Telementoring for surgical training in low-resource settings: a systematic review of current systems and the emerging role of 5G, AI, and XR.

Telementoring in surgical training enables expert surgeons to provide real-time remote guidance to trainees. This technique is increasingly adopted to address surgical training gaps in low- and middle-income countries (LMICs), i.e., nations with a gross national income per capita of $13,845 or less. However, existing systems are constrained by conventional communication systems, which experience high latency, limited bandwidth, and poor video resolution. These challenges hinder the integration of immersive and interactive technologies such as virtual reality (VR), augmented reality (AR), and haptic feedback, which would enhance learning outcomes, especially in resource-constrained environments. AR overlays digital images onto the real-world environment, whereas VR immerses users in a fully computer-generated environment, enabling trainees to interact with surgical components as if they are in the real world. In addition, the advent of the fifth generation of mobile networks (5G), which delivers ultra-low latency, high bandwidth, and support for network slicing, offers a promising foundation for scaling high-fidelity telementoring systems. Moreover, the integration of artificial intelligence (AI), i.e., equipping computer systems with the ability to perform tasks that would typically require human intelligence, can enable real-time performance analytics and skill assessment of the trainees. In regions lacking reliable network backbone infrastructure, such as fiber, hybrid approaches that combine low-cost 5G deployments with satellite communication can be leveraged to achieve reliable end-to-end connectivity. Therefore, this systematic literature review evaluates current surgical telementoring systems, their enabling technologies, and associated challenges, with emphasis on LMIC contexts, where such systems will have the greatest benefits. Through a structured Population, Intervention, Comparison, and Outcome (PICO)-based synthesis, we address five key research questions that span key aspects such as current telementoring systems and technologies, functional and technical requirements, educational outcome effectiveness, and the gaps addressed by modern technology and connection solutions, i.e., 5G, AI, VR, and AR. In addition, we identify recurrent challenges and propose a design framework that can be adopted in low-resource settings. Finally, we outline future development directions, including AI-driven evaluation models, scalable system architectures, and policy frameworks to guide the development of secure, cost-effective, and equitable telementoring platforms to advance global surgical education.