title: Thoracoscopic repair of esophageal atresia with tracheoesophageal fistula: overcoming the learning curve.
abstract: OBJECTIVE
  We describe our initial experience of thoracoscopic esophageal atresia with distal tracheoesophageal fistula (EA/TEF) repair.
  
  
  METHODS
  Twenty-three consecutive cases of thoracoscopic repair of EA/TEF were performed between October 2008 and March 2013. The medical records of 22 patients were retrospectively reviewed, excluding one case of early postoperative mortality.
  
  
  RESULTS
  The study period was divided into two sections: from 2008 to 2011 (13 cases) and from 2012 to 2013 (9 cases). Patient characteristics did not differ between the two study periods. Mean operation time was significantly shorter in period 2 compared to period 1 (p<0.01). There was one case that was converted to open repair via thoracotomy during period 1. Anastomosis leakage was seen in two cases during period 1, while no cases of leakage were encountered in period 2. Ten of 13 cases (76.9 %) in period 1 had clinically significant esophageal strictures requiring one or more sessions of balloon dilatations. No cases of esophageal strictures were seen in period 2 (p<0.01).
  
  
  CONCLUSIONS
  When the initial learning curve was endured, surgical outcomes of thoracoscopic repair of EA/TEF were superior to the outcomes of earlier cases, and comparable to past experiences with open thoracotomy.
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Sanghoon
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Suk-Koo
authors.initials: SK
authors.lastname: Lee
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address: jm0815.seo@samsung.com.
authors.forename: Jeong-Meen
authors.initials: JM
authors.lastname: Seo
mesh_terms: D057868:Anastomotic Leak / Q000453:epidemiology; D004933:Esophageal Atresia; D004940:Esophageal Stenosis / Q000601:surgery; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D059032:Learning Curve; D008297:Male; D061646:Operative Time; D012189:Retrospective Studies; D013906:Thoracoscopy; D013908:Thoracotomy; D014138:Tracheoesophageal Fistula / Q000601:surgery*; D016896:Treatment Outcome
keywords: Esophageal atresia; Minimally invasive; Thoracoscopy; Tracheoesophageal fistula