Demonstration of the IDEAL recommendations for evaluating and reporting surgical innovation in minimally invasive oesophagectomy.
BACKGROUND
The Idea, Development, Evaluation, Assessment and Long term study (IDEAL) framework makes recommendations for evaluating and reporting surgical innovation and adoption, but remains untested.


METHODS
A prospective database was created for the introduction of minimally invasive techniques for oesophagectomy. IDEAL stages of development and evaluation were examined retrospectively in a series of patients undergoing laparoscopically assisted oesophagectomy (LAO), two- or three-phase minimally invasive oesophagectomy (MIO) and open oesophagectomy.


RESULTS
A total of 192 patients were involved. In IDEAL stages 1 and 2a, LAO in 16 patients was uneventful, but two-phase MIO in six patients was abandoned following consecutive technical complications. Two-phase MIO was modified to a three-phase MIO procedure, and the results of LAO (67 patients), three-phase MIO (35) and open techniques (68) were studied in IDEAL stage 2b. Major complications (Clavien-Dindo grades III and IV) occurred in 12 (18 per cent), nine (26 per cent) and 14 (21 per cent) LAO, three-phase MIO and open procedures respectively. There were four in-hospital deaths (2 LAO and 2 open).


CONCLUSIONS
The IDEAL framework is a feasible method for documenting the development and implementation of a procedure. MIO should now be compared with open surgery in a randomized controlled trial (IDEAL stage 3).
Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK. j.m.blazeby@bristol.ac.uk
J M
JM
Blazeby
N S
NS
Blencowe
D R
DR
Titcomb
C
C
Metcalfe
A D
AD
Hollowood
C P
CP
Barham
D000230:Adenocarcinoma / Q000188:drug therapy / Q000601:surgery*; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D004059:Diffusion of Innovation; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013531:Surgicenters