The implications of 5G technology on cardiothoracic surgical services in India

Abstract

The fifth-generation (5G) technology is finally making its long-anticipated arrival in India, where it has evoked much hope to advance healthcare accessibility and delivery to the masses as well as improving patient safety and efficiency. The 5G technology standard for broadband and cellular networks comes with improved coverage capability; better throughput, speed, bandwidth, and signal strength; and low latency. Such salient-advanced features could be the knight in shining armor for the cardiothoracic surgical community in bridging gaps in perioperative care, outreach, education, research, and much more.

Introduction

Technology has become indispensable in the daily hustle and bustle of a modern thoracic and cardiovascular surgeon. Technology and cardiothoracic surgery (CTS) have evolved in a symbiotic relationship lasting well over seven decades now, largely thanks to needful necessity and innovative ideas that continue to make splashes every now and then. Telecommunication technology is an occult entity that continues to contribute to this growth story.

On 15 June 2022, the Union Cabinet of the Indian Government approved to make fifth-generation (5G) telecommunication services available in India [1]. The technology was thereafter launched on 1 October 2022 and is set for widespread outreach in phases [2]. The availability of 5G to cardiothoracic surgical (CTS) services in India may allow several reforms, such as in implementing quality, patient safety, and achieving better patient outreach with better network efficiency and transparency standards. We shall review some pressing concerns in patient outreach and treatment delivery that our profession faces and how the new 5G technology can help leverage improvements.

Healthcare in this century, recognized by data-driven approaches to facilitate access, derive precision, and provide better outcomes to patients, often finds itself at odds with the growing burden of diseases, decentralization of specialty-based care, public health inequities, and shifting scales of demand–supply ergonomics that have made the healthcare scene chaotic, congested, and expensive. Modalities using technologies such as cloud computing, big data, artificial intelligence (AI), internet of things (IoT, now known as internet of medical things, IoMT), and machine learning (ML), as may be familiar to the reader, have spread out in application and scope in the healthcare sector to aid healthcare professionals in making smart decisions and focus their energy towards clinical and academic priorities. This potential to our profession remains largely untapped in alleviating logistical, fiscal, and resource-based constraints that often bring peril to the patient-surgeon relationship.

Surgeons and institutions are undoubtedly data-driven and better aware of technology, however, are in the dark when it comes to leveraging technology to facilitate measures that can make CTS safe, reliable, and evidence-based for the patient and themselves. There are fewer hospitals that utilize the incumbent fourth-generation (4G) technology in their day-to-day transactions, as a large majority run their information systems on the intranet (in-hospital cabled network) or solely on paperwork. It would be safe to say that technological advances we have experienced are largely through the evolution in network and telecommunication technology. From first generation (1G) to the existing spectrum of 4G, communication has become faster (speed), more accessible (availability and adaptability), and efficient (drop in latency) (Fig. 1).

Fig. 1.

Evolution of wireless network technology. The growing capability and reduction in size of hardware technology such as phones is intrinsic to the evolving capability of wireless technology as represented here. SMS, short message service; GPS, global positioning system; IP, internet protocol; IoT, internet of things

Introduction of the 5G technology, which will replace the existing 4G technology in stages, is expected to make a splash. Inherent features that could possibly overcome pre-existing limitations include high-speed data, ultra-low latency, wider connectivity, higher bandwidth, improved durability, and larger capacity. Immense possibilities for stakeholders include improvements in diagnostics, surgical outcomes, patient safety, care delivery, education and training, telemedicine, and innovation.

Current status of cardiovascular surgery network infrastructure

The existing CTS landscape faces many impediments and challenges, largely from an evident lack of digital resources, serviceable real-time technology, and services. We list three major themes revolving around these issues that could be extrapolated across subspecialties of CTS.

1. Limited resources: A patient who underwent total correction for tetralogy of Fallot must undertake an interstate travel across two days for routine serial echocardiography simply due to absence of such a local facility. The challenge is that the nearest echocardiography clinic does not have a surgeon to interpret the test.

2. Patient Records and Access: A patient who underwent the Ross-I procedure presents with pulmonary insufficiency to the hospital where the first operation was performed after fifteen years. The hospital does not have the patients’ records (since hospitals in India are not compelled to retain patient records beyond ten years). The challenge is that records of the surgery being unavailable increases the risk of a reoperation outcome multifold.

3. Specialty integration: A patient following coronary artery bypass returns to a standalone cardiac center in a suburban town with deranged renal function. The setup does not have a nephrology unit, and nor does the hospital with nephrology facility have a CTS unit. A challenge has arisen in treating an operated CTS patient for a non-cardiac cause.

Some of these examples are cited not as mere humdrums but as true anecdotal references from day-to-day practice where patient safety and outcomes stand endangered. There are several causative factors and issues behind them that continue to challenge healthcare delivery, access to quality healthcare, universal coverage, and patient safety. We shall discuss the saliency of 5G technology in converting some of these misses to hits which are applicable across subspecialty themes of CTS.

Peri-pandemic evolution of technology: on-call to on-the-phone

The global health workforce strength is a victim of attrition for many causes, one of them being the coronavirus (COVID-19) pandemic. With 13 million professionals set to leave by 2035, close to 57 nations will face shortage when it comes in providing even basic primary healthcare [3].

The medical community has been on the accelerated wheel of evolution to cover its bases in the face of shortage of staff and infrastructure with frugal innovation [4] in telemedicine, remote consultation, remote laboratory testing, or screening. The virus continues to be a penurious cause of concern over the duo of Streptococcus and Staphylococcus aureus to the CTS community.

The peri-pandemic experience has been the nidus of transformation for CTS when it comes to adaptability and application of technology. Among the positive changes encountered hitherto, one stands out: the ability of physical interfaces such as smartphones having the ability to harness unprecedented performance capability by virtue of cloud computing and telecommunication. This distinction of smartphones in leveraging innovation without additional accessories or interfaces lies in the complementary capability of software applications (apps) and network capability. Telecommunication made it possible for us to help our patients reconnect with their families, establishing the line of much needed comfort and bonding especially during terminal events when physical contact was impossible. With safety becoming the norm, technology is the new normal.

Opportunities with 5G

5G shows potential in contributing to patients in cardiothoracic healthcare and represents a major shift in telecom technology with swift connectivity, ultra-low latency, widespread coverage, and improved capability in service density. Its integration in CTS services is expected to see improvements in the following areas (Fig. 2).

Fig. 2.

Cartoon depicting the potential areas suitable for implementation of 5G technology to facilitate efficiency and transparency and improve patient safety in cardiothoracic surgery

Efficiency inside

Introduction of 5G technology will play a positive role by offering higher density connectivity, faster transmission, and most importantly ameliorate cluttered networks. Connectivity in institutions and CTS units, therein facing significant latency, secondary to overcrowding and cluttered connectivity can obtain a lease of fresh air.

On the administrative front, paperwork and files that oft clutter our consultation rooms and workspaces devalue patient care. Unfortunately, many CTS services continue to rely on paper-based patient records, making the transition to electronic records a real struggle. Efficiency, transparency, and good work ethics can be heralded in departmental transactions and employees when it concerns finances and important documentation, most of which can be handled through computerized means [5]. This would most certainly resolve the issue of Patient Records and Access highlighted in the previous section. Going digital and investing in development of robust digital services would save much effort and hassle resulting from mishaps or disasters incurring legal, financial, and administrative indemnification. Several public (All India Institute of Medical Sciences, New Delhi), private (Narayana Hrudayalaya, Reliance, and Apollo), and philanthropic institutions (Sathya Sai Institutes in Bangalore and Puttaparthy) have successfully implemented digital ecosystems and patient data records models in their clinical and administrative areas.

5G services in hospitals offer CTS units the capability to establish integrated registration, payment service–oriented platforms for patients which would decongest administrative sections involved in registration and payment services. In addition, wholesome integration of waiting, specimen-collection, examination, consultation, payment, and follow-up will greatly make patients’ transactions equally seamless.

For the surgeons, development of integrated picture archiving and communication systems (PACS), radiology information systems (RIS), and patient health records will greatly benefit surgeons to view images in their operating rooms as well as access reports from laboratory services on a dynamic scale. Another advantage of 5G is the high bandwidth coverage that will allow field sensors to be further spread out. The improved high frequency range may enable connectivity when you are in extreme environments such as moving elevators, basements, and enclosures with thick concrete walls — each of which may affect your team’s access to you during an adverse event, where connectivity matters.

Follow-up and telemedicine

Perhaps the most virtuous of all capabilities of 5G is in extending a virtual hand to our patients. Most operated patients from the lower economic strata, especially in the developing world, find themselves financially burdened in traveling to hospitals in the cities, especially during these times. 5G offers CTS services and allied specialties the opportunity to collaborate and establish a patient care network with local healthcare centers and physicians accessible to operated patients. Enhanced data efficiency is an aspect that 5G hopes to make connectivity reachable to the masses that stands out in this aspect of application. Teleconferencing with 5G will establish faster connectivity, low lag/latency, and better image and sound quality for both doctors and patients behind the screen. Routine follow-up through video conferencing will go a long way in monitoring patients for their well-being, improve survival and outcomes, and reduce adverse events with local support and awareness.

5G will go a long way in reviving the potential of telemedicine, especially in rural India. Screening, detection, and monitoring of patients with heart disease are vital from epidemiological, diagnostic, and treatment perspectives, for the unaccounted burden of congenital, rheumatic, and acquired heart diseases in the Indian population that continues to plague our healthcare scene. Multidisciplinary teams involved in caring for patients from the depths of our society will benefit from the value-addition that 5G will bring in the workflow of taking these patients from diagnosis to treatment, which can then be complemented by follow-up care as discussed in this section. This would resolve the issue of limited resources ascribed to in the previous section.

Advancements being discussed herein will also enable patients to access their records, which rightfully belong to them. Patients in India are often burdened by having to carry around physical records in the form of files and storage devices. 5G offers government and healthcare institutions the unique opportunity to develop smart and robust database infrastructures that can be linked with universal healthcare identification programs. Such programs can be made dynamic, interactive, and user-friendly with the proviso that patients shall have access to their data at any healthcare institution enrolled under universal coverage. Privileges of multi-level authentication and linkage of unique government-issued identification will go a long way in bringing India under one bracket that guarantees patients their rights and safety.

Remote monitoring and wearable devices

In addition to strengthening patient follow-up via teleconsultation and online follow-up, 5G offers the untapped potential of utilizing the power of remote monitoring of patients with telehealth devices and gadgets. Wearable devices with the capability of keeping track of patient physiological parameters can now be used to leverage the possibilities of real-time tracking and analysis of cardiopulmonary function and vital signs of patients, all the way from hospitals to their places of stay.

Remote health monitoring is an upcoming area with much interest in preoperative patients, which may well be extended to operated patients, to track their progress and physiological signs of recovery following surgery. This technology can be realized with the help of improved throughput, transfer, and analysis of data in real-time. An interest in such technology can help us understand the outcomes of CTS in operated patients [6], obtain real-time and accurate data about survival, identify and pickup evolving comorbidities in time for salvage, and integrate emergency response activation systems through wireless fidelity (WiFi) and Bluetooth®-WiFi sync chains. This will greatly help our community in improving postoperative outcomes. In addition to this, data from cardiothoracic conditions, cardiopulmonary interactions, and disease progression would be invaluable in developing robust epidemiological studies and establish public health figures from an Indian perspective [7].

With the wearable device technology forum predicted to grow from the existing USD 16.2 billion to USD 30.1 billion industry by 2026 [8], growth in innovations, indigenous products, and patient-centric products is expected to result in a wide dissemination of this economy making it affordable and user-friendly for the consumer market. Growing demand for wearable devices customized to physicians’ needs would also be a much-needed impetus for the growth of house-spun start-ups and industry focusing on indigenous biomedical device development.

The availability of IoMT, big data analytics, neural network algorithms, wireless connectivity in devices, and development of applications that can offer cognitive and deterministic capabilities as per requirement in application is crucial in developing human resource frameworks that can minimize the risk of exposure to healthcare professionals [3] in CTS.

Remote surgical capability

Remote healthcare using technology can be broadly classified as telemedicine and surgery. We have discussed the latter earlier. Real-time remote-controlled robotic surgery is an evolving trend across the world. An extension of remote consultation and assistance in resource-constrained environments, surgery through a high-fidelity device and long-distance communication has been made possible with advances in telecommunication and robotic technology.

Reports of remote robot-assisted surgery emerged in the early parts of this century [9] and have now been implemented in a one-to-many scheme in surgical specialties including spinal [10, 11], neurovascular [12], pediatric [13], and gastrointestinal surgery [14].

More recently, the world’s first remote percutaneous coronary intervention was performed in Ahmedabad, Gujarat [15]. Remote surgical interventions have been made possible with long-range transmission of operating room audio, image, voice, and video via wireless networks and robotic control systems for surgical maneuverability and manipulation. The system delay and instability in network speeds often resulted in data lag, connectivity, and information-action mismatch with earlier technology [10]. There is now hope that the availability of 5G will make the practice of remote surgery more efficient and seamless, both for the remote surgeon and the patient with high speed, low latency, and high bandwidth that 5G offers [11]. Performing CTS with this technology is a matter of debate and contention.

Collaboration

Indian CTS services continue to witness a rise in the upturn of centers performing CTS, especially in tier-three cities and further. Most of these centers are manned by surgeons, anesthesiologists, and perfusionists who endeavor to take specialty care to the depths of our society often by beginning standalone programs here. Such units may not have access to in-house support specialties such as physiotherapy, anesthesiology, cardiology, nephrology, diabetology, neurology among many other specialties. Such endeavors will benefit from the development of collaborative network platforms in their attempts of expanding the envelope of cardiothoracic care to the masses.

Oft times, the methodology of patient referrals is skewed and based on word-of-mouth or acquaintance. This is not limited to just CTS referrals, but plagues much of modern medicine specialties being a major hurdle in achieving universal healthcare coverage. Structured referral paradigm that involves establishment of healthcare zones, geospatial identification of institutions, tele-networking with local leadership, and first response teams can be established by the capabilities proffered with 5G. Developing inter-institutional referrals with cost-effective solutions such as scheduled online consultations, time-bound tele-audits, and reviews would help in the national integration of services in tier-2 towns and beyond. This will obviate a large cohort of misses associated with limited resources, as discussed earlier. This would go a long way in resolving the issue of specialty integration highlighted in the previous section.

The cost of instituting a digital infrastructure would not vary much from standard network facility commercial rates and interface development charges for institutions. Such infrastructure is undervalued in India and is predicted to grow at 31.2% between 2019 and 2025 with an estimated target upwards of USD 53 billion globally [16]. Going a step further, it would be ideal for the Indian CTS community to partake in a goal-oriented data registry, such as the existing Indian Association of Cardiovascular-Thoracic Surgeons (IACTS) National Database platform. This could entail a national consensus to record pan-national surgical workload, clinical parameters, outcomes, and follow-up data of operated patients. This could resolve the issue of Patient Records and Access highlighted in the previous section, on a national level.

Education

Cardiothoracic education happens in the operating rooms and intensive care, albeit hiatuses resulting from outbreaks compelled CTS units to restructure and reinvent residency, fellowship, and continuing medical education. Presence of bare hardware such as smartphones, network connectivity, and innovative leadership, not in any particular order, play a vital role in educating cardiothoracic (CT) surgeons, both in the present and the future.

Several societies, interest groups, and individuals have made efforts to conduct webinars, conferences, and workshops before and during the pandemic. These efforts go beyond education and help engage, involve, and gather like-minded individuals in a diverse pool of interests. Webinars and online events in CTS, which are the order of the day, were few and far between before the pandemic. The IACTS was among the earliest professional CTS fraternities to conceptualize and put together an online-teaching program, the IACTS Masterclasses [17], to upskill and engage members and young surgeons of the society. This was a clarion call and working model that several other societies adopted to spread the power of education globally through the internet.

5G technology will continue to harness this power and play a vital role in ensuring continuity towards upskilling, knowledge enhancement, and dissemination to CTS professionals and medical professionals in general through continuing medical education programs with faster and better connectivity with enhanced image, sound, and voice quality. Inter-institutional seminars, surgical demonstrations, teaching sessions, and updates in CTS are about to get much better with faster data transfer, better internet speeds, and improved voice, video, and sound quality.

The impact of extended reality in CTS is yet to be felt. This market, valued under USD 1 billion, is expected to cross USD 7 billion in the next two years [16]. The face of education can be extended beyond lectures and classroom-like teaching. The value of simulation with virtual reality (VR) in training is the buzz in medical education. Value addition of VR includes surgical planning through customization, personalization, and incorporation of varying levels of complexity as well as integration with advanced diagnostic planning for pre-surgical planning and deliberation. This feature offers a novel perspective to patient safety by enabling prior and preemptive planning, effacing risks associated with on-table surprises and complications resulting thereunto. It also enables surgeons to involve patients (or parents) in their care before surgery.

Novel features accrued from virtual and augmented reality technology can be incorporated to offer surgeons the opportunity to experience simulation and extended reality. This feature also has huge potential and impact when it comes to training and teaching. Surgeons can mentor residents and fellows as well as teach remote colleagues various surgical procedures with extended reality models of surgical specimens and cases.

5G technology will enable the inclusion of haptic feedback, real-time sensing, gyroscopic all-motion cognition, as well as tactile feedback in transmission, providing true touch and feel to such resources. Recognition of these features in surgical simulation planning would enable mentors to showcase and provide feedback on depth, precision, texture, and contour. The added advantage in feeling tissue resistance, weight of the needle holder, and effort to take a needle-bite in simulation are some novel possibilities with 5G technology. Incorporating ML and AI in learning modules could be customized to offer augmented mentorship and analysis of performance with digital memory in simulation-based training and assessment.

Skills and simulation labs that are built using such technology will not only harness the true power of automation and enhanced learning but shall also enable trainees to hone their skills with personalized guidance and feedback, without restraint for time. Such investments in pedagogy, in addition to teaching and training in the operating rooms, intensive care, and the bed side of patients, will enhance both the ergonomic capability and decision-making ability of surgeons in training and those seeking further skills.

Research and further scope

In evolving application, 5G could impact the way we conduct research to improve patient outcomes in CTS. This will enable research portfolios from basic sciences to translational and outcomes research in fostering workbench capability with connectivity, tethering unafflicted by rush-hour network traffic and real-time performance capabilities. From basic science researchers to data scientists in CTS who are dependent on the digital continuum for their data-driven work will benefit from the availability of 5G to carry out work in and around automation, quantum computing/information sciences, and AI [18]. The product of high-end research will have lasting impacts, when funneled down to improve patient care and outcomes in CTS.

5G technology enabled improvements in communication has enabled the accentuation of remote patient care through the introduction of de novo modalities such as remote surgical care and robotic surgery [19]. Facilities for supercomputing and blockchain development at higher standards could be a possible reality in institutions that could seek to adopt data-driven approaches in day-to-day monitoring of patient care, resource utilization, and human resource performance as well as formulation of healthcare policy.

The presence of advanced imaging and derivative technologies such as additive printing (most prominent application being three-dimensional printing) continue to expand the care of patients with pre-emptive advanced diagnostics, planning, and execution. Some salient capabilities of 5G including low latency, high speed, and improved signal strength would be key areas to advance precision-guided technologies where high bit-rate transfer and high image resolution are vital parameters [20]. In good time, IoMT in imaging processing and three-dimensional printing modalities will enable expeditious processing and enable production of finer objects [21]. As with supply chain management, strong and robust wireless connectivity in automation processes, remote operations, and multi-level processes could strengthen translational care from the bench to the patient’s bedside — a feature that CT surgeons can look forward to.

AI and its heirs

Much can be written about the limitless possibilities that trained automated models can bring to CTS with the advent of 5G. 5G will enhance the speed and integration of other technologies, while AI will allow machines and systems to function with greater cognitive levels. In addition to enhancing capabilities with the development of applications mentioned hitherto, end-to-end security, which is vital to security with 5G, can be achieved with AI and ML.

They will play vital role in design, modelling, and automation of efficient security protocols against diverse and wide range of threats, having already proven their effectiveness in different fields for classification, identification, and automation with higher accuracy. As 5G networks’ primary selling point has been higher data rates and speed, it will be difficult to tackle wide range of threats from different points using typical/traditional protective measures. Therefore, the duo can play a central role in protecting highly data-driven infrastructure and virtualized network components [22].

AI-driven deep learning algorithms, heuristics analytics, support vector machines, and a host of neural networking modalities could be incorporated into supporting and enhancing patient recovery following surgical discharge as well as prior to surgery. In improving patient survival during follow-up, a follow-up kiosk system that will monitor parameters from follow-up reports received from healthcare centers and patients, to prioritize and triage patient records on a critical, exigent, and urgent basis for prompt physician intervention and necessary action at the patient’s end with activation of emergency response system.

Computer diagnostic algorithms built on ML, now upgraded to deep learning, have been successfully deployed in laboratory diagnostics [23], ophthalmic screening [24], imaging [25], and cardiovascular medicine [26], among other specialties. In addition, the data gathered from remote monitoring and wearable devices could be channeled into a central server that analyses the patient’s real-time physiological parameters and issues necessary notifications to first response teams and the nearest institution for prompt recognition and intervention. This could be one of many innovative ways to interlink emergency response, hospital preparedness to salvage patient outcomes, as is extremely necessary in patients with a risk of coagulopathy, thrombogenicity, end-stage heart failure, mechanical circulatory support, malignant arrhythmia, and other risk factors who need to be under close observation once discharged.

Work in progress

The success of any technology is a double-pronged effort, resulting from innovation and feedback. Some causes of concern among the public and aspects for appraisal are discussed here.

Data and network security

Personal health information (PHI) of a patient must be confidential and protected. No part of data generation, collection, access, storage, and transmission should be available to anyone unconcerned with patient care. This can be achieved with a tripartite strategy encompassing consensus among healthcare professionals, technical infrastructure to maintain security, and the presence of a legal framework to safeguard patient information.

There is a pressing need to implement specialized protocols and establish a decentralized institutional framework by legislation to safeguard patient PHI, lay an embargo on patient data theft, and constitute punitive measures to those who threaten the safety of patients and their PHI in India. Unlike parts of the developed world, where concrete data protection mechanisms have been enacted, either by acts of legislation such as the General Data Protection Regulation (GDPR, European Union) [27], Health Insurance Portability and Accountability Act (HIPAA, USA) [28], Personal Information Protection and Electronic Documents Act (PIPEDA, Canada) [29], Health Data Protection Regulation (HDPR, Australia) [30], Personal Data Privacy Protection Law (PDPPL, Qatar) [31], Personal Health Information Protection Act (PHIPA, Canada) [32], or with organizational frameworks such as the National Health Service (NHS, UK) Regulations [33], something similar is yet to be enacted in India, where patient PHI is forsterly governed by the Information Technology Act, 2000 [34]. The Indian legislation is a generalized legal framework for all forms of electronic data and is not as well equipped to bulwark the threats to PHI in this day and age.

Notwithstanding the absence of such legal measures, 5G must be equipped to combat cyber vulnerabilities, to retool PHI integrity and security. The salient feature of Dynamic Spectrum Sharing capability (larger density coverage) and development of smart IoT interfaces [35] in 5G are expected to expose vulnerability towards hackers who would seek to disrupt the infrastructure with malware and trojan transgressors into networks that would be “more open” than before. Policy and cybersecurity experts must come together in this era of open-source web-operationalization to assess risk, implement safety nets, develop a safe cyber ecosystem, and develop cyber preparedness with prompt defense mechanisms in combating cyber threats. The United States’ National Institute for Standards and Technology Cybersecurity Framework recommends [36] that frameworks adopt a regimen of “identify, protect, detect, respond, and recover” in an evolving state of technology to strengthen the work chain that depends on the same. Multi-level cipher mechanisms, zero-trust approach, universal encryption, and protection to orchestrated AI are key areas to protect PHI.

Radiation hazard

One major concern with high-frequency technology is its propensity to cause harm to human health. Karipidis and colleagues in a review of research into low-level radiofrequency fields above 6 GHz noted that the levels of 5G are well below the human exposure limits established by the International Commission of Non-Ionizing Radiation Protection (ICNIRP), a global watchdog that sets scientific guidelines on the use of radiation technology. This study [37], which included results from experimental and epidemiological studies, concluded that there is little evidence to suggest adverse health effects including cancer at different sites, reproductive deficits, or other chronic conditions/diseases with exposure to radiofrequency levels above 6 GHz, as will be used by 5G.

With increased coverage and boosted power of signals that have accrued with 5G, it would be possible for telecommunication corporations to utilize radio wave altimeters to strategically place radio towers and boosters away from densely populated areas. Integrated with optimal antenna positioning, safe power levels and necessary boosters would be a conscious step towards safeguarding the health and welfare of the public in extension to what has been cited by the Federal Aviation Administration in the USA along the lines of flight safety [38].

Cost and device compatibility

Another concern with 5G has to do with the cost associated with new technology. There is speculation among technical experts that the initial phases of procuring, testing, and disseminating 5G will incur additional costs that may be expected for a latency period spanning introduction to wide dissemination of the technology [39]. This is not expected to cause significant disruption in the consumer market, as experts ascertain the benefits outweigh concerns and shall result in normalization of consumer trends [40]. It is worth noting here that a reasonable increase in internet and mobile communication tariff may be safe to expect, until broad coverage is achieved across the country.

The initial offering to customers who wish to utilize 5G services is said to be voluntary and not compulsive [39], which may change over time as the telecom regulator may choose to make 5G the national norm, as has been the case with every incumbent technology. Maintenance and logistical support for 5G technology is expected to reflect the present state of telecommunication support and troubleshooting in network services. With the host of electronic hardware such as mobile phones, routers, laptops, and other office essentials (manufactured in the last five years) equipped to be compliant with 5G technology, no disruption in the transition from 4G to 5G is expected to take place.

Advanced technologies in healthcare find their true essence of purpose in harmonizing decision-making processes and elevating safety standards of therapeutic care through diagnostic, preventative, and information-based practices. In allying with the World Health Organization’s tenets [41] for patient safety and technology, we believe that 5G can play a responsible role by helping improving man-power efficiency, efforts to raise patient safety standards, research, education, and collaboration, especially in the developing world.

A note on patient safety

Patient safety is a vital component in the deployment of any technology. Now you may ask what this has to do with 5G technology? Good clinical practice that is centered around the safety and well-being of patients can be achieved by improving decision-making that is fact-based and policy-oriented on micro, meso, and macro levels [4], i.e., upholding the patient-doctor relationship and adopting a no-holds barred approach in the care of patients with the patient themselves, your team, and resolving this as a policy in unit.

Patient contact and physician involvement are indispensable in achieving patient safety, especially in CTS. There can be no form of technology that can substitute the presence of a compassionate and caring surgeon. Virtual and video contact, which saw an upturn during the pandemic by necessity, provided much needed succor, peace, and togetherness between families and patients. However, the injudicious use of technology in elective settings can undermine and possibly dent the singular relationship between the caregiver and the patient. The essence of eye contact, touch, and physician presence at the bedside are most reassuring and respectful to the patient and help with healing [42]. The availability of advanced technology must not be the basis for substitution of a physician’s presence, or for that matter the surgeon’s in the perioperative and postoperative care of patients.

Technology is a conduit to possibilities and 5G is no exception to this rule. Pinning the blame for imprudent application on the technology itself would be unjust, for healthcare institutions and providers, who are the key guardians of patient safety, must exercise clinical judgement, and reason ethically when they implement technology in conventional and novel areas of patient care [42].

Conclusion

5G has the potential to impact our healthcare milieu and could revolutionize our nation’s medical infrastructure. In addition to the possible applications described here, CT surgeons will likely find most of these avenues pertinent in their day-to-day practice. Thoracic and cardiovascular surgery has the potential in this regard to set the tone to maximizing patient care, safety, and outreach with innovative measures using this upcoming technology as its base.

Patients on the other hand will benefit immensely from the proactive and multidisciplinary approach of caregivers to improve their safety and survival. Our specialty has the unique advantage of setting an example to sister specialties by ushering in quality, patient-safety, and compassion in a high-risk group by leveraging the edge, this de novo technology has to offer, in a responsible and conscious manner.

There are few hurdles and opportunities aplenty in harnessing the features that 5G has to offer towards enhancing patient care, ushering efficiency, and maximizing delivery of CTS services to the last man in the long waiting line. When we truly disseminate and adopt these features to proffer quality healthcare to our patients of the past and future, the symbiotic relationship between CTS and 5G technology shall win the day.

Funding

None.

Declarations

Ethics committee approval

Not applicable being a review article.

Informed consent

Not required, as no patient data was utilized.

Research involving human participants and/or animals

None.

Conflict of interest

None.