Thoracic Robotic Surgery: the UK’s first virtual observership programme

Thoracic Robotic Surgery: the UK’s first virtual observership programme
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The Robotic Surgery virtual observership programme at Guy's and St Thomas' NHS Foundation Trust is a six-week course enabled by Proximie. Observers will be able to remotely engage in interactive learning experiences from some of the UK’s leading Thoracic surgeons to gain a deep understanding of different surgical procedures. This will include virtually attending live surgeries and interacting with an expert surgical team, an online education series, and having access to an extensive video library of on-demand surgical content, which will be hosted on the Proximie platform and provided by Guys’, which has the largest robotic surgery programme in the UK.

Mr Andrea Bille is a Consultant Thoracic Surgeon at Guy's and St Thomas’ NHS Foundation Trust, who - alongside colleague Mr Tom Routledge, also a Consultant Thoracic Surgeon - will be leading the virtual observership programme. 

“This is the first - and currently only - virtual observership programme in the UK,” Mr Bille explains. “It is aimed at all thoracic surgeons planning on starting the robotic programme, or surgeons already in the robotic programme who want more opportunities to see procedures and share their experience with us to help improve outcomes and productivity. It is also aimed at full surgical teams who are looking to upskill as a group.

“The fact that the programme is virtual - thanks to live surgeries and video libraries of on-demand content made possible by Proximie’s content management system - means that overseas participants are able to attend several operations over a six-week period, while avoiding all the travel-related disruptions inherent in leaving their countries, and the negative impact this has on their clinical practice and patients. These benefits are even more pronounced for full surgical teams, who are also able to make use of multiple camera views that show what any member of the team performing a procedure is doing at any given moment.”

The Robotic Surgery virtual observership programme is a six-week course, during which observers can engage in interactive learning experiences and gain a deep understanding of different surgical procedures remotely. 

Guy's and St Thomas' is continuing to pioneer the use of robotic technology after almost two decades. It has the largest robotics programme in the UK with six robots; five da Vinci robots and one Versius robot. The team operates across six surgical specialities – urology, thoracic, head and neck, gynaecology, transplant and gastrointestinal. In 2021, 24 surgeons from Guy's and St Thomas' carried out almost 1,300 robotic operations despite the challenges posed by COVID-19, which was the most ever in the UK for one Trust.


Dr. Bille continues: “The remote viewing of live surgery provides invaluable insight into what routinely happens in thoracic robotic theatres as well as the challenges that teams may encounter during procedures. However, participants also have access to Proximie’s video library of surgical content that enables course participants to view many different recordings of the same procedure to see first-hand if there are slightly different techniques between surgeons.” 

The course will invite attendees to ask questions about the ways procedures have been performed, in both live surgeries and archived ones. This creates the opportunity for participants to refine their techniques based on the wealth of expertise and information collected in the archive.

“Proximie is an excellent system for recording and remotely viewing these procedures, and we have found it to be an indispensable training tool,” Dr Bille says. “The analogy I always use is sports; for every sport, there is always a huge amount of video recording that coaches carry out so athletes can review and improve their performance. One of the best features of Proximie is that you can record surgical procedures and then sit down with a fellow, trainee or colleague and go through the procedure with them, finding new ways to enhance their technique in order to increase efficiency, reduce unnecessary surgical times and improve outcomes for patients.” 

Using Proximie, the virtual observership programme is helping to connect surgeons from different countries to share ideas and thoughts around different surgical techniques used from different regions. This provides surgeons, both those teaching the course and those attending it, the benefit of being able to discuss real-world examples of where surgeries have gone well and, occasionally, where issues might have been encountered. Proximie’s extensive virtual library of surgical content, continuously populated with surgeries from Guy's and St Thomas’, will supplement the live virtual observership of surgeries taking place at Guy's and St Thomas’ state-of-the-art robotics facilities, broadcast to attendees live using Proximie’s telepresence technology. 

Dr Bille says: “In addition to speeding up the learning curve, Proximie can also be used as a tool to validate lower volume surgeons by sending footage of their cases to be evaluated by higher volume surgeons who can provide feedback on anything that could be improved. What’s important to highlight about Proximie, from my perspective, is that its teleproctoring, video sharing and live streaming functions aren’t about finding ways to blame surgeons, but finding ways to provide a sustainable way for surgeons to improve their techniques and have their performance continually revalidated in the future.”

Dr. Bille, who routinely uses Proximie to record all of his surgeries to allow him and colleagues to go back and review procedures - before, during and after surgery - has amassed an archive on Proximie’s content management system of over 200 individual surgeries.  

“Proximie’s suite of tools enable the rapid and clear exchange of knowledge. It would be incredible to invite some of the attending surgeons to the Robotic Surgery virtual observership programme to upload videos of themselves carrying out procedures during the last week of the course. I would then be able to review a video of someone carrying out a right upper lobectomy in a different country, talk to them about it and provide feedback. I might see that someone’s technique is completely different from mine, but also that it’s very efficient - and that could be a learning opportunity for me. 

“Before the pandemic I used to go and watch other surgeons once or twice a year, because you can always pick something up to help you slightly change or refine your techniques. So running a course like this one, when you are using a platform like Proximie, means you are sharing content and interacting - and that means it is not just one-way teaching, but an exchange of information. That has the potential to help both the teacher and the surgeon, and - better yet - to share beneficial knowledge with any surgeon in every hospital linked to this programme.” 

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