Virtual ablation: unlocking critical remote cancer treatment during COVID-19
Using Proximie, Professor Afshin Gangi, a globally-respected interventional radiologist from the University Hospital of Strasbourg, France, and president of The Cardiovascular and Interventional Radiological Society of Europe (CIRSE), virtually scrubbed-in from France to collaborate with a team at Guy’s and St Thomas’ NHS Foundation Trust, including Consultant Interventional Radiologists Dr Shahzad Ilyas and Dr Athanasios Diamantopoulos, to ensure important cancer procedures could continue despite the emerging threat of the Omicron variant.
At the end of 2021, Professor Afshin Gangi was virtually scrubbed-in to a series of Cryoablation procedures that took place at Guy’s and St Thomas’ NHS Foundation Trust (GSTT). Professor Gangi would have normally proctored this series of cancer treatments in person, however, he was unable to attend due the rise of the Omicron variant and the subsequent COVID-19 travel restrictions. These cases risked being cancelled but instead, Professor Gangi was able to work remotely and in real-time with Consultant Interventional Radiologist Dr Athanasios Diamantopoulos and Radiologist Dr Shahzad Ilyas to ensure these important oncology procedures could continue despite the challenges posed by the pandemic.
Cryoablation for cancer is a treatment to kill cancer cells with extreme cold. During cryoablation, a thin, wandlike needle (cryoprobe) is inserted through the skin and directly into the cancerous tumour. A gas is pumped into the cryoprobe in order to freeze the tissue, and the tissue is then allowed to thaw.
As the backlog of surgery continues to rise, Proximie, the software platform founded by an NHS surgeon, Dr. Nadine Hachach-Haram BEM, is being used to ensure non-elective surgeries can continue during the pandemic.
The huge surgical backlog for NHS care in England has been estimated to reach between 7 million and 12 million by early 2025, according to the National Audit Office (NAO). The data indicates that the shutdown of most non-COVID-19 services in the first wave of the pandemic — combined with fewer patients being able to attend surgeries due to lockdown and other pandemic-related factors — means the NHS is facing a large backlog of non-COVID-19 care which is continuing to rise.
“I would have normally attended these procedures in person, but once I saw I would need to spend two days isolating in a hotel room before I could do the case, it was impossible to go to London. So we decided to try Proximie,” Professor Gangi explains. “At the beginning things weren’t that straightforward because of the hospital blocking things like internet access. So I tethered off the WiFi of my computer. The connection was good and it helped a lot.
“It would have been catastrophic [to have had to cancel]. There were six patients to see and postponing cancer procedures is always difficult; you never know what will happen. During COVID-19, virtual proctoring is essential.
“Using Proximie we are able to teach multiple people without the need to travel. By taking a typical case of ablation of the bone or kidney we could feasibly train 15 participants online at the same time, they can ask questions during the procedure and see exactly what you’re doing.
“It’s a great teaching tool and I really think this is the way to go; I’d love to get this software in Strasbourg.”
Interventional Radiologist, Dr Shahzad Ilyas, was on site at Guys and St Thomas’ collaborating in real-time with Professor Gangi. Despite the distance between the clinical teams in London and Strasbourg, Dr. Ilyas suggests Proximie’s interface is well-suited to interventional oncology, due to some of the technicalities involved in such procedures, and it can be an important tool in ensuring important surgeries can continue during COVID-19.
Dr. Ilyas explained: “As a platform, Proximie worked well, and as a team we worked well too. To have managed to do all of these cases at a time when they would have been cancelled is obviously a huge positive.
“Technically, Proximie is well-suited to ablation because there isn’t a big operative sight. The key things you want to share are the imaging and what is happening on the skin surface. So the camera orientation works well and the image overlay and annotation function is extremely useful. It allows the other attendees to annotate and you can share ideas quite easily, which is good.
“It’s not exactly the same as someone being in the room with you, but I think it’s almost as good.”
Dr Ilyas believes Proximie has a central role to play in the future of surgery.
He said: “I think Proximie has two big roles to play [in the future of surgery]; firstly for training and teaching, I think it will have a huge role in that. And secondly — as was the case in this procedure — when you’ve got complex cases, or you’re using new technologies, you want to be able to collaborate with world leaders who have the highest level of expertise available. This platform allows that level of remote collaboration, bringing people together to do these cases and share experiences.”
Professor Afshin Gangi, Dr Ilyas and Dr Diamantopoulos have continued to use Proximie to ensure important surgeries can continue.