大腸における技術認定制度の現況

Current condition of Endoscopic Surgical Skill Qualification System in Japan

◆要旨：日本内視鏡外科学会における消化器一般外科領域の技術認定は，2005年に第1回の認定がなされ，その後2007年の認定まで計3回の認定がなされた．大腸癌に対する腹腔鏡下手術は，10数年を経て標準的な適応と術式が確立され，最近特に普及速度が高まっていると思われる．本術式は，技術的な難易度が高いものと考えられており，安全な手術を施行するためには十分な技術的な修練を必要とする．消化器一般外科領域の技術認定制度における3回の審査の過程で，大腸領域のビデオの症例提出基準や審査基準の内容が改変されてきた．その結果，現時点で一定した偏りのない審査が継続的に可能となったと思われる．合格率は37～40％と一定しており，安全な手術が施行できかつ指導的な立場に立って後輩の修練指導をなしえる技術を認定するという目的からして，妥当なものであったと考えられる．本技術認定は，標準的な手術を安全確実に施行し得る技術を認定するものであり，内視鏡外科手術の質的向上に寄与するものと思われる．

　The Endoscopic Surgical Skill Qualification System（ESSQS）in Japan started in 2004, and the yearly accreditation has already been conducted three times since then. Laparoscopic colorectal surgery started in 1993, and in recent years, standardization for indication and surgical techniques has been almost well established. However, laparoscopic colorectal surgery needs to have a high technical skill level and good experience. Therefore, a well designed and intensive training should be considered for the advancement of the surgical procedures and clinical practice. During the three year period of ESSQS in Japan, there have been changes in the criteria for technical assessment and surgical video presentation. Due to the changes and improvement of the criteria, the equitable judgment of the technique has become possible. As a result, the success rate in the field of colorectal laparoscopic surgery range from 37 to 40%without significant variability. This relatively low success rate is considered appropriate because the purpose of the ESSQS is to accredit the technique level with which one can conduct a safe and sufficient operation as well as an adequate teaching for the trainees. ESSQS in Japan is considered to contribute to the improvement of the technique for laparoscopic surgery.