title: Short-term outcomes and one surgeon's learning curve for thoracoscopic esophagectomy performed with the patient in the prone position.
abstract: OBJECTIVE
  Thoracoscopic esophagectomy with the patient in the prone position (TEP) is now being performed as minimally invasive esophagectomy for esophageal cancer. This study examines the short-term outcomes and the learning curve associated with TEP.
  
  
  METHODS
  One surgeon ("Surgeon A") performed TEP on 100 consecutive patients assigned to three periods based on treatment order. Each group consisted of 33 or 34 patients. The outcomes of the three groups were compared to define the influence of surgeon expertise.
  
  
  RESULTS
  Outcomes improved as Surgeon A gained experience in performing this operation, as evidenced by reduced thoracic operative times between periods 1 and 2, and then between periods 2 and 3 (p = 0.0033 and p = 0.0326, respectively); an increased number of retrieved chest nodes between periods 1 and 2 (p = 0.0070); and a decline in recurrent laryngeal nerve (RLN) palsy between periods 2 and 3 (p = 0.0450). Period 2 was the pivotal period for each learning curve.
  
  
  CONCLUSIONS
  An individual surgeon's learning curve over the course of 100 TEP procedures had three outcomes: a shortened operative time, a higher number of retrieved chest nodes, and a decreased rate of RLN palsy. Approximately 30-60 cases were needed to reach a plateau in the TEP procedure and a reduction in the morbidity rate.
authors.affiliation: Department of Gastroenterological Surgery, Hyogo Cancer Center, 13-70, Kitaoji-cho, Akashi, Hyogo, 673-8558, Japan. oshikiri@med.kobe-u.ac.jp.|Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan. oshikiri@med.kobe-u.ac.jp.
authors.forename: Taro
authors.initials: T
authors.lastname: Oshikiri
authors.affiliation: Department of Gastroenterological Surgery, Hyogo Cancer Center, 13-70, Kitaoji-cho, Akashi, Hyogo, 673-8558, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yasuda
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hasegawa
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Kanaji
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
authors.forename: Kimihiro
authors.initials: K
authors.lastname: Yamashita
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
authors.forename: Takeru
authors.initials: T
authors.lastname: Matsuda
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Sumi
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
authors.forename: Tetsu
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Department of Gastroenterological Surgery, Hyogo Cancer Center, 13-70, Kitaoji-cho, Akashi, Hyogo, 673-8558, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujino
authors.affiliation: Department of Gastroenterological Surgery, Hyogo Cancer Center, 13-70, Kitaoji-cho, Akashi, Hyogo, 673-8558, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tominaga
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kakeji
mesh_terms: D000368:Aged; D002983:Clinical Competence; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000193:education* / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D007858:Learning / Q000502:physiology*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D016684:Prone Position / Q000502:physiology*; D066231:Surgeons / Q000193:education* / Q000523:psychology*; D013906:Thoracoscopy / Q000193:education* / Q000379:methods* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000453:epidemiology / Q000517:prevention & control
keywords: Learning curve; Short-term outcome; Thoracoscopic esophagectomy in the prone position