Telementoring as an adjunct to training and competence-based assessment in laparoscopic cholecystectomy

Background: We set out to assess telementoring as a training adjunct and an objective means of assessing competence in laparoscopic cholecystectomy (LC). Methods: Consecutive patients underwent LC performed by a higher surgical trainee (HST). The laparoscopic image was relayed to an adjoining theater, where the trainer observed as he operated during a parallel operating list. Interaction occurred between trainer and trainee as appropriate; and interaction, procedure difficulty, and duration were recorded. Results: LC was accomplished in 33 of 34 patients, with one (2.9%) open conversion and one (2.9%) postoperative bile collection. Ln 21 cases (69%), there was no interaction; in II cases (32.4%), there was verbal interaction; and in two cases (5.9%), the trainer scrubbed. Interaction rates for difficulty grades 1, 2, and 3 were 15% (2/13), 41.2% (7/17), and 50% (2/4), with median operating times of 35, 45, and 92 min, respectively. Conclusions: Telementoring in LC is feasible, appears to be safe, and may generate objective assessment of a trainee's performance and progress. Evaluation of this technique in a cohart of trainees at different stages is now required.