Background <p>Pelvic intraoperative neuromonitoring (pIONM) prevents functional disturbances after low anterior rectal resection. We investigated the workload of performing pIONM under telementoring conditions to catalyze translation into surgical practice.</p> Methods <p>Six patients with rectal cancer underwent nerve-sparing total mesorectal excision (TME) with laparoscopic or robot-guided pIONM. A telementoring system enables cross-reality interaction, with online communication between a briefed on-site surgeon at the operating room and a remote mentor at an external hospital. The validated NASA Task Load Index (NASA-TLX) was used to measure the workload for standardized pIONM.</p> Results <p>The pIONM was installed and performed without any problems. It required a median 7&#xa0;min stimulation time (range 7–10&#xa0;min) and confirmed nerve-sparing TME in all six patients. Remote and on-site telepresence required a median 31&#xa0;min (range 24–44&#xa0;min), enabling adequate application training for a first-time user. The overall NASA-TLX-based workload realizing pIONM was a median 8.7 (range 3.3–16.3) points. There was no significant difference in TLX between on-site and remote surgeons (<i>p</i> = 0.180). Overall workload was highest for the first-time user but decreased upon repetition. Significantly higher values were found in the following subscales for the surgeon performing pIONM: physical demand (<i>p</i> = 0.002) and temporal demand (<i>p</i> = 0.03).</p> Conclusion <p>Initiation of pIONM supported by teleconsulting is feasible and requires a low workload.</p>