Can qualified teaching assistants improve the outcomes of laparoscopic Nissen fundoplication?

The Endoscopic Surgical Skill Qualification System (ESSQS) for pediatric endoscopic surgeons in Japan is designed to evaluate the technical skills of laparoscopic teaching surgeons. This study aimed to examine how surgical outcomes changed when procedures were performed under the guidance of ESSQS-qualified surgeons. In this retrospective study, we reviewed 43 patients who underwent laparoscopic Nissen fundoplication (LNF) with gastrostomy, performed by non–ESSQS-qualified surgeons between January 2009 and December 2023. Patients were divided into two groups: the ESSQS-qualified teaching assistant group (Q group: procedures with an ESSQS-certified surgeon as first assistant) and the non–ESSQS-qualified teaching assistant group (NQ group). Demographic data were summarized as mean ± standard deviation and analyzed using univariate and multivariate regression models. There were no significant differences in baseline patient characteristics between the two groups. The mean insufflation time was significantly shorter in the Q group than in the NQ group (193 ± 42 min vs 233 ± 70 min, p = 0.026). Mean operative time and reoperation rates did not differ significantly between groups (256 ± 56 min vs 277 ± 81 min, p = 0.311; and 7.4% vs 18.7%, p = 0.271, respectively). In multivariable linear regression analysis, shorter insufflation time was independently associated with the presence of an ESSQS-qualified teaching assistant. Teaching by ESSQS-qualified surgeons was associated with a significant reduction in insufflation time. These findings suggest that ESSQS certification may be a useful system for ensuring and promoting teaching proficiency in pediatric endoscopic surgery.