NIH Consensus Conference on Laparoscopic Cholecystectomy: Are Reforms Necessary?-Reply

In Reply.  —We regret that Drs Jacoby and Scott thought we were skirting controversy in the NIH Consensus Conference on laparoscopic cholecystectomy. These conferences are based on specific questions posed by a planning committee to address controversies for which there are data to form unbiased, scientifically based recommendations. The issue of certification and training was not one of these questions. Prescribing training guidelines has been, and remains, inappropriate for NIH consensus conferences. Comments about training were invited, and Charles K. McSherry, MD, experienced in laparoscopic training, provided useful information. Learning laparoscopic cholecystectomy depends on the skills and aptitudes of the trainee surgeon; no definitive number of procedures determines when a surgeon is qualified. From the panel's statement: "[I]t is imperative that detailed guidelines be established for surgeon training, determination of competence, certification, and continuous monitoring of quality."The panel did not try to dictate whether the common bile duct should