Development and evaluation of an international teleproctoring program for bronchoscopic procedures

Francesca M Conway; Anand Tana; Cielito Caneja; James Tonkin; Laura Avanzi; Justin Garner; Christopher M Orton; Karthi Srikanthan; Ley Chan; John Thornton; Rainer Joachim; Virgile Donet; Philip J Johnson; Pallav L Shah

doi:10.1016/j.isci.2024.111653

Development and evaluation of an international teleproctoring program for bronchoscopic procedures

iScience. 2024 Dec 20;28(3):111653. doi: 10.1016/j.isci.2024.111653. eCollection 2025 Mar 21.

Authors

Francesca M Conway^{1

2

3}, Anand Tana^{1

2

3}, Cielito Caneja^{1

2}, James Tonkin^{1

2}, Laura Avanzi², Justin Garner^{1

3}, Christopher M Orton^{1

2

3}, Karthi Srikanthan⁴, Ley Chan^{1

2

3}, John Thornton^{2

3}, Rainer Joachim⁵, Virgile Donet⁵, Philip J Johnson⁵, Pallav L Shah^{1

2

3}

Affiliations

¹ National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK.
² Department of Respiratory Medicine, Chelsea and Westminster NHS Foundation Trust, London SW10 9NH, UK.
³ Department of Respiratory Medicine, Royal Brompton and Harefield Hospital, part of Guys and St Thomas' NHS Foundation Trust, London, UK.
⁴ Department of Respiratory Medicine, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
⁵ Nuvaira, Inc, Suite 105 3750 Annapolis Lane North, Minneapolis, MN, USA.

Abstract

Medical procedures often require proctoring that is traditionally done face-to-face, but this poses a significant carbon footprint and logistical challenges. Little is known about the safety and efficacy of remote "tele"proctoring, particularly in the respiratory field. The aim was to develop, implement, and evaluate a teleproctoring program for bronchoscopy procedures. Seventy-eight targeted lung denervation procedures were performed at UK hospitals; 20 with teleproctoring, with real-time multimodality data streaming to an off-site proctor; and 58 with on-site proctoring. Procedure completion, procedure duration (bronchoscopy, anesthetic, and fluoroscopy), and safety outcomes (adverse events and device deficiencies) were compared between groups. Teleproctoring offered a safe alternative to on-site proctoring, with little difference in completion rates, procedure durations or safety outcomes. Teleproctoring could be a cost-effective, sustainable and efficient alternative to face-to-face proctoring in appropriate centers. Further work could expand this system to allow remote expert advice to facilitate procedures in clinical practice, and for procedural teaching.

Keywords: Respiratory medicine; Surgery; Surgical procedure.