Telemedicine-Enabled Surgical Outreach across the Surgical Continuum to Bridge the Gap in Low- and Middle-Income Countries: Lessons from the COVID-19 Era and Applications Beyond

Abstract

INTRODUCTION: Telemedicine has revolutionized health care delivery globally, reducing health care costs, increasing patient satisfaction, and improving surgical outcomes. Innovation is often born out of necessity, and during the Coronavirus disease 2019 (COVID-19) pandemic, there was a surge of telemedicine initiatives both in surgical education and surgical care delivery. This has been well documented in high-income countries, but there has been less evaluation of the use and potential application of telemedicine in low- and middle-income countries (LMICs) to support surgical outreach efforts. This review seeks to describe telemedicine-enabled surgical outreach across the surgical continuum that emerged from the COVID-19 era in LMICs and provide recommendations for future practices. METHODS: A scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Identified studies on telemedicine indexed in PubMed, Web of Science, Scopus, and Embase from January 2020 to February 2025 were aggregated. The search terms included "telemedicine," "surgery," "COVID-19," "SARS-CoV-2," "e-learning," "remote," "tele-simulation," and "LMICs." Of 713 papers, 15 eligible studies were found. Data were summarized by study type, intervention type, and outcomes. Themes of accessibility, efficacy, and user satisfaction were analyzed. Key implementation challenges were reviewed. Summary recommendations for future directions are provided. RESULTS: The 15 studies identified provide evidence for the feasibility and effectiveness of a variety of surgical teleinterventions within LMICs. The majority of the qualifying research consisted of prospective cohort studies that involved physicians, surgical residents, and patients. The primary findings include improvements in surgical skills, positive perception by participants, and high satisfaction with tele-simulation and e-learning. Key implementation challenges identified were technical issues, insufficient infrastructure, and unreliable internet. CONCLUSION: Preliminary experience suggests that telemedicine applications during the COVID-19 pandemic proved to be effective tools for both surgical education and patient care. These initiatives may hold promise for augmenting surgical outreach efforts in a more sustainable fashion to facilitate both surgeon training and improved care delivery for underserved communities in LMICs. However, numerous challenges must be addressed to ensure long-term effectiveness and sustainability.