BEIRUT: Hospitals in Lebanon have long been on the forefront of medical expertise, but over the last few years the country’s doctors have been leading a new medical revolution: remote surgical technology. The ability to conduct and advise surgical procedures over distance is “the next frontier” of medicine Dr. Ghassan Abu Sitta of the American University of Beirut Medical Center’s Department of Surgery told The Daily Star.

In the past, to get the specialty treatment patients needed to visit expert consultants. However, now online technology is shaking up the medical world and giving patients access to specialist consultation via the rise of online apps.

One of the most prominent technologies in this emerging field is Proximie. According to Dr. Nadine Haram, a surgeon in the U.K. and co-founder of the company, the idea traces back to 2014. A group of surgeons from the U.S. and AUBMC coordinated to organize a training session for doctors in Syria and Iraq. However, because of instability in both countries, none of the physicians were able to attend. “We thought ‘This is a lost opportunity’” Haram said.

This experience, in conjunction with the costs of sharing surgical expertise across long distances, spurred Haram and her team to find a solution. The end result was Proximie, a remote technology that allows surgeons to collaborate and assist others in the operating room from anywhere in the world.

According to Abu Sitta, the concept of the technology is relatively straightforward. Two screens, one in the operating room and one in a remote location, transmit video of the proceedings back and forth. For the remote operator, “you see the surgical field in real time, and you are able to draw your incision on the screen and they will show up on [the other] screen,” he explained.

“It’s like you’re in the room with him,” he continued. Haram corroborated the effectiveness of the program, noting that, “A surgeon is able to talk through the whole operation from start to finish. He can point to things that need to be removed or manipulated.”

The technology is upending traditional medical practices. “The thing the internet does best is distribute information,” Dr. Joshua Landy, the founder of phone-based medical app Figure 1 told The Daily Star. Because of this, “specialists should not be out of reach of anybody with an internet connection.”

Figure 1 is another notable example of remote medical technology with applications and origins in Lebanon. Landy, a Canadian intensive care physician, founded the company after a rare but easy-to-treat disease caused the death of a patient. The app allows doctors to post secure images and notes of cases that are then distributed to a network of over 1 million doctors, nurses, and Emergency Medical Technicians around the world, effectively “crowdsourcing” diagnoses.

Thus far, both pieces of technology have seen two primary uses. The first, assisting doctors in developing countries deal with complex and unfamiliar treatment, is the one that has garnered the most attention. The second is in the field of education.

Abu Sitta has had first-hand experience with remote technology, having guided several surgeons in Gaza through complex operations from his base in Beirut. In one example, according to Haram, “a kid was injured in a bomb blast, and an expert surgeon just needed a bit more help [with the surgery].” Working with the surgeon at Al-Awda hospital in Gaza, Abu Sitta said he they were “able to take him through two reconstructive surgeries.”

However, it has become clear over time that programs like Proximie and Figure 1 could also change medical education. “Medicine is such a visual field,” Landy explained. “We turn information like heartbeats into visual information so we can consume it.” Because of this, “creating a network [like Figure 1] could improve the way that medicine is both taught and practiced.”

Abu Sitta agreed, explaining that if medical students have access to technology like Proximie then they can watch and participate more effectively in surgical demonstrations. “Rather than having 15-20 students in the room, they are in a classroom and they are being taken through the surgery by the operating surgeon,” he said. Not only does this improve educational insight by allowing more students to observe real life surgeries, but it also decreases safety concerns associated with large numbers of people in operating rooms. Haram noted that the tool is now being used a lot at AUBMC.

Both Haram and Abu Sitta think of Proximie as a unique asset for Lebanon. “For countries like Lebanon where there is a surplus of medical expertise and with the collapse of health systems in the region ... you need a new way of training the new generation of surgeons,” Abu Sitta said. With this technology, “anywhere where there is a concentration of academic expertise can become a focus for lending a hand.”

However, for Colm Reilly, CEO of the UK Lebanon Tech Hub – a partnership between the U.K. and Lebanese governments to provide international support for local tech startups – the implications of technologies like this go beyond conflict zones and university education.

Reilly explained that the fundamental goal of technologies like Figure 1 and Proximie is to “improve either the productivity or efficacy of treatment for individual patients.” This imperative is not limited to places like Lebanon and Syria, where limited resources and conflict makes the need for such applications immediately evident.

Rather, remote technology can be used to solve what Reilly called the “amplification question.” Put simply, the app can give unparalleled access for patients to specialist doctors anywhere.

Nevertheless, Landy says the impact of places like Lebanon adopting technology quickly could be significant globally. “We may eventually see places in the developing world overtake traditional North American and European leaders in health care by not being handcuffed to legacy systems or infrastructure.”

“To get a change in the U.S. delivery of health care requires a massive change of infrastructure,” he said.

However, the ability to quickly adapt to new technology is allowing countries like Lebanon to race ahead in this pioneering field and in medicine generally.

Haram echoed this sentiment. “We are breaking down barriers, democratizing surgery, and making surgical expertise more available” she said. “It’s all about making a global community of surgeons,” but, she said, “the idea was born in Lebanon.”