We know the demands for orthopaedic surgery, to your example, are very high. They’re high across Canada. Every jurisdiction is challenged with the demands for orthopaedic access to surgery and operating room time. I think it’s really important to note that as we look at this as a system, we also have the evolution of robotics to centres like the Valley Regional Hospital with significant interest from their team to move in this direction and receive…

 

THE CHAIR: Order. Sorry, the 20 minutes have expired.

 

We’ll now move on to the Liberal caucus. We’ll start with MLA Druhan.

 

HON. BECKY DRUHAN: In January 2026 the Office of the Auditor General of Nova Scotia released a report: Action for Health Key Performance Indicators. The office found that many of the KPIs had ineffective or no benchmarks for success. I recognize absolutely that you and your teams rely heavily on data and access and use that to assess the success and the output of measures that are in place. VP MacGibbon, you outlined some of the data that is demonstrating the work that’s being done.

 

Having said that, I think having it rolled into KPIs that Nova Scotians can understand and be able to measure against is incredibly important, as illustrated by the AG’s report. In light of that, we know the robots have been positive for surgical teams and patients, but we’ve also heard about the cost, and the factors that go into assessing the success of that are not just limited to current surgeries or output but also future training.

 

In light of all of that, can you explain more clearly what goals the Province, the NSHA, and the IWK have for the future of surgical robotics? What accountability measures are in place now and that we would expect to put in in the future to ensure we’re meeting those targets?

 

THE CHAIR: Dr. Darling.

 

GAIL DARLING: First of all, I would like to applaud the Nova Scotia Health Authority for their data and analytics arm, which does give us the data, which has been incredibly helpful.

 

In terms of our outcome measures, or ROI, for robotics, we’ve already spoken about the reduced length of stay, the reduced emergency room visits, and reduced readmissions. Those were all things that we hoped would happen with robotics, and now we know they have. Those are real benefits to the system in that more patients can get through the emergency room, and more patients can get admitted to hospital. Robots have generally fewer complications, so then patients don’t require revisional surgeries or secondary surgeries. Those benefits are real.

 

The other things are things that are maybe a little harder to measure. For example, blood transfusions. Most surgery that is done in an open manner will require blood to be cross-matched, which means the lab has to take a couple of units or four units of blood, and they have to do all this special testing, and then they have to set those units of blood aside for that patient having that surgery. We know now that with the robotics surgery, we almost never have to give a transfusion. With our anaesthesia colleagues and our periop group, we now have guidelines that say, “For this robotic procedure, we don’t have to cross-match the blood. We can just do a type and screen.” Those units of blood can stay in the blood bank and be available to other people. That’s a benefit to the system. We think it’ll save us $1 million a year at the QEII. It’s also a benefit to that patient because blood transfusions have risks - not only immediate risks like transfusion reactions but downstream effects, especially for cancer surgery, because it can affect their immunity. We’re looking at that stuff.

 

In terms of training - and this is all being done through the Centre of Excellence. The data that we can extract from the da Vinci robot in particular can look at how many moves a surgeon makes to accomplish a particular goal. The new da Vincis have two consoles, so we can have a resident on one console and the staff surgeon on the other. We can look at how the resident is doing and how many moves and at what point they become competent, and we can translate in the future to becoming a training centre for robotics.

 

We’ve actually already kind of started this in urology and orthopaedic surgery, but in the future, building it to the da Vinci model where we can have surgeons coming from all over the province to train - we will be able to tell them when they’ve done enough that they’re competent, and we’ll be able to do that for our residents as well. We’ll be able to attract high-quality residents to our programs. We’ll be able to train the surgeons of Nova Scotia, and we’ll be able to train - there’s no training centre for da Vinci across Canada. We could be the first.

 

BECKY DRUHAN: Okay, I appreciate that. The benefits that the robotics and the specialists who operate them offer are very clear, not only to the system but also to the patients.

 

I’m interested, though, in the way that that gets reflected in KPIs and the setting of KPI benchmarks. There’s a difference between implementing a change and then identifying the improvements that happen after that change versus strategically identifying benchmarks in advance and measuring against those. I think that’s a really key role for government to be able to understand if the return on investment is appropriate or if more investment should be made in other areas.

 

I’m wondering about that specific question. This is all great data, but how does it get translated into those KPIs that the Auditor General is referencing so that Nova Scotians can understand in advance what the goals are for this and then be able to determine on an ongoing basis if we’re hitting them or not?

 

THE CHAIR: Ms. MacGibbon.

 

EILEEN MACGIBBON: When we first appeared here three years ago, it was more or less to talk about our vision for what we felt we could realize in terms of value and benefits to Nova Scotians. Here we are three years later, and we do now have the ability to demonstrate with data that the expected or intended outcomes and objectives are being met. Folks like Dr. Bailly, Dr. Darling, and members of their team can speak to the elements that have been more generically realized in other centres, but also the pieces that are feedback components with patients, the experience they have in hospital, the reduced use of resources - i.e. bed use, emergency department visits - and all of the things that Dr. Darling referenced.

 

We have a very rigorous process for perioperative service in general as it relates to the Nova Scotia Health Authority and how we look in a very data-driven way at what we do, how we do it, and where we have areas that we want to look at potential improvements. Robotics surgery is a dimension of that work. We would come together - and we do come together, since the formation of the Nova Scotia Health Authority - to focus on the KPIs that are important to surgical services. A dimension of that work now, very clearly, is related to robotics surgery and then also looking at the opportunities for that to enhance services outside of Central Zone.

 

BECKY DRUHAN: Is there a place that Nova Scotians can go to specifically see those anticipated KPIs associated with the adoption of robotics and to be able to sort of evaluate those on an ongoing basis? Are those being published online or elsewhere?

 

EILEEN MACGIBBON: That’s our intent. We are just on the cusp of having information that we do want to release to the public. We are - just due to time in acquiring enough to be statistically significant from a data analytics perspective, to have information that we feel is meaningful and exactly what our public would want to see as it relates to the value of robotics surgery as an option. That’s very soon to be part of the information we’re sharing.

 

THE CHAIR: Dr. Bailly.

 

GREG BAILLY: I think it’s important to recognize that the first robotics program in Canada came in 2007. We started a da Vinci robotics program in 2019. We were the 34th da Vinci in Canada. Now there are 65. In the U.S., there are 4,000, and in the rest of the world, there are 7,500. That’s just da Vinci. We talked about the orthopaedics and - this is not new, innovative techniques for surgery that we’re talking about. It’s new for our region, but all of this data has been proven - the benefit to patients, hospitals, return-to-work, economy, all of those things. This is not something that we need to study. This is the standard of care. We can never go back. The question is, can we go forward as quickly as everybody else is? Hopefully what we’re going to try to work out today is, what is the investment that’s going to be required in our province to keep up with the rest of the world?

 

All of those improvements that perhaps the Auditor General’s going to look at and whatnot - yes, it’s important, but that’s kind of behind us. It’s a proven benefit for many of the reasons that we’ve stated.

 

BECKY DRUHAN: I appreciate that. I wouldn’t at all want to leave the impression that that’s what my line of questioning is about. I think the benefits are well established, for sure.

 

My questions around KPI are less about establishing that these benefits are important and more about establishing whether our system is realizing the benefits. We know that robotics can improve outcomes and they can improve duration of stay and a variety of metrics, but whether the system is marshalled in a way that patients in Nova Scotia realize those benefits is a really important question, as we do continue to see wait times that are excessive in many areas.

 

This is by no means a question of whether the robotics and those operating them are doing well. It’s whether the rest of the system is marshalled around that in such a way that we really feel the benefits. That’s my focus around the KPIs.

 

It sounds like there hasn’t yet been an established outline of what the anticipated KPIs would be, but we may be close to that. That’s excellent, but I’m curious if we could learn more about how we will establish those KPIs so that we can be confident that the investment that we’re making and the work that you and all of your teams are doing are being felt by Nova Scotians.

 

GAIL DARLING: If I may, and I may not have a clear understanding of all the KPIs, but the big one that stands out for me is more, faster. As I mentioned previously, the government provided funding for us to open up three new operating rooms. Two we opened at Dartmouth, one at the HI. Along with that, we need personnel to work in those operating rooms. That’s anaesthesiologists, surgeons, and nurses; we need the support staff, the medical device reprocessing people. Just like I said about the orthopaedic assessment clinic, having enough surgeons to see patients, to assess people, is key. We’ve been able to recruit 26 surgeons in the last two or three years.

 

In terms of your KPIs of more, faster - we are reporting that all the time, at least internally, on our volumes: how many operations we do. More than the number of operations is the operating room hours. You can do one neurosurgical case that will take all day. We’ve been looking at our operating hours, and those have increased steadily since the end of the pandemic. We’re looking at both daytime hours and nighttime hours. To me, that’s a real number - the same with the wait times. We know that, at least at the QEII, our waiting list is coming down. We’ve also taken significant steps to address those long waiters. That number’s coming down as well. I don’t know if those numbers are available to you or not.

 

[1:45 p.m.]

 

BECKY DRUHAN: I do appreciate that. I recognize that your mission as leaders and your team’s mission as practitioners is to execute on the resources that you’re provided with to offer the best outcome to patients. My question is really around the goal setting and the KPIs, and that may be a question for ministerial decision makers, right? “More, faster” is not a KPI. (Laughs) But that is not on you. I’ll just move on from that. I do appreciate it.

 

That does lead me, though, to another question, and that’s around the rest of the system and the support of the robotics and the other specialists. You don’t have an illness or an injury and then immediately find yourself being treated for it. There is a process by which you have to get there, through a practitioner - if you’re lucky enough to have one - or otherwise, and often through referrals from specialists.

 

If we look, as an example, at arthritis, which is a leading cause of joint replacement in Nova Scotia, it’s a significant financial burden of over $1 billion in the provincial health care system, to say nothing about the dramatic impact that it has on the patients’ lives and their experience of well-being. I’ve heard regularly from advocates and from patients that there is an exceptionally long wait-list to see a rheumatologist in Nova Scotia, but many people are unable to get to a surgeon until they get through that step. That’s not unique to rheumatology. The specialist shortage goes beyond that.

 

I’m wondering if we could hear about what the Province and the NSHA are doing to actively recruit specialists such as rheumatologists. I’d like to know if that lack of specialists is preventing surgical-related resources like those robots from operating at full capacity.

 

EILEEN MACGIBBON: It’s a pretty big question, as it relates to subspecialties. We know that subspecialties - like you mentioned rheumatology, neurology - a number of those subs within medicine are challenged with respect to the demands on their service and, quite frankly, to have enough resources, often in the form of physician specialists, to see and support the needs of our communities.

 

I will say that from an NSHA perspective, there have been enormous gains as it relates to very innovative ways of working differently and finding efficiency with the use of physician extenders in really progressive, proactive ways to create what can, very comfortably, be a solution for a specialist to see patients and not solely rely on the physician to triage and to help the patient make their way through the trajectory of care.

 

We have a number of areas where that has been an enormous improvement; neurology is a good example. Are there still gaps in terms of vacancies and a lot of neurology programs across Canada vying for the small number of neurologists looking? That’s the reality, but I do think we are trying lots of really different ways of enabling access to care that don’t solely rely on a traditional model. We know that traditional model is a tough one to have as a solid solution when we know the realities are what they are across the country.

 

BECKY DRUHAN: I want to thank you very much for that. I won’t ask this as a question right now, but I would like to know more about what those alternate pathways are. If we could get details of those? (Interruption) Yes, great.

 

I do want to ask very briefly - and my colleague may pick up on this. We know that many of the surgeries are happening in the Central region. For example, the number of hip and knee replacements - more were completed in the Central Zone than any other area of the province. We also know that wait times for knee and hip replacements in the Valley, South Shore, southwest, and across the province continue to be lengthy. I am wondering if you can share whether the NSHA has any intention of developing capacity for robotic-assisted surgeries outside the HRM, especially considering the length of wait times that exist there.

 

GREG BAILLY: As part of the Centre of Excellence vision, our mandate would be to oversee and come up with a strategy to very carefully assess the needs of all four zones in the province, but recognizing the resources required, the personnel required, and the support required to put those in.

 

I think one of the misconceptions is that if you put a robot in a hospital, the people there can just start using it. That’s not the case. It might be the case for some of the robots - I can’t speak on the orthopaedic robots, but perhaps orthopaedic surgeons can learn that easier than the da Vinci, which is a much more complicated robot. For instance, if in the future - and this has happened across the country. Again, we’re a little bit late here. Across the country there are regional hospitals that are adopting robotics, whereas it was just the tertiary care hospitals initially. They’re recruiting people who were trained in that specialty ahead of time. They’re identifying people three to five years out and saying, “If we get a robot here, we’ve got to hire two or three people who know how to use it.”

 

Yes, the Centre of Excellence - not as a brick-and-mortar place. It’s going to be a function of looking at our province - a million people. We’re a perfect-sized geographic area to be able to distribute and plan and strategize. How do we prepare for the fact that robotics will be in all four zones eventually? It won’t be next month, but it’s going to be...

 

THE CHAIR: Order. Thank you. The 20 minutes has expired.

 

We’ll move on to the Progressive Conservative caucus, and we’ll start with MLA Hilton.

 

NICK HILTON: Thank you all for being here today. I wasn’t here three years ago when you were here, but it’s really exciting to know that we’ve gone from theory to realizing some of those benefits about robotics surgery. When you hear things about reduced wait times, reduced hospital stays, reduced readmissions, reduced need for blood transfusions, increased OR availability, increased recruitment of physicians - I like to hear that we’ve recently recruited up to 26 surgeons. That’s significant work that’s been done over the past three years - and other opportunities, like to be - I’m assuming a national leader, but even a world leader when it comes to training in robotics.

 

Those are exciting things that Nova Scotians should be proud of, and all of you. I hope that’s what comes out of today: that we’re able to share some of that.

 

My colleague even said that it’s very clear that there are benefits from robotics surgery and what they offer. Maybe to start we can just share a little bit of the history of how we got here. Can you walk the committee through how the capacity for surgical robots in the QEII has grown since 2019? What’s made that growth possible?

 

THE CHAIR: Dr. Bailly.

 

GREG BAILLY: In 2018, in a pretty short order, we got together a committee of people including from the Nova Scotia Health Authority, physician leaders, administrative leaders, leaders in the QEII Health Sciences Centre Foundation, and the public. The public was a huge driving force of this. We were able to secure funding and get support from the Nova Scotia Health Authority and the Department of Health and Wellness to start robotics.

 

From there, within two or three years, we were adding the orthopaedics Mako robots and the neurosurgery robots. It just started going up from there. Like others have said here today, we have some very talented physicians in this province who are very much forward-thinking innovators. We’ve had the Nova Scotia Health Innovation Hub research that the Nova Scotia Health Authority has supported in the last five or six years. All of those things have led to a momentum of saying that everything that we can offer in Halifax can be offered anywhere else in the world. We don’t really think of ourselves as any different here. Our goal really was to work with those three or four groups of people and just continue to move forward.

 

The problem, though - and this is kind of how things evolve - is that once you start offering something very innovative with the benefits that we’ve all recognized today, there becomes a centralization of care. That has happened everywhere that robots have started. That means that a lot of things start funnelling into the Central Zone because we’re offering robotics.

 

Somebody asked how many surgeries we were doing. Before we had a robot, we were doing about 150 prostatectomies for prostate cancer per year, and now we’re doing between 250 and 270 per year. That’s because robotics and all the benefits that it owes - more people come in. That drives our wait-lists up as well in Halifax. We need more resources. Now we have a second robot, which Dr. Darling was instrumental in pushing for, because the other surgical departments needed one. Now we need a third robot. We’ll probably have another robot in the other zones in the next five to ten years.

 

The evolution is that if you build it, they will come. It’s expanded as we predicted, and I think that it’s almost like a tsunami of progression in the type of health care that we can provide Nova Scotians. In a very short time, the vendors of the products that we use - the units that we use - have come out and said, “You guys are doing high-volume, very efficient work.”

 

We keep track of efficiency as well. We’re leading the country in da Vinci efficiency in the OR. The number of cases that our da Vinci robot did last year - it was the number one da Vinci robot in the country in terms of volume. It’s a workhorse. It runs from 7:30 a.m. to 5:00 p.m. every day, and sometimes later.

 

NICK HILTON: You just mentioned the partners that have played a role in making this happen. What role have the hospital foundations and donors played in funding this program, and how does the partnership model work alongside government investment?

 

THE CHAIR: Ms. MacGibbon.

 

EILEEN MACGIBBON: I think that’s an important point to focus on. We know that, as Dr. Bailly said, centres across Canada that had originally moved toward having robotics acquired for use in 2007 and 2008 - it was almost solely because they had a foundation that had generous donors to provide the finances needed to purchase. We are in the same situation here in Nova Scotia, where we’ve had incredible generosity from our donors. The philanthropic combination of government funding and donor foundation funding has been the perfect complement to the solutions needed with respect to the financials to enable us to move in the direction that we have.

 

I think it goes without saying that if you look across Canada, the centres that have moved in the direction we have before us have done so in a similar way. Foundations have been instrumental. I think what we want to ensure, as Dr. Bailly said, is that we use our Centre of Excellence and leverage all that we have within Central Zone now to help the rest of the province move in that same direction at a pace that makes sense and realizes the benefit across all four zones, not only centralized in the space that we’re in right now.

 

I think it’s reflective of where we are in our evolution since 2018, but we’re already seeing, as I mentioned earlier, significant interest from other zones - their surgeons, their surgery programs - to acquire robotic technology as well for orthopaedics, and da Vinci as well for broad-based specialties like urology, gyne, and general surgical services. We know it’s moving, and we know that we will get there not only by way of foundations but with the operational government funding that we have in place as well to do that.

 

NICK HILTON: Maybe a question for you, Dr. Davies. IWK Health and the QEII partnered on Canada’s first robotic-assisted pediatric scoliosis surgery. What did that collaboration look like?

 

THE CHAIR: Dr. Davies.

 

DAFYDD DAVIES: We have a very active spine surgery program at the IWK for scoliosis. Most of those children generally need surgery as adolescents. We can safely provide care for most adolescents at the QEII, but the scoliosis part of the surgery is more of a pediatric expertise, so the spine surgeons who do that work primarily at the IWK. They were able to go to the QEII and take some of our patients who were young teens and safely do them there using the infrastructure that’s already in place at the QEII. They use that robot there to do that.

 

NICK HILTON: My last question for this round - we’ve talked a little bit about wait times. I just wanted to share a couple of things. At the end of 2025, this province was at a 10-year low when it comes to surgical wait times. That takes into account a significant population increase over that period of time. I think that really speaks to the work that you guys are doing. It’s really exciting to see. We talk about wait-lists, but really, the important thing to take away from today is that they’re slowly decreasing.

 

[2:00 p.m.]

 

I’d like to hear a little bit more from you guys in terms of where you see us headed, wait time-wise. Another stat was that surgical long-waiters - that list has decreased. That’s for people waiting 365 days. It decreased in 2025 by more than 1,600 patients. We are making progress, and I do believe we’ll get there.

 

Last week it was reported that wait times for hip and knee replacements in Nova Scotia are now the shortest on record. Congratulations to you for that. In 2019 under the previous Liberal government, Nova Scotia had some of the longest wait times in the country. Our government has done a lot of work and made a lot of important investments to reverse that trend. Would you be able to tell this committee about some of the changes that you’ve seen in health care over the past five years that have contributed to this positive progress?

 

THE CHAIR: Dr. Darling.

 

GAIL DARLING: The government has invested heavily in health care. As I mentioned previously, we’ve opened three new operating rooms, which isn’t just the physical rooms. It’s the nurses, anaesthesia, and surgeons. They’ve been instrumental in funding new positions for surgeons. Not all those surgeons are new; they’re net new. I think that they’ve invested heavily, and that’s paying off. If we look at the orthopaedic one in particular, they invested heavily in the arthroplasty group. That’s how we got to be number one in the country. It definitely paid off there.

 

The Nova Scotia Health Authority and the data and analytics group developed a tool to help us with organizing our surgical wait-lists so that they’re ranked in terms of priority. Also, we have benchmarks for the time - if they’re a Level 2, they need to be done within two weeks; if they’re what we call a Lucas Black, those are the long-waiters. They’re long-waiters because they’re not immediate-priority patients. If you have a cancer, you’re not a Lucas Black. What was happening was those people were waiting a long time because they kept getting pushed down the list.

 

The Nova Scotia Health Authority brought in a centralized wait-list management program. The booking people look at the list and look at who’s booked and how long they’ve been waiting, and they will send the list to the surgeon’s office and say, “You’ve got these patients waiting, and amongst those are those long-waiters.” They basically focused a light on them and brought them to attention so they don’t get forgotten. I think that those couple of things have really paid off in terms of reducing the wait-list.

 

THE CHAIR: MLA Fadare.

 

ADEGOKE FADARE: It’s important for us not to lose - many of the insights, just listening closely to the conversations, the discussions I’m hearing today, I’m hearing 4,000 patients have already benefited from robotic-assisted surgery. I’m hearing that we are seeing reduced stays in hospital. I’m hearing that readmission rates are falling. I’m also hearing that there are thousands of hours that have been returned to the health care system. I think those are some of the things I can say that I’m hearing from the conversation that we’re having so far.

 

We know that the surgical wait-list is at the lowest, like my colleague has said, in 10 years - in more than a decade - despite the significant population growth. Nova Scotia has increased in terms of the numbers, yet the surgical wait times are reduced. I think that’s something we need to underscore. I love Dr. Bailly’s conversation around the question - whether the technology’s coming is not the issue. We see it used rapidly in the United States. It’s how we prepare Nova Scotians for that.

 

I wanted you to speak about - you talked about the concept of the Centre of Excellence not just being bricks and mortar, not like a physical location itself. Can you help us describe the Centre of Excellence in terms of the robotics surgery and the structure of it? Perhaps more importantly, what are the priorities you want to accomplish over the next few years? You talked about how it’s not every zone that will get it tomorrow, but you talked about maybe a timeline of about five or ten years.

 

I’m just wondering if you can speak about the structure of the Centre of Excellence so that not just people here in this place but people who are watching online can have a better understanding of what that structure looks like, and also around the priorities and the things that you’re set to accomplish. I think we’re in the right direction as a province.

 

THE CHAIR: Dr. Darling.

 

GAIL DARLING: The Centre of Excellence started with an idea that robotics was here to stay and was going to be increasing. Dr. Bailly pointed out that a province of a million people is a perfect size to kind of keep a lens on everything. We got together - surgeons and administrators and so on - and we came up with five goals for the Centre of Excellence. These are, of course, patient benefit, system benefit, education and training, which I’ve already mentioned, data so that we can look at our efficiencies, and research. We’ll get the data and then we’ll use that to answer questions.

 

The other part of it is what’s called clinical application and new technology. As Ms. MacGibbon mentioned, we’ve had inquiries from other centres in the province about getting a da Vinci, for example. You know, it’s a big-ticket item. It’s not like they can just put it down and start using it, like Dr. Bailly said. The whole idea of this particular work group - the clinical application and new technology - is to evaluate the need for a da Vinci, for example, in Sydney or in Truro. Do they have the population to support it? Do they have the surgeons to support it? What are they going to use it for? What’s the training stream for those surgeons? Then we can do it in an intelligent manner rather than just the hospital foundation in Sydney deciding they’re going to buy a da Vinci robot. Not that we want to be a barrier; we just want to make sure that it’s operationalized in a sensible, safe manner - that kind of thing.

 

That’s a very important work stream at the Centre of Excellence. It’s not to be a barrier, and we’re working with the Health Innovation Hub on that to make sure that these centres that want a robot are supported in terms of training and data so they can implement it intelligently and safely.

 

The other part is the new technology. Da Vinci is the only game in town so far in terms of the manipulative robot, but for the image-guided or the navigational robots, there are many different vendors. For example, for the orthopaedic robot, the one that we have at the QEII and at Dartmouth is a Mako robot. There are other vendors. The Health Innovation Hub is helping us evaluate those other vendors’ robots to see how they compare with what we’ve got already - do they offer advantages, that sort of thing. As opposed to a vendor just speaking to a surgeon and the surgeon going to their foundation and saying, “Hey, buy me this,” we’re evaluating it.

 

THE CHAIR: Dr. Bailly.

 

GREG BAILLY: I’ll just add one comment. I think that because there are so many moving parts and complexity in robotics in general, it’s in the best interest of the institutions, the Province, and particularly the patients that there’s a governing body to really oversee the expansion of robotics. It’s very different from a new piece of equipment that any hospital or operating room can get and figure out how to use. This is more of a program, and because there are so many different medical conditions and body parts and diseases that are being used, it will expand.

 

One of the comments earlier was that in Canada, the focus is on oncology because robotics is a limited resource and we prioritize cancer for the use of it. In other countries - in particular in the U.S. - it has expanded. There’s the person who went and got their surgery for endometriosis. We have one of our residents who just graduated this year. He’s in Colorado learning how to do very advanced reconstructive surgery, which is now coming to Ontario and coming to British Columbia.

 

A Centre of Excellence is really looking forward with governance and oversight to ensure that we get this right. It’s expensive. It has to be done in a formal, organized format. I think that’s why we recognize the Centre of Excellence as the way to do that.

 

THE CHAIR: MLA Fadare with one and a half minutes remaining.

 

ADEGOKE FADARE: I think it’s clear from what I’m hearing - it’s obvious that it’s not about putting robots in every hospital. Somebody might be asking, “Why don’t we get the money and just put robots in the hospitals? It’ll fix all the problems.” I’m hearing clearly that you’re talking about the need to have trained people. You have to have trained surgeons who are able to use it - trained teams. You need to have the infrastructure in place, and also have the expertise and the experience. You talked earlier regarding a number of normal procedures that need to take place in order for you to get better using the robots. That offers a template, or should I say an opportunity, to leverage knowledge and transfer it somewhere else.

 

I was going to ask a question, but I’m not sure one minute will be enough for me to ask the question. I’d rather wait for the next round, because they won’t be able to answer effectively.

 

I just wanted to say that it’s important, what you’re doing. I think that you echoed it loud and clear - just listening to you, Dr. Bailly, how behind we are as a province in some of this new technology. There are some people who would allow us to form a committee to publish studies on the usefulness or the productivity of robots, but you’ve clearly said today that there are a lot of studies already about that.

 

I’m hoping that people are hearing that and recognizing that they need to be on board and not trying to criticize for the sake of criticizing. Just see how we can support and ensure that we’re able to do this for the benefit of the patients, which ultimately is the most important. I guess that’s time up.

 

THE CHAIR: We’ll now move on to our second round of questioning. We have 13 minutes per caucus.

 

We’ll once again start with the NDP, and this time MLA Wilson.

 

ROD WILSON: My questions may seem rapid-fire. It’s only because I only have 13 minutes and I like to talk, so bear with me.

 

A couple of questions about capacity building: Are your current residents, particularly in your surgical adult residency programs - is training in robotics a core competency (inaudible) the Royal College of Physicians and Surgeons of Canada, or is it more requiring a fellowship? The reason I’m asking is, are we training in-house residents who can actually go out and have the skill set to function somewhere like Kentville, or does it require extra training?

 

THE CHAIR: Dr. Bailly.

 

GREG BAILLY: Currently, it still requires fellowship training. Subspecialty training is not just the technical aspect; it’s the decision-making around the disease, understanding how best to treat prostate cancer, bladder cancer, esophageal cancer, these things. What we’re finding and what we’re hearing from the fellowships that our residents are going to is that they’re coming so well prepared. They’re getting so much experience in our centre that when they go to do a fellowship, it’s that much better for them.

Currently, it’s not a core competency in the Royal College. Will it become one? Eventually it probably will, because to be honest, the residents aren’t seeing open surgery anymore. Our residents wouldn’t even know what an open prostatectomy looked like. It still is a fellowship thing.

 

THE CHAIR: Dr. Darling.

 

GAIL DARLING: It’s not a core competency in general surgery either.

 

ROD WILSON: You also mentioned that it’s used mostly in gyne oncology. When I looked at our wait times for gynecology, which were horrific, most of the procedures were vag hysterectomies and non-gynecological - vag hysterectomy being a slow, complicated procedure. You mentioned that in the U.S., it’s used outside of gyne.

 

Do you see a point, hopefully in the near future, where robotics could assist and decrease those wait times in the stuff that is non-gynecological that is adding to the big wait times, I think particularly in the Valley?

 

GREG BAILLY: I think you have to ask how quickly a robotic hysterectomy is done versus a vaginal hysterectomy. A robotic hysterectomy, I believe, is longer operating room time. There are procedures, as Dr. Darling said, that are still done laparoscopically or transvaginally that are safe, low-morbidity, and quick recovery. Those, I think, will continue to be done quicker than robotic surgeries. The actual robotics surgery, once you get started, is faster than the open surgery, but the set-up for the room, the takedown of the room, and all those technical aspects take a two-hour case and makes it three sometimes.

 

We’ve gotten much shorter because we’ve gotten faster at everything. In many senses, when a robot comes into an institution, there’s a learning curve for the entire team - the nurses, the techs, and everything - and eventually, your efficiency takes over and you’re probably doing as much or more than you were open.

 

[2:15 p.m.]

 

ROD WILSON: I recently toured Dartmouth General Hospital and saw the benefits of their robotic arms for orthopaedics. While our wait times have decreased from consult to surgery, we still have horrific wait times for consult to see the surgeon. In Kentville, 362 days is the mean - more than twice the wait time for Dartmouth and Halifax. While we should be proud of those, these other measurements are not something we should be proud of.

 

I guess what I’m trying to understand is: Is there a point in time where, as our wait time - will robotics actually help at some point - and if so, when - to decrease the time from referral to consult? The consult to surgery time is shortened, but what I hear all about was one of my biggest frustrations as a family doctor: “When’s my surgery?” “Don’t know.”

Interestingly, now as an MLA, I get phone calls from rural Nova Scotia - my colleagues’ constituencies - saying, “I’ve been waiting a year, two years. You’re a family doctor. What’s going on?”

 

Really, while we celebrate that, I think what we’re missing - the Nova Scotian experience - is will robotics at some point in time - will there be a tipping point - maybe there won’t, and that’s okay - to decrease that one- to two-year wait time to see a surgeon? Million-dollar question.

 

GAIL DARLING: I don’t think robotics is going to change that, to be blunt. I think what changes that are the other things that we’ve started, which is the orthopaedic assessment clinic. I think that’s a good thing to roll out across the province and not just have it at the QEII. That gets the patients in and gets them assessed and gets some treatment for them while they’re waiting for surgery, if they need surgery. It takes those other people off the list who don’t need surgery. There’s that.

 

There’s the Ocean referral system, which is province-wide. I will say this about the Ocean system: It has shone a light on the patients waiting who just don’t get seen. The Ocean system has now provided surgeons with the opportunity to say, “No, I’m not going to accept that patient because my wait-list is too long.” We’re actually starting to get a handle on the data of how many patients really are waiting. We had no idea before. That’s not a solution, but at least we have data to support that.

 

I don’t think robotics is going to make a difference to that wait time to consult. These other efficiencies will.

 

THE CHAIR: Ms. MacGibbon.

 

EILEEN MACGIBBON: I just wanted to add to Dr. Darling’s comment about the strategies with respect to earlier assessment and triaging. We have seen that with joint replacement - the potential for arthroplasty to not actually be needed. That has been spread throughout Nova Scotia in other zones as well. We’re seeing the benefits.

 

As well, the spinal program here in Halifax has moved in that same direction where patients are assessed as proactively as possible to understand if they actually need spine surgery or not, and teeing that up in a team-based way so that it’s not solely reliant on the spine surgeon - doing that in an interdisciplinary team-based fashion so that we can influence wait times in a positive way. That’s another good example of where we have opportunity to make those kinds of advancements in other specialty areas across the province.

 

I will say that Dr. Darling is spot on with respect to the challenge with not knowing. We now have an ability within Nova Scotia to understand what those waits really look like for patients. We’ve had the anecdotal evidence mostly through concerns being expressed through primary care providers. That’s the similar experience across the country where jurisdictions just don’t have a good handle on that first segment, or Wait 1. Now we understand what Wait 1 looks like across the province. Then we have the ability to influence it and find improvements and strategize, as Dr. Bailly said, where we can funnel patients and tee them up in ways that reduce their ultimate wait time.

 

ROD WILSON: Thank you, Dr. Darling, for actually acknowledging that robots are not going to decrease that wait time. We’ve not heard that any time before today. We’ve only heard celebrations. I honour the celebrations, but the Nova Scotians waiting, they kept thinking, “Okay, what’s the robot going to do to my wait times?” It’s very refreshing to hear some accurate opinions, so thank you.

 

I guess the question I want to ask is - Dr. Bailly, you had mentioned - and I want to quote you - something about: We want to move forward. We need to get going. You mentioned that robots are standard care. To the surgeons in the room, what do you need to get going that you don’t have right now?

 

GREG BAILLY: We need an expansion of robotic equipment. Currently we have eight robots. We need more. I won’t get into the details. We need more OR time and more surgeons to decrease the Wait 1 times. There’s a lot more we need.

 

Right now, though, I think we need a signal from government. To your question earlier, I’ve been in this role as department head into my ninth year now, and I have noticed a significant investment in health care in the last five years. I think that we need the government to recognize that in order to bring wait times down, both to be seen and to have surgery, we need more.

 

As a physician, you know. You either work harder and see more patients per day, or you add more doctors, or you become innovative, like Eileen was saying about having these clinics where non-physicians perhaps can screen patients. That’s the only way we can bring wait times down.

 

I’m not really answering your question. I am? I am. (Laughter) That’s all, then.

 

GAIL DARLING: I would echo what Dr. Bailly just said. We need more surgeons and more ORs, and with more ORs, all the things that go with that: nurses, anaesthesia, and device reprocessing.

 

In terms of the robotics piece for my department, we desperately need at least one more da Vinci. We could probably use two more da Vincis. Right now, we know that urology alone could use one, and they graciously give up some to gyne oncology. I think gyne oncology could use one all by themselves.

 

We would like to expand into cardiac surgery. I don’t know how many people saw that on the news: Marc Ruel from the University of Ottawa Heart Institute doing a robotic coronary-bypass surgery. We have a guy already here who could start that. We’d like to expand into cardiac surgery.

 

We have two more colorectal surgeons who are anxious to get going, but we just don’t have enough time to give them. If we dilute the experience of the people already doing it, their skills are going to drop down and then their efficiency is also going to get worse. We have to give them enough time on the robot to maintain their skills and efficiency. Meanwhile, we’ve got other surgeons who could use a robot, but we don’t have the robot.

 

THE CHAIR: Dr. Davies.

 

DAFYDD DAVIES: A lot of it is the work that comes out of the Centre of Excellence, and I think IWK Health will benefit significantly from that. The whole process of robotics needs oversight. It needs support. We’re every day looking at different ways that we can tackle the wait-list, whether it’s Wait 1 or Wait 2 - trying to innovate, trying to make sure everyone’s working to their full capacity, which I guarantee you all of them are. When we come and say, “Look, we really need this to tackle the wait-list,” we’re being as responsible as humanly possible, I think, to make sure that we do that wisely.

 

I think trusting what we’re saying when we say, “We really need to do this. This is important for medicine and health care in Nova Scotia” - and that we’re keeping an eye on the wait-list and we’re trying to make sure that we’re also advancing in the technology at the same time.

 

THE CHAIR: MLA Wilson, with 50 seconds remaining.

 

ROD WILSON: Hopefully my colleagues in the government were listening to your recommendations.

 

My last comment is thank you for trying. I also worry that those who keep working harder burn out. We have to admit that.

 

My other thing is - maybe I’ll follow up with another question - can we decentralize so that a person in Sydney or Chéticamp doesn’t have to wait twice as long as someone in Halifax?

 

THE CHAIR: Dr. Davies, with 20 seconds remaining.

 

DAFYDD DAVIES: I think the centralization needs to happen currently, because the big benefits to robotic surgery are in the complex cases, which need to get done in a tertiary care centre. The complex patient from Chéticamp is being done in Halifax anyway, so they’re getting that care. I think the basic, more standard care is happening in a decentralized fashion, and that’s how it has to be for now, with time as we expand.

 

THE CHAIR: Order. Thank you very much. We’ll move on to the Liberal caucus and MLA Mombourquette.

 

HON. DEREK MOMBOURQUETTE: Thank you, Chair, and thank you all for the opportunity to ask a few questions. I only have 10 minutes.

 

I will say that as the longest-serving MLA who’s on the committee now - 11 years in - I remember when the robotics program was launched in 2019. It was because of the work of some amazing donors, families across the province, and of course, the work of all of you and your team. It’s something that we talked about way back when - how important it was in trying to expand the options for new technology to support Nova Scotians every day. Here we are in committee having a conversation in 2026, and now I get to hear it again and hear the updates. I really appreciate it.

 

One of the things, with the limited amount of time I have - there have been a lot of questions around data and wait times and whatnot. The biggest thing for me is what Dr. Bailly said about what’s next. One of the themes that came out of this - and Ms. MacGibbon, you mentioned this too - is the donor versus capital expense. That’s really a big part of this. Ultimately, to expand robotics - donors are amazing. We see donors all over the Island. We have a great foundation in Cape Breton. But they also are being asked a lot.

 

My question - through you, Chair, to whoever wants to take it - will you look to the government, and has an ask been given to the government to look at this as more of a capital expense - something that they should be investing in more than depending on donors?

 

THE CHAIR: Ms. MacGibbon.

 

EILEEN MACGIBBON: The evolution of robotic-assisted surgery as an acquisition and the significant capital investment coming by way of donor generosity obviously has been the trend across the entire country. I think that, as Dr. Bailly said, as we move toward what is really considered to be a standard of care, we are already seeing and we’ve seen demonstrated through significant government support that we are embedding the support required and the resources required within our operational budgets to support robotics surgery.

 

As we look at your example of Cape Breton and the opportunity, I think what we want to be very smart about is delineating or differentiating what our foundations should be considering and not asking them to be looking to campaign for something that should reside within what we would say is our operational budgets. I think we’ve been very smart about that, and I think our foundations have appreciated that.

 

That said, I do think that as we move forward - Dr. Bailly mentioned the number of cases that have made their way to Halifax. I do not believe that the patient in Chéticamp, if they have complex needs that are benefited by way of a da Vinci approach, is in any way disadvantaged. I think they are making - we have the data to support that they’re making their way to Halifax, but should they have an opportunity for that same service in Sydney? Perhaps. That’s where the Centre of Excellence will play a pivotal role in ensuring that we create a blueprint that’s sensible.

 

I would hope - we all hope - we have not seen a significant reduction in pricing related to robotics yet in our system, I think because the bigger players in that sphere have been lone wolves with respect to having the market pretty much sewn up for them. That’s just the way it’s been. I do hope that we have more competition, because that would hopefully lead to reduced expenses from a capital point of view. That will make it easier for us to move in the direction Dr. Bailly mentioned earlier, which is not just academic centres, not just tertiary sites, but the ability to have robotics programs in regional hospitals and not solely reliant on foundations to support it.

 

DEREK MOMBOURQUETTE: It’s an interesting conversation. I was involved with hospice at home. We look at the conversation around PET scan technology, having it in two locations, just giving Nova Scotians the ability in other parts of the province to - if they can’t access it in Halifax, which - I know lots of Cape Bretoners are coming to Halifax to receive support. It would be nice to eventually get to a point where there’s a second location where you can actually have this technology.

 

I always - I represent Sydney. The CBRM is a population of 100,000-plus people. Lots of folks are travelling. It’s also a place where people can go from the eastern side of the province to receive that care as well, so hopefully down the road. It’s something that, regardless of who’s in the government of the day - donors play a huge part in this, but we also know that donors are being asked to fund a lot. We’ve been very fortunate over the years to have some really amazing people step up across the province to fund some of the most important pieces of equipment that Nova Scotians use every day.

 

[2:30 p.m.]

 

One thing I will say as we move forward as well, the government of the day guaranteed 24/7 operating rooms. That has been something that has been on the docket now by the government for years. What would that do if the government kept their commitment of 24/7 operating capacity?

 

EILEEN MACGIBBON: Is that something that we’d like to achieve? I think all of us have - if you look at it from an industry-agnostic point of view, we would want to run our services as much as we possibly can. The challenge we have in health care, like many other industries, is the balance from a human resource perspective. The numbers of folks that we have today are often challenged by the number of vacancies within specialties for physicians. We see it in almost every clinical discipline now: lab, diagnostic imaging, nursing. That’s not unique to Nova Scotia.

 

Our ability to optimize the use of operating rooms outside of more traditional hours is definitely challenged by our ability to staff them in a way that creates a balance that will retain our folks. We don’t want to create a system of expectation that actually puts us in a worse state as it relates to folks leaving because they don’t like the conditions of employment. I will say, though, when I think about what we’ve achieved at Dartmouth General Hospital, we know that one of the pinch points, as it relates to access to the operating room, is bed access. The Dartmouth General was leading the country nine years ago, eight years ago, when they started doing joint replacement surgery with patients going home the same day safely with great outcomes. That took away the dependency on admission to a bed, which was often the reason they couldn’t optimize the operating room time. We’ve seen that expand across Nova Scotia, not just at the Dartmouth General now.

 

I think what we’re trying to do is find efficiencies in every way that we can and use OR time as best we can. Dr. Bailly referenced, as well, the extended days we have with the robot. They’re certainly not being turned off at 3:30 p.m., and we are running them as much as we can from a staffing balance point of view.

 

THE CHAIR: MLA Mombourquette with six minutes remaining.

 

DEREK MOMBOURQUETTE: Feels like I have an hour. It’s going good. I have one question as a Cape Bretoner. We see lots of folks traveling to Halifax. I have a family member coming up. We’ll be meeting with IWK Health around an injury. Can you break down the wait time compared - we want everybody to get the same access to care. I live the furthest away. Yarmouth maybe, too. The point is that we hear it at home: People come to Halifax and they have to travel to Halifax. Is there a big gap in the wait time between somebody receiving care who may live closer to Halifax than outside?

 

THE CHAIR: Dr. Bailly.

 

GREG BAILLY: There really should be no difference in any individual in the province in the wait time to be seen in Halifax because we triage based on priority or risk of disease. I know that I can only speak for my group, but we wouldn’t base any kind of triaging on where someone lives ever.

 

DEREK MOMBOURQUETTE: It’s always a question. We’re always trying to support families who are trying to make it to the capital for a number of reasons. Financial is an issue. We have a lot of seniors who try to come, and it’s a bit of a navigation for them to do that. Dr. Bailly, I’ll ask you this question: In an ideal situation, for me, we’re seeing this evolve since 2019. Staff deserve all the credit. Governments come and go; governments make investments. We want to see investment in health care regardless of what side of the floor you serve on as an elected representative, because we all want the best for the people that we represent.

 

The team at IWK Health and beyond, Dalhousie University - and I know some people at home who have involved as well; there are some great medical professionals at home who’ve been involved in this conversation and deserve a lot of credit for the work they do every day to support families across the province. Again, I always go back to the next step. For you, what is the next step? You mentioned continued government investment, and I’ll talk specifically about robotics. I always try to go into these committees with one key takeaway that we can all, when we go back into the Legislature, reference this and have the conversation. I’d like to hear from all of you, if you want to partake in the answer: What is the next step? Ultimately, you’re at this point, we’re seeing great success, you’re seeing support, you’re seeing wait-lists reduced, you’re seeing numbers for the betterment of people who are getting the service. What’s the next step? What’s the next best move?

 

GREG BAILLY: To put it quite simply, I would like to see the government commit to a significant long-term investment in supporting - well, health care in general, but in particular today, we’re talking about robotics. Some of the comments that Eileen made - the foundations have delivered, and the public through the foundations have delivered these new products to us, whether it’s a PET scanner, an MRI, or a robot, but eventually, it comes time where the Province needs to commit that they will continue to operationalize those services. That’s the next step for me. It’s a collaborative approach between government, the Nova Scotia Health Authority, the foundations, and physicians.

 

THE CHAIR: Would anyone else like to - Dr. Darling.

 

GAIL DARLING: I would echo what Dr. Bailly has already said. The other component I think is important is investing in physician extenders. They recently opened the Master of Physician Assistant Studies program at Dalhousie University. These individuals are really extremely well trained to be physician assistants, to take on some of those roles in assessing patients or supporting surgeons or whoever to expand our capabilities beyond the one surgeon. I think that was a very good move. I think it needs to be supported and expanded.

 

THE CHAIR: Would anyone else like to speak to it?

 

MLA Mombourquette with one minute.

 

DEREK MOMBOURQUETTE: I won’t have time for an answer, but I’ll just end with thanking all of you. Thank you to all of your staff and donors and people who are involved with this.

As I said from the onset, this is one example where you had significant donors step up back in 2019 to really lead the charge on this. Dr. Bailly, you referenced it again, too. We’ve seen amazing people step up - MRIs, hospice in Cape Breton, big conversations around PET scans, these pieces of equipment that we’ve continually had the blessing of people who would come forward and say, “As a family, we want to donate” or “As an individual, I want to donate.” I think it’s going to be a big conversation moving forward around, whoever is in government, what is that long-term investment, that sustainable investment in the operational side of things?

 

I’ll just end with also saying that as you build that Centre of Excellence and your advisory - I’m sure you’re talking about this - representation from across the province is key.

 

THE CHAIR: Order. We’ll now move on to the Progressive Conservative caucus. We’ll start with MLA Fadare.

 

ADEGOKE FADARE: I know you, Dr. Bailly, have said this a couple of times, that it’s not just about technology. You need the people. We’ve obviously been a government that’s been willing to be innovative with different kinds of initiatives. It’s not just about the equipment itself. It’s also ensuring that we have the right skill sets and the right trained individuals. I needed to echo that, because I kept hearing that particular phrase over and over from my member opposite.

 

I want to just quickly ask my question that I was trying to ask earlier on. We’ve seen how robotics is supporting surgeries across all kinds of specialties right now, from orthopaedics to urology to neurosurgery to spine and all that. I’m just wondering, what would determine the next expansion in terms of what other specialties you’re looking at?

 

Also, one of the things that’s making rounds is, what are you looking at to determine what specialty and what community would benefit from this? I think we have nowhere else to go but to expand. That’s the way I feel. I don’t know if Dr. Bailly would like to answer that? And any other person who might be interested in that?

 

THE CHAIR: Dr. Bailly.

 

GREG BAILLY: There are certain services or subspecialties that should never leave Halifax, because the volume of those conditions, of those diseases, should really remain in one centre. That would be thoracic surgery, vascular surgery - at least cardiac surgery, I mean. For pelvic surgery and orthopaedic surgery, I can see that those - and when I say “pelvic,” I mean perhaps bowel surgery, prostate surgery, kidney surgery, anything in the abdominal cavity or joints. I can see that those could eventually expand to regional centres. Again, you’ve noted the importance of the appropriate clientele or, sorry, the appropriate personnel and support. It’s not just the surgeon who does it. You need the special equipment to sterilize the equipment, and you need the post-operative expertise - the nursing, the floors, and all that kind of stuff, the physiotherapies and all that. I think that certain ones would always remain in Halifax because there’s no role to put those in a regional centre. Then some of the inter-abdominal things and joints could go to other centres eventually.

 

Now, the preparation for that is identifying how many surgeons you need and how many patients you have to keep up the skills of those surgeons. It’s very difficult as we know, and we know this from Sydney and other places in Canada. It’s very difficult to send in one person as an expert in something and expect them to stay because they get overrun and they get burned out and they have to leave. I think the Province has done a good job at looking at the zones and saying, well, we really only need one or two urologists here, but we’re going to have to put three or four because that’s the only way we’re going to keep a urology service there.

 

I think the same goes for Sydney, and I’m going to come back to Sydney because people in Cape Breton really don’t want to come up to Halifax to have their treatment - and I don’t blame them. They’ve had tremendously gifted surgeons in Sydney. As they replace those surgeons as they retire or move, I think there has to be a real focus on let’s not just hire a urologist, let’s look for a urologist who’s trained in robotics and let’s look for another one to join them. He and she, let’s provide them with a really supportive environment that attracts them to come. We can attract people in Halifax because they’re joining a group of 15 people, but it’s different. It’s a different way of thinking when you’re opening up robotics in a regional centre. It requires more investment.

 

THE CHAIR: Dr. Davies.

 

DAFYDD DAVIES: I think it’s going to be really important for the Centre of Excellence to guide that because you’re never going to give us a blank cheque for this. There’s always going to have to be someone making sure that there’s a fair distribution of the limited resource. Part of the reason that I thanked everyone for allowing me to be part of this is that the kids sometimes get left behind. We need to be at the table, and it’s important that someone’s at the table representing all of the different specialties because, unfortunately, we’re not hearing too much about gynecological surgery today. Gynecological surgery is a huge part of the health care burden in Nova Scotia. Somebody, some central committee, needs to be looking at that and asking, “Okay, what is next? What makes sense? What’s feasible? What’s efficient? What’s going to have the most impact for the limited amount that we have?” I’m thankful that it exists and IWK Health will be certainly piggybacking on top.

 

THE CHAIR: Thanks for that. We’ll move on to MLA Robicheau.

 

RYAN ROBICHEAU: Thank you, Chair, and thank you to all the witnesses. Admittedly, I was not very knowledgeable on this subject, so this meeting was very informative. I feel like I can walk away from this meeting knowing where we are with this and what the next steps will be.

 

My first question, we touched on it a few times: How are surgeons and trainees being recruited or retained because of access to this technology?

 

THE CHAIR: Dr. Darling.

 

GAIL DARLING: I think that it varies by specialty. I would say Dr. Bailly would not be able to recruit a urologist without having access to the da Vinci robot. We are not there yet in other surgical disciplines. Let me backtrack a little bit. Gyne oncology is another one. They recently had a very difficult time recruiting, and their only way they can recruit - they were successful in recruiting because they had access to the robot. The gynecological oncologist will not do surgery without the robot. They just have to have it.

 

In other surgical disciplines, it’s coming. For example, we just recruited a liver surgeon who spent a whole year doing a robotic fellowship in liver and pancreas surgery. He would have gone somewhere else if we didn’t have a robot. We were able to retain a thoracic surgeon who basically was going to leave unless we had a robot. It’s coming to where we will not be able to recruit surgeons in the future if we don’t have robotics. It’s already true for residents in training, where they’re looking to see that where they’re going to go train has robotics, because they know that’s the future. It’s already happening.

 

[2:45 p.m.]

 

RYAN ROBICHEAU: It’s very evident that it’s crucial to have this in place so that we can keep attracting these surgeons. How does the Province’s robotics program compare to what’s available in other Canadian jurisdictions?

 

THE CHAIR: Ms. MacGibbon.

 

EILEEN MACGIBBON: I think we demonstrated that we are leading the country. Dr. Bailly mentioned earlier that we weren’t first with respect to acquiring a da Vinci, but what we have achieved since acquiring the da Vinci and the Mako and the Mazor, and we have ROSA ONE Brain for epilepsy - we have a robotics program that’s now creating the ability for us to enable first - like we’ve seen with spine surgery, like we’ve seen with joint arthroplasty. We know that as it relates to where we are in the country, we’re certainly not behind. We weren’t the first to acquire, but we’ve caught up quickly.

 

I think it’s the momentum that we’ve created now that causes Dr. Bailly and Dr. Darling to say what they say about the next, because we want to ensure that we use the Centre of Excellence to create a blueprint. It’s not that there aren’t examples from lots of other jurisdictions that we can rely on to understand where the biggest benefit is, and if that aligns with what we have for demand in Nova Scotia, that would obviously give us an area that we need to be moving to next and give us an easier way of prioritizing the specialties or the areas that we want to now have as part of the robotics program.

 

RYAN ROBICHEAU: We’ve touched on this a bit, but if we could just go further. How does robotic surgery affect patient recovery time and length of hospital stay compared to traditional surgical approaches?

 

THE CHAIR: Dr. Bailly.

 

GREG BAILLY: We’ve been able to collect some of that data. It reduces the stay in hospital - how many days a patient stays in hospital afterwards. We’ve shown that it’s reduced the need for: narcotic analgesics or painkillers after a surgery, and that’s been tracked; blood transfusions; pain scores in general; and also a return of function. Return to work is quicker because there’s less pain. You get back on your feet quicker.

 

The cancer outcomes are very important as well. It wouldn’t all make sense if the outcomes were not better from a cancer point of view. For the majority of procedures that we do, the research shows that the outcomes from cancer are superior as well.

 

Some of those are not measurable by dollars and cents. Some of those are tangible and some of them are intangible benefits to both the patient and the institution.

 

There’s also a benefit to the surgeons. If you could see the surgeon do the surgery the old way, which is leaning over someone and turning for several hours versus sitting in a chair like this in sock feet and hands, with music on, doing the surgery - it has significantly improved the comfort level for the surgeons, and that’s translated into longevity of surgical lifespan. I’ve had two back surgeries. I’m sure it’s because of the surgeries I was doing. That’s been looked at. It’s a benefit that we don’t think about to the surgeon themself.

 

RYAN ROBICHEAU: That’s an excellent point. I never thought about that.

 

What has been the most significant lesson learned since 2019, and how has that shaped how the program has grown?

 

GREG BAILLY: I think we underestimated. When we were looking at the volume of cases that we thought we were going to do when we were - we did a five-year plan and we budgeted out a five-year plan. The person who put this all together, Joanne Dunnington, who’s in the back - we went through that in about three years because of centralization of care. It was an eye-opener for us. Like I said earlier, when you introduce this kind of life-changing, career-changing innovation into health care in a region like ours, it just grows and we have to grow with it.

 

One of the biggest things I think from that that I’ve learned is the frustration of the demand coming because we brought it on ourselves to not be able to respond quickly. To get the second robot in sight, on site, in my opinion, it took too long. There was too much red tape to get this thing in. Now we need a third one and a fourth one. I don’t want to wait another two and four and five years, because the patients are sitting on the doorstep now. That was the biggest thing I think I’ve learned.

 

THE CHAIR: Ms. MacGibbon with 30 seconds remaining.

 

EILEEN MACGIBBON: I think, you know, we’ve mentioned a number of times how transformative and how innovative this is. I think what it’s created for us is it’s really - I would describe it as disciplined innovation because we’ve done so with a structure in mind and not just haphazardly introducing without thinking about all the dimensions of value and the opportunity to spread and scale this across Nova Scotia in a sensible way.

 

THE CHAIR: Great, thank you very much. We’ll wrap it up. There’s only five seconds remaining, so we’ll bring that to a close. Are there any closing remarks? Would anyone like to provide closing remarks? Ms. MacGibbon.

 

EILEEN MACGIBBON: Thank you once again for the opportunity to speak to the many advancements being made through surgical robotics, the strength of our new Centre of Excellence in robotics, and what that brings to Nova Scotia - all of Nova Scotia - and our goals for continued expansion.

 

As health care leaders and providers, we bear a great responsibility for providing the best possible care and service to the patients and communities we all serve. As demand for health care continues to grow, we know we must make the best use of our time, resources, and expertise while continuing to provide high-quality care. It is clear from the information that we presented today that robotic-assisted surgeries have and will serve a key role in supporting these goals. As Dr. Darling said, they’re not going anywhere.

 

Few changes in health care have captured the attention and excitement that we are experiencing with robotics, and for good reason. Robotic technologies are equipping our teams to provide patients with better outcomes, better quality of life, and in some cases, making surgery and recovery options that wouldn’t otherwise exist. We are immensely proud of the results we have achieved for our patients, our province, and for the entire health system.

 

Ultimately, this is not simply an investment in technology. It’s an investment in our patients, our health care professionals, and the future capacity of the entire health system in Nova Scotia. We look forward to continuing our work with your support.

 

THE CHAIR: Thank you very much. We appreciate your time here this afternoon. Thank you for coming. You can leave now.

 

We’ll take a five-minute break before we do the - or a three-minute break. (Interruptions) There’s no committee business, so we’re good? Okay. Meeting adjourned. Thank you very much.

 

[The committee adjourned at 2:53 p.m.]