Supplementary Material for: Feasibility of telementoring during robot-assisted minimally invasive esophagectomy

Introduction Telementoring could increase the quality, reduce the time, and increase cost efficiency of the proctoring program for robot-assisted minimally invasive esophagectomy (RAMIE). However, feasibility is unclear as no studies assessed telementoring for RAMIE. Methods The feasibility of telementoring was assessed during the thoracic part of RAMIE procedures in three high-volume centers. RAMIEs were performed by trained surgeons, proctored by two experts. The primary outcome was impact of the technology on conveying and understanding instructions. Results Between December 2021 and December 2022, nine RAMIE procedures were proctored using the telementoring. Overall quality of the telementoring technique was scored good to excellent (median score: good). The vast majority of the 24 proctor instructions were conveyed and understood fluently (n=21, 96%). Most proctor instructions were aimed at improving surgical exposure (n=9, 38%). The major point of criticism was the use of the audio as the communication through the headset of the performing surgeon was not accessible by the complete team. Conclusion Telementoring is deemed feasible for proctoring trained RAMIE surgeons after onsite proctoring. Technical improvements with regard to audio technology are warranted for broad implementation, especially in earlier training settings. The role of telementoring in the training pathway of learning surgeons needs clinical validation. Study registration number: 21/322 Date of registration: 14-5-2021