Diseases of the Esophagus (2017) 31, 1–9 DOI: 10.1093/dote/dox124 Original Article A structured training program for minimally invasive esophagectomy for esophageal cancer— a Delphi consensus study in Europe E. Visser, 1 P. S. N. van Rossum, 1 , 2 H. van Veer, 3 K. Al-Naimi, 4 M. A. Chaudry, 5 M. A. Cuesta, 6 S. S. Gisbertz, 7 C. A. Gutschow, 8 A. H. H ¨ olscher, 9 M. D. P. Luyer, 10 C. Mariette, 11 K. Moorthy, 12 G. A. P. Nieuwenhuijzen, 10 M. Nilsson, 13 , 14 J. V. R¨ as¨ anen, 15 P. M. Schneider, 16 W. Schr¨ oder, 17 E. Cheong, 18 R. van Hillegersberg 1 1 Departments of Surgery, 2 Radiation Oncology, University Medical Center Utrecht, Utrecht, 3 Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium, 4 Departments of Anesthesiology, 5 Department of Surgery, Royal Marsden Hospital NHS Foundation Trust, 6 Department of Gastrointestinal Surgery, VU Uni- versity Medical Center, 7 Department of Surgery, Academic Medical Center, Amsterdam, 8 Department of Vis- ceral and Transplantation Surgery, University Hospital Zurich, 9 Department of Surgery, Center for Esophageal and Gastric Surgery, and Frankfurt, 10 Department of Surgery, Catherina Hospital Eindhoven, Eindhoven, The Netherlands, 11 Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France, 12 Department of Biosurgery and Surgical Technology, Imperial College, St Mary’s Hospital, London, United Kingdom, 13 Department of Surgery, Karolinski University Hospital, 14 Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden, 15 Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Helsinki, Finland, 16 Department of Surgery, Hirslanden Medical Center, Zurich, Switzerland, 17 Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany, and 18 General Surgery, Norfolk and Norwich University Hospital, Norwich SUMMARY. Evidence suggests that structured training programs for laparoscopic procedures can ensure a safe standard of skill acquisition prior to independent practice. Although minimally invasive esophagectomy (MIO) is technically demanding, no consensus on requirements for training for the MIO procedure exists. The aim of this study is to determine essential steps required for a structured training program in MIO using the Delphi consensus methodology. Eighteen MIO experts from 13 European hospitals were asked to participate in this study. The con- sensus process consisted of two structured meetings with the expert panel, and two Delphi questionnaire rounds. A list of items required for training MIO were constructed for three key domains of MIO, including (1) requisite criteria for units wishing to be trained and (2) to proctor MIO, and (3) a framework of a MIO training program. Items were rated by the experts on a scale 1–5, where 1 signifed ‘not important’ and 5 represented ‘very important.’ Consensus for each domain was defned as achieving Cronbach alpha ≥0.70. Items were considered as fundamental when ≥75% of experts rated it important (4) or very important (5). Both Delphi rounds were completed by 16 (89%) of the 18 invited experts, with a median experience of 18 years with minimally invasive surgery. Consensus was achieved for all three key domains. Following two rounds of a 107-item questionnaire, 50 items were rated as essen- tial for training MIO. A consensus among European MIO experts on essential items required for training MIO is presented. The identifed items can serve as directive principles and core standards for creating a comprehensive training program for MIO. KEY WORDS: consensus, Delphi methodology, expert, minimally invasive esophagectomy, training program. Address correspondence to: E. Visser, DRS, University Medical Center Utrecht, Department of Surgery, POBOX 85500, 3508 GA, Utrecht, the Netherlands. Email: E.Visser-3@umcutrecht.nl Specifc author contributions: All authors (E. Visser, P.S.N. van Rossum, H. van Veer, K. Al-Naimi, M. A. Chaudry, M. A. Cuesta, S. S. Gisbertz, C. A. Gutschow, A. H. H¨ olscher, M. D. P. Luyer, C. Mariette, K. Moorthy, G. A. P. Nieuwenhuijzen, M. Nilsson, J. V. R¨ as¨ anen, P. M. Schneider, W. Schr¨ oder, E. Cheong. R. van Hillegersberg) have contributed to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work; AND drafting the work or revising it critically for important intellectual content; AND fnal approval of the version to be published; AND agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. No means of funding were received for this contribution. C  The Authors 2017. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 1 Downloaded from https://academic.oup.com/dote/article/31/3/dox124/4601761 by guest on 16 June 2022