In early April 2020, shortly after British Prime Minister Boris Johnson announced the first pandemic lockdown in the UK, a urologist named Archie Fernando contacted one of his colleagues, Nadine Hachach-Haram.
Both doctors worked at Guy’s and St Thomas’s Hospital, one of the busiest in the country, at a time when nearly a thousand more people were dying from covid-19 every week. Most surgeries were postponed, unless they were life or limb cases. and pressing cancer surgeries, and Hachach-Haram, who is a reconstructive plastic surgeon, remembers how dead she felt. doing any and all things, like wear and tear and pronation, turning patients to breathe lightly. “
Hachach-Haram is also the founding CEO of a small fitness technology company called Proximie. The company had developed an augmented truth platform that allowed surgeons to collaborate remotely. Its web-based software allowed surgeons to communicate with each other while sharing a live video stream. of an operation, adding up to 4 streams showing other camera perspectives and medical scans, and featured a computer-generated overlay that can only be used to draw commands on split screen.
Fernando wanted to call Proximie for an urgent and confusing procedure. His patient Mo Tajer, a 31-year-old man who had undergone chemotherapy for testicular cancer. The cancer had spread to her abdomen, where a 5-centimeter tumor stuck around her. The aorta and inferior vena cava, two of the largest blood vessels in the body, making surgical removal difficult. Under general circumstances, Fernando would have performed open surgery, but this would also have required a two-week post-operative recovery era in the extended care unit at the height of the pandemic. “It’s not an environment where you need someone to feel immunocompromised,” Hashach-Haram says. “They needed me to get in and out of the hospital as temporarily as possible. “
The safest option is minimally invasive robotic surgery, but Fernando does not have enough experience in this procedure. However, with Proximie, it can work under the direction of a colleague, an American surgeon named Jim Porter. Porter, who is the medical director of robotic surgery at Seattle’s Swedish Medical Center, had not only pioneered such operations, but also one of the most experienced laparoscopic surgeons today.
The operation took place on May 21. Fernando, dressed in full non-public protective equipment, operated the surgical robot’s console, two meters from the patient. The robot has 4 articulated arms, 3 equipped with surgical tools and a 4th holding a thin tube with a camera at the end, which, when inserted into Tajer’s abdomen, allowed Fernando to see inside the patient. portable. For five hours, he guided Fernando through the operation step-by-step, talking to him while an augmented reality pointer identified anatomical parts and drew annotations to identify where quick incisions were desired.
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Hashash-Haram, who had logged in to watch the operation, “speechless. “
“I was inspired through his calmness,” she says. It’s the first time since the beginning of the pandemic that he noticed Proximie being used in a doctor’s office. He learned that, without his invention, this important operation may never have been carried out, and as he watched it unfold, he began to think. cry.
Proximity in a robot operating room.
Like most surgeons, Nadine Hachach-Haram’s education followed a pedagogy known in medical circles as “see one, make one, teach one. “It is a culture that interns, once they have observed a specific type of surgery or use of equipment, deserve to then attempt to perform it, the first times under supervision and then through them. themselves. After accumulating enough first-hand experience, surgeons are expected to teach those skills to the next generation. Hachach-Haram still vividly remembers the first surgery he witnessed, when he was 14 years old. He had moved to Beirut from his local San Diego 4 years earlier, in 1990, after his parents returned to their home country. The civil war in Lebanon was then over, but the fighting between the Israeli army and the Lebanese paramilitary organization Hezbollah continued unabated, resulting in injuries and deaths among masses of innocent civilians. “It wasn’t the safest time to grow up in Lebanon,” says Hachach-Haram. “You would see a lot of other people with severe burns, deformities, no limbs. “
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One day, his circle of relatives receives a layover from a friend, a New York plastic surgeon traveling to Lebanon to care for trauma victims. Hachach-Haram was intrigued, and she convinced him to let her accompany him to one of her operations. She watched mesmerized as he worked on a young woman who had a foot contracture, a severe hardening of the skin that limited her movement. “Her foot of hers was burned by a bomb blast,” Hachach-Haram said. “The surgeon had to do what is called a Z-plasty, where a contracture is released through geometric cuts that allow the skin to be moved and the scars checked. I was surprised that he was able to help him walk back just by moving the skin from one position to another. It was the day that Hajaj-Haram made a decision about what he wanted to do with his life. He wanted to be like that plastic surgeon in New York, someone who was willing to fly 9,000 miles around the world to work on someone in desperate need. “I sought to help everyone in the world get the same quality of care,” she says. “I sought to give other people an opportunity.
Hachach-Haram would perform his first surgery 12 years later, helping a senior surgeon remove a thyroid gland as a first-year medical student in London. She then specialized as a reconstructive plastic surgeon for pelvic and breast cancer, training others as it progressed. through their own exercise. In 2006, she began volunteering for global fitness charities, flying to places like Peru, Vietnam and Lebanon to exercise and receive information from local doctors. For a moment, she could describe herself as satisfied. Over the years, another feeling began to settle, the feeling that what I was doing wasn’t enough.
She remembers a specific day when that sense of frustration took over. It was April 2015 and she was sitting alone in the operating room, pregnant with her third child, who had just returned from another long vacation and would soon have others. The Lancet medical journal had just published a report concluding that nine out of ten people in low- and middle-income countries did not have access to basic surgical care. This bloodless statistic felt, as she puts it, “like a punch in the gut. . . I had worked so hard to verify access and assistance and make all that difference, and suddenly it all seemed useless. “
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As she reflects on her own experience as a coach, it has become obvious to her that it is not so much the case that she hasn’t done enough that she has done it wrong. “I would exercise other people and then not see them again,” he says. “I had no idea how they had followed the technique, if they had done it correctly. “And this inefficiency, he realized, was a direct result of the pedagogy of “see one, make one, teach one. “obsolete,” he says. It’s just not at scale. “
What the operating room needed, he thought, was an operating system. A virtual interface that could connect surgeons during live operations, so they could observe, learn, collaborate and share their expertise, without geographical restrictions. She describes having this vision of a spinning planet dotted with operating rooms around the world, all networked.
Surgeons can get a database of beyond procedures.
With the help of a software engineer, in late 2015, he developed an application that allowed surgeons to remotely view their surgical fields and overlay undeniable illustrations and annotations through split-screen drawings. To test the idea, he enlisted the assistance of a California surgeon who volunteered for the Global Smile Foundation, which introduced cleft lip surgery to children. As part of this program, he traveled to Trujillo, Peru, every three months to practice as a local physician. That year, instead, he used the Hashaj-Haram prototype to conduct the remote exercise weekly. “During this year, she was able to complement the skills of the Peruvian doctor. They measured that not only had he become more efficient, but his decision-making was also faster,” she says.
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A few months later, Hashash-Haram received a call from a colleague who was running in Gaza and needed his help. He told her that an 18-year-old boy had injured his left hand while trying to disarm an unexploded bomb. Don’t shower or get dressed. He had undergone six botched operations with local surgeons and, due to the Israeli blockade, may not be able to travel abroad for treatment.
Although Proximie is not used in live surgery, Hachach-Haram asked a trauma surgeon in Beirut to lend a hand to the local surgeon remotely. “I’m very nervous,” she says. The opportunity to replace this person’s life is very important to me. It was as if the dream I had had since I was 14 came true.
The good fortune of this operation encouraged Hashash-Haram to devote his studies to a genuine enterprise. She raised funds, hired a team to expand the technology, and spent the next two years proselytizing tirelessly at virtual operating room conferences. “I would fly 10 hours just to give a 10-minute lecture,” he says. In 2019, Proximie was in a position to launch its ad.
When the Covid-19 pandemic hit the UK a year later, Proximie had already been used in 1200 surgeries in over 30 countries. “Like all corporations in the early weeks of the pandemic, we announced to our shareholders that we were going to prioritize our intellectual well-being and just try to survive,” says Hachach-Haram. A week later, he replaced his mind. ” I realized, wait a minute, that is precisely when other people will want our technology,” he said. Says. He called another shareholders’ meeting and announced: “Abandon the previous plan. Let’s speed up. ” In six months, the number of users increased tenfold and the number of surgical sessions reached 5500. Today, more than 20% of NHS hospitals have access to software. “Before, we were just a science fiction concept with some potential,” he said. says. ” All of a sudden, we were the only way to do things. “
Hachach-Haram commercially introduced Proximie in 2019.
Due to the suspension of regime operations due to the pandemic, Hashach-Haram has gone several months without acting as a single operation. “When we resumed our activities, our confidence was shaken,” says Hashach-Haram. “We had to go back to it, so we were going to get married and ask a colleague to help us through this, because we needed that support.
When it wasn’t imaginable to have any other representative physically present, many used Proximie to get remote assistance instead. If the loss of skills and confidence during the pandemic was a fear for experienced surgeons, the challenge was even more pronounced for their younger colleagues: according to official data, NHS exercisers saw 50% relief in exercise opportunities for surgery. “Many exercised in the prime of life have lost 18 months of practice,” he says. “We can’t afford to take 10 years to exercise people. We had to think about how Proximie could push this forward. »
The American Society of Gastrointestinal and Endoscopic Surgeons, for example, sent anatomically realistic models of porcine tissue to trainees running away from home, so they could perform abdominal wall hernia maintenance while receiving assistance from remote experts. The Hip Preservation Society, on the other hand, established a normal virtual education program that included live surgery, for example, a labrum reconstruction procedure, broadcast to more than 500 people worldwide. “Historically, only a few trainees had access to a procedure,” he says. “Now many other people can have access to the few instances that were happening. “
Today, more than 95% of Proximie’s surgical sessions are also recorded in their online library, allowing surgeons to edit and tag images that can then be used for educational or informational purposes. As of late, this library retails over 20,000 surgery videos, making it the largest database of its kind. “When we started, we only had the live surgery feature in mind,” she says. “But then we thought, what if other people wanted to have post-op feedback or review their performance? That’s why we built the library. When he first looked at footage of his own operations, Array Harach-Haram knew, for example, that his El Her habit was, as she describes it, “a bit aggressive. I found that I liked to do the operations myself, even when there were trainees in the room,” she says. Now, in similar situations, she forces herself to hand over the surgical instruments, she intentionally clasps her hands close to her chest and walks away from the operating table. “I’ve learned not to be in their space,” she says. “I just give them the room. “
This article appears in the July/August 2023 factor of WIRED UK.
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