Practice <scp>G</scp>uidelines on <scp>E</scp>ndoscopic <scp>S</scp>urgery for qualified surgeons by the <scp>E</scp>ndoscopic <scp>S</scp>urgical <scp>S</scp>kill <scp>Q</scp>ualification <scp>S</scp>ystem

Abstract

The first edition of the Practice Guidelines on Endoscopic Surgery was published on 1 September 2008. A new guidelines committee was established 2 years later in September 2010 to revise the guidelines. With the introduction and spread of robot-assisted and single-port access surgeries for a wide range of applications, endoscopic surgery has evolved at an impressive pace in recent years in Japan. Through various activities, such as the establishment of the Endoscopic Surgical Skill Qualification System, the provision of educational seminars, and the development of the Practice Guidelines on Endoscopic Surgery, the Japan Society for Endoscopic Surgery has been contributing to the promotion of safe practice for endoscopic surgery, including these new techniques. The present situation is complex: sufficient evidence for recommending endoscopic surgeries has been established in some areas, but there remains a lack of well-established evidence in other areas. In the first edition of our guidelines, we mentioned the difficulty in covering such a wide spectrum of medical specialties to which endoscopic surgery should be applied in a standardized format. Such difficulties have also been raised by the members of the External Review Committee. The guidelines clearly specify the surgeons qualified by the Endoscopic Surgical Skill Qualification System as the target population. (The guidelines are applicable in the chest surgery area to surgeons with training experience and skills comparable to those of surgeons accredited by the Endoscopic Surgical Skill Qualification System in other specialties, because the Japanese Association for Chest Surgery does not have a skill qualification system in place. Similarly, in the orthopedic area, a qualification system for qualified spinal endoscopic surgeons is in place, but there is no qualification system available for widely practiced arthroscopic surgeries. Therefore, these guidelines are applicable to surgeons who have comparable training experience and skills to those qualified by the Endoscopic Surgical Skill Qualification System in other areas.) The guidelines shall address the techniques covered by health insurance or the techniques listed as advanced medical care (as of March 2013). The clinical question format shall be used in all areas. The guidelines are prepared for each area and do not address robotic or single-port access surgeries separately. Prof. Takeo Nakayama (Department of Health Informatics, Kyoto University School of Public Health) joined our committee as a special adviser for this revision. Although he proposed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system as a new approach to guidelines development, more time was required to allow all committee members from a wide spectrum of areas to understand this method. Therefore, it will be addressed in the next revision. We hope these guidelines will serve as a benchmark to enhance the broader application of endoscopic surgery. Yoshiharu Sakai Chairman of the Guidelines Committee of the Japan Society for Endoscopic Surgery September 2014 These guidelines are applicable to qualified surgeons accredited by the Endoscopic Surgical Skill Qualification System of the Japan Society for Endoscopic Surgery. The guidelines aim to explicitly provide the indication criteria and recommendations for techniques covered by health insurance. These guidelines aim to eliminate over- and under-treatment. These guidelines are designed to promote mutual understanding and will thus be available to members of relevant academic societies and associations. The revision of these guidelines is anticipated to promote the safe and wider application of endoscopic surgeries and to improve the treatment outcomes and benefits to patients. The Japan Society for Endoscopic Surgery shall accept responsibility for the contents of these guidelines. However, the primary physician directly involved in treating each patient shall be resp