WHY THIS MATTERS IN BRIEF

If you’re self-isolating or not allowed to go to work normally it’s a hassle, but it’s an even bigger problems for hospitals and surgeons.

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The current Coronavirus pandemic, Covid-19, means that over half the world’s population is in some form of lockdown. While that might not be too dire a situation for sales managers or internet marketers it’s a real problem if you’re a surgeon.

Over the past couple of years I’ve been talking about the continued rise of semi-autonomous and autonomous robo-surgeons, robots that can perform surgeries, from inserting dental implants to basic procedures, as well as in one conceptual case “tentative” brain surgery, and the rise of tele-robotic surgeries where surgeons perform surgery over 5G networks while being hundreds of miles away from the patient.

Now though Covid-19 is accelerating the need to find new ways, quickly and today, to let surgeons work from home, and now a solution that first came to light in 2016 is coming to the rescue.

In 2016, Nadine Hachach-Haram, a reconstructive plastic surgeon in the UK, was contacted by a colleague in Gaza who told her about Fadel – an 18 year old boy with a severe bomb blast hand injury. After six unsuccessful operations, Fadel was still unable to work, or shower and dress on his own. Because of the Gaza-Israel conflict, Fadel couldn’t leave the region. The surgeon asked Hachach-Haram if she could help.

Hachach-Haram is the founder of Proximie, a web-based dashboard that allows surgeons to collaborate remotely via audio, video and Augmented Reality (AR). A remote expert can use the software to guide a surgeon step by step through an operation, using digital annotations and drawings overlaid on a live video feed of the surgical field – the area where the surgery is being performed – to indicate where to make incisions and what to avoid.

In 2015, an early version of Proximie was tested with a surgeon in Peru and another in San Diego as part of a programme by the Global Smile Foundation, which provides cleft palate surgery for children.

“The US surgeon used to travel to Peru every three months to train the local surgeon, but that year they tried to do it remotely,” Hachach-Haram says. “The results were phenomenal. Her skills improved significantly – she was doing less revision surgery because of fewer complications and operating on more cases – and she was able to train other surgeons in her community.”

But Proximie had not been used during a surgery in real-time, until Hachach-Haram heard about Fadel. Within days, she recruited a trauma surgeon in Beirut to remotely assist the local surgeon during the operation. It was a success.

“You could see how touched he was to be able to make a difference,” Hachach-Haram says. “That he could, sitting comfortably at his desk, help that boy.”

Today, Proximie is used in over 250 surgical operations every month in more than 30 countries around the world in hospitals including the American University Hospital in Lebanon, UMass Memorial Health Care in the US, and Guy’s and St Thomas’ in London, and its use is accelerating under the lockdowns.

“There’s evidence that surgeons who collaborate do better. That added layer of interaction, where a remote surgeon can virtually indicate where a cut should be made, for instance, makes the experience much more real,” Hachach-Haram says. “The feedback I get from many surgeons is that they feel like there’s an expert standing right next to them. It’s as if they’re also in the room.”

Besides the live component, the current version of Proximie includes the ability to overlay scans and medical records and a secure library where detailed recordings of surgeries can be stored and every single interaction tagged, allowing experts to debrief and discuss past procedures. “What really became very clearly apparent to us was that the technology that can help people in remote parts of the world was the same technology that was absolutely needed in this part of the world,” Hachach-Haram says. “We have a mismatch of supply and demand of surgical expertise everywhere.”

In 2019, the UK Ministry of Defence awarded Proximie a multi-year contract to provide access to its AR system to RAF field hospitals and Royal Navy ships located around the world. This contract was signed after the software was successfully tested in simulated battle-injured patients during one of the biggest large-scale military exercises ever conducted, the Saif Sareea 3, in Oman.

“We had already deployed Proximie in the most austere of environments and in the most sophisticated hospitals in the US and Europe,” Hachach-Haram says. “We went out against some big blue chip companies and won because of what we could deliver in terms of the scalability and with low bandwidth.”

Recently, Hachach-Haram received some more good news: Fadel has gone on to become a nurse and is now helping others in Gaza.

“It was one of my proudest moments,” she says.

Now, fast forward again to April 2020 and the technology has been rolled out at a number of NHS hospitals to help self-isolating surgeons support those still on the front line.

“Incorporating integrated technologies like Proximie into routine or complex practices can seamlessly maximise healthcare resources, scale the delivery of expertise, reduce transmission of the virus, and ultimately ensure that every single patient has access to the best possible care, regardless of where they are in the world,” Hachach-Haram says, and in the midst of the madness that is Covid-19 it’s wonderful to see how human ingenuity combined with technology, yet again, is helping change lives and make a difference around the world.