Robotic surgery has experienced exponential growth in gynecology over the past two decades. Traditional apprenticeship models require on-site mentoring, presenting significant challenges in resource distribution, geographical accessibility, and training standardization. Teleproctoring represents a potentially transformative innovation in surgical education, offering real-time remote supervision and guidance through advanced communication platforms. However, comprehensive comparative evidence specific to robotic gynecological surgery remains limited, with most existing studies employing observational designs or focusing on non-gynecological procedures. This study evaluated the effectiveness of teleproctoring compared to traditional on-site supervision for robotic gynecological surgery training using validated assessment instruments and comprehensive technical platform evaluation.

This prospective randomized 2×2 crossover pilot study enrolled two robotic surgery fellows who each performed 10 consecutive robotic total hysterectomies, alternating between traditional bedside supervision and remote teleproctoring using a high-definition platform with real-time telestration. The primary outcome was technical skill development measured by Global Evaluative Assessment of Robotic Skills (GEARS). Secondary outcomes included learning curves (CUSUM analysis), validated technical assessments (R-OSATS, GOALS-RH), perioperative outcomes, safety metrics, autonomy, and platform performance.

All 20 procedures were completed with 100% protocol compliance. Teleproctoring demonstrated superior technical performance compared to traditional supervision (mean GEARS score 22.0±2.8 vs 20.2±2.9), with 100% achieving competency threshold versus 80% with traditional training. After adjusting for period effect, treatment effect showed medium effect size favoring teleproctoring (η²=0.121). CUSUM analysis revealed similar learning trajectories with competency achieved within 3 procedures. No major complications occurred in either group. Surgical autonomy and communication quality were numerically higher with teleproctoring. The technical platform demonstrated excellent performance with zero failures, mean latency 57.5±12.9ms, and high satisfaction ratings.

The findings indicate that teleproctoring is not only non-inferior but potentially superior to traditional methods for initial robotic training. The significant improvement in GEARS scores suggests that remote expert feedback is highly effective for refining precision and spatial awareness. Moreover, the reduction in operative times highlights the efficiency of the PEGASO curriculum in optimizing the learning curve, making it a viable solution for standardized surgical education.

This pilot study provides preliminary evidence that teleproctoring in robotic hysterectomy training achieves equivalent safety with numerically superior technical performance and enhanced trainee autonomy compared to traditional supervision. With appropriate infrastructure and trained proctors, teleproctoring represents a viable educational modality that could democratize access to expert surgical mentorship and optimize certain dimensions of surgical skill acquisition. These findings support designing large-scale trials to establish evidence-based guidelines for teleproctoring implementation in robotic surgical education