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Abstract
Minimally invasive esophageal atresia (EA) repair is deemed one of the most demanding procedures in pediatric surgery. Open repair is considered the gold standard and learning opportunities for minimally invasive repairs remain scarce. “Telemedical Interdisciplinary Care for Patients with Esophageal Atresia (TIC-PEA)” offers free access to an interdisciplinary network of experts for telemedical consultation (telementoring). The aim of this study was to determine the frequency of minimally invasive surgery (MIS) in TIC-PEA patients compared to the general population. TIC-PEA patients were matched and compared to controls regarding the use of MIS, patient characteristics, and complications. Patients (n = 31) were included at a mean age of 62.8 days (95%-CI: 41.4–84.3, 77% after the primary esophageal repair). The odds-ratio to have MIS was 4.03 (95%-confidence interval: 0.79–20.55) for esophageal anastomosis and 4.60 (95%-confidence interval: 0.87–24.22) for tracheoesophageal fistula-repair in the TIC-PEA group. Telementoring offered the chance to select the ideal candidate for MIS, plan the procedure, and review intraoperative images and videos with the expert. Telementoring as offered is ideal to promote MIS for EA and helps to address the individual learning curve. In order to maximize benefits, patients need to be included prior to the first esophageal procedure.
Highlights
Esophageal atresia repair is one of the most challenging minimally invasive procedures in pediatric surgery
Experts are chairpersons of German academic centers experienced in the treatment of esophageal atresia and/or members of the advisory board of the KEKS e.V. (Kinder und Erwachsene mit kranker Speiseröhre, the German national patient support group)
After receiving informed consent from both caregivers and practitioners, infants born with esophageal atresia may be included throughout the first year of life
Summary
Esophageal atresia repair is one of the most challenging minimally invasive procedures in pediatric surgery. After the first successful thoracoscopic repair in 1999 [1], minimally invasive surgery (MIS) has evolved in terms of operative equipment and technique. In a survey from 2014, only 6% of senior surgeons preferred the minimally invasive approach [2]. Up to 34.7% [5] minimally invasive repairs, with liberal conversion-rates of 33.3% [5] to. Because amenable cases are rare, it is hard for a single surgeon to reach a plateau in the learning curve in a foreseeable time. In order to prepare surgeons for this procedure, mentoring programs have been implemented [7]. A structured program may include theoretical and experimental training, simulation, training in centers of reference, and personal operative experience [7]. Personal mentoring is a crucial part of this program [7].
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