Surgical case libraries: Optimising training, research and technique refinement

Mr Andrea Bille is a consultant thoracic surgeon at Guy’s and St Thomas’ NHS Foundation Trust and Honorary Senior Clinical Lecturer at King’s College University. He specialises in the treatment of thoracic conditions and treats benign and malignant thoracic disease performing minimally invasive surgery and robotic surgery for lung and mediastinal conditions.

I’ve been recording my cases with my own devices for some time now, and I was looking for a more reliable, safe and technologically advanced platform for making these recordings. I saw a urologist using Proximie and spoke to him about it, and it seemed like exactly what I needed. No more unreliable recordings onto CDs or hard drives that might get corrupted.

I’ve found switching to Proximie extremely easy – and a huge improvement. When I arrive in the morning, I have the laptop set up close to the console and I create a session based on my theatre list schedule. Before starting a case, I begin recording and log in on the console, meaning all of my cases can be stored and cross-referenced on the Proximie platform.

Now it is routine for me to use Proximie to record every procedure I perform, allowing me to go back and review the procedure and refine my techniques. I have so far recorded and archived more than 200 procedures, and I have also provided Proximie with the DVDs of approximately 100 procedures I have recorded previously to upload onto the platform. Once that’s complete, those 300+ recordings will constitute a library of pretty much any possible thoracic procedure you can perform. So the potential here is to create a highly detailed archive divided according to histology, where someone can go in and specifically search for a right upper lobectomy for a stage one cancer, or a right upper lobectomy for a stage three cancer, for example.

Having an archive of recordings like this is a great way to speed up the learning curve of trainees by providing them with quick exposure to a large number of procedures being performed – because the first month and a half of training is usually taken up with watching surgeons operating. Having access to a digital archive of a particular procedure before going into theatre means you’re getting ahead of the learning curve.

Another useful application would be as a black box recorder in operating rooms, similar to the way they’re employed on planes in the aviation industry. Whatever happens, you would then have a clear record that everything has been done properly in surgery. Whenever there’s a complication, surgeons are always asking themselves the question of whether the complication was a result of something that was done during surgery – so having a video record of everything that was done could be highly reassuring for surgeons, as well as providing transparency for patients. The question is how this content should be stored and used from a legal perspective, and that’s something that needs to be discussed with hospitals.

Proximie is going to have a major impact in the operating rooms of the future. Firstly, as a means of surgeons improving their surgical techniques and finding a way to calculate their matrix. Secondly, as a training tool that can expedite trainees’ fellowships by enabling them to view videos of accredited surgeons, rather than via the more time-consuming process of viewing those procedures in person. Thirdly, Proximie can be used as a means of accreditation; if someone finished a fellowship with me, they could then do three lobectomies which would be recorded. Those three videos would then be reviewed by myself and two colleagues, and based on those recorded performances we would be able to officially accredit the fellow.

Lastly, I envisage Proximie becoming a vital aspect of observership all around the world. Many trainees are interested in finding out how robotic surgery works, for example, and this is now possible without the time and expense of long distance travel. Proximie has created an integrated platform for the world’s most senior surgeons to provide the opportunity for virtual observership alongside face-to-face interaction. Some procedures and techniques will no doubt still benefit from being viewed in the theatre in person, but Proximie’s scope for increasing trainees’ learning curves and surgeons’ abilities to review and refine their own performance – while building a detailed video archive of procedures and techniques – is virtually limitless.

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