Use of mobile low-bandwith telemedical techniques for extreme telemedicineapplications

Background: Telemedicine is traditionally associated with the use of very e xpensive and bulky telecommunications equipment along with substantial band width requirements (128 kilobytes per second [kbps] or greater). Telementor ing is an educational technique that involves real-time guidance of a less experienced physician through a procedure in which he or she has limited ex perience. This technique has been especially dependent on the aforementione d requirements. Traditionally, telemedicine and telementoring have been res tricted to technically sophisticated sites. The telemedicine applications t hrough the existing telecommunication infrastructure has not been possible for underdeveloped parts of the world. Study Design: Telemedicine and telementoring were applied using low-bandwid th mobile telemedicine applications to support a mobile surgery program in rural Ecuador run by the Cinterandes Foundation and headed by Edgar Rodas, MD. A mobile operating room traveled to a remote region of Ecuador. Using a laptop computer equipped with telemedicine software, a videoconferencing s ystem, and a digital camera, surgical patients were evaluated and operative decisions were made over low-bandwidth telephone lines. Similarly surgeons in the mobile unit in Ecuador were telementored by an experienced surgeon located thousands of miles away at Yale University School of Medicine. Results: Five preoperative evaluations were conducted from Sucua to Cuenca, Ecuador, with excellent clinical correlation. Additionally, a laparoscopic cholecystectomy was successfully telementored from the department of surge ry at Yale University School of Medicine to the mobile surgery unit in Ecua dor. The telementored surgery was performed using a telephone line with a b aud rate of 12 kbps. Conclusions: Mobile, low-bandwidth telemedicine applications used in the pr oper technical and clinical algorithms can be very effective in supporting remote health care delivery efforts. Advantages of such applications includ e increased cost-effectiveness by limiting travel, expanding services to pa tients, and increased patient quality assurance. (J Am Coil Surg 1999;189:3 97-404. (C) 1999 by the American College of Surgeons).