Defined Protocols Help Ensure Surgical Telementoring Is Safe, Scalable

Surgical telementoring has emerged as a powerful tool to expand access to expertise, accelerate skill acquisition, and enhance patient safety as surgical innovation continues to outpace traditional training pathways.

While the technologies enabling remote mentorship, including high-definition video, telestration, low-latency connectivity, and secure audiovisual platforms, have advanced rapidly, the foundational principles governing surgical education and accountability remain unchanged.

Telementoring is not a substitute for sound surgical judgment or local responsibility; rather, it represents an extension of established educational paradigms delivered through secure, remote platforms, consistent with the broader evolution of surgical education and coaching models described in contemporary literature.^1-3

At its core, surgical telementoring must operate under the same professional, ethical, and educational standards as in-person surgical instruction. This approach is particularly notable when comparing telementoring to telesurgery.

Whereas telesurgery involves remote physical control of operative instruments by an offsite surgeon, telementoring preserves the onsite surgeon as the primary operator, decision-maker, and surgeon of record. This difference alters the ethical, legal, and professional frameworks involved with telementoring.

Published experience suggests that telementoring, when appropriately structured, carries lower medico-legal complexity and greater scalability than telesurgery, while still providing meaningful educational and clinical benefit.^4,5

The qualifications of the telementor are central to the integrity of this model. The remote mentor should be a fully licensed physician, board certified or board eligible in the relevant specialty, and actively practicing with demonstrable expertise in the procedure for which they are providing mentorship.

Most institutions require documentation of case volume, favorable outcomes, and prior experience as an educator, proctor, or attending surgeon. In addition, formal training in telementoring technology, including telestration, image optimization, and closed-loop communication, is essential to mitigate issues that are sometimes associated with remote guidance. These expectations mirror standards described in surgical coaching and quality improvement literature from major academic societies.^6-8

Within a single healthcare system, intra-institutional telementoring offers substantial educational and operational value. By allowing experienced faculty to mentor colleagues remotely, systems can standardize care pathways, disseminate best practices, and support the safe adoption of new techniques without the logistical and financial constraints of travel.

This model has been particularly effective in robotic surgery, advanced minimally invasive procedures, and endoscopy—in any environment where a camera mediates the operative field. Studies published in Surgical Endoscopy and Annals of Surgery have demonstrated that such approaches improve surgeon confidence and procedural consistency while maintaining institutional oversight and quality assurance.^2,9

Extra-institutional telementoring further expands access to highly specialized expertise, particularly for hospitals or regions with limited subspecialty volume. When implemented with formal inter-institutional agreements, this model allows surgeons to benefit from the experience of national or international leaders while preserving local autonomy through verification of licensure and credentialing, appropriate malpractice coverage, and compliance with state and federal regulations.

Notably, the onsite surgeon remains fully responsible for operative execution and clinical decision-making, reinforcing accountability and aligning with guidance published in JAMA Surgery and the Journal of the American College of Surgeons.^10,11

Remote Mentors Can Offer Immediate Guidance in OR

Telementoring also may function as a real-time intraoperative consultation. In this context, it resembles an enhanced form of intraoperative consult rather than a casual curbside discussion.

Successful implementation requires preoperative planning, technology verification, explicit patient consent, and clearly defined escalation and communication protocols. When these elements are in place, telementoring can provide immediate expert input during critical operative moments while maintaining patient safety, role clarity, and closed-loop accountability within the OR. Research indicates that this structure is essential to avoid ambiguity in responsibility and documentation.^7,12

Beyond individual cases, teleteaching from the OR to large learner audiences represents another important application of this technology. Secure livestreaming platforms allow surgeons to teach residents, fellows, and practicing surgeons across institutions and geographic boundaries in real time.

This approach has been shown to enhance educational reach while preserving patient privacy and operative focus, particularly when combined with moderate interaction and delayed Q&A sessions. Such models align with broader trends in virtual surgical education and augmented learning environments described in recent educational literature.^9,13

As telementoring becomes more integrated into routine surgical practice, legal, regulatory, and financial considerations must be addressed. Surgeons and healthcare systems should ensure appropriate licensure, credentialing, informed consent, malpractice coverage, and data security.

From a reimbursement perspective, the consultative nature of intraoperative telementoring raises the possibility of billing structures analogous to intraoperative consultations. While current reimbursement models remain limited, emerging discussions suggest that standardized documentation and demonstrated value could support scalable billing frameworks in the future, particularly as telemedicine continues to gain regulatory acceptance.^11,14

Surgical telementoring represents a natural and necessary evolution of surgical education, one that extends expertise without compromising standards. Whether deployed within a healthcare system, across institutions, as an intraoperative consultative resource, or as a teleteaching platform, its success depends on rigorous credentialing, robust technology, regulatory compliance, and mutual respect between mentor and mentee. As emphasized by recent publications, mentorship remains foundational to surgical excellence, and telementoring offers a modern mechanism to preserve that tradition while responsibly embracing innovation.¹⁵

A telementoring checklist (available as a PDF below) provides guidance for starting a telementoring program at your hospital or training center.

Disclaimer

The thoughts and opinions expressed in this column are solely those of the authors and do not necessarily reflect those of the ACS.

Dr. Christopher DuCoin is a professor of surgery, vice-chair of surgery, and chief of the Division of Gastrointestinal and General Surgery at the University of South Florida in Tampa.

Dr. Jay Redan is past-chief of surgery at Advent Health-Celebration in Florida and professor of surgery at the University of Central Florida College of Medicine in Orlando. He also is Chair of the ACS Continuing Education Workgroup, as well as an ACS Governor and a Past-President of the ACS Florida Chapter.

References

1. Rassweiler JJ, Autorino R, Klein J, Mottrie A, et al. Future of robotic surgery in urology. Ann Surg. 2017;265(5):823-830.
2. Augestad KM, Bellika JG, Budrionis A, Chomutare T, et al. Surgical telementoring in knowledge translation—clinical outcomes and educational benefits. Surg Endosc. 2013;27(8):2733-2742.
3. Schlachta CM, Nguyen NT, Ponsky T, Dunkin B. Project 6: Telementoring in laparoscopic surgery. Surg Endosc. 2010;24(4):806-811.
4. Marescaux J, Leroy J, Rubino F, Smith M, et al. Transcontinental robot-assisted remote telesurgery: Feasibility and potential applications. Ann Surg. 2002;235(4):487-492.
5. Lacy AM, Bravo R, Otero-Piñeiro AM, Pena R, et al. 5G-assisted telementored surgery. Br J Surg. 2019;106(11):1576-1579.
6. Greenberg CC, Ghousseini HN, Pavuluri Quamme SR, Beasley HL, et al. Surgical coaching for individual performance improvement. Ann Surg. 2015;261(1):32-34.
7. Bilgic E, Endo S, Lebedeva E, Takao M, et al. Telementoring in surgery: A systematic review. Ann Surg. 2022;275(2):e254-e262.
8. Budrionis A, Augestad KM, Patel HRH, Bellika JG. An evaluation framework for defining the contributions of telestration in telementoring. Surg Innov. 2016;23(2):185-195.
9. Meier AH, Rawn C, Krummel TM. Virtual reality and augmented reality in surgical education. JAMA Surg. 2020;155(10):893-894.
10. Vickers SM, Hohmann SF, Katsogridakis YL, et al. Telemedicine and surgical consultation: Opportunities and challenges. J Am Coll Surg. 2019;228(4):517-526.
11. Hoyler M, Finlayson SRG, McClusky DA, et al. Ensuring surgical quality in the era of telemedicine. J Am Coll Surg. 2021;232(2):197-204.
12. Smith R, Day A, Rockall T, Ballantyne G, et al. Advanced telementoring in surgery: A review of the evidence. J Surg Educ. 2015;72(1):e1-e10.
13. Doarn, CR, Latifi, R. Telementoring and teleproctoring in trauma and emergency care. Curr Trauma Rep 2, 138–143 (2016).
14. Satava RM. Surgical robotics: The early chronicles. J Robot Surg. 2017;11(2):125-131.
15. DuCoin C, Pavani P. The future of surgical education: Beyond the mentor–mentee model. General Surgery News. September 26, 2025. Available at: https://www.generalsurgerynews.com/Opinion/Article/09-25/Surgical-Education-Digital-Revolution/78123. Accessed February 23, 2026.