IN EARLY APRIL 2020, shortly after the British prime minister Boris Johnson had announced the first pandemic lockdown in the United Kingdom, a urologist named Archie Fernando reached out to one of her colleagues, Nadine Hachach-Haram.
The two doctors worked at Guy’s and St Thomas’ hospital, one of the busiest in the country, at a time when nearly a thousand people were dying of Covid-19 every week. Most surgeries were being deferred, except for life-or-limb cases and urgent cancer surgeries, and Hachach-Haram, who is a reconstructive plastic surgeon, recalls how useless she felt. “I would just walk into the wards and ask the nurses what I could do to help,” she says. “I started doing everything, like portering and proning, turning patients over to make their breathing slightly better.”
Hachach-Haram was also the founding CEO of a small health-tech startup called Proximie. 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—including up to four feeds displaying different camera perspectives and medical scans—and featured a computer-generated overlay which could be used to draw instructions on the shared screen.
Fernando wanted to use Proximie for an urgent and complicated procedure. Her patient was Mo Tajer, a 31-year-old man who had undergone chemotherapy for testicular cancer. The cancer had spread into his abdomen, where a 5-centimeter tumor was attached around the aorta and the inferior vena cava, two of the largest blood vessels in the body, making its surgical excision challenging. In normal circumstances, Fernando would have performed an open surgery, but this would have also required a two-week postoperative recovery period in the intensive care ward during the peak of the pandemic. “That’s not an environment where you want someone who’s immunosuppressed to be sitting around,” Hachach-Haram says. “They needed him in and out of the hospital as fast as possible.”
The safer alternative was a minimally invasive robotic keyhole surgery, but Fernando wasn’t experienced enough in that procedure. With Proximie, however, she would be able to operate with the guidance of a colleague, a US-based surgeon named Jim Porter. Porter, who was the medical director for robotic surgery at the Swedish Medical Center in Seattle, had not only pioneered this type of operation, he was also one of the most experienced laparoscopic surgeons currently working.
The surgery took place on May 21. Fernando, wearing full personal protective equipment, operated the console of the surgical robot, two meters away from the patient. The robot has four articulated arms, three fitted with surgical instruments and a fourth holding a thin tube with a camera at the end, which, upon insertion into Tajer’s abdomen, allowed Fernando to see inside the patient. Porter, wearing his pajama robe and sitting at his home in Seattle, had access to that exact same view on his laptop. For five hours, he guided Fernando through the surgery step by step, talking to her while using an augmented-reality pointer to identify anatomical parts and drawing annotations to pinpoint where specific incisions should be made.