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Background: Telesimulation has been shown to be effective for teaching simple surgical techniques; however, its usefulness for teaching advanced skills remains unclear. The aim of this randomized controlled trial was to investigate the impact of a telesimulation program on training for laparoscopic inguinal hernia repair., Methods: Novice trainees were randomly assigned to the intervention group or control group using a permuted block design. Intervention group participants received a 1-hour didactic telelecture and three 1-hour telesimulation sessions with a hernia specialist, whereas control group participants engaged in self-directed training using the same simulator and materials. Trainees' procedural videos, recorded before and after training, were assessed using the transabdominal preperitoneal checklist and the Global Operative Assessment of Laparoscopic Skills-Groin Hernia. Pre- and post-training tests were performed to evaluate knowledge of inguinal hernias and self-confidence in transabdominal preperitoneal procedures., Results: Forty-three participants from 16 institutions in Japan were enrolled, with 22 and 19 in the intervention group and control group, respectively, completing the final analysis. Median post-test transabdominal preperitoneal checklist scores were 16 (interquartile range: 15-18.5) in the intervention group and 11 (interquartile range: 8.5-14.5) in the control group; intervention group participants significantly outperformed their counterparts (P < .001). However, comparison of pre- and post-test scores showed skill improvements in both groups (P < .001). Both groups also showed increased knowledge and confidence., Conclusion: The telesimulation program effectively enhanced the surgical skills of novice trainees in learning laparoscopic inguinal hernia repair, demonstrating superiority over self-directed learning., Competing Interests: Conflict of Interest/Disclosures Dr Poudel received grant from Japanese Society for the Promotion of Science KAKENHI (grant number 21K17221) to support this work. Dr Watanabe received grants and royalties from EBM Corporation and honoraria for speaker from Medtronic not related to present work. The other authors have indicated that they have no conflicts of interest regarding the content of this article., (Copyright © 2024 Elsevier Inc. All rights reserved.)