Evaluating the Role of Surgical Telementoring in the Acquisition of Surgical Skills in Laparoscopic Cholecystectomy: Protocol for a Pilot Randomized Controlled Trial.

Background: Developing surgical skills among residents requires time and resources, often in conflict with the goals of efficiency and hospital economics in surgical practice. Optimizing resident training may prevent a decline in quality. Skilled surgeons are vital to effective and safe surgical performance, yet the training trajectory for surgical residents is often inefficient, particularly in the era of minimally invasive surgery. A framework that efficiently disseminates surgical skills is essential to cultivate skilled future surgeons within an acceptable time frame. Surgical telementoring (ST) aligns well with minimally invasive surgery because the mentee operating in the field shares the telementor's perspective. Despite growing experience with telemedicine, data on educational outcomes remain limited. Objective: We aim to conduct a pilot randomized controlled trial (RCT). Data collection will inform a future full-scale RCT evaluating whether real-time ST, combined with structured postoperative coaching, is superior to traditional on-site mentoring in developing laparoscopic cholecystectomy skills among surgical residents. Methods: Eligible residents will be randomly assigned in a 1:1 ratio to either the intervention group (real-time ST and postoperative coaching) or the control group (traditional intraoperative hands-on teaching). This research adheres to the extended SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) statements for pilot RCTs and follows the intention-to-treat principle. Residents in both groups will perform 5 consecutive procedures under standardized intraoperative conditions. The primary outcomes are the Global Operative Assessment of Laparoscopic Skills (GOALS) score and the Non-Technical Skills for Surgeons (NOTSS). We hypothesize that the intervention group will show a 3- to 5-point improvement in the GOALS score compared with the control group. To achieve 0.8 statistical power, a P value <.05, and a 20% dropout rate in a definitive RCT, 12 residents per group are required. We present a pilot RCT with 5 residents per group. Challenges encountered during the trial will be reported, and amendments will be proposed to assess the need for a future definitive RCT. Results: The primary outcomes will be technical and nontechnical surgical skills, measured by the GOALS and NOTSS scores, respectively. Patient-reported experience measures and satisfaction scores of eligible mentees and mentors will be analyzed as secondary outcomes. The ST system configuration at the 2 inclusion centers was completed in December 2023. Ethics approval and the most recent update report to ClinicalTrials.gov were obtained on October 23, 2023, and December 8, 2024, respectively. Recruitment of residents to the study commenced in spring 2024. Recruitment is expected to be completed in May 2026, with data analysis in November 2026 and manuscript submission of results in January 2027. Conclusions: The SURGTEACH (Surgical Telementoring in Acquisition of Surgical Skills of Laparoscopic Cholecystectomy) trial is the first pilot RCT evaluating ST for educational outcomes. This research may provide high-quality evidence to improve surgical education, particularly in rural hospitals.