Smart glasses-assisted telementoring in inguinal hernia repair: a new frontier in surgical training?

Recent challenges in surgical training, including the COVID-19 pandemic, staff shortages, and service centralization, have accelerated the adoption of telemedicine technologies. Among these, smart glasses-assisted telementoring enables real-time, bidirectional interaction between mentor and mentee, potentially improving surgical performance and learning outcomes. This study aimed to evaluate the efficacy and educational impact of smart glasses-assisted telementoring in open inguinal hernia repair.

This prospective, randomized pilot study was conducted at the Department of General Oncological Surgery, Santa Rosa Hospital, Viterbo (Italy) from January 2024 to June 2024. Forty-five elective open inguinal hernia repairs were performed by three general surgery residents at a comparable level of their learning curve. Procedures were randomly assigned to one of three groups composed of passive assistance only, on-site mentoring and telementoring (Vuzix M400) group. Surgical and postoperative data were collected and stored for analysis.

Procedural accuracy was significantly higher in the mentoring settings, particularly for local anesthesia administration (Group 1: 26.7%, Group 2: 80%, and Group 3: 93.3%; p = 0.001) and spermatic cord isolation (Group 1: 60%, Group 2: 86.7%, and Group 3: 100%; p = 0.014). Mean operative times were 45.33 ± 12.88, 44.00 ± 11.21, and 60.66 ± 14.37 min in groups 1-2-3, respectively (p = 0.003). No statistically significant differences were detected in postoperative pain (VAS at 3 h, 24 h, and 7 days), hematoma formation, or readmissions; however, the study was not powered to assess differences in postoperative complications. Among the fifteen telementored procedures, mentees reported that telementoring influenced surgical decision-making in 93.3% of cases and consistently improved both perceived safety and self-confidence (100%), without any reported increase in anxiety or discomfort.

Smart glasses-assisted telementoring demonstrated encouraging educational potential as a feasible approach for surgical training. These preliminary findings require confirmation in larger adequately powered studies.