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Comment & Response
February 20, 2019

Debunking Myths About the Purpose and Intentions of Fundamentals of Laparoscopic Surgery Testing—Reply

Author Affiliations
  • 1Department of Surgery, Harbor–UCLA Medical Center, Torrance, California
  • 2Department of Surgery, Stanford University Medical Center, Palo Alto, California
  • 3Los Angeles Biomedical Research Institute, Harbor–UCLA Medical Center, Torrance, California
JAMA Surg. 2019;154(5):468-469. doi:10.1001/jamasurg.2018.5590

In Reply We appreciate the viewpoints of Vassiliou et al in response to our study.1 The Fundamentals of Laparoscopic Surgery (FLS) curriculum was initially conceived in the 1990s at a time when laparoscopic surgery grew quickly, and there were “a lot of complications related to its introduction” such that “benefits that were obvious with the technique weren’t being realized and patients were suffering.”2 There was concern that this rapid expansion would “put a…good technique at jeopardy.”2 The sharp rise in common bile duct injuries created worldwide concern. As such, one of the original goals of the FLS examination was to “improve the quality and safety of surgical care delivered to…patients.”3 Thus, we feel it is reasonable to extrapolate that given that the FLS curriculum was created to improve laparoscopic safety in an era of rising common bile duct injuries, the hope was that FLS implementation would result in a decline in complications associated with laparoscopic surgery, including, by extension, complications during the most commonly performed laparoscopic procedure, laparoscopic cholecystectomy (LC).

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