Extra resident laparoscopy training no help in cholecystectomy

Last Updated: 2018-09-10

By David Douglas

NEW YORK (Reuters Health) - A training program aimed at surgical residents shows no appreciable effect on the outcomes of cholecystectomy, according to a retrospective review.

As Dr. Christian de Virgilio told Reuters Health by email, "The implementation of FLS (Fundamentals of Laparoscopic Surgery) training was not associated with improved surgery resident performance or patient outcomes for laparoscopic cholecystectomy."

In a paper online August 29 in JAMA Surgery, Dr. de Virgilio of Harbor-UCLA Medical Center, in Torrance, California, and colleagues note that, "As laparoscopy has become mainstream, the ongoing value of FLS certification as a high-stakes examination comes into question."

To investigate, the team examined data on more than 3,000 laparoscopic cholycystectomies (LCs) conducted between 2005 and 2014 by junior surgical residents (postgraduate year 3) along with a senior resident (postgraduate year 4-5) teaching assistant.

They then compared the outcome of the procedure for both the period 2005-2009 before FLS certification became mandatory and 2010-2014 when the certification requirement was in place.

Over the whole study period, there were 35 intraoperative complications including 10 bile duct injuries. However, bivariate analyses indicated no significant difference in intraoperative complications before and after the FLS certification requirement. This was also the case for a variety of other parameters including the need for conversion to open surgery and length of surgery.

There was a significant difference between the pre- and post-FLS period in hospital length of stay and 30-day readmissions, but multivariable analyses showed no factor was associated with length of stay and increasing patient age was the only factor significantly associated with intraoperative complications and with readmission.

The researchers concede that "the residents at our institution participate very early in hands-on training in laparoscopic surgery," which may reduce the influence of mandatory FLS certification. However, the current findings are in keeping with those of other researchers, they note.

Dr. de Virgilio concluded, "Surgical educators need to reassess whether FLS, in its current format as a high-stakes exam, is worth the time and money, particularly since residents are required to undertake an increasing number of costly tests to become board certified."

SOURCE: https://bit.ly/2N2AJ9F

JAMA Surg 2018.