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in early April In 2020, shortly after British Prime Minister Boris Johnson announced the first pandemic lockdown in the United Kingdom, a urologist named Archie Fernando reached out to a colleague, Nadine Hutch-Haram.
The two doctors worked at Guy’s and St Thomas’ hospital, one of the busiest in the country, at a time when around a thousand people were dying of Covid-19 every week. Most surgeries were being postponed except for life-or-limb cases and urgent cancer surgeries, and Huchch-Haram, who is a reconstructive plastic surgeon, recalls how useless she felt. “I would just go around the wards and ask the nurses what I could do to help,” she says. “I started doing everything, like porting and proning, turning patients to make their breathing a little better.”
Huchch-Haram was also the founding CEO of a small health-tech startup called Proximi. The company had developed an augmented reality platform that allowed surgeons to collaborate remotely. Its web-based software enabled surgeons to talk to each other while sharing a live video stream of an operation – consisting of four feeds displaying different camera perspectives and medical scans – and a computer-generated overlay Shown which can be used to draw instructions. shared screen.
Fernando wanted to use Proxy for an urgent and complex process. Her patient was Mo Tajer, a 31-year-old man who had undergone chemotherapy for testicular cancer. The cancer had spread to his abdomen, where a 5-centimeter tumor had attached itself around the aorta and the inferior vena cava, the two largest blood vessels in the body, making surgical excision challenging. Under normal circumstances, Fernando would have had an open surgery, but this would also have required a two-week postoperative recovery period in an intensive care ward during the peak of the pandemic. “That’s not an environment where you want someone who is immunosuppressed to be around,” Huchch-Haram says. “They needed him in and out of the hospital as soon as possible.”
The safer option was a minimally invasive robotic keyhole surgery, but Fernando didn’t have enough experience with that procedure. However, with Proximy, she would be able to operate under the guidance of a colleague, a US-based surgeon named Jim Porter. Porter, who was medical director of robotic surgery at Swedish Medical Center in Seattle, not only pioneered this type of operation, but he is also one of the most experienced laparoscopic surgeons currently working there.
The surgery took place on 21 May. Wearing full personal protective equipment, Fernando operated the surgical robot’s console two meters away from the patient. The robot has four articulated arms, three equipped with surgical instruments and the fourth holding a thin tube with a camera on the end that, when inserted into the abdomen of the taser, allows Fernando to see inside the patient. Porter, wearing his pajamas and sitting at his home in Seattle, could access the exact same view on his laptop. For five hours, they guided Fernando step-by-step through the surgery, talking to him using an augmented-reality pointer to identify anatomical parts and drawing annotations to indicate where specific incisions would be made. Where should it be made?