Imagine you are waiting for the results of tests into an as yet undiagnosed medical condition. You know something is wrong – after feeling unwell, you visited your doctor and you were quickly referred to your local hospital for further investigation.
Finally, the diagnosis comes through. Your condition is treatable, but you will need an operation. You feel relieved on the one hand, but nervous about what lies ahead.
Then you are told there is a catch. There is no surgeon in your local area, or even your region, available to perform the procedure you need. To receive the surgery, you will have to travel hundreds of miles to a specialist centre on the opposite side of the country. Not only that, but the centre is oversubscribed at the moment, so there is a long waiting list.
Think how you would feel. On top of the trepidation about undergoing surgery, all the upheaval you would have to face, with your work, with your family, to get the treatment you need. Will your loved ones be able to travel with you? How long will you have to stay?
These types of situation are all too common for patients seeking access to surgical care. There are a variety of reasons – centralisation of surgical services to save resources, difficulties with sharing expertise for specialist procedures. But what they all boil down to is a shortage surgeons at a local level.
Remote surgery – one expert, many locations
There is a scene in the comic book Hollywood blockbuster Dr Strange where Benedict Cumberbatch, playing the surgeon-sorcerer of the film’s title, magically transports himself into an operating theatre to help a surgeon save a patient’s life.
Thanks to modern digital technology, we don’t need magic to achieve the same effect. As evidenced by Proximie, the sharing of surgical expertise across time and space, making it available where it is needed most, has become a reality in modern medicine. Using an internet connection, a smart device and AR software, we really can achieve the Dr Strange effect – the rich virtual experience of a remote specialist scrubbing in to guide a procedure in the operating room.
Over the past couple of decades, centralisation has been a major trend in the organisation of surgical services across the developed world. With national bodies such as the NHS facing enormous funding pressures, plus a decline in the numbers of trained surgeons, this was seen as necessary to protect available resources and use them as efficiently as possible.
But patients have always been the losers in this arrangement. The drawing of specialist surgical expertise inwards to dedicated ‘hubs’ has only served to reduce local access, forcing more and more patients to travel, even for relatively routine procedures.
The technology which enables remote surgery means this drawing in of expertise can finally be reversed. Instead of the patient having to head to where the expert is, skilled surgeons can help local surgeons on the ground from any location.
We are seeing this work well with the delivery of skin cancer treatment from the plastic surgery team based at the Royal Free Hospital, London. Instead of patients having to travel into London for removal and graft procedures, the team under Consultant Ash Mosahebi is using the Proximie app to guide local practitioners to deliver the treatment. This is not only more convenient and comfortable for the patient, it is saving time, including reducing waiting times, and saving money.
Helping to upskill surgeons
Boosting the availability of specialist expertise at point of delivery is only one part of the conundrum facing local surgical provision. Another critical challenge is the shortage of trained surgeons full stop. In the US, the number of qualified general surgeons has been below the target 7 per 100,000 population ratio for a decade or more, with the figures heading in the wrong direction.
Without surgeons on the ground to deliver procedures, even virtual surgery applications like Proximie cannot help.
AR-assisted remote surgery platforms help in another way. Not only do they allow, through virtual demonstration and digitally enhanced instruction, for complex procedures to be overseen from afar, they are also perfect training tools.
We learn best through experience. By recreating, augmenting and enhancing experiences digitally, AR platforms like Proximie have the power to breathe new life into surgical skills development. It enables a rich two way flow of knowledge – a surgeon being guided through an operation can actually be shown what to do, through virtual mark-up, overlay of digital content, and the gestures of the remote expert being replicated in their field of vision on the device. As a result, they develop new skills much more quickly than they would just by listening to instruction, watching a video or reading a text.
This was realised with outstanding results in a project to deliver cleft lip and palate corrections to children in Peru. Through the Smile Foundation, a local surgical team operating in the city of Trujillo linked up, using Proximie, with a specialist team at the Riverside University, California. The team in Peru was shown a range of new techniques and approaches, not just in abstract, but actually as they performed surgery, so the learning was immediate, relevant and practical. In no time at all, they had raised the number of procedures they were completing by 30 per cent.
The same opportunity applies to students and junior surgeons observing practice. Through AR, it is no longer just a case of passively watching on a screen, or listening as the consultant explains each step. Proximie allows for fully interactive learning, for students to get ‘hands-on’ with a procedure in the virtual space.
And all of this is, of course, without any restrictions posed by location. Any surgeon, or any surgical trainee, in any local hospital or clinic, can connect and learn from any other practitioner. No more having to travel to conferences, seminars and residential placements to learn new techniques. Thanks to AR technology, surgical knowledge and skill can break out of its silos, and be passed back to the local areas where it is needed most.