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Theatres without borders: a systematic review of the use of intraoperative telemedicine in low- and middle-income countries (LMICs)
  1. Hariharan Subbiah Ponniah1,
  2. Viraj Shah1,
  3. Arian Arjomandi Rad1,2,
  4. Robert Vardanyan1,2,
  5. George Miller2,3,
  6. Johann Malawana2,3
  1. 1 Faculty of Medicine, Department of Medicine, Imperial College London, London, UK
  2. 2 Research Department, The Healthcare Leadership Academy, London, UK
  3. 3 Department of Health Sciences, University of Central Lancashire School of Medicine, Preston, UK
  1. Correspondence to Mr Arian Arjomandi Rad, Faculty of Medicine, Department of Medicine, Imperial College London, London, UK; arian.arjomandi-rad16{at}


Objective This systematic review aims to provide a summary of the use of real-time telementoring, telesurgical consultation and telesurgery in surgical procedures in patients in low/middle-income countries (LMICs).

Design A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane Collaboration published guidelines.

Data sources EMBASE, MEDLINE, Cochrane, PubMed and Google Scholar were searched for original articles and case reports that discussed telementoring, telesurgery or telesurgical consultation in countries defined as low-income or middle-income (as per the World Banks’s 2021–2022 classifications) from inception to August 2021.

Eligibility criteria for selecting studies All original articles and case reports were included if they reported the use of telemedicine, telesurgery or telesurgical consultation in procedures conducted on patients in LMICs.

Results There were 12 studies which discussed the use of telementoring in 55 patients in LMICs and included a variety of surgical specialities. There was one study that discussed the use of telesurgical consultation in 15 patients in LMICs and one study that discussed the use of telesurgery in one patient.

Conclusion The presence of intraoperative telemedicine in LMICs represents a principal move towards improving access to specialist surgical care for patients in resource-poor settings. Not only do several studies demonstrate that it facilitates training and educational opportunities, but it remains a relatively frugal and efficient method of doing so, through empowering local surgeons in LMICs towards offering optimal care while remaining in their respective communities.

  • public health
  • surgical procedures
  • operative
  • healthcare quality
  • access and evaluation

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Twitter @Hari_SubPon7, @virajtalks, @AArjomandiRad, @DrGeorgeWMiller, @johannmalawana

  • HSP and VS contributed equally.

  • Contributors HSP, VS, AAR, RV, GM, JM contributed to concept and design, data interpretation, drafting article, approval of article. HSP, VS, AAR, RV contributed to data collection, drafting article. AAR, RV, GM, JM contributed to supervision, critical revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.