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Dezawa Education of endoscopic spine surgery

the sound spread and progress of endoscopic spinal arising from this form of surgery has tended to rise
surgery in Japan. [2] annually (from 66 cases in 2005 to 361 cases in 2014).
However, the mean incidence of complications per
COURSE AND METHODS OF year has remained essentially unchanged at 2.4%
QUALIFICATION AND RESULTS (1.57-2.81%) [Table 1]. [3,4]

Qualification procedures for skills are as follows. First, PRINCIPLE AND SIGNIFICANCE OF
the applicant, satisfying the requirements for filing an ENDOSCOPIC SPINAL SURGERY SKILL
application for skill qualification, submits the necessary QUALIFICATION SYSTEM
documents and an unedited videotape. On the basis of
the submitted materials, the skill of each application is It loses trust of the whole endoscopic surgery that
assessed by multiple referees (referee committee on complications of the endoscopic surgery in the field of
surgical skill qualification). Assessments are based on spine increase, serving as a major obstacle slowing
scoring of each checked item (full score: 100 per item). and even blocking advances in endoscopic surgery
at all related specialties. This is a serious problem for
During assessment of the videotape, if one referee all surgeons involved in endoscopic surgery. Every
raises an objection, another referee or all members time such complications arise, citizens, the mass
of the referee committee conduct further evaluations. media and governmental organs begin arguing about
If two or more referees raise objections, the applicant the necessity of establishing an educational system
is automatically judged to be “unacceptable” for and a qualification assessment organization/system
qualification. The referee qualification must be updated for endoscopic surgeons. The JOA rules on the skill
every fifth year. Each referee applying for renewal qualification system were drafted taking this viewpoint
of the referee qualification has several obligations, into account. The rules are based on two principles: (1)
including submission of a certificate of clinical activity the system is aimed at accrediting endoscopic spinal
for 5 consecutive years. surgeons with sufficient skills through assessment
in accordance with high-level standards; and (2) the
The first application from surgeons for skill qualification system is aimed at evaluating the skill level of only
under this system was received in December 2004. surgeons engaged in endoscopic spinal surgery and
Through strict assessment of the documents, DVD is not based on the specialist surgeon system set
and videotape submitted, on April 1, 2005, 6 surgeons forth by the specialist surgeon accreditation council.
were accredited as to the anterior approach skill and The significance of establishing this qualification
18 surgeons as to the posterior approach. [2] system lies in: (1) the endoscopic spinal surgeon’s skill
qualification in accordance with high-level standards
We sent a questionnaire to facilities registered with makes endoscopic spinal surgeons more acceptable
JOA in advance as spine surgery special hospital. to the public and raises their value; (2) an increase in
During the period from 2005 to 2014, responses to the the number of qualified surgeons and their activities
questionnaire were collected from 1,148 facilities per will operate favorably as a mechanism to mitigate
year on average. The mean response rate was 56.4% Table1: Changes over time from 2004 to 2015 in the
(45.2-63.9%). number of applicants for skill qualification and the
percentage of successfully qualified applicants
The number of facilities providing endoscopic surgery Year Board certified surgeon Applicant Success ratio (%)
averaged 262.9 (208-297), with the mean percentage
being 24.8% (20.3-27.3%). 2004 24 30 80
2005 8 14 53
Under this qualification system, 167 surgeons were 2006 14 30 45
qualified in terms of endoscopic surgical skill between 2007 17 31 55
2004 and 2015. The posterior approach skill (MED, 2008 14 31 45
PELD) qualification was obtained by 165 surgeons 2009 13 32 41
(MED: 141, PELD: 24) and the anterior approach skill 2010 13 26 50
qualification by 2 surgeons [Table 1]. 2011 15 30 50

2012 14 30 47
The mean percentage of applicants who qualified
successfully was 50.6% (39.1-80%) after video 2013 20 35 57
assessments. Following the recent increase in 2014 16 27 59
endoscopic surgery, the number of complications 2015 15 32 47
Mini-invasive Surgery ¦ Volume 1 ¦ June 30, 2017 53