As we previously reported, the Japan Society of Endoscopic Surgery (JSES) has founded the Endoscopic Surgical Skill Qualification System (ESSQS) in an effort to encourage sound advances in techniques and more widespread use of endoscopic procedures in Japan. In addition to paperwork, applicants were requested to submit unedited videotapes that recorded laparoscopic procedures. For objective analysis of the skill level of each applicant, criteria was made for general and organ specific skills, sharing 60 and 40 points, respectively. Submitted tapes were evaluated with these criteria in a double blind fashion. When two judges scored more than 70 points, the applicant is qualified for cirtification, and when the decision splitted, the tape was subjected to the third judge or discussion by the working group of each organ. In the first year of 2004, a total of 422 surgeons applied, 212 surgeons were qualified (53%). In addition to the fact that granting rate varies widely in organs, ranging 28% in the esophagus to 65% in the biliary tract, inter-rater agreement (weighted kappa value, Cohen) of the two judges was as low as 0.31, ranging 0.18 in the biliary tract to 0.40 in the stomach. Toward the 2005 qualification, consensus meetings were held to improve inter-rater agreement. In the stomach group, decision was made to limit the procedure to laparoscopic distal gastrectomy for the better agreement. In 2005, a total of 275 surgeons applied, 128 surgeons were qualified (47%). Inter-rater agreement of the two judges improved to 0.40, most remarkably in the stomach group from 0.37 in 2004 to 0.59 in 2005. Preliminary calculation shows that the complication rate of qualified surgeons compares significantly better than the others. In the process of revision of criteria and consensus discussion, procedures are much standardized. ESSQS is the first system to certify technical aspect of endoscopic surgery, run by an academic body. We believe this system will enhance the surgical skills of endoscopic surgeons and thus decrease adverse outcome. It may also play an important role in the education system of endoscopic surgery.