远程医疗在外科学中的研究进展
Advancements in Telemedicine Applications with in Surgical Practice
摘要: 远程医疗(Telemedicine),作为一种结合通信和信息技术的医疗服务创新模式,在改善医疗服务可及性、降低成本及提升患者体验方面展现出显著潜力。伴随着5G网络、人工智能(Artificial Intelligence, AI)、物联网(Internet of Things, IoT)等技术的快速进展,远程医疗在外科领域的应用得到了广泛扩展。该综述详尽考察了远程医疗在外科学中的最新研究进展,全面覆盖了从术前评估、术中操作指导,到术后随访与康复管理的整个手术治疗流程。本文不仅系统总结了远程医疗在各手术阶段的应用场景与临床效果,而且深入分析了其在提高医疗效率、优化资源配置以及改善患者结局方面的实际作用。此外,文章还探讨了远程医疗在实际外科应用中遭遇的技术挑战、法规限制与伦理问题,并对未来的发展方向及潜在的解决策略进行了展望,旨在为远程医疗技术在外科领域的广泛应用提供理论依据和实践指导。
Abstract: Telemedicine, as an innovative model of medical service that integrates communication and information technology, shows significant potential in improving accessibility of medical services, reducing costs, and enhancing patient experience. With the rapid development of 5G networks, artificial intelligence (AI), and the Internet of Things (IoT), the application of telemedicine in the field of surgery has been extensively expanded. This review thoroughly examines the latest research advancements in telemedicine within the field of surgery, covering the entire surgical treatment process from preoperative assessment and intraoperative guidance to postoperative follow-up and rehabilitation management. The article not only systematically summarizes the application scenarios and clinical outcomes of telemedicine at each stage of surgery but also delves into its practical effects on enhancing medical efficiency, optimizing resource allocation, and improving patient outcomes. Additionally, the paper discusses the technological challenges, regulatory constraints, and ethical issues encountered in the practical application of telemedicine in surgery and looks forward to future development directions and potential solutions, aiming to provide a theoretical basis and practical guidance for the widespread application of telemedicine technology in the field of surgery.
文章引用:刁首文, 张剑波, 朱鹏. 远程医疗在外科学中的研究进展[J]. 临床医学进展, 2025, 15(1): 2184-2192. https://doi.org/10.12677/acm.2025.151287

参考文献

[1] Haleem, A., Javaid, M., Singh, R.P. and Suman, R. (2021) Telemedicine for Healthcare: Capabilities, Features, Barriers, and Applications. Sensors International, 2, Article 100117. [Google Scholar] [CrossRef] [PubMed]
[2] Buvik, A., Bugge, E., Knutsen, G., Småbrekke, A. and Wilsgaard, T. (2016) Quality of Care for Remote Orthopaedic Consultations Using Telemedicine: A Randomized Controlled Trial. BMC Health Services Research, 16, Article No. 483. [Google Scholar] [CrossRef] [PubMed]
[3] Apaza-Avila, R.E. (2024) Telemedicine and Its Impact on the Preoperative Period. International Journal of Advanced Computer Science and Applications, 15, 187-200. [Google Scholar] [CrossRef
[4] 梁霄, 蔡秀军. 5G远程医疗机器人手术的现状和展望[J]. 中华消化外科杂志, 2024, 23(4): 554-560.
[5] Qaderi, S.M., Swartjes, H., Vromen, H., Bremers, A.J.A., Custers, J.A.E. and de Wilt, J.H.W. (2021) Acceptability, Quality of Life and Cost Overview of a Remote Follow-Up Plan for Patients with Colorectal Cancer. European Journal of Surgical Oncology, 47, 1637-1644. [Google Scholar] [CrossRef] [PubMed]
[6] Mihalj, M., Carrel, T., Gregoric, I.D., Andereggen, L., Zinn, P.O., Doll, D., et al. (2020) Telemedicine for Preoperative Assessment during a COVID-19 Pandemic: Recommendations for Clinical Care. Best Practice & Research Clinical Anaesthesiology, 34, 345-351. [Google Scholar] [CrossRef] [PubMed]
[7] Hlavin, C., Ingraham, P., Byrd, T., Hyre, N., Gabriel, L., Agrawal, N., et al. (2023) Clinical Outcomes and Hospital Utilization among Patients Undergoing Bariatric Surgery with Telemedicine Preoperative Care. JAMA Network Open, 6, e2255994. [Google Scholar] [CrossRef] [PubMed]
[8] Wienhold, J., Mösch, L., Rossaint, R., Kemper, I., Derwall, M., Czaplik, M., et al. (2021) Teleconsultation for Preoperative Evaluation during the Coronavirus Disease 2019 Pandemic. European Journal of Anaesthesiology, 38, 1284-1292. [Google Scholar] [CrossRef] [PubMed]
[9] Popivanov, P., Bampoe, S., Tan, T. and Rafferty, P. (2022) Development, Implementation and Evaluation of High-Quality Virtual Preoperative Anaesthetic Assessment during COVID-19 and beyond: A Quality Improvement Report. BMJ Open Quality, 11, e001959. [Google Scholar] [CrossRef] [PubMed]
[10] Quemeneur, C., Le Saché, F., Ayrault, C., Griscenco, E., Raft, J., N’Guyen, P., et al. (2024) Anesthesia Teleconsultation: Quality, Medicoeconomic Interest, and Patient Satisfaction of Preoperative Assessment—A Prospective Observational Study. Telemedicine and e-Health, 30, 457-463. [Google Scholar] [CrossRef] [PubMed]
[11] Rahman, M.M., Azam, M.G., Bohorquez-Rivero, J., Garcia-Ballestas, E., Agrawal, A., Moscote-Salazar, L.R., et al. (2020) Letter to the Editor: “Telehealth and Telemedicine in the COVID-19 Era: A World of Opportunities for the Neurosurgeon”. World Neurosurgery, 142, 541-542. [Google Scholar] [CrossRef] [PubMed]
[12] Gillman-Wells, C.C., Sankar, T.K. and Vadodaria, S. (2020) COVID-19 Reducing the Risks: Telemedicine Is the New Norm for Surgical Consultations and Communications. Aesthetic Plastic Surgery, 45, 343-348. [Google Scholar] [CrossRef] [PubMed]
[13] Jin, M.L., Brown, M.M., Patwa, D., Nirmalan, A. and Edwards, P.A. (2021) Telemedicine, Telementoring, and Telesurgery for Surgical Practices. Current Problems in Surgery, 58, Article 100986. [Google Scholar] [CrossRef] [PubMed]
[14] Acemoglu, A., Krieglstein, J., Caldwell, D.G., Mora, F., Guastini, L., Trimarchi, M., et al. (2020) 5G Robotic Telesurgery: Remote Transoral Laser Microsurgeries on a Cadaver. IEEE Transactions on Medical Robotics and Bionics, 2, 511-518. [Google Scholar] [CrossRef
[15] Lacy, A.M., Bravo, R., Otero-Piñeiro, A.M., Pena, R., De Lacy, F.B., Menchaca, R., et al. (2019) 5g-Assisted Telementored Surgery. British Journal of Surgery, 106, 1576-1579. [Google Scholar] [CrossRef] [PubMed]
[16] Chou, W., Wang, T. and Zhang, Y. (2004) Augmented Reality-Based Preoperative Planning for Robot Assisted Tele-Neurosurgery. 2004 IEEE International Conference on Systems, Man and Cybernetics, Netherlands, 10-13 October 2004, 2901-2906. [Google Scholar] [CrossRef
[17] Richter, F., Funk, E.K., Seo Park, W., Orosco, R.K. and Yip, M.C. (2021) From Bench to Bedside: The First Live Robotic Surgery on the dVRK to Enable Remote Telesurgery with Motion Scaling. 2021 International Symposium on Medical Robotics (ISMR), Atlanta, 17-19 November 2021, 1-7. [Google Scholar] [CrossRef
[18] Wachs, J.P., Kirkpatrick, A.W. and Tisherman, S.A. (2021) Procedural Telementoring in Rural, Underdeveloped, and Austere Settings: Origins, Present Challenges, and Future Perspectives. Annual Review of Biomedical Engineering, 23, 115-139. [Google Scholar] [CrossRef] [PubMed]
[19] Kachare, M.D., Rossi, A.J., Donohue, K.D. and Davidov, T. (2020) Telesurgical Assessment: Using Smartphone Messaging to Efficiently Manage Postoperative Wounds. Telemedicine and e-Health, 26, 1540-1542. [Google Scholar] [CrossRef] [PubMed]
[20] Leyendecker, J., Prasse, T., Bieler, E., Yap, N., Eysel, P., Bredow, J., et al. (2024) Smartphone Applications for Remote Patient Monitoring Reduces Clinic Utilization after Full-Endoscopic Spine Surgery. Journal of Telemedicine and Telecare. https://pubmed.ncbi.nlm.nih.gov/38321874/ [Google Scholar] [CrossRef] [PubMed]
[21] Gesuete, F.P., Molle, M., Gubitosi, A., Izzo, S., Todde, S., Nicoletti, G.F., et al. (2023) Telemonitoring Wound Recovery with Smartphone: An Italian Experience during Pandemic Period. Plastic and Reconstructive SurgeryGlobal Open, 11, e5076. [Google Scholar] [CrossRef] [PubMed]
[22] Baniasadi, T., Ghazisaeedi, M., Hassaniazad, M., Kalhori, S.R.N. and Esmaeili, M. (2020) Surgical Patients Follow-Up by Smartphone-Based Applications: A Systematic Literature Review.
[23] Herrero, C.P., Bloom, D.A., Lin, C.C., Jazrawi, L.M., Strauss, E.J., Gonzalez-Lomas, G., et al. (2021) Patient Satisfaction Is Equivalent Using Telemedicine versus Office-Based Follow-Up after Arthroscopic Meniscal Surgery. Journal of Bone and Joint Surgery, 103, 771-777. [Google Scholar] [CrossRef] [PubMed]
[24] DeAntonio, J.H., Kang, H.S., Cockrell, H.C., Rothstein, W., Oiticica, C. and Lanning, D.A. (2019) Utilization of a Handheld Telemedicine Device in Postoperative Pediatric Surgical Care. Journal of Pediatric Surgery, 54, 1005-1008. [Google Scholar] [CrossRef] [PubMed]
[25] Wang, S.C., Au, Y., Ramirez-GarciaLuna, J.L., Lee, L. and Berry, G.K. (2020) The Promise of Smartphone Applications in the Remote Monitoring of Postsurgical Wounds: A Literature Review. Advances in Skin & Wound Care, 33, 489-496. [Google Scholar] [CrossRef] [PubMed]
[26] Sánchez, A.S., Vico, T.D., Hevia, M.F., Munar, M.G., Montes, C.R., García, I.R., et al. (2021) Telementoring in Times of Covid-19 For Training in General Surgery. British Journal of Surgery, 108, znab160.052.
[27] Modi, R. and Verma, P. (2021) Experience of Virtual Learning in the Times of Pandemic and Its Future Perspectives: Observations from ‘Gynecological Oncology’ Trainee Survey. Gynecologic Oncology, 162, S156-S157. [Google Scholar] [CrossRef
[28] Coles, R.A., Goh, S.J., Livingstone, D. and Qasim, A. (2020) Medshr: Improving Patient Care through Clinical Case Discussion. Minerva Cardioangiologica, 68, 175-187. [Google Scholar] [CrossRef] [PubMed]
[29] Borejsza-Wysocki, M., Hermann, J., Wallner, G., Richter, P., Torres, K., Skoczylas, T., et al. (2024) The Usefulness and Effectiveness of Interactive Telemedicine in Surgery Classes—A Survey of Polish Medical Students. Polish Journal of Surgery, 96, 1-8. [Google Scholar] [CrossRef] [PubMed]
[30] Dinh, A., Yin, A.L., Estrin, D., Greenwald, P. and Fortenko, A. (2023) Augmented Reality in Real-Time Telemedicine and Telementoring: Scoping Review. JMIR mHealth and uHealth, 11, e45464. [Google Scholar] [CrossRef] [PubMed]
[31] Elmoghazy, S., Yaacoub, E., Navkar, N.V., Mohamed, A. and Erbad, A. (2021) Survey of Immersive Techniques for Surgical Care Telemedicine Applications. 2021 10th Mediterranean Conference on Embedded Computing (MECO), Budva, 7-10 June 2021, 1-6. [Google Scholar] [CrossRef
[32] Zheng, J., Wang, Y., Zhang, J., Guo, W., Yang, X., Luo, L., et al. (2020) 5G Ultra-Remote Robot-Assisted Laparoscopic Surgery in China. Surgical Endoscopy, 34, 5172-5180. [Google Scholar] [CrossRef] [PubMed]
[33] Emu, M.A.H., E-Elahi, Q.M., Ahmed, S. (2022) 5G-Based Smart Health Care System Design Using IoT in Bangladesh. Proceedings of the 5th International Conference on Industrial & Mechanical Engineering and Operation Management, Dhaka, 26-27 December 2022, 1-9.
[34] Tian, W., Fan, M., Zeng, C., Liu, Y., He, D. and Zhang, Q. (2020) Telerobotic Spinal Surgery Based on 5G Network: The First 12 Cases. Neurospine, 17, 114-120. [Google Scholar] [CrossRef] [PubMed]
[35] Dananjayan, S. and Raj, G.M. (2020) 5G in Healthcare: How Fast Will Be the Transformation? Irish Journal of Medical Science, 190, 497-501. [Google Scholar] [CrossRef] [PubMed]
[36] Shakya, S., Alsadoon, A., Prasad, P.W.C., Haddad, S., Pham, L., Alrubaie, A., et al. (2020) Novel Secure Surgical Telepresence Using Enhanced Advanced Encryption Standard: During, Pre and Post Surgery. Multimedia Tools and Applications, 79, 14265-14290. [Google Scholar] [CrossRef
[37] Bhat, S. and Kavasseri, A. (2023) Enhancing Security for Robot-Assisted Surgery through Advanced Authentication Mechanisms over 5G Networks. European Journal of Engineering and Technology Research, 8, 1-4. [Google Scholar] [CrossRef
[38] Iqbal, S., Farooq, S., Shahzad, K., Malik, A.W., Hamayun, M.M. and Hasan, O. (2019) Securesurginet: A Framework for Ensuring Security in Telesurgery. International Journal of Distributed Sensor Networks, 15, Article 155014771987381. [Google Scholar] [CrossRef
[39] Mohammadzadeh, N., Rezayi, S. and Saeedi, S. (2022) Telemedicine for Patient Management in Remote Areas and Underserved Populations. Disaster Medicine and Public Health Preparedness, 17, e167. [Google Scholar] [CrossRef] [PubMed]
[40] Shah, S. (2024) The Intersection of Technology and Health Economics: Innovations and Challenges. Premier Journal of Public Health, 1, 1-12. [Google Scholar] [CrossRef
[41] Nanda, M. and Sharma, R. (2021) A Review of Patient Satisfaction and Experience with Telemedicine: A Virtual Solution during and Beyond COVID-19 Pandemic. Telemedicine and e-Health, 27, 1325-1331. [Google Scholar] [CrossRef] [PubMed]
[42] Venkataraman, A., Fatma, N., Edirippulige, S. and Ramamohan, V. (2024) Facilitators and Barriers for Telemedicine Systems in India from Multiple Stakeholder Perspectives and Settings: A Systematic Review. Telemedicine and e-Health, 30, 1341-1356. [Google Scholar] [CrossRef] [PubMed]
[43] Ansarian, M. and Baharlouei, Z. (2023) Applications and Challenges of Telemedicine: Privacy-Preservation as a Case Study. Archives of Iranian Medicine, 26, 654-661. [Google Scholar] [CrossRef] [PubMed]
[44] Solimini, R., Busardò, F.P., Gibelli, F., Sirignano, A. and Ricci, G. (2021) Ethical and Legal Challenges of Telemedicine in the Era of the COVID-19 Pandemic. Medicina, 57, Article 1314. [Google Scholar] [CrossRef] [PubMed]