‘Untenable’ to quit regions: Jonathan Lewin

Royal Melbourne Hospital head of urology Anthony Costello.
Royal Melbourne Hospital head of urology Anthony Costello.

RESTRICTING access to laparoscopic surgeries would “considerably compromise” health care in regional communities, a court has heard.

Jonathan Lewin, one of two Border surgeons providing evidence to an inquest on Corowa man Robert Hawkins, said centralising laparoscopic nephrectomies — keyhole surgery to remove the kidney — to Melbourne did not seem tenable.

Mr Lewin cut the wrong artery during surgery on Mr Hawkins in 2010, contributing to his death.

He told Wodonga Coroners Court it had taken him six months to regain the confidence to perform the surgery and he had since completed 19 more procedures without any complication.

He voluntarily stopped again last year following a report from Royal Melbourne Hospital head of urology Anthony Costello and offered to undergo an audit of his skills.

The court was told all research available at the time showed it was an “exceedingly rare” complication and of equal risk whether performed via open or keyhole surgery.

Mr Costello has said he believed the surgery should only be conducted in large metropolitan centres by surgeons who specialised in the procedure, and had completed at least 40 before being unsupervised.

There are no guidelines detailing how urologists should be credentialled for certain surgeries, leaving it to hospitals’ discretion, although some medical literature states 15 surgeries would be appropriate.

Mr Lewin had completed more than 20 surgeries when he was appointed senior urologist and given unlimited privileges to operate at Wodonga hospital in 2009, and another seven before meeting Mr Hawkins.

“I think it would be extremely difficult for every urologist to achieve that number during their (training),” he said.

“Even if you did 40, it (a tumour like Mr Hawkins’) still could be something never seen before. It’s so extremely rare.”

Mr Lewin said “contrary to Dr Costello’s opinion”, Albury Wodonga was not a rural but a major regional centre and complex laparoscopic surgery had been done for many years.

Moving all keyhole nephrectomies to Melbourne from regional areas would put extra burden on those centres, he said.