Beyond theatre: How digital tech is reshaping surgery and saving lives

An ongoing surgery at Makueni County Referral Hospital, where modern technology is used to boost surgeries with guidance of specialized doctors outside the surgery rooms. [Mercy Kahenda, Standard]

For more than a decade, Caroline Wambua lived behind scarves to protect her dignity. What began as a small swelling on her neck in 2012 gradually developed into a massive goitre that changed her appearance, affected her health and left her isolated as she endured stigma from her community.

“At first it was just a small growth and I ignored it. With time, it kept growing bigger and bigger,” recalls the Wote, Makueni resident.

The condition worsened over time, bringing symptoms such as irregular heartbeats, palpitations, headaches, difficulty in breathing and dizziness. As the swelling grew, Wambua began covering her neck with scarves to avoid the stares from people around her.

Although doctors recommended surgery, the procedure was repeatedly postponed due to her uncontrolled high blood pressure. Its complexity, coupled with a shortage of specialists at Makueni County Referral Hospital, also led to her referral to Kenyatta National Hospital.

However, long waiting lists at the national referral facility further prolonged her suffering and uncertainty.“I was scared and afraid of the surgery because I knew it was complicated. Every time it was postponed, I became more anxious,” she says.

In 2024, doctors reassured her that the delicate procedure would be handled by a team of specialists to ensure her safety. This assurance came alongside the introduction of advanced health technology including artificial intelligence and computing systems that digitised the operating theatres at Makueni Hospital.

During the surgery, lead surgeons were linked in real time with a team of more experienced surgeons outside the theatre, who monitored the procedure and provided guidance and immediate solutions. Wambua’s family also followed the operation as it progressed, which gave them confidence that their daughter was safe during the high-risk seven-hour procedure.

“Having a number of specialists closely monitoring the surgery gave me courage, trust and reassurance that any complications would be quickly managed by experts,” says Wambua.

Today, Wambua is happy. She is free from pain, fear and stigma.

Reflecting on her decade-long battle with goitre, she says her recovery has been so remarkable that many who knew her during her years of illness can hardly recognise her now. Her journey mirrors the silent suffering endured by many patients battling various ailments in Makueni and across the country — suffering often worsened by delayed access to specialised care, fear of surgery and stigma associated with visible illnesses.

Digital technology

This challenge is now being eased through the adoption of digital technology, which allows specialists to guide and monitor procedures via cameras mounted in operating theatres. The cameras are connected to a central laptop system, with doctors and other health workers logging in before surgery begins. The system is activated with the patient’s details and live feeds from cameras positioned above the operating room.

The cameras can be remotely controlled to focus on different areas, with the main view remains fixed on the patient. An operator manages the theatre lighting, while clinicians wear microphones to ensure clear communication with the team outside the operating room. Other consultants can also join procedures virtually through secure log-ins, enabling them to observe the surgery in real time from their respective locations and offer guidance, instructions and second opinions.

A visit by The Saturday Standard to an operating theatre in Makueni County captured a Caesarean section in progress. Alongside the surgical team, unseen specialists monitored the operation, guiding every critical step through live cameras installed above the theatre.

Eveline Mwende, 25, had just undergone a Caesarean section (CS) delivery. She recalled how the technology helped ease her fears. As doctors prepared to operate, Mwende was informed that cameras had been installed in the theatre to allow other specialists to monitor the procedure and provide guidance if needed.

“They explained that other doctors would be watching the operation. This gave me confidence because I knew my life was not in danger. I felt assured that if anything happened, I would receive immediate help,” she said.

Mwende, a first-time mother, noted that many women fear C-sections due to the risk of complications or death in theatre. “A lot of women fear C-sections because they think they might lose their lives or something may go wrong,” she says.

In Kenya, at least 15 women and 92 newborns die each day during or around childbirth. Excessive bleeding accounts for up to 59 percent of maternal deaths, while other leading causes include high blood pressure, obstructed labour and infections.

Mwende’s surgery was successful, and both mother and baby recovered well.  “My baby is fine, breastfeeding well and has no complications,” she says.

The use of digital health technology has significantly improved maternal delivery outcomes in Makueni, despite the shortage of doctors and specialists.

For instance, the Makueni maternity ward, with a bed capacity of 139, handles an average of 300 deliveries per month. Staffing remains limited, with only two gynaecologists, two medical officers, four reproductive health clinicians and four nurses managing the services.

Game changer

According to Christine Wanjiru Muteria, in-charge of the maternal and child health wing, between 38 and 51 per cent of deliveries are Caesarean sections — a high rate driven by the hospital’s referral status. Many of these are repeat C-sections.

To manage this demand, the facility, with support from partners, has installed cameras in the maternity, surgical and orthopaedic theatres.

“In maternity, it has been a game changer. It is innovation in telemedicine,” she says.

The system streams surgeries in real time, enabling consultants in other locations to guide procedures, support junior clinicians and provide second opinions during complex cases.

“In some cases, a consultant is guiding a doctor who is stuck in a procedure while located in a different facility,” she says. “We are able to audit operations better. Beyond practice, it is also learning.”

Consultations can also be conducted remotely, allowing specialists to support clinicians in lower-level facilities handling complicated cases.

Before the technology was introduced, the facility often experienced overcrowding in theatres with limited opportunities for supervision. Now, procedures can be observed from a separate room, improving oversight and clinical understanding. Patients are informed beforehand when procedures will be recorded and must provide consent, ensuring ethical use of the technology.

Despite the perception that Caesarean sections are straightforward, Muteria notes that complications still occur. In some cases, patients experience sudden bleeding during or after delivery, requiring urgent intervention. She recalls instances where surgeons managing post-partum haemorrhage were guided in real time by consultants, helping stabilise patients and prevent deaths.

“These interventions have helped improve outcomes significantly,” she says.

The system has also enabled collaboration across counties, reducing unnecessary referrals and lowering costs for both patients and facilities.

While there was initial resistance to the technology, health workers have gradually embraced it, recognising its value in improving care quality and patient safety. Dr Harvey Mulei, the County Chief Officer for Health Human Resource Management, says the county adopted the technology to reduce delays caused by referrals and limited access to specialists.

Makueni was the first county to pilot camera-based theatre technology, with several others now adopting it.

Before its adoption, many patients had to travel to Kenyatta National Hospital, often facing long delays due to distance, poor roads, and limited ambulance services. “In emergencies such as post-partum haemorrhage, delays in referrals sometimes led to loss of lives,” he says.

With the technology, junior doctors can now perform complex procedures under real-time guidance from specialists elsewhere.“If there is a doctor across the river, they should still be able to save a life using technology,” he says.

A specialist can also support multiple theatres simultaneously. The system has strengthened training, allowing interns and junior doctors to observe and participate in complex procedures under supervision.

During our visit, a medical officer in Kibwezi reached out to a specialist at Makueni County Referral Hospital and saved a woman suffering from post-partum haemorrhage. The attending doctor had never independently performed a hysterectomy, but a remote obstetric specialist guided the procedure step by step.

“The consultant logged in and guided the surgery. The woman’s life was saved,” says Mulei.

Dr Shannon Shibata-Germanos, a partner in the technology, says the impact of the system — first adopted in Makueni — has seen 14 other counties embrace it.

Strengthened training

“Makueni is the place where innovation thrives. It has shown what is possible in digital surgery,” she says.

Governor Mutula Kilonzo Jr applauds the technology, saying it continues to improve the quality of healthcare in Makueni and across the country. He emphasises that technology is not meant to replace health workers but to strengthen the health system amid rising demand and limited specialist capacity.

As a maternal health ambassador, he notes that the rapid pace of innovation in medicine requires continuous upskilling of doctors and nurses.

“We cannot train enough nurses and doctors to meet all the needs we have. Our specialists must continuously improve their skills because every day there is something new in the market,” he says.

Just as in agriculture and other sectors, technology makes healthcare more affordable, accessible and efficient by cutting unnecessary referrals and transport costs. It also helps bridge the shortage of specialists.

For example, Kenya has only 11 surgeons trained to repair obstetric fistula, a number inadequate to handle the growing cases. “There are many women suffering silently from this condition. Some only speak about it during surgical interventions. I have seen a woman who lived with it for 19 years,” the governor says.

Many of these women endure dignity challenges, including using diapers due to loss of control — a condition that could be treated with better access to specialist care.

Maternal deaths linked to post-partum haemorrhage, anaemia and pre-eclampsia remain high, partly due to delays in accessing specialist care.

In Makueni alone, there are about 21,000 deliveries a year and many of these deaths are preventable.

Governor Mutula argues that Kenya must embrace innovation in healthcare to reduce costs, improve efficiency and ensure equitable access.

“We will never have enough doctors, but technology allows us to extend their reach at a lower cost. To attain this, we need strong partnerships to sustain the sector,” he says.