Evolution of the surgical technique of minimally invasive Ivor-Lewis esophagectomy: description according to the IDEAL framework

Totally minimally invasive Ivor-Lewis esophagectomy (Ivor Lewis TMIE) is a technically challenging procedure and is associated with a learning curve. Refinement of surgical technique is an important part of this learning curve. However, detailed descriptions of these refinements according to the ide...

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Bibliographic Details
Published in:Diseases of the esophagus 2019-03, Vol.32 (3)
Main Authors: Stenstra, M H B C, van Workum, F, van den Wildenberg, F J H, Polat, F, Rosman, C
Format: Article
Language:English
Subjects:
Aged
Carcinoma - surgery
Esophageal Neoplasms - surgery
Esophagectomy - education
Esophagectomy - methods
Female
Humans
Laparoscopy - education
Laparoscopy - methods
Learning Curve
Male
Middle Aged
Outcome and Process Assessment, Health Care - methods
Outcome and Process Assessment, Health Care - standards
Proof of Concept Study
Thoracoscopy - education
Thoracoscopy - methods
Treatment Outcome
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Summary:Totally minimally invasive Ivor-Lewis esophagectomy (Ivor Lewis TMIE) is a technically challenging procedure and is associated with a learning curve. Refinement of surgical technique is an important part of this learning curve. However, detailed descriptions of these refinements according to the idea, development, exploration, assessment, and long-term follow-up (IDEAL) framework are lacking and this study was undertaken to fill this knowledge gap. From 2010 until 2016, all consecutive patients (n = 164) were included from the first patient undergoing Ivor Lewis TMIE. Surgical reports were analyzed and surgeons were interviewed to determine surgical refinements. These data were used to describe the transition of the surgical technique from IDEAL stage IIB to stage III. The main findings were that four refinements were made to the surgical procedure in IDEAL stage IIB: (1) At case 9, the use of the 25 mm OrVil was abandoned, exchanged for a 28 mm EEA stapler and a large omental wrap around the anastomosis was introduced; (2) at case 27, the omental wrap was reduced in volume; (3) at case 60, the omental wrap was refined to cover the full 360° of the anastomosis and (4) at case 77, the fixation of the anvil with the Endostitch was replaced by fixation with two Endoloops®. During the transition from IDEAL stage IIB to stage III, the incidence of anastomotic leakage decreased from 26.0% to 4.6% (P 
ISSN:1120-8694
1442-2050
DOI:10.1093/dote/doy079