Presence in the OR: Proximie’s lower tech AR system brings surgeons together digitally during operations

[The Boston Globe reports on the increased use of several types of presence-evoking technology in the medical sphere, driven in part by the pandemic. The focus is on Proximie’s “only as high-tech as it has to be” system that links surgeons to remote operating rooms and is in use at over 300 hospitals in the U.S. –Matthew]

[Image: The virtual hand of a remote doctor was able to guide a surgical procedure thanks to Proximie’s software interface. Credit: Proximie]

Telesurgery surges to meet pandemic needs. Think of it as Zoom for surgeons

By Hiawatha Bray, Globe Staff
March 23, 2021

In late January, neurosurgeon Sohum Desai of Harlingen, Texas, wanted assistance with a brain operation. So he called in some extra help from two colleagues who looked over Desai’s shoulder, using their voices and hands to guide him through each step of the process.

Neither of Desai’s fellow surgeons were in the operating room. One was in a nearby building, and the other was 1,600 miles away, in Los Angeles. But because the hospital was equipped with a kind of telemedicine system from the Boston company Proximie, it didn’t matter.

Proximie uses augmented reality to let expert surgeons peer into far-off operating rooms and lend a hand to their less-experienced colleagues. Think of it as Zoom for surgeons. But in this version, a camera shows the remote doctor exactly what the operating surgeon sees, allowing him or her to point a digital finger at exactly the right spot to make an incision, or draw a circle around damaged tissue.

“They could see what I was doing. I could see what they were doing,” Desai said. “Basically, it gives them a telepresence, so it’s like they’re right there.”

It’s a powerful concept made even more powerful by the global COVID-19 pandemic, which has forced doctors and patients to hunker down at home while generating massive new demand for Internet-based medical services.

The biggest boom is in virtual doctor visits, in which patients rely on computers or smartphones, rather than office visits. FAIR Health, an independent organization that tracks insurance claims, said that usage of telehealth services by patients soared 3,000 percent in October 2020, compared to a year earlier. And Doximity, a networking service for medical professionals, estimates that virtual doctor visits generated $29 billion in revenue last year and will crack $106 billion by 2023.

Proximie is for surgeons, not consumers. Still, the company has seen a 430 percent increase in use of the system since the coming of COVID. The system is installed at 300 hospitals worldwide, including Massachusetts General Hospital, and has been used in over 10,000 surgeries, including 6,500 last year alone.

“Since COVID,” said the founder, plastic surgeon Nadine Hachach-Haram, “our company has dispersed all over the world.”

For example, in June a specialist in Seattle used Proximie to direct a colleague as she employed a surgical robot to remove a cancerous tumor from a patient 5,000 miles away in London. Pre-COVID, the two doctors may have consulted face-to-face in the United States or the United Kingdom. When worldwide travel restrictions made that impossible, Proximie provided a lifesaving alternative.

In the Texas case, Desai needed to install a stent to hold open a blood vessel in a patient’s brain, to prevent clotting and strokes. Ameer Hassan, Desai’s colleague at Valley Baptist Neuroscience Institute, viewed the surgery on a standard office computer linked to the Proximie network. The screen split into four segments, showing the surgeons as well as live X-ray images of the patient’s brain, as Desai slowly inserted a catheter into a blood vessel.

A digital camera aimed at the top of Hassan’s desk transposed a digitized image of his finger onto a monitor in the operating room. Hassan could point at the damaged blood vessel, draw circles around a critical spot, and add lines that showed how far Desai should insert the catheter. All the while, Los Angeles neurosurgeon and self-described “brain plumber” Mikayel Grigoryan was dialed in and offering suggestions of his own.

“You can really discuss the whole case as if you were really there,” Grigoryan said. “You become the extension of the hands of the actual operator.”

It’s just what Hachach-Haram had in mind when she launched Proximie in 2016. For a decade, she had traveled to remote regions of the Middle East, Africa, and South America as a volunteer surgeon to assist local doctors on tough cases. In 2014, she began to rethink her efforts.

“Wouldn’t it be interesting if I didn’t have to travel every time to Peru or to all these countries, but I could just virtually scrub in?”

With her own money she hired software engineers to build a prototype. Though Hachach-Haram, her husband, and children have lived in the United Kingdom for 15 years, she decided to base her operation in Boston, because of the ample supply of tech talent and because she has relatives in the region.

Microsoft is testing how its HoloLens augmented reality helmet can be used as a surgical tool, but it’s bulky and heavy. By contrast, Proximie is only as high-tech as it has to be. It uses off-the-shelf components, such as laptops and digital cameras, and displays images on standard video monitors, rather than on a head-mounted display.

The system can produce decent results over network connections as slow as 3 megabits per second, though 10 megabits and up is recommended. A newbie can set up the whole thing in about 15 minutes, Hachach-Haram said.

And she’s expecting a lot more newbies in the years ahead. Like everyone else in health care, Hachach-Haram thinks COVID has permanently shifted attitudes about every aspect of virtual medicine, including surgery. “The future of the operating room is digital,” she said.


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