ABSTRACT Background Objective assessment of surgical technical skills is essential for ensuring patient safety and maintaining high‐quality surgical care. Although the Endoscopic Surgical Skill Qualification (ESSQ) System of the Japan Society for Endoscopic Surgery (JSES) has contributed to the standardization of endoscopic surgery, factors associated with pass–fail outcomes in the certification examination have not been systematically evaluated. Methods This retrospective observational study included applicants who underwent the colorectal endoscopic surgical skill qualification examination between 2020 and 2024. Applicant‐, institutional‐, patient‐, tumor‐, surgical‐, and reviewer‐related variables registered at the time of application were analyzed. Associations with pass–fail outcomes were assessed using uni‐ and multivariable analyses. Results A total of 1945 applications were analyzed. The overall pass rate during the study period was 33.2%, with robot‐assisted cases showing comparable results, although the number of robot‐assisted cases was limited. Primary reviewers agreed in 68.1% of cases, and the overall Cohen's kappa was 0.336. Multivariable analysis identified fewer application attempts, larger institutional bed capacity, 3D scope use, shorter operative time, and lower blood loss as independent predictors of successful qualification (all p < 0.05). Reviewer demographics showed no associations. Conclusions This study provided the first comprehensive evaluation of factors associated with pass–fail outcomes in the ESSQ Examination of the JSES. Certification results were influenced by applicant‐ and institution‐related characteristics, as well as operative performance indicators, whereas reviewer demographic factors showed no measurable impact.
Hasegawa et al. (2026) studied this question.