title: Overcoming challenges in implementing a minimally invasive esophagectomy program at a Veterans Administration medical center.
abstract: BACKGROUND
  Minimally invasive esophagectomy (MIE) is a technically demanding procedure that requires expertise in laparoscopy and esophageal surgery. The authors hypothesized that the safe and effective development of such a program could be performed at a Veterans Administration health care system using existing faculty members.
  
  
  METHODS
  Length of stay, operative factors, and morbidity and mortality of patients undergoing MIE from December 2007 to August 2009 were reviewed.
  
  
  RESULTS
  Eighteen consecutive patients underwent planned MIE. They were all men, with a median age of 60 years (range, 43-69 years) and a median American Society of Anesthesiologists score of 3. Eighty-three percent were able to undergo MIE resection. Eighty-nine percent of patients received neoadjuvant therapy. The median operative duration was 420 minutes (range, 300-480 minutes). There was 1 death within 30 days because of a pulmonary embolus and 1 anastomotic leak. Three patients had postoperative pneumonias. The median and mean length of stay were 10 and 13 days, respectively (range, 6-50 days). Negative margins were achieved in all patients. The mean number of lymph nodes resected was 15 (range, 6-30).
  
  
  CONCLUSIONS
  The development of an MIE program is feasible at a Veterans Administration hospital when combining the expertise of minimally invasive and esophageal surgeons.
authors.affiliation: Department of Surgery, University of Florida College of Medicine, Gainesville, USA.
authors.forename: George
authors.initials: G
authors.lastname: Rossidis
authors.forename: Nicole
authors.initials: N
authors.lastname: Kissane
authors.forename: Steve N
authors.initials: SN
authors.lastname: Hochwald
authors.forename: William
authors.initials: W
authors.lastname: Zingarelli
authors.forename: George
authors.initials: G
authors.lastname: Sarosi
authors.forename: Kfir
authors.initials: K
authors.lastname: Ben-David
mesh_terms: D000328:Adult; D000368:Aged; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000193:education* / Q000379:methods*; D005240:Feasibility Studies; D006078:Government Programs; D006284:Health Plan Implementation; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000193:education*; D016730:Program Development; D014481:United States