A Nation-Wide Laparoscopic Skills Qualification: A Thirteen-Year Experience in Japan

  • Tadashi MatsudaEmail author
  • Tomonori Habuchi
  • Hiroomi Kanayama
  • Toshiro Terachi


For laparoscopic and robotic surgeries, the surgeons’ competency is important to keep high quality of surgical treatment. Japanese Society of Endourology (JSE) and the Japanese Urological Association established a urological laparoscopic skills evaluation system called the Endoscopic Surgical Skill Qualification (ESSQ) System in Urological Laparoscopy in 2004.

By 2016, a total of 1463 urologists had qualified from a total of 2561 applicants after skills assessment on non-edited videos by two referees, resulting in a pass rate of 57.1%. Details of the system and the skill assessment results are shown. Prospectively collected surgical outcomes of 2590 laparoscopic urologic operations performed by 130 qualified doctors 5 years post-qualification were excellent, demonstrating the good predictive validity of the ESSQ System. The reliability of video assessments by referees was analyzed statistically on 1220 videos which had fixed points by two referees. The results showed moderate reliability for the video assessments by the referees, but the final qualification rates showed no significant differences among the referees, which indicated that the video assessments by the referees were fair for all applicants.

In the 13 years since the launch of the ESSQ System, it has become the goal of young urologists in Japan who learn laparoscopic surgery. According to a nation-wide survey by JSE, open conversion rates and major complication rates have dramatically decreased during these 26 years since 1990.


Urology Laparoscopy Skill assessment Reliability 



Sixty referees, including the authors and the late Drs. Yoshinari Ono and Kazuo Suzuki, spent a lot of time to assess the videos every year. Ms. Keiko Iijima, the chief secretary of the JSE, performed all the clerical works on the system.

All authors contributed to this chapter as the chair of the ESSQ System.

Remarks: Ethical approval is granted for the studies involved in this article according to local regulations.

Disclosures: Drs. Tadashi Matsuda, Tomonori Habuchi, Hiroomi Kanayama, and Toshiro Terachi have no conflicts of interest or financial ties to disclose.


  1. Habuchi T, Terachi T, Mimata H, et al. Evaluation of 2,590 urological laparoscopic surgeries undertaken by urological surgeons accredited by an endoscopic surgical skill qualification system in urological laparoscopy in Japan. Surg Endosc. 2012;26:1656–63.CrossRefGoogle Scholar
  2. Iwanaka T, Morikawa Y, Yamataka A, et al. Skill qualifications in pediatric minimally invasive surgery. Pediatr Surg Int. 2011;27:727–31.CrossRefGoogle Scholar
  3. Japanese Society of Endoscopic Surgery. Results of 13th nationwide survey of endoscopic surgery in Japan. J Jpn Soc Endosc Surg. 2016;21:772–96.Google Scholar
  4. Matsuda T, Ono Y, Terachi T, et al. The Endoscopic Surgical Skill Qualification system in urological laparoscopy: a novel system in Japan. J Urol. 2006;176:2168–72.CrossRefGoogle Scholar
  5. Matsuda T, Kanayama H, Ono Y, et al. Reliability of laparoscopic skills assessment on video: 8-year results of the Endoscopic Surgical Skill Qualification System in Japan. J Endourol. 2014;28:1374–8.CrossRefGoogle Scholar
  6. Mori T, Kimura T, Kitajima M. Skill accreditation system for laparoscopic gastroenterologic surgeons in Japan. Minim Invasive Ther Allied Technol. 2010;19:18–23.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Tadashi Matsuda
    • 1
    Email author
  • Tomonori Habuchi
    • 2
  • Hiroomi Kanayama
    • 3
  • Toshiro Terachi
    • 4
  1. 1.Department of Urology and AndrologyKansai Medical UniversityHirakataJapan
  2. 2.Department of UrologyAkita University Graduate School of MedicineAkitaJapan
  3. 3.Department of UrologyTokushima University Graduate School of MedicineTokushimaJapan
  4. 4.Department of UrologyTokai University School of MedicineIseharaJapan

Personalised recommendations