To the Editor The Research Letter by Dubina et al1 misses the mark with the stated conclusion. Fundamentals of Laparoscopic Surgery (FLS) testing has never claimed to decrease surgical complications; rather, FLS testing is a verification of the knowledge and skills required to perform basic laparoscopy. Practicing FLS skills to proficiency may help to accelerate learning and clinical transfer of skills, but there are no data about this in the current study.1 In addition, as noted in their communication citing the work of Schwaitzberg et al2 on 53 632 laparoscopic cholecystectomies, where FLS graduates performed statistically worse in terms of bile duct injury, some key points were missed. First, the FLS examination does not assess any knowledge or skills specific to cholecystectomy and thus is not expected to affect bile duct injury. The key finding of the study by Schwaitzberg et al2 was demonstration of an experience and perception gap between recent graduates and more experienced surgeons. Out of that work, the Society of American Gastrointestinal and Endoscopic Surgeons Safe Cholecystectomy task force was created. Second, the analysis of complications specifically addressed in the FLS curriculum demonstrated a leveling-out of outcomes between junior and senior surgeons, suggesting it was possible to narrow the experience gap through education, training, and assessment. Finally, delineating the statistical effect on bile duct injury specifically (despite a 50% reduction in the FLS group) in a sample of only 3000 patients is potentially misleading when interpreting the results as having no difference.
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Vassiliou MC, Mellinger JD, Schwaitzberg SD. Debunking Myths About the Purpose and Intentions of Fundamentals of Laparoscopic Surgery Testing. JAMA Surg. 2019;154(5):468. doi:10.1001/jamasurg.2018.5584
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