Application of telemedicine in global surgery partnerships between high-income and low- and middle-income countries: a scoping review

Introduction The Lancet Commission on Global Surgery (LCoGS) estimated that 5 billion people worldwide lack access to safe, timely, and affordable surgical, obstetric, and anesthesia care. Bidirectional partnerships between institutions in high-income (HICs) and low- and middle-income countries (LMICs) have grown increasingly common. We sought to describe the current state of these partnerships with a focus on telemedicine. Methods A literature search was performed using MEDLINE/PubMed and Cochrane Database of Systematic Reviews databases for publications between 1970 and 2021 that described surgical partnerships between a HIC and LMIC that utilized telemedicine. Additional papers were abstracted from the reference list of the publications returned in the search. Title/abstract and subsequent full-text reviews were performed. Results Of 746 resultant articles, 35 papers (3.4%) were included. The years with the highest number of publications were 2012 ( n = 5, 14.2%) and 2018 ( n = 4, 11.4%). Plastic surgery was the most represented specialty ( n = 8, 23%), followed by ophthalmology ( n = 6, 17%) and general surgery ( n = 5, 15%). Manuscripts described partnerships between 12 HICs across 3 World Health Organization (WHO) regions and 36 LMICs across 5 WHO regions. Patient-provider teleconsultation was the most common utilization of telemedicine ( n = 18, 51.4%), followed by education ( n = 9, 25.7%). There was no difference in telemedicine application by publication year ( p = 0.482), surgical specialty ( p = 0.385), WHO region of LMIC or HIC in partnership ( p = 0.292 and p = 0.258, respectively). Conclusion Telemedicine technology has grown increasingly popular in global surgery partnerships to bridge the gap in providing care and educational opportunities. Future surgical partnerships should expand the implementation of this technology, particularly in intraoperative consultation for complex surgical specialties, which would otherwise not reach underserved populations.