The success of this operation encouraged Hachach-Haram to turn their research project into a real enterprise. She raised money, hired a team to develop the technology, and spent the next few years tirelessly proselytizing at conferences about the digital operating room. “I would fly 10 hours just to give a 10-minute presentation,” she says. In 2019 Proximie was ready for commercial launch.
By the time the Covid-19 pandemic hit the UK a year later, proximy had already been used in 1,200 practices in over 30 countries. “Like every company in the early weeks of the pandemic, we announced to our shareholders that we will make our mental well-being a priority and simply try to survive,” says Hachach-Haram. A week later, she changed her mind. “I realized, wait a minute, that’s when people will need our technology,” she says. She called another shareholders’ meeting and announced: “Fuck the previous plan. We will accelerate.” Within six months, the number of users increased tenfold and the number of surgical sessions rose to 5,500. Today, more than 20 per cent of NHS hospitals have access to the software. “We used to be just a science fiction concept with potential,” she says. “Suddenly we were the only way to get things done.”
Due to the Due to the suspension of routine surgeries during the pandemic, Hachach-Haram did not have to perform a single surgery for many months. “When we started operations again, our confidence was shaken,” says Hachach-Haram. “We needed to get back into it, so we got together and asked a colleague to help us with that because we needed that support.”
When it was not possible to have another advisor physically present, many instead used proximate to receive remote assistance. While the loss of skills and confidence during the pandemic has been a problem for experienced surgeons, the problem has been even more pronounced for their younger colleagues: NHS trainees have faced a 50 per cent drop in surgical training opportunities, according to official data. “Many trainees in the prime of their training have missed 18 months of practice,” she says. “We don’t have the luxury of taking ten years to train people. We had to think about how proximy could speed that up.”
The Society of American Gastrointestinal and Endoscopic Surgeons, for example, provided anatomically realistic porcine tissue models to trainees working from home so they could practice abdominal wall hernia repair with the help of remote experts. The Hip Preservation Society, on the other hand, established a regular virtual education program that also included live surgeries — a labrum reconstruction procedure, for example, was broadcast to over 500 people around the world. “Historically, few trainees had access to a process,” she says. “Now hundreds could have access to the few cases that just happened.”
Currently, more than 95 percent of proximate surgical sessions are also recorded in the online library, which allows surgeons to edit and markup footage that can later be used for training or debriefing. This library currently stores more than 20,000 videos of surgeries, making it the largest database of its kind. “When we started, we only had the Live Surgery feature in mind,” she says. “But then we thought, ‘What if people want to have feedback after surgery or review their performance? That’s why we built the library.” For example, when she first viewed footage of her own operations, Harach-Haram learned that what she describes as her behavior was “a bit pushy.” “I noticed that I like to perform the operations myself, even when there were trainees in the room,” she says. Now, in similar situations, she forces herself to hand over the surgical instruments, clasps her hands in front of her chest and moves away from the operating table. “I learned not to be in their space,” she says. “I just give them the space.”
This article will appear in the July/August 2023 issue of WIRED UK magazine.