Development of an objective endoscopic surgical skill assessment system for pediatric surgeons: Suture ligature model of the crura of the diaphragm in infant fundoplication

Background and aim The Japanese Society of Pediatric Endoscopic Surgeons developed an endoscopic surgical skill qualification (ESSQ) system. However, this is a subjective system we developed and validated an objective skill evaluation system for pediatric surgeons. Methods In the ESSQ system, the task operation is laparoscopic fundoplication. Therefore, we set up a suture ligature model of the crura of the diaphragm for infant fundoplication. Examinees were divided into 2 groups, 10 experts and 16 trainees. They had to perform two suture ligatures of the crura using an intracorporeal knot in the box. Evaluation points were time, force on the tissue, suture tension, stitch spacing, equidistance, mean score, and total score. Statistical analysis was performed and p<0.05 was considered statistically significant. Results Experts showed better score than trainees in the time score (p<0.0001), the score for force on the tissue (p<0.0001), the stitch spacing score (p<0.05), the equidistance score (p\0.005), the mean score (p<0.0001), and the total score (p<0.0005), respectively. Conclusion The results revealed that the expert group possessed gentle and speedy skills compared with that of the novices. Using this validation study, our established model could be used to objectively evaluate the endoscopic surgical skills of pediatric surgeons.