The Use of Mobile Low-Bandwidth Telemedical Techniques
for Extreme Telemedicine Applications

James C. Rosser, Jr., MD, FACS, Yale University School of Medicine, Department of Surgery
Robert L. Bell, MD, MA, Yale University School of Medicine, Department of Surgery
Brett Harnett, BS, Yale University School of Medicine, Department of Surgery
Hani Ramzy, MD, Yale University School of Medicine, Department of Surgery
Edgar Rodas, MD, Cinterandes Foundation
Michinori Murayama, MD, PhD, Yale University School of Medicine, Department of Surgery
Ronald Merrell, MD, FACS, Yale University School of Medicine, Department of Surgery

Corresponding Author:
James C. Rosser, Jr., MD, FACS
Director, Yale Endo-Laparoscopic Center
40 Temple Street, Suite 3-A
New Haven, CT, USA 06510

ABSTRACT

Background
Telemedicine is traditionally associated with the use of very expensive and bulky telecommunications equipment along with substantial bandwidth requirements (128 kbps or greater). Telementoring is an educational technique that involves the real-time guidance of a less experienced physician through a procedure in which he or she has limited experience. This technique has been especially demanding of the aforementioned requirements. Telemedicine and telementoring have been restricted to technically sophisticated sites. The application of high-end telemedicine through the existing telecommunication infrastructure has not been possible for underdeveloped parts of the world


Methods
Telemedicine and telementoring were applied using low-bandwidth 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 videoconference system, 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 mentored an experienced surgeon located thousands of miles away at the Yale laboratory.


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 Surgery at Yale University School of Medicine to the mobile surgery unit in Ecuador. The telementored surgery was performed using a POTS (Plain Old Telephone System) line with a baud rate of 12 kbps


Conclusions
Mobile, low-bandwidth telemedicine applications employed in the proper technical and clinical algorithms can be very effective in supporting remote health care delivery efforts. Advantages of such an application include increased cost-effectiveness by limited travel, expanded services to patients, and increased patient quality assurance.