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World J Gastroenterol. Nov 28, 2018; 24(44): 4974-4978
Published online Nov 28, 2018. doi: 10.3748/wjg.v24.i44.4974
Learning curves in minimally invasive esophagectomy
Frans van Workum, Laura Fransen, Misha DP Luyer, Camiel Rosman
Frans van Workum, Camiel Rosman, Department of Surgery, Radboud University Medical Center, Nijmegen 6500 HB, Netherlands
Laura Fransen, Misha DP Luyer, Department of Surgery, Catharina Hospital, Eindhoven 5602 ZA, Netherlands
Author contributions: van Workum F, Luyer MDP and Rosman C designed research; van Workum F and Fransen L performed research; van Workum F analyzed data; all authors wrote the paper.
Conflict-of-interest statement: The authors have no conflict of interest to declare. The work has not been previously published and has not been submitted for publication elsewhere.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author to: Frans van Workum, MD, Academic Research, Doctor, Department of Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, Nijmegen 6500 HB, Netherlands. frans.vanworkum@radboudumc.nl
Telephone: +31-24-3611111 Fax: +31-24-3540501
Received: August 25, 2018
Peer-review started: August 27, 2018
First decision: October 11, 2018
Revised: October 28, 2018
Accepted: November 2, 2018
Article in press: November 2, 2018
Published online: November 28, 2018
Processing time: 94 Days and 14.7 Hours
Abstract

Surgical innovation and pioneering are important for improving patient outcome, but can be associated with learning curves. Although learning curves in surgery are a recognized problem, the impact of surgical learning curves is increasing, due to increasing complexity of innovative surgical procedures, the rapid rate at which new interventions are implemented and a decrease in relative effectiveness of new interventions compared to old interventions. For minimally invasive esophagectomy (MIE), there is now robust evidence that implementation can lead to significant learning associated morbidity (morbidity during a learning curve, that could have been avoided if patients were operated by surgeons that have completed the learning curve). This article provides an overview of the evidence of the impact of learning curves after implementation of MIE. In addition, caveats for implementation and available evidence regarding factors that are important for safe implementation and safe pioneering of MIE are discussed.

Keywords: Minimally invasive esophagectomy; Learning curve; Pioneering; Safe implementation; Proficiency gain curve

Core tip: Surgical innovation and pioneering are important for improving patient outcome, but can be associated with learning curves. The impact of surgical learning curves is increasing, due to increasing complexity of innovative surgical procedures and the rapid rate at which new interventions are implemented. Learning curves of minimally invasive esophagectomy can take years to complete and evidence based training and safe implementation programs are paramount to decrease implementation associated morbidity.