Surgical telementoring might be a way to meet societies need for new surgeons. The length of time it takes to train surgeons, the anticipated decrease in hours worked by surgeons in younger generations, and the potential decreases in graduate medical education funding suggest that there may be an insufficient surgeon workforce to meet population needs. Surgeons are often sparsely geographically distributed, and with a predicted shortage of surgeons distance education might become increasingly important. Existing maldistribution patterns are likely to be exacerbated, leading to delayed or lost access to time-sensitive surgical procedures, particularly in rural areas [4]. Forecasts show that overall surgeon supply will decrease 18 % during the period form 2009 to 2028 with declines in all specialties except colorectal, pediatric, neurological surgery, and vascular surgery. Model simulations suggest that none of the proposed changes to increase graduate medical education currently under consideration will be sufficient to offset declines [4]. Recently, an estimate was made that by 2030, there would be a 9 % shortage in the general surgical workforce, with greater shortages in other surgical specialties [4, 5]. In 2009, there were only 3.18 urologists per 100,000 habitants in the US, which is a 30-year low. Mirroring this nationwide lack of urologists, a recent survey of the academic urologic workforce predicts that over 369 faculty positions need to be filled out in the next 5 years, suggesting that the shortage of academic urologists is more severe than that of other specialities [6]. Unless the rate at which general and urological surgeons are trained increases, the number of surgeons per population will continue to decline [7]. The imminent nature of reductions in surgical workforce supply, combined with increased utilization that will result from a changing and growing population (and potentially from insurance expansion or some form of coverage reform), suggests that proactive actions to graduate medical education training numbers, new models of care, and extending surgical productivity are needed. Without making these changes, there is a risk that there will be access issues—particularly in rural communities—as increasing numbers of surgeons retire. Thus, there is a significant need to increase the rate and volume of surgical education. In our opinion, tele-mentoring and telemedicine may be used as tools to enhance surgical education to meet the increasing surgical demand [3].

Reported results of mentoring are improved surgical practice, education, treatment and postoperative care and telementoring is described as a natural fit in surgery. Mentoring using videoconferencing technology has gained increasing popularity in all fields of medicine, especially in education of medical personnel [3, 8–11]. Solutions have been demonstrated for laparoscopic surgery and in combination with robotic surgery [12–14]. More recently, mobile solutions for surgical telementoring have been demonstrated (Fig. 4.2) [15].

Recent developments in information technology have led to a renewed interest in the potential of telemedicine to provide new collaborative solutions. Recently a national US research initiative was launched; The American Medical Foundation for Peer Review and Education has brought together several specialty surgical societies to determine whether telementoring is an effective way for physicians to learn new skills and improve old ones [16]. Telementoring has been shown to be successful in training residents. A 2010 study in the Journal of the American College of Surgeons reported that eight general surgery residents operating on animal cadavers while telementored achieved higher overall mean performance scores when compared with completing the same operations without the telerobotic proctoring. The residents also said they felt more competent when they were telementored [17].

Safety issues during surgical telementoring has been debated. Recently, Augestad et al. reported a 5 % complication rate during 433 telementored surgical procedures [18]. This means that the safety during surgical telementoring is similar to that reported in onsite mentoring. Recently, a meta-analysis supports evidence that trainees can obtain similar clinical results to expert surgeons in laparoscopic colorectal surgery if supervised by an experienced trainer [10]. Two surveys of laparoscopic telementoring were included in this review, showing no significant difference in conversion, anastomotic leak or mortality compared to on site mentoring [19, 20]. Similar results were also shown by Panait et al. [21]. One study reports decreased operation time of telementoring compared to physical presence [22]. In contrast Schlachta’s surveys revealed an increased operating time, but a significant decrease in hospital days [19, 23]. Most studies were not randomized, this makes it difficult to estimate significance of the survey. There is no evidence in included studies of increased cost-effectiveness of surgical telementoring, for instance reduced transfers between hospitals or other terms of resource utilization. Telementoring as a tool for education between different levels of healthcare has been described by different surgical specialties. Demartines et al. assessed telemedicine in surgical education and patient care [24]. Participant satisfaction was high and the opportunity to discuss case management were significantly improved. However, there are insufficient proof of the educational benefits of surgical telementoring. In a recent review of 34 trials of surgical telementoring, eight surveys (23 %) had an educational assessment as primary outcome [18]. Surgical performance was evaluated by recognition of anatomical landmarks, the “Global Operative Assessment of Laparoscopic Skills” (Table 4.1) [25], or measurement of task performance (grasping, cutting, clip applying, suturing, economy of movement). All surveys report an expert-novice mentor situation. Two surveys included simulation, three surveys robotics (remote camera control or grasper). All reviewed surveys report a positive outcome of telementoring on surgical education (Table 4.2).