Endoscopic Surgical Skill Qualification System in Japan. an Analysis of Complication Rate, Or Time, and Ebl in Accumulated 1895 Surgeons Who Applied to This System for 7 Years.

Toshiyuki Mori, MD, Fumio Konishi, MD, Taizo Kimura, MD, Seigo Kitano, MD. The committee for Endoscopic Surgical Skill Qualification System. Japan Society for Endoscopic Surgery

Purpose and Method Japan Society of Endoscopic Surgery started surgical skill accreditation in 2004, as reported previously in this meeting. Comprehensive analysis of surgical skill and instructive ability was possible with this system. It is 7 years since its start, and a total of 1895 surgeons applied to this system. The purpose of this study is 1.to validate the system, 2. to delineate the appropriate procedure to assess the laparoscopic surgical skill. The peri-operative parameters including the complication rate, OR time, and estimated blood loss (EBL) were collectively analyzed and compared in the qualified and non-qualified groups. The age of the applicants were also analyzed. The same analysis was performed for the subgroups of Lap Chole (LC:n=693), gastrectomy (Gas:n=440), and colectomy (Col:n=552). Results are also compared in-between these subgroups. Results A total of 835 surgeons were qualified, yielding 44% of total qualification rate. In total, statistically significant differences were calculated for complication rate between the qualified and non-qualified groups, total complication rate (4.8 vs.7.8%, p<.01), OR time (161 vs. 178 min, p<.01), EBL (25.6 vs.35.2 p=.019), and post operative hospital stay (PHS:8.8 vs. 9.7 days, p=0.02), respectively. Differences in OR time, EBL and PHS are more prominent in the Gas and Col groups, but not found in LC group. The difference in complication rate was most prominent in the Col group (3.0 v. 7.4%, p=.03) and marginal in the Gas group (6.7 vs.8.2%, p=.06), and not found in the LC group (4.5 vs.5.0%) The mean age of applicants in the qualified group is significantly younger when compared to those in non-qualified group (42 vs. 43 years, p=.001). This difference in the mean age of qualified and non-qualified surgeons were more prominent in Gas (41 vs. 43, p=.01) and Col groups (41 vs. 43, p=.001), but not found in the LC group (42 vs. 42). Conclusions Standardized procedures with appropriate complexity, such as LADG or lap. colectomy, may be suitable procedures to assess the laparoscopic surgeon’s skill. Laparoscopic cholecystectomy may be too simple to be a qualification tool for this kind of systems. Our accreditation system may be a useful tool to identify the group of surgeons who can offer better laparoscopic surgery for the stomach and colon. There might be suitable age of surgeons to be more effectively trained in laparoscopic surgery.

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