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. 2022 May 6;224(3):869–880. doi: 10.1016/j.amjsurg.2022.04.038

Table 1.

Description of studies included in the scoping review.

Author Country Setting Technology Used Mentee Participants Intervention Measures of Outcome Outcomes Level of Evaluation
Andersen et al., 201621 USA Simulation Lab System for Telementoring with Augmented Reality (STAR) 20 Premedical & Medical Students 2 tasks with multiple sets each Placement error of incisions, number of focus shifts, and task completion time
  • ●

    Improved placement error (p < 0.001, p < 0.001 for port placement and for abdominal incision, respectively)

  • ●

    Improved focus shifts (p < 0.001, p = 0.03 for port placement and for abdominal incision, respectively

  • ●

    Slower time completion for port placement (p = 0.003)

  • ●

    No difference in abdominal incision time (p = 0.165)

  • ●

    Satisfaction surveys completed afterward indicated that although the telestrator was unnecessary for several trainees, the ability of the mentor to indicate areas directly in the trainee's field of view was useful.

 2
Zakrison et al., 201711 USA Online Communication Email, FaceTime, Skype, GoToMeeting 65 Resident, Fellow, & Junior Faculty N/A Surveys
  • ●

    High mentee satisfaction (91% wished to continue mentorship, 85% would recommend to peers)

  • ●

    Mentoring relationship focused on research (45%), navigating “sticky situations” [e.g., personal conflict, challenging cases, work-life balance, communication, promotion, negotiation] (27%), education (18%), or administrative issues (10%)

 1, 3
Ponce et al., 201426 USA Clinical, Operating Room Stryker Endoscopic tower 6 Residents 15 surgeries Length of surgery and satisfaction surveys
  • ●

    Mean operative times did not differ significantly (p = 0.90, p = 0.57 for rotator cuff repair and shoulder instability repair surgeries respectively)

  • ●

    Easy and safe to use

  • ●

    Favorable utility of VIP to highlight anatomy and provide feedback to the resident

  • ●

    No lag between motions or interference w/surgery

 1, 2
Ereso et al., 201027 USA Simulation Lab Mounted Canon VB-50i 8 Residents 24 surgeries Operative Performance Scale and surveys
  • ●

    Higher performance scores with individual tasks of tissue handling, instrument handling, speed of completion, knowledge of anatomy (p < 0.001)

  • ●

    Higher overall mean performance score (p < 0.001)

  • ●

    Greater satisfaction and comfort among residents on the survey (p < 0.001)

  • ●

    3 of 7 residents believed that the telestrator was not necessary or used very much when proctored through a craniectomy.

 1,2
Chou et al., 201923 Australia Clinical Email 1 Surgeon 85 surgeries Sink modification of the Clavien-Dindo classification system, Harris Hip score, Harris Pain Score, Yasunaga classification of Hip congruency, and Tonnis classification of Pre- and postoperative grading of osteoarthritis
  • ●

    44 patients with Sink grade of 0 (no complications), 40 patients with grade I-III, 0 patients with Grades IV or V

  • ●

    The median Harris hip score preoperatively and postoperatively was 58 and 78, respectively

  • ●

    The median Harris pain score preoperatively and postoperatively was 20 and 40, respectively

  • ●

    Yasunaga hip congruency improved in 18 PAOs, and decreased in two hips postoperatively

  • ●

    Osteoarthritis of the 85 hips had a preoperative mean Tönnis grade of 0.6 to a postoperative mean of 0.9

 2, 4
Forgione et al., 201528 Italy, Russia Clinical, Operating Room OR1 Smartconnect 1 Surgeon 2 surgeries Surgical complications
  • ●

    2 uncomplicated successful surgeries under telementoring guidance

  • ●

    Post-mentoring experience operated independently on 25 more patients

 2, 3, 4
Vera et al., 201433 USA Simulation Lab Augmented Reality Telementoring (ART) 19 Medical Students 10 suturing tasks each Speed of placement, placement errors, Wright's cumulative average model of the learning curve slope, and surveys
  • ●

    Shorter learning curve

  • ●

    Reduced # of failed attempts (8 vs. 12)

  • ●

    Faster suture times (p = 0.014) and more attempts per hour of training (p = 0.0208)

  • ●

    Surveys show most students agree or strongly agree that the ART platform is an effective mentoring device (4.44/5)

 1,2
Treter et al., 201332 USA Clinical, Operating Room Video 2 Surgeons 2 surgeries Surgical complications and length of surgery
  • ●

    Both procedures were uneventful with no complications

  • ●

    Operative times were a total of 77 min for patient 1 and 136 min for patient 2, compared to an average time of 138 min for non-mentored comparison

  • ●

    The benefit of telementoring includes providing an instant experienced second opinion

 2, 4
Snyderman et al., 201610 USA, Slovenia Clinical, Operating Room VisitOR1 1 Skull-based Surgical Team 10 procedures Telesurgery Evaluation Form, Surgical complications, the extent of tumor resection, length of surgery, and satisfaction survey
  • ●

    No surgical complications

  • ●

    Improved surgical exposure

  • ●

    Increased extent of tumor resection

  • ●

    Decreased duration of surgery

  • ●

    Results of survey positive

  • ●

    The greatest value is the opportunity to share surgical tips and tricks with operating surgeons

 1, 2, 3, 4
Shin et al., 201524 USA Clinical, Operating Room da Vinci Connect 11 Residents 55 surgeries Global Evaluative Assessment of Robotic Skill (GEARS) form and an evaluation of the mentoring interface
  • ●

    No significant difference between in-room and remote cases was felt by the residents or mentors (p = 0.5, p = 0.8 respectively)

  • ●

    Mentors preferred remote (p = 0.05), trainees had no significant difference in preference (p > 0.05)

  • ●

    One intraoperative complication was noticed and handled accordingly

  • ●

    No postoperative complications in either group

 1, 2, 4
Ponsky et al., 201415 USA Clinical, Operating Room Skype, VisitOR1 4 Surgeons 6 surgeries Surgical complications and length of surgery
  • ●

    All six procedures were completed successfully laparoscopically without loss of transmission, in a time-efficient manner

  • ●

    No surgical complications

 2, 4
Okrainec et al., 201037 Canada, Botswana Simulation Lab Skype 13 Surgeons & 3 Junior Trainees 5 FLS tasks each Simulator scores for each task and Fundamentals of Laparoscopic Surgery (FLS) score
  • ●

    Surgeons in the telesimulation group had much higher scores for all tasks, significant for four tasks (p = 0.002, p = 0.001, p = 0.004, p = 0.02) except for the ligating loop task (p = 0.06)

  • ●

    Significantly higher overall Fundamentals of Laparoscopic Surgery (FLS) score (p = 0.001)

 2
Nguyen et al., 201720 USA, Canada (two surgeons in Guatemala and Argentina) Clinical, Operating Room VisitOR1 15 Surgical Fellows & Surgeons 30+ surgeries with a minimum of 2 surgeries per mentee Surgical complications and survey on quality of telecommunication and effectiveness of mentoring by both mentee and mentor
  • ●

    No reported intraoperative or postoperative complications in any of the telementoring cases

  • ●

    Both mentees and mentors saw telementoring as satisfactory and as an excellent educational tool

  • ●

    Rated 4.7/5 by mentors, 4.8/5 by mentees (1 for poor, 5 for excellent)

 1, 2, 3, 4
Mizota et al., 201716 Japan Simulation Lab Go Pro HERO3+, Google Hangouts 20 Residents 91 remote sessions Survey, task completion time, and knot error points, and duration of coaching
  • ●

    All participants agreed remote system increases opportunities to practice skills, most (90%) agree that it is useful for training

  • ●

    The step-wise training group had an insignificant increase in training scores (p = 0.20) compared to the comprehensive training group

  • ●

    Shorter coaching times (p = 0.002)

 1,2
Miller et al., 201117 USA, Australia Clinical, Operating Room Skype 1 Surgeon 3 surgeries Surgical complications and length of surgery
  • ●

    All 3 procedures were successful and uneventful with no intraoperative or postoperative complications

  • ●

    23 successful PRAs after the telementoring experience

 2, 3, 4
Kirkpatrick et al., 201518 Canada Simulation Lab Skype 12 Med techs 1 simulation task Performance on incision fluid loss and time, retraction fluid loss and time, direction fluid loss and time, identification fluid loss and time, packing fluid loss and time, number of sponges, skin incision closure percentage, and survey of participants confidence levels
  • ●

    Survey results showed mentoring increased non-surgeon procedural confidence (p = 0.004)

  • ●

    No significant difference in the fluid loss in those being mentored than the unmentored group (p = 0.073)

  • ●

    Significant increase in fluid loss between mentored group and the surgeon group (p = 0.001)

 1, 2
Hinata et al., 201425 Japan Clinical, Operating Room da Vinci S 4 Surgeons 120 surgeries with 30 surgeries per surgeon Operating time, blood loss, transfusion %, complication %, continence rate at 3 month post-op, and surgical margin %
  • ●

    No significant differences between the surgeons in each group in operating time (p = 0.933), estimated blood loss (p = 0.090), complication rate (p = 0.299), 3-month continence rate (p = 0.315), positive surgical margins (p = 0.376, p = 0.161 for pt2 and pt3 respectively)

 2, 4
Fuertes-Guir et al., 201619 Spain Clinical, Operating Room Adobe Connect 2+ Surgeons 36 patients Operating time, length of hospital stay, conversions, post-op outcomes
  • ●

    Shorter operating times (p < 0.01)

  • ●

    Shorter hospital admissions among patients receiving surgery (p < 0.01)

 2, 4
Dawe et al., 201831 Canada Simulation Lab Reacts Lite 4 Non-Surgeon Medical Officers 3 tasks per mentee Task-specific scores determining success, comfort and pre- and post-operative willingness survey
  • ●

    All tasks completed successfully

  • ●

    Perceived increase in comfort after the telementoring activity

  • ●

    High rating of the benefit of telementoring

 1, 2
Datta et al., 201536 USA, Paraguay, Brazil, Germany Clinical, Operating Room Google Glass 2 Surgeons 10 surgeries Lichtenstein-Specific Operative Performance Rating Scale (OPRS) and post-training survey
  • ●

    Successful 4 operations, meeting criteria in all parameters

  • ●

    Trainee indicated an increase in confidence

  • ●

    The trainee has since trained 46 additional surgeons using the same training paradigm

 1, 2, 3
Burckett-St Laurent et al., 201613 Canada Simulation Lab Skype 19 Anesthetists 19 tasks 22 item procedural checklist and 9 item Global Rating Scale (GRS) and post-training survey questionnaire
  • ●

    Significantly higher post-training checklist scores for both on-site and off-site training locations via telesimulation (p < 0.001 for both on-site and off-site)

  • ●

    Significantly higher GRS scores for both on-site and off-site training (p < 0.001 for on-site, p = 0.003 for off-site training)

  • ●

    Increased confidence and positive learning experience with training

 1, 2
Budrionis et al., 201630 Norway Simulation Lab Laprotrain Endoscopic Trainer 8 Telemedicine & E-Health Students 6 tasks per mentee Localization error distance, duration of task, quality of mentoring communication, user satisfaction survey
  • ●

    Sessions mentored by telestration were 33% shorter in duration than verbally guided

  • ●

    No significant improvement in accuracy (p = 0.5241) between telementoring with telestrations and those with solely verbal

  • ●

    Mentee survey reported increased quality of mentoring (6/8 students preferred telestrations)

 1, 2
Bruns et al., 20168 USA, France Clinical, Operating Room VisitOR1 2 Surgeons 2 surgeries Surgical complications and length of surgery
  • ●

    Successful surgeries, no intraoperative complications

  • ●

    One postoperative complication of postoperative abscess that required IV antibiotics

  • ●

    Positive experiences from mentees and mentors

  • ●

    Mentee successfully performed the same procedure independently two months after

 1, 2, 3, 4
Andersen et al., 201722 USA Simulation Lab System for Telementoring with Augmented Reality (STAR) 20 Premedical & Medical Students 2 tasks per mentee Placement error, focus shifts, and time of task completion
  • ●

    Significantly lower placement error (p = 0.0003)

  • ●

    Significantly less focus shifts (p = 0.003)

  • ●

    No significant difference in length of task completion (p = 0.165)

 2
Glick et al., 202012 Israel Simulation Lab HoloLens AR glasses 13 Medical Students 13 tasks Surveys, placement accuracy, placement time, and nine procedure-specific parameter assessments
  • ●

    No significant difference in thoracotomy placement or time to placement

  • ●

    Statistical significant improvement in 2 of 9 skill assessments (correct plane of dissection p = 0.006, blunt dissection at the superior border of rib p = 0.045) with improved quality

  • ●

    No significance in the other 7 assessments

  • ●

    Statistical significant increased mentee confidence (p = 0.035)

 1, 2