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Proximie is using augmented reality to create a bridge between experienced and inexperienced surgeons

Startup Spotlight

If I had closed my eyes, I could have easily believed myself to be standing in the operating room in Gaza. I could hear Dr. Ghassan Abu Sitta debate the best place to start the incision with the other surgeons. Occasionally, the reassuring beat of the heart monitor was interrupted by a soft clatter of surgical utensils. But I wasn’t in Gaza; I was in Beirut, sat in a far less stimulating conference room. Next to me, Dr. Abu Sitta stared attentively into his laptop.

I was attending a live demo of Proximie, a newly launched SaaS-based augmented reality (AR) enabled telesurgery platform. Proximie’s main feature combines conventional teleconferencing with AR, creating a real time, interactive communication channel that allows doctors to supervise less experienced colleagues through surgical processes. During this demo, Dr Abu Sitta, head of the plastic surgery division at American University of Beirut Medical Center (AUBMC), oversaw a reconstruction of a blast injury of the hand being performed in Gaza from a conference room at the AUBMC.

Watching the operation on his laptop, Dr Abu Sitta was able to pinpoint the exact starting point and course of the incision virtually on the patient’s arm with the tip of a bic pen.

Proximie was founded by Nadine Hachach-Haram, a 34-year-old Lebanese surgeon based in the UK who specializes in reconstructive surgery, and Talal Ali Ahmad, a quadragenarian telecom engineer based in Boston.

An invaluable opportunity

A 2015 Lancet Commission on Global Surgery report stated that as many as 5 billion people did not have access to safe surgery, and that only 6% of the 313 million procedures that are undertaken worldwide each year occur in the poorest countries, where over a third of the world’s population lives. Furthermore, the report stated that 1.27 million additional surgical providers will need to be trained by 2030 in order to cope with this burden. As such, broadening the reach of trained surgeons and transfering their expertise would represent an invaluable opportunity to improve local surgical competence in disadvantaged areas.

“The idea is to really create an integrated tool that would allow doctors to guide, help, support and train surgeons remotely through the use of augmented reality,” explained Hachach-Haram. Targeting both professional and educational medical institutions, Proximie is able to integrate and adapt the platform to their particular needs. So far, the platform has been used in over 20 operations.

How does the AR function work?

In order to put together its augmented environment, Proximie simply overlays two video feeds – in this instance, the one emanating from Gaza, and another shot through a standalone camera hooked to Dr Abu Sitta’s laptop. The first camera videos the operation; the second should point at a blank, preferably dark, surface. Users then have to manually balance the transparency of the feeds, up to a point where both are simultaneously discernable in one combined view.

As a result, anything that gets introduced into the sight of Dr Abu Sitta’s camera will be overlayed on top of the broadcast of the surgery. In this case he used a bic pen, with its cap still on, which is bright and contrasts well enough with the other elements to show clearly in the combined feed.

Hachach-Haram is keen to stress that Proximie is hardware agnostic; “the good thing about Proximie is that it’s a platform that you can link in with any hardware”. Proximie does work with third party distributors to provide hardware however, and currently has two operating room models: a mobile medical cart that sports a screen and a camera mounted in an arm swivel that can be dragged into operating rooms as well as fixed mounting solutions.

At the moment, in order to use the telesurgery feature, doctors need to schedule appointments in advance. In a future iteration, the service will host a database of surgeons, listed according to expertise, that would allow colleagues to see who is available, in real time, and seek their assistance.

In addition to the AR telesurgery feature, Proximie also offers an integrated medical records system. During surgery, doctors can take snapshots that, along with any video recording, are stored automatically onto the patient’s file. This is particularly useful for patients who change doctors within the same institution.

Furthermore, Proximie is developing an interface aimed at medical students, whereby students and junior residents can log in and watch surgeries, or seek assistance from more experienced doctors. This feature is reminiscent of Touch Surgery.

Looking forward

Right now, the company’s client list comprises University College London, the University of California Riverside and the American University of Beirut. Proximie is also in talks with two medical institutions, one in London and one in Boston, as well as a medical devices company.

Proximie is evolving. The company is developing a photo cataloguing system that would be able to read images and automatically share relevant info from the institution’s library. So for instance, if a doctor takes a snapshot of a cleft palate, the system will recognize it and share relevant information with the doctor, such as pre surgery instructions.

As the company evolves further, it increases the opportunities that can bridge the gap between surgeons operating in developed countries and those operating under austere conditions, which would inevitably lead to more successful surgeries and better outcomes for patients.

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