Development and evaluation of a tele-proctoring program in interventional bronchoscopy

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Background: Bronchoscopic interventions often necessitate on-site presence of a proctor to oversee the procedure. Face to face (F2F) proctoring poses logistical challenges, a financial burden, travel requirements and a carbon footprint. Aim: To develop, implement and evaluate the feasibility, safety and efficacy of a remote international proctoring program for a bronchoscopic procedure. Methods: We designed and developed an off-site international tele-proctoring (TP) pilot program to allow procedures to continue during covid-19 restrictions. Between July 2019 and July 2023, 78 interventional bronchoscopy procedures of Targeted Lung Denervation or Sham were performed at a UK hospital, 58 with F2F proctoring and 20 with TP. Results: All procedures in both arms were completed with no premature discontinuation. No audiovisual issues restricted ability to perform TP procedures. There was no significant difference between the TP group and the F2F group in procedure time (76.2 vs 70.6min, p=0.23), anaesthetic time (88.1 vs 84.1min, p=0.28) or fluoroscopy time (228 vs 241secs, p=0.81). 5/20 (25%) TP procedures and 9/58 (15%) F2F procedures had ≥1 device deficiency, none were considered related to proctoring method. We did not observe higher rates of procedure-related complications in the TP group vs F2F group: possible procedure related cardiac events 0/20 vs 1/58 (1.7%); acute respiratory failure 1/20 (5%) vs 5/58 (8.6%), haemoptysis 0/20 vs 1/58 (1.7%) respectively. Conclusions: Tele-proctoring offered a safe and feasible alternative to on-site proctoring for this interventional bronchoscopy procedure for COPD performed by an experienced team in our specialist centre.

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