The shortage of surgeons in rural hospitals is a serious problem in Japan. In this study, we investigated the potential contribution of surgical telementoring systems to improving surgical skills and resolving the shortage of surgeons in rural hospitals. The conference room at Tokushima University was connected to the operating room at Miyoshi Hospital, a rural hospital approximately 75 km away, via a virtual private network. Telementoring was conducted for surgeries performed at Miyoshi Hospital from Tokushima University using ADMENIC ANNOTATOR (Carina Corporation). A questionnaire using the NASA Task Load Index was completed by two surgeons who received remote instruction. The surgeries when using the surgical telementoring system had significantly better "mental", "performance", and "frustration" scores compared with those performed without using the system. In a questionnaire about the surgical telementoring system, both surgeons did not notice a communication delay and indicated that annotation and voice instruction was easier to understand than voice only. In addition, fifty fifth-year medical students completed a questionnaire. After experiencing the surgical telementoring system, the number of students who responded favorably to working in a rural hospital increased from 22 (44%) to 31 (62%) (p <
0.01). Surprisingly, 10 of the 27 students who were not interested in becoming a surgeon indicated that they were now interested in becoming a surgeon (p <
0.01). This study suggests that the introduction of a surgical telementoring system in rural hospitals may help improve the skills of rural surgeons and contribute to eliminating the maldistribution and shortage of surgeons in the future.