Telementoring in laparoscopic cholecystectomy: a useful adjunct in training and assessment of higher surgical trainees

Abstract

Abstract Aims This study assessed the feasibility, safety and utility of telementoring as a training tool in laparoscopic cholecystectomy (LC) for higher surgical trainees (HST). Telementoring in LC was developed as a technique for objective assessment of performance and progress in order to help decide when an HST is competent to perform LC unsupervised. Methods This was a prospective study of patients attending for LC, with surgery performed by an HST, in which the laparoscopic image was relayed live to an adjoining room where a supervising consultant observed the procedure. The trainee or supervisor sought or proffered advice/assistance as appropriate, and safety, complication rates, operating time, difficulty of procedure, intervention rate and type were recorded. Results LC was accomplished in 33 of 34 patients enrolled; there was one conversion to an open procedure. Interaction between the HST and trainer occurred in 11 cases, by way of advice being sought or offered, and in two of these the supervisor scrubbed up and took over the operation. The rate of interaction and duration of the procedure increased with procedure difficulty, with rates of interaction for difficulty grades 1, 2 and 3 of 15 per cent (two of 13), 41 per cent (seven of 17) and 50 per cent (two of four), and overall median operating times of 35 (23–50), 45 (28–75) and 92 (45–110) min respectively. Conclusions Telementoring for trainees capable of performing LC is feasible and appears to be safe with a supervising surgeon situated in the immediate vicinity. Telementoring in LC is a promising tool that may provide objective assessment of a trainee's insight, skill and progress in operative performance.