Two doctors separated by thousands of miles, carried out a lifesaving operation using a robot. It's the start of a major change in how surgery is performed. In early April 2020, a urologist named Archie Fernando reached out to one of her colleagues, Nadine Hachach - Haram. The two doctors worked at Guy's and St Thomas' hospital, one of the busiest in the country, at a time when nearly a thousand people were dying of Covid-19 every week. Most surgeries were being deterred, except for life-or-limb cases and urgent cancer surgeries, and Hachach-Haram, who is a reconstructive plastic surgeon, recalls how useless she felt. "I would just walk into the wards and ask the nurses what I could do to help," she says. "I started doing everything, like portering and proning, turning patients over to make their breathing slightly better."                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     Hachach-Haram was also the founding CEO of a small health-tech startup called Proxime. The company had developed an augmented reality platform that allows surgeons to collaborate remotely. Its web-based software enabled surgeons to talk to each other while sharing a live video stream of an operation-including up to four feeds displaying different camera perspectives and medical scans-and featured a computer-generated overlay which could be used to draw instructions on the shared screen. Fernando wanted to use Proximie for an urgent and complicated procedure. Her patient was Mo Tajer, a 31-year old man who had undergone chemotherapy for testicular cancer. The cancer had spread into his abdomen, where a 5-centimeter tumor was attached around the aorta and the inferior vena cava, two of the largest blood vessels in the body, making its surgical excision challenging.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         In normal circumstances, Fernando would have performed an open surgery, but this would have also required a two-week postoperative recovery period in the intensive care ward during the peak of the pandemic. "That's not an environment where you want someone who's immunosuppressed to be sitting around," Hachach-Haram says. "They needed him in and out of the hospital as fast as possible."  The safer alternative was a minimally invasive robotic keyhole surgery, but Fernando wasn't experienced enough in that procedure. With Proximie, however, she would be able to operate with the guidance of a colleague, a US-based surgeon named Jim Porter. Porter, who was the medical director for robotic surgery at the Swedish Medical Center in Seattle, had not only pioneered this type of operation, he was also one of the most experienced laparoscopic surgeons currently working.                                                                                                                                                                                                                                                                                                                                                                                           Porter, wearing his pajama robe and sitting at his home in Seattle, had acccess to that exact same view on his laptop. For five hours, he guided Fernando through the surgery step by step, talking to her while using an augmented-reality pointer to identify anatomic parts and drawing annotations to pinpoint where specific incisions should be made. Hachach-Haram, who had logged in to watch the operation was "speachless." "I was just in awe of how calm they were," she says. This was the first time since the start of the pandemic that she was seeing Proxime being used in a surgery. She realized that, without her invention, that lifesaving surgery could have never taken place, and as she watched it unfold, she began to cry.                                                                                                                                                                                                                                                                                                                                                                                                                          With the help of a software engineer, by the end of 2015 she had developed an app that allowed surgeons to share a view of their surgical fields remotely and overlay simple illustrations and annotations by drawing on the shared screen. She raised money, hired a team to develop the technology, and spent the next couple of years relentlessly proselytizing at conferences about the digital operating room. In 2019, Proximie was ready for its commercial launch. When the Covid-19 pandemic reached the UK a year later, Proximie had already been used in 1,200 surgeries in over 30 countries. In six months, the number of surgical sessions increased to 5,500. Today more than 20 percent of NHS hospitals have access to the software.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   "Before, we were like a sci-fi concept with some potential," she says. "Suddenly, we were the only way of doing things." When it wasn't possible to have another consultant physically present, many used Proximie to receive remote support instead. Currently, more than 95 percent of the surgical sessions using Proximie are also recorded onto its online library, which enables surgeons to edit and tag footage that can be later used for training or debriefing. This library currently stores more than 20,000 videos of surgeries, making it the largest database of this sort.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             Hachach-Haram is originally from San Diego,California. She moved to Beirut, Lebanon after her parents decided to return to their country of origin.