Consideration to improve Quality of the section of Laparoscopic Cholecystectomy in Endoscopic Surgical Skill Qualification in Japan

The Japan Society for Endoscopic Surgery (JSES) started Endoscopic Surgical Skill Qualification (ESSQS) in 2004, and carried out three examinations up to 2006. Assessment was performed by reviewing documents, which included laparoscopic surgery experiences, and qualifying unedited video tape by two independent referees. We adopted two criteria to evaluate surgical skills, as common and procedure-specific criteria to each gastrointestinal organ. Common criteria were given 60 points regarding basic endoscopic practice, and procedure-specific criteria were given 40 points to evaluate specialized skills of the practice. A score of 70 points is designated as the passing mark. Laparoscopic cholecystectomy was evaluated by ten practice steps and degree of difficulty in completion. The proper skill evaluation was by the following items, elevating gall bladder (GB), retracting duodenum and transverse colon, exposing layer around cystic duct, identifying cystic artery and right hepatic artery, identifying common bile duct, transecting cystic duct, layer of dissecting from liver bed, bleeding control at liver bed and retrieval of GB. Each step was given three points respectively, and further points were added by referee, from neither for easy case to 10 points for difficult case according to the difficulty to complete.
In 2004, 110 surgeons were qualified among 170 candidates (66%). In 2005, 62 surgeons were qualified among 137 candidates (45%). In 2006, 36 surgeons were qualifiec among 101 candidates (36%). To assess inter-rater agreement between referees, Cohen’s weighted kappa value was calculated. It was 0.18 in 2004, up to 0.32 in 2005, but declined to 0.29 in 2006. The result off 2006 was unexpected although we have revision of criteria and frequent meeting to make consensus among referees. We should explore the reason of disagreement between the two judges crossing 70 points. And we must found a method to overcome this disagreement. These might be influenced by different understanding of good laparoscopic view, or procedures of dissecting layer, or that of exposing the biliary tract and cystic artery.

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Program Number: P152

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