Video Based Assessment Collection ToolCase Related QuestionsSubmitter Last Name*Submitter First Name*Procedure performed byAttendingFellowResidentInstitutionContact Email*For troubleshooting and followup purposes only. Procedure Date* Were any procedures performed in addition to a fundoplication? (select all that apply) Hiatal hernia repair <4cm Hiatal hernia repair >4cm Paraesophageal hernia repair Esophageal myotomy Esophageal lengthening procedure (e.g. Collis gastroplasty) Takedown of prior fundoplication (i.e. redo or revisional antireflux surgery) No additional procedures were performedDo you know of any post-operative issues? (Select all that apply) Dysphagia > 3 months Persistent/Unresolved reflux Need for endoscopic intervention Need for surgical re-intervention Readmission related to the surgery No issues UnknownWhat is the patient's BMI<2525-29.930-34.935-39.9≥40Please rate your opinion of the performance of each of the following steps.Below AverageAverageAbove AverageVisualization of operative fieldHiatal dissectionFundus mobilizationEsophageal mobilizationHiatus repairWrap creationPlease note anything in this video that we should pay attention to. Portions that are particularly educational? Notable challenges? Etc.Trainee Involvement QuestionsWas a trainee involved?*YesNoWhat level of supervision did the trainee have for the following steps of the procedureShow and TellActive HelpPassive HelpSupervision OnlyVisualization of operative fieldHiatal dissectionFundus mobilizationEsophageal mobilizationHiatus repairWrap creationSee definitions of the Zwisch scale supervision levels.CommentsThis field is for validation purposes and should be left unchanged.