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Surg Endosc. 2022 Jan;36(1):446-460. doi: 10.1007/s00464-021-08304-5. Epub 2021 Feb 19.

European consensus on essential steps of Minimally Invasive Ivor Lewis and McKeown Esophagectomy through Delphi methodology.

Surgical endoscopy

Yassin Eddahchouri, Frans van Workum, Frits J H van den Wildenberg, Mark I van Berge Henegouwen, Fatih Polat, Harry van Goor, Jean-Pierre E N Pierie, Bastiaan R Klarenbeek, Suzanne S Gisbertz, Camiel Rosman


  1. Department of Surgery, Radboud University Medical Center, 618, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. [email protected].
  2. Department of Surgery, Radboud University Medical Center, 618, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
  3. Department of Surgery, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands.
  4. Department of Surgery, Amsterdam UMC, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.
  5. Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
  6. Centrum voor Opleiding en Onderwijs Wenckebach, University Medical Center Groningen, Groningen, The Netherlands.

PMID: 33608767 DOI: 10.1007/s00464-021-08304-5


BACKGROUND: Minimally invasive esophagectomy (MIE) is a complex and technically demanding procedure with a long learning curve, which is associated with increased morbidity and mortality. To master MIE, training in essential steps is crucial. Yet, no consensus on essential steps of MIE is available. The aim of this study was to achieve expert consensus on essential steps in Ivor Lewis and McKeown MIE through Delphi methodology.

METHODS: Based on expert opinion and peer-reviewed literature, essential steps were defined for Ivor Lewis (IL) and McKeown (McK) MIE. In a round table discussion, experts finalized the lists of steps and an online Delphi questionnaire was sent to an international expert panel (7 European countries) of minimally invasive upper GI surgeons. Based on replies and comments, steps were adjusted and rephrased and sent in iterative fashion until consensus was achieved.

RESULTS: Two Delphi rounds were conducted and response rates were 74% (23 out of 31 experts) for the first and 81% (27 out of 33 experts) for the second round. Consensus was achieved on 106 essential steps for both the IL and McK approach. Cronbach's alpha in the first round was 0.78 (IL) and 0.78 (McK) and in the second round 0.92 (IL) and 0.88 (McK).

CONCLUSIONS: Consensus among European experts was achieved on essential surgical steps for both Ivor Lewis and McKeown minimally invasive esophagectomy.

© 2021. The Author(s).

Keywords: Consensus; Esophagectomy; Essential steps; Minimally invasive surgery; Upper GI


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