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Scalpel, tongs . . . WiFi? The rise of virtual surgery

Earlier this week, I watched some online videos that were both grisly and inspiring. They showed a team of surgeons conducting colorectal, cardiac and neurological procedures — scalpels, blood and all.

But instead of clustering around the patient in an operating theatre, as depicted in TV shows such as ER, the surgeons were scattered: some were beside the patient; others were many miles away, guiding their colleagues with a (virtual) hand, thanks to augmented reality.

Call this, if you like, Zoom for surgeons — instead of conducting an office meeting via video, they are inserting a scalpel into a brain. Or as Nadine Hachach-Haram, a plastic surgeon in the UK’s NHS and the founder of Proximie, the platform I watched, says: “The idea is to bring virtual healthcare workers together — we are digitising the operating theatre and bringing it to people around the world.”

Welcome to another unexpected story arising from Covid-19. Hachach-Haram, who is 39, first mooted the idea of doing virtual surgery a decade ago when, like many doctors in the west, she did volunteer medical work in war-torn regions of the world and became frustrated by the lack of access to surgeons there.

To rectify this, in 2016 she founded Proximie as a training tool. However, in those early days, she says she faced an uphill battle persuading other doctors to embrace the idea: most had been trained to believe that “proper” surgery involved proximity to the patient. The roadblock “was a cultural issue as much as an issue of technology”, she tells me.

But during Covid-19 lockdowns, with travel restricted, doctors have not been able to work in other countries or share expertise with colleagues face to face. As a result, some of the cultural resistance among surgeons towards telemedicine has started to melt away. In 2020, there were ninefold and fivefold increases respectively in the number of users and procedures on Proximie’s platform.

To date, 9,200 procedures at 270 hospitals around the world have been carried out on it. Two-thirds of these are in the west and Hachach-Haram tells me that, in the UK, Proximie is now being used in one-fifth of NHS trusts. Much of the take-up has been recent.

This reflects a bigger pattern that has benefited many telemedicine start-ups. “Covid-19 caused a rapid increase in virtual healthcare use,” says a recent report from consultancy McKinsey, noting that telemedicine consultations increased “25-fold from February to April 2020 in the US, a trend mirrored in China and western Europe”.

McKinsey predicts this level of growth will decline when lockdown ends, but says telemedicine “is expected to stabilise at higher than pre-pandemic levels and continue growing”. To put it another way, now that the cultural resistance to virtual medicine has been broken down, we are unlikely to forget this lesson. “Zoom surgery” is likely to remain a feature of modern medicine.

It is a striking example of how the concept of “normality” can change in unexpected ways. However, there is a thought-provoking twist to this story: telemedicine is also an example of “reverse innovation”, or the concept of bringing smart ideas developed for or originating in the non-western world into the west (instead of always assuming that innovation happens the other way around).

The trigger that inspired Hachach-Haram to start Proximie was seeing the need for better surgery in poorer regions of the globe (including Lebanon, where her family comes from). Doctors there embraced her pilot schemes because they were eager for help and, unlike in the west, there was less embedded legacy medical infrastructure. Having been developed there, the concept has now been brought back.


This might just be a lucky accident. Or maybe not: a similar pattern has played out in pockets of finance too. In 2007, a telecoms company in Kenya launched M-Pesa, a mobile payments system, to get around the lack of established banking infrastructure in Africa. The concept was embraced in Kenya, faced cultural resistance in the west but was eventually adopted later.

Could this type of “leapfrogging” occur more frequently? Noor Sweid, who runs the Global Ventures investment fund in Dubai (which invested in Proximie), thinks so. She predicts that education could soon be another arena for reverse innovation. And cash-rich venture capitalists are scouring the world for hot new ideas.

“Every [investment] manager today is looking for that innovation curve,” says Peter Kraus of Aperture Investors, a New York-based investment manager. “They are looking for new ideas or ways to take an idea from one area and apply it somewhere else. Developing markets can sometimes leapfrog the west because there is less resistance to digital adoption.”

To put it another way, when historians look back at the Covid-19 era, they may not just conclude that it changed how we work but that it also accelerated the movement of skills, ideas and money. Those gory videos of “Zoom surgery” are one tiny symbol of a new type of globalisation.

Follow Gillian on Twitter @gilliantett and email her at [email protected]

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