When surgical teams talk about improving efficiency, the focus often falls on the operator - can the surgeon go faster or can technique be refined? At Guy's and St Thomas' NHS Foundation Trust (GSTT), leaders in robotic thoracic surgery, took a different approach. They examined the ‘non-procedural' time surrounding each case using Proximie's Intelligence Suite to surface hidden capacity within the operating day.

Education to operational insight

Bille initially adopted Proximie's platform several years ago as an educational tool.

‘We started using Proximie because we were doing more robotic surgery and wanted a way to record procedures for teaching,' Bille explains. ‘We have a thoracic robotic fellowship, and video review allows us to go through critical steps with trainees and accelerate their learning curve.'

The platform enables him to review his own cases, identifying areas for improvement, and objectively track progress over time. ‘I found it very helpful for me to improve my efficiency, even looking back at my videos, and I can see the difference over the years. The more you operate, the better you become,' Bille says. ‘But having an objective way to look at yourself is incredibly powerful.'

Bille says an important consideration for selecting the platform was independence. With multiple robotic systems in use, GSTT needed a solution that was not tied to a single manufacturer. Proximie's compatibility across surgical modalities - robotic, thoracoscopic, laparoscopic, and open - made it adaptable across specialties and technologies.

Proximie also enables surgeons to control the case schedule from an app on their phone.

Measuring invisible time

The GSTT team installed cameras in the anesthetic room and operating theatre, recording the flow of entire surgical days from 8am to 5pm. Staff only had to be trained how to stop and start the recording, which is ‘very simple to do'. 

‘This kind of technology doesn't require any extra skill or extra personnel, and it doesn't require any effort in terms of extra time,' says Bille.

All video footage was anonymised, no facial recognition was used, so individuals could not be identified. The goal was to observe movement, sequencing, and handoffs, not to evaluate people's performance.

As a result, the team made one practical change, positioning patients in the anaesthetic room while the operating theatre was being cleaned and counted down from the previous case. By overlapping these workflows, the team eliminated idle intervals without increasing pressure on clinical staff.

Across two NHS robotic thoracic surgery lists, ambient data collection and AI-driven analysis revealed 19–25% recoverable operating room time. On average, surgical procedure lengths were reduced by nearly 20 minutes per case by optimising how the patient was put asleep, where the patient was positioned, unlocking close to an hour of additional capacity per list. 

‘We didn't change the actual procedure time, but we changed the efficiency on how the theatre is prepped and clean before and after the case,' Bille says.

When modelled across a full day, that efficiency translated into the potential to add another major case, without overrunning theatre time or compromising safety.

Cultural barriers

Introducing recording and analytics into the operating room can raise understandable concerns, Bille explains; staff may worry about blame, scrutiny, or performance policing.

‘We were always clear, this is not a system to judge your work,' he adds.

Bille said that once that message was communicated, teams became curious rather than defensive, eager to see how objective data could improve practice without adding stress.

The distinction between subjective oversight and data-driven insight also resonated. While some robotic manufacturers offer efficiency programmes involving on-site observers, Proximie's model relies on recorded data and analytics to generate recommendations. That objectivity, Bille argues, reduces bias and increases trust.

One size doesn't fit all

Bille warns that efficiencies identified at GSTT cannot simply be transplanted to another trust. Physical layouts, building age, and infrastructure - such as whether an anaesthetic room is available - vary widely.

He advises other trusts to ‘use the technology to examine your own environment and see where time can be saved safely'.

The next frontier

Looking ahead, GSTT plans to continue measuring efficiency and test alternative operational models, such as extending activity in a single theatre, to determine the most cost-effective configuration while safeguarding clinician wellbeing.

For Bille, the key differentiator is that Proximie's Intelligence Suite does not focus solely on the surgeon.

‘Surgery is a team sport,' he says. ‘You can have a superstar, but if the rest of the team isn't aligned, you won't achieve the best results.'

By illuminating the full operative pathway, from anesthesia induction to theatre turnover, the platform supports improvement across every ‘player' in the room.

As NHS providers grapple with record waiting lists and constrained resources, such system-wide visibility may prove indispensable.