Daring robotic surgery saved man’s life


early April In 2020, shortly after British Prime Minister Boris Johnson announced Britain’s first pandemic lockdown, a urologist named Archie Fernando contacted one of his colleagues, Nadine Hahaharam.

The two doctors were working at Guy’s and St. Thomas Hospital, one of the busiest hospitals in the country at a time when nearly 1,000 people were dying from COVID-19 each week. With most surgeries postponed, except for life-threatening or limb-threatening cases and emergency cancer surgeries, the reconstructive plastic surgeon Hahahaharam recalls how helpless he felt. “I just walked into the ward and asked the nurses what they could do to help,” she says. “I started doing portering, proning and all sorts of things to help my patients breathe a little bit better.”

Hachach-Haram was also the founding CEO of a small healthtech startup called Proximie. The company was developing an augmented reality platform that allowed surgeons to collaborate remotely. Its web-based software allows surgeons to share live video streams of surgeries, including up to four feeds showing different camera perspectives and medical scans, while allowing surgeons to converse and provide instructions. It had a computer-generated overlay that could be used to draw the . shared screen.

Fernando wanted to use Proximie for emergency and complex procedures. Her patient was Mo Tajell, a 31-year-old man undergoing chemotherapy for testicular cancer. The cancer had spread to her abdomen, with a 5-centimeter tumor surrounding the aorta and inferior vena cava, the largest blood vessels in the body, which were difficult to remove surgically. Under normal circumstances, Fernando would have had an open surgery, but at the peak of the pandemic, he needed a two-week recovery period in an intensive care unit. “It’s not the kind of environment to sit an immunosuppressed person in,” Hahahaharam says. “They needed to get him in and out of the hospital as soon as possible.”

A safer alternative was minimally invasive robotic keyhole surgery, but Fernando lacked experience with it. But with Proxime, he can operate under the guidance of his colleague, US-based surgeon Jim Porter. As medical director of robotic surgery at the Swedish Medical Center in Seattle, Porter was not only a pioneer of this type of surgery, but also one of the most experienced laparoscopic surgeons working today.

The operation was performed on May 21st. Wearing full personal protective equipment, Fernando operated the console of the surgical robot from two meters away from the patient. The robot has four articulated arms, three with surgical instruments attached, and a fourth holding a thin tube with a camera at the tip that is inserted into Tagel’s abdomen. Fernando is now able to see inside the patient. Sitting at home in Seattle in his pajama robe, Porter had access to the exact same view on his laptop. Over the course of five hours, he took Fernando step by step through her surgery, using an augmented reality pointer to identify anatomical sites and talking to her while drawing annotations to pinpoint specific incisions.



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