title: Use of mobile low-bandwith telemedical techniques for extreme telemedicine applications.
abstract: BACKGROUND
  Telemedicine is traditionally associated with the use of very expensive and bulky telecommunications equipment along with substantial bandwidth requirements (128 kilobytes per second [kbps] or greater). Telementoring is an educational technique that involves real-time guidance of a less experienced physician through a procedure in which he or she has limited experience. This technique has been especially dependent on the aforementioned requirements. Traditionally, telemedicine and telementoring have been restricted to technically sophisticated sites. The telemedicine applications 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 videoconferencing 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 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 surgery at Yale University School of Medicine to the mobile surgery unit in Ecuador. The telementored surgery was performed using a telephone line with a baud rate of 12 kbps.
  
  
  CONCLUSIONS
  Mobile, low-bandwidth telemedicine applications used in the proper technical and clinical algorithms can be very effective in supporting remote health care delivery efforts. Advantages of such applications include increased cost-effectiveness by limiting travel, expanding services to patients, and increased patient quality assurance.
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Rosser
authors.forename: R L
authors.initials: RL
authors.lastname: Bell
authors.forename: B
authors.initials: B
authors.lastname: Harnett
authors.forename: E
authors.initials: E
authors.lastname: Rodas
authors.forename: M
authors.initials: M
authors.lastname: Murayama
authors.forename: R
authors.initials: R
authors.lastname: Merrell
mesh_terms: D004484:Ecuador; D006801:Humans; D008611:Mentors; D008952:Mobile Health Units; D010817:Physician-Patient Relations; D019114:Remote Consultation; D013514:Surgical Procedures, Operative; D017216:Telemedicine / Q000295:instrumentation*