by Caroline Medin; Eduardo Ortiz; Parisa Kamali, MD (@Pari_Kamali); and Samuel J. Lin, MD, MBA (@Dr_SamuelLin)
Despite a significant growth in diseases requiring surgical intervention, to date there is still gross disparities in access to safe, essential surgical care worldwide. The Lancet Commission on Global Health recently reported that 5 billion people —two-thirds of the world’s population—lack access safe, affordable surgical care when needed.  Out of the roughly 250 million operations performed each year, only 3.5% are performed in the poorest 1/3 of the world’s population.  One of the solutions proposed for this burden is the use of telemedicine. Telemedicine is “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.” Telemedicine includes a growing variety of applications and services using two-way video, email, smart phones, wireless tools and other forms of telecommunications technology.
Proximie, a company specialized in augmented reality, aims to provide greater access to skilled surgeons via its cloud-based telehealth solution.  Proximie’s augmented reality (AR) is unique in that, unlike virtual reality, it supplements the user’s view of a real-world element with computer-generated sensory input pertaining to the user’s environment and surrounding objects.   Proximie requires just two iPads: one in the operating room, and one in the hands of a skilled surgeon, who can provide remote assistance in real time. The live feed enables the surgeon to mark on his or her screen exactly where to make an incision, and guide their colleague through a procedure. Dr. Ghassan Abu-Sitta, head of Plastic Surgery at the American University of Beirut Medical Center, has used this software to lead procedures conducted hundreds of miles away in the Gaza strip. So far, Dr. Abu-Sitta has helped his colleagues in Gaza to operate on a congenital abnormality of the hand and to treat a patient who was injured from an explosion.
Proximie’s technology reduces the need to travel to access highly specialized surgical care. It is also applicable in a teaching setting, as medical students can utilize its augmented reality platform to watch surgeries in progress and even train remotely. Currently, Proximie is collaborating with the Global Smile Foundation, Facing the World, EsSalud Hospital Trujillo, Peru Cleft Program and Al Awda Hospital in Gaza.
Proximie is not the only company to use technology to allow remote access to the inside of an operating room. On April 14, 2016, the UK-based company Medical Realities live-streamed Dr. Shafi Ahmed of the Royal London Hospital operating on a man with colon cancer.  Nearly 55,000 people worldwide viewed the procedure via mobile device or the Medical Realities website; viewers were able to manipulate their 360˚ viewpoint and zoom in or out to focus on different elements during the surgery. Dr. Ahmed’s next goal is to construct completely virtual surgery, where the viewer operates on a virtual patient, to serve as a training tool for medical students.
These augmented and virtual reality technologies, while still in early stages of development and implementation, have exciting implications for both medical education and global health. The increasing portability of healthcare technology allows people in less developed nations better access to safe and affordable treatment. Moreover, these advancements can allow medical students more opportunities to learn, regardless of their own physical location in the world. Hopefully, the growing use of technologies such as Proximie and Medical Realities will result in improved access and reduced cost of both healthcare and training.
- Akire BC, Raykar NP, Shrime MG, et al. Global access to surgical care: a modelling study. The Lancet Global Health. April 2016;3(6):e316-e323.
- The Lancet Commission on Global Surgery. About the Commission. The Lancet Commission on Global Surgery. 2016. Available at: http://www.globalsurgery.info/about-the-commission/. Accessed July 14, 2016.
- Suzie East fC. CNN Health. CNN. May 26, 2016. Available at: http://www.cnn.com/2016/05/24/health/telesurgery-proximie-beirut-gaza/index.html. Accessed July 11, 2016.
- Meera Senthilingam fC. CNN. April 21, 2016. Available at: http://edition.cnn.com/2016/04/21/health/virtual-reality-cancer-surgery/index.html. Accessed July 11, 2016.
- Available at: http://www.proximie.com. Accessed July 11, 2016.
- Medical Realities, Ltd. 2016. Available at: http://www.medicalrealities.com. Accessed July 11, 2016.