To reduce the complications of endoscopic surgery, The Japan Society for Endoscopic Surgery (JSES) established a committee for the Endoscopic Surgical Skill Qualification System (ESSQS) in 2001. The committee decided that qualified surgeons should have sufficient competence to act as mentors for endoscopic surgery. Here we report the methods and results obtained with ESSQS over four years in the field of digestive surgery. The first review was performed in 2004, and examinations have been conducted once a year since then. Applicants should be the board certified surgeons and should have performed at least 50 laparoscopic cholecystectomies or 20 advanced laparoscopic procedures as the chief surgeon. They must submit a list of patients on whom they have performed surgery (including complications) and an unedited video showing one of the relevant surgical procedures. The initial judging committee consisted of 25 experienced surgeons who were recommended by the JSES and mutually reviewed videos submitted by the other surgeons. They were divided into six groups (esophagus, stomach, colon, biliary tract, spleen, and endocrine/others). For assessment of the videos, the judging committee prepared gcommon criteriah (60 points) and gprocedure-specific criteriah (40 points). Assessment of videos was done by two judges. If both judges assigned a score of 70 points or more, the applicant passed. If the two judges disagreed, a final decision was made by either obtaining the opinion of a third judge or by group assessment. Over four years, there have been 1,111 applicants and 518 (46.6%) have been successful. The main problem with this system has been relatively low inter-rater agreement (kappa value: 0.31-0.40) between the initial two judges. However, it seems to obtain valid results because the incidence of complications was significantly lower in patients treated by successful applicants (4.2}0.3%) than in those treated by failed applicants (5.5}0.4%)(p=0.0295). To improve inter-rater agreement, consensus meetings of judges have been held, and the assessment criteria have been modified and made more detailed. Although the ESSQS still has some problems, this system should promote training and decrease complications.
Program Number: P220