Address correspondence to: Hans F. Fuchs, MD, Head Surgeon Robotic Surgery, Assistant Professor of Surgery, University of Cologne, Department of General, Visceral, Cancer and Transplantation Surgery, Kerpener Str. 62, 50937 Köln, Germany. Tel: +49-221-478-4801; Fax: +49-221-478-4843; Email: hans.fuchs@uk-koeln.de © The Author(s) 2021. 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 Diseases of the Esophagus (2022), 35, 1–24 https://doi.org/10.1093/dote/doab055 Original Article Robotic-assisted minimally invasive esophagectomy (RAMIE) for esophageal cancer training curriculum—a worldwide Delphi consensus study Hans F. Fuchs, 1 Justin W. Collins, 2 Benjamin Babic, 1 Christopher DuCoin, 3 Ozanan R. Meireles, 4 Peter P. Grimminger, 5 Matthew Read, 6 Abbas Abbas, 7 Rubens Sallum, 8 Beat P. Müller-Stich, 9 Daniel Perez, 10 Matthias Biebl, 11 Jan-Hendrik Egberts, 12 Richard van Hillegersberg, 13 Christiane J. Bruns 1 1 Department of General, Visceral, Cancer, and Transplantation Surgery, University of Cologne, Cologne, Germany 2 University College London Hospitals, London, UK 3 Department of Surgery, University of South Florida, Tampa, USA 4 Department of Surgery, Harvard Medical School, Boston, USA 5 Department of General Surgery, University of Mainz, Germany 6 University of Melbourne, Melbourne, Australia 7 Temple University, Philadelphia, USA 8 University of Sao Paulo, Sao Paulo, Brazil 9 Department of Surgery, University of Heidelberg, Heidelberg, Germany 10 Department of Surgery, University of Hamburg, Hamburg, Germany 11 Department of Surgery, Charité Berlin, Berlin, Germany 12 Department of Surgery, University of Kiel, Kiel, Germany 13 Department of Surgery, University of Utrecht, The Netherlands SUMMARY. Background: Structured training protocols can safely improve skills prior initiating complex surgical procedures such as robotic-assisted minimally invasive esophagectomy (RAMIE). As no consensus on a training curriculum for RAMIE has been established so far it is our aim to define a protocol for RAMIE with the Delphi consensus methodology. Methods: Fourteen worldwide RAMIE experts were defined and were enrolled in this Delphi consensus project. An expert panel was created and three Delphi rounds were performed starting December 2019. Items required for RAMIE included, but were not limited to, virtual reality simulation, wet-lab training, proctoring, and continued monitoring and education. After rating performed by the experts, consensus was defined when a Cronbach alpha of ≥0.80 was reached. If ≥80% of the committee reached a consensus an item was seen as fundamental. Results: All Delphi rounds were completed by 12–14 (86–100%) participants. After three rounds analyzing our 49-item questionnaire, 40 items reached consensus for a training curriculum of RAMIE. Conclusion: The core principles for RAMIE training were defined. This curriculum may lead to a wider adoption of RAMIE and a reduction in time to reach proficiency. KEY WORDS: training program., robotic-assisted minimally invasive esophagectomy (RAMIE), expert, Delphi methodology, consensus. INTRODUCTION Esophageal cancer is an increasing disease, especially in the western world. 1 Surgery is the cornerstone of treatment for patients, mostly in the multimodal setting. 2 It is well known that esophagectomy is a complex procedure with a high percentage of accompanying severe complications. 3 – 5 Minimally invasive esophagectomy (MIE) and, more recently, robotic-assisted minimally invasive esophagectomy (RAMIE) seem to diminish these complications sig- nificantly; results of the first randomized controlled trials comparing these techniques to open or hybrid esophageal cancer surgery were recently published. 6 , 7 There is still a substantial debate in the literature whether patients benefit more from totally minimally invasive procedures or hybrid minimally invasive esophageal resection. 8 The usage of robotics is increasing worldwide, espe- cially in general surgery. Extensive distribution of robotic technology and associated increased experi- ence of many surgeons are driving factors of this development. 9 Totally minimally invasive Ivor Lewis esophagectomy is among the most complex surgical procedures and the extensive learning curve of this procedure has been previously reported. 3 The recon- struction phase and the technologies used in this part of the operation are continuously discussed, and the added dexterity of robotic systems may play a major role in overcoming the difficulties of this step. 10 1 Downloaded from https://academic.oup.com/dote/article/35/6/doab055/6348318 by guest on 19 June 2022