Opportunities for Remote Supervision: Leveraging Proximie Technology for Neurosurgical Teaching in Kenya

Abstract

Background: Remote operative supervision can strengthen safe surgical practice in decentralized neurosurgical services. Proximie is a telepresence and augmented-reality platform that enables real-time collaborative participation in theater even when specialists are geographically distant. In 2024, Proximie was piloted at Makueni County Referral Hospital to evaluate its role in neurosurgical teaching and early specialist support in a newly developing service. Objective: To evaluate the feasibility, collaborative benefit, and educational impact of Proximie deployment within a county-level neurosurgical service. Methods: Ten neurosurgical procedures were supervised remotely between April 2024 and October 2025. These included craniotomies, ventriculoperitoneal shunt placement, meningocele repair, and lumbar and cervical spine decompression and fusion. Remote participants included a consultant neurosurgeon from Mombasa, general surgeons, and a neuroscientist based in Geneva. Technical performance, quality of feedback exchange, and intraoperative learning were assessed. Results: All procedures were completed successfully with enabling real-time specialist input. Proximie improved operative confidence, team communication, anatomical referencing, and perioperative coordination. Challenges included occasional bandwidth limitations and audiovisual integration requirements, but these were mitigated by workflow adaptation and pre-connection testing. The pilot confirmed applicability for supervision of early-career neurosurgeons and is now being introduced to the wider neurosurgical fraternity as a scalable mentorship tool. Conclusion: Telepresence-based surgical collaboration using Proximie is feasible and educationally valuable in a devolved health system. This model supports safe expansion of neurosurgical access, promotes skill transfer, and strengthens post-training mentorship, contributing to national neurosurgical workforce development.