269. CURRENT STATUS OF THE INTRODUCTION PROCESS OF MINIMALLY INVASIVE TRANSCERVICAL ESOPHAGECTOMY (MICE), TYPICALLY IDEAL 2A STRUGGLES

Abstract

Abstract Background The introduction of a novel complex surgical technique is a challenging process and can be associated with a long learning curve and learning-associated morbidity. In order to introduce Minimally Invasive transCervical Esophagectomy (MICE) in a safe way, the IDEAL framework was a used. Method MICE is an innovative surgical technique, combining a single-port transcervical mediastinal dissection with a laparoscopic transhiatal esophagectomy. MICE could reduce pulmonary complications and the consequences of anastomotic leakage, without compromising oncological radicality. Our five-step approach of the ‘pre-clinical stage 0’ made the IDEAL framework more applicable as a practical guideline and led to a safe ‘first-in-human procedure, IDEAL stage 1’. Currently we are prospectively collecting data of a single-center Radboudumc cohort, going through the learning curve and finetuning the surgical technique, which is typical for IDEAL stage 2A ‘Development’. Results In another abstract, the clinical outcomes of our single-center Radboudumc learning curve cohort will be presented. By the time of the 2023 ISDE conference, around 70 cases will be included. As a result of technical difficulties during the learning curve and succinct evaluation with peers and patients, several changes to the MICE procedure have been made, like: indications, cervical incision, continuous NIM, sequence of abdominal/cervical approach, camera system, extraction and reconstruction, conversion, surgical team. Conclusion The surgical technique of MICE evolved during the collection of a singe-centre Radboudumc learning curve cohort. These changes are typical for the ‘IDEAL development stage 2A’, thorough evaluation of these changes might help limiting learning associated morbidity.