OBJECTIVE: To demonstrate our experience with establishing a video-based assessment conference (VBA) for rare and complex procedures in a pediatric surgery fellowship program. DESIGN: We share our experience in establishing a VBA conference in our Division of Pediatric Surgery from case selection, methods of operative video recording, equipment, and editing, and the structure of how cases are presented in conference. SETTING: Pediatric Surgery Fellowship at the Johns Hopkins Children's Center in Baltimore, MD. PARTICIPANTS: Pediatric surgery faculty, pediatric surgery fellows, general surgery residents, medical students, and nurse practitioners at Johns Hopkins participated in the conferences. Medical students and faculty were responsible for video recording and editing. CONCLUSIONS: Allowing VBA of operative cases can improve comprehensive learning in technically challenging and rare cases seen in pediatric surgery. Our paper shares one methodology of establishing a successful VBA conference.