Thoracic Portal Survey Results – Minimally Invasive Esophagectomy

For purposes of this survey, readers were asked to assume that they consulted on an otherwise healthy middle aged patient with a distal esophageal adenocarcinoma, T1bN0 by EUS. There were no contraindications to esophagectomy.

A relatively small number of respondents participated in this survey, which perhaps reflects the small amount of penetration of MIE in the thoracic surgery community and the small amount of interest in esophageal surgery among thoracic surgeons in some regions. Of those who did participate, 73% had some familiarity with MIE, whereas 26% did only open resections.

Of surgeons who currently perform MIE, 29% learned it during training and 59% learned it after completing their formal training. Twelve percent of respondents indicated that they were learning MIE techniques in other ways.

Among surgeons who perform MIE, 43% use a totally minimally invasive technique, whereas most of the rest used a hybrid technique, opening either the abdomen or the chest.

Over 50% of respondents indicated that their comfort level with MIE was either high or very high. Two-thirds of respondents indicated that they routinely caution patients about the possible need to convert to an open procedure.

A relatively high percentage of respondents (44%) indicated that they are currently teaching residents or fellows to perform MIE. The majority of respondents indicated that 25 MIEs were necessary for trainees to achieve adequate skill in performing this procedure. More than half of the respondents (61%) did not believe that a short course focused on MIE was sufficient to learn the procedure.

In contrast to prior surveys, the vast majority of respondents were from North America, which perhaps correlates with the lack of esophageal experience/training/expertise among thoracic surgeons on other continents.

1. Would you normally perform an MIE for this patient?
	answered question		102
	skipped question		1
		Response Percent	Response Count
Yes		72.5%	74
No		25.5%	26
I don’t perform esophagectomies		2.0%	2

2. How did you learn to perform MIE?
	answered question		97
	skipped question		6
		Response Percent	Response Count
During a formal (accredited) thoracic residency/fellowship.		28.9%	28
During a non-accredited clinical fellowship lasting a year or more.		9.3%	9
At a short, focused course for MIE.		6.2%	6
By informal observation at a busy clinical center.		13.4%	13
On your own using videos, trial and error.		29.9%	29
Other		12.4%	12

3. What approach do you use for MIE?
	answered question		98
	skipped question		5
		Response Percent	Response Count
Totally minimally invasive		42.9%	42
Hybrid with an open thoracic portion		18.4%	18
Hybrid with an open abdominal portion		30.6%	30
Other		8.2%	8

4. What is your comfort level for performing MIE?
	answered question		98
	skipped question		5
		Response Percent	Response Count
Very high		29.6%	29
High		21.4%	21
Moderate		32.7%	32
Low		16.3%	16

5. Do you caution patients about the possible need for conversion to an open approach?
	answered question		96
	skipped question		7
		Response Percent	Response Count
No, the likelihood of this in my practice is too low to warrant this discussion in most instances.		7.3%	7
Yes, but only when I believe the risk is increased.		22.9%	22
Yes, routinely.		69.8%	67

6. Do you teach residents or fellows how to perform MIE?
	answered question		97
	skipped question		6
		Response Percent	Response Count
Yes		44.3%	43
No		55.7%	54

7. How many MIEs do you think are necessary to perform to achieve adequate skill in this procedure?
	answered question		97
	skipped question		6
		Response Percent	Response Count
10		23.7%	23
25		56.7%	55
50		13.4%	13
75 or more		6.2%	6

8. Do you believe a short course focused on learning MIE is sufficient to permit safe clinical performance of this procedure?
	answered question		98
	skipped question		5
		Response Percent	Response Count
Yes		38.8%	38
No		61.2%	60

9. In what region is your surgical practice based?
	answered question		102
	skipped question		1
		Response Percent	Response Count
North America		53.9%	55
Europe		20.6%	21
South America		4.9%	5
Asia		20.6%	21
Africa		0.0%	0