title: A comprehensive review of telementoring applications in laparoscopic general surgery.
abstract: BACKGROUND
  Incorporation of advanced laparoscopic procedures in the practice of institutions without respective experience is a significant impediment in the dissemination of minimally invasive techniques. On-site mentoring programs carry several cost-related and practical constraints. Telementoring has emerged as a practical and cost-effective alternative mentoring tool. The present study aimed to review the pertinent literature on telementoring applications in laparoscopic general surgery.
  
  
  METHODS
  A systematic review using the Medline database was performed. Articles reporting on clinical experience with telementoring applications in general surgery were included. Variations in methodology, study design, and operative procedures precluded cumulative outcome evaluation. Instead, a critical appraisal of current evidence was undertaken.
  
  
  RESULTS
  Seventy-five articles were identified in the primary search, and ten studies were considered eligible. No randomized studies comparing on-site mentoring with telementoring were identified. The included studies reported on a total of 96 laparoscopic telementored procedures: 50 cholecystectomies, 23 colorectal resections, 7 fundoplications, 9 adrenalectomies, 6 hernia repairs, and 2 splenectomies. Completion of remotely assisted procedures was feasible in the vast majority of cases, whereas technical difficulties included video and audio latency with low transfer rates (<128 kbps) and inadequate guidance regarding the correct plane for dissection.
  
  
  CONCLUSIONS
  Current evidence supports the feasibility and safety of telementoring programs in general surgery. Their clinical effectiveness as teaching alternatives to traditional mentoring programs remains to be further evaluated.
authors.affiliation: Department of General and Visceral Surgery, Center for Minimally Invasive Surgery, Hospital "Maria v. d. Aposteln" Neuwerk, Mönchengladbach, Germany. stavros.antoniou@hotmail.com
authors.forename: Stavros A
authors.initials: SA
authors.lastname: Antoniou
authors.forename: George A
authors.initials: GA
authors.lastname: Antoniou
authors.forename: Jan
authors.initials: J
authors.lastname: Franzen
authors.forename: Stefan
authors.initials: S
authors.lastname: Bollmann
authors.forename: Oliver O
authors.initials: OO
authors.lastname: Koch
authors.forename: Rudolf
authors.initials: R
authors.lastname: Pointner
authors.forename: Frank A
authors.initials: FA
authors.lastname: Granderath
mesh_terms: D003365:Costs and Cost Analysis; D004502:Education, Medical, Continuing / Q000191:economics / Q000379:methods* / Q000639:trends; D004992:Ethics, Medical; D005544:Forecasting; D013502:General Surgery / Q000191:economics / Q000193:education* / Q000639:trends; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000193:education* / Q000639:trends; D059032:Learning Curve; D008611:Mentors; D010817:Physician-Patient Relations; D013663:Teaching / Q000191:economics / Q000379:methods / Q000639:trends; D017216:Telemedicine / Q000191:economics / Q000379:methods* / Q000639:trends