A research agenda for the European Association for Endoscopic Surgeons (EAES)

Abstract

Introduction

The European Association of Endoscopic Surgeons (EAES) conducted this study aiming to identify the top research questions which are relevant to surgeons in Minimal Access Surgery (MAS). This is in order to promote and link research questions to the current clinical practice in MAS in Europe.

Methods

Using a systematic methodology, (modified Delphi), the EAES members and leadership teams were surveyed to obtain consensus on the top research priorities in MAS. The responses were categorized and redistributed to the membership to rate the level of importance of each research question. The data were reported as the weighted average score with a scale from 1 (lowest agreement) to 5 (highest agreement).

Results

In total, 324 of 2580 (12.5%) of the EAES members and the leaders responded to the survey and contributed to the final consensus. The ranked responses over the 80th percentile identified 39 research priorities with rating ranged from 4.22 to 3.67. The top five highest ranking research priorities in the EAES were centered on improving training in MAS, laparoscopic surgery for benign upper gastrointestinal conditions, integration of novel technology in OR, translational and basic science research in bariatric surgery and investigating the role of MAS in rectal cancer.

Conclusion

An EAES research agenda was developed using a systematic methodology and can be used to focus MAS research. This study was commissioned by the European Association for Endoscopic Surgery (EAES).

Appendix 1: reporting on all the questions and their ranks in rounds 2 and 3

Category	Question	Weighted average round 2	Weighted average round 3
Health economics	How can the availability of MAS in low income countries be increased?	4.10	3.60
	What is the effect of volume criteria and centralization on MAS procedure?	3.83	3.56
Emergency surgery	What is the role of MAS in emergency surgery?	4.09	3.84
Training, quality and safety	How can the quality of MAS training be improved?	4.58	4.22
	How should skill acquisition in MAS be measured?	4.04	3.83
	How can MAS techniques and performance be assessed?	4.03	3.95
	How can MAS team working be improved?	3.99	3.87
Perioperative care, complications, outcome	How effective are emerging techniques for pain management in MAS?	3.61	3.44
New technology	How can new technologies be integrated in the operating room (radiology, endoscopy, ultrasound, robotics, etc.)?	4.25	4.16
	What is the impact of imaging guided surgery with near-infrared vision for different clinical situations?	3.97	3.41
	What are the benefits of new technologies for in situ ablation of the tumors?	3.97	3.74
	Will the use of 3D imaging outcome for MAS?	3.69	3.52
General or hernia surgery	What is the role of MAS for older patients?	3.91	3.71
	What is the optimum method of mesh fixation for MAS hernia repair?	3.70	3.57
Surgical oncology	What is the role of MAS following complete clinical response after neo-adjuvant chemo-radiotherapy for rectal cancer?	4.07	3.94
	What is the optimal anastomosis after total gastrectomy?	3.99	3.78
	What is the feasibility of MAS D2 gastrectomy, ensuring similar outcomes to open surgery?	3.95	3.75
	What is the role of MAS for esophageal cancer?	3.90	3.77
	What is the role of MAS following complete response after neo-adjuvant chemo-radiotherapy for oesophagogastric cancer?	3.87	3,61
	What is the role of sentinel node in gastrointestinal cancer surgery?	3.74	3.38
	What is the role of laparoscopy in intraperitoneal drug delivery?	3.59	3.33
Colorectal	What is the role of MAS for management of colorectal cancer with liver metastasis?	4.04	3.79
	What is the role of transanal total mesorectal excision for rectal cancer?	4.03	3.87
	What is the role of MAS lavage in Hinchey 2 and 3 diverticulitis	3.93	3.74
	What is the optimum method for prevention or treatment for parastomal hernia?	3.87	3.73
	What is the role of total mesorectal excision in right colon cancer?	3.82	3.88
	What is the optimal MAS technique for rectal prolapse	3.80	3.81
Benign upper gastrointestinal disease	What is the best long-term therapy for gastroesophageal reflux disease: laparoscopic antireflux surgery or medical therapy?	4.17	4.17
	What is the optimal technique for repairing the crural defect in large hiatal hernia?	4.09	4.12
Bariatric surgery	What is the mechanism of action of bariatric surgery in the treatment of diabetes mellitus?	4.11	3.99
	What is the optimum technique for bariatric surgery (e.g., Roux-en-Y, gastric bypass and single anastomosis, gastric bypass plus emerging technologies)?	4.03	3.92
	How can personalized treatment for the morbid obese patient be achieved?	4.03	3.88
	Is there any role for endoluminal minimal access surgery in bariatric surgery?	3.63	3.32
Surgery of the liver and of the pancreas	How can the safety of MAS liver dissection be improved?	3.98	3.89
	What is the role of MAS in the treatment of benign liver disease?	3.75	3.77
	What is the role of MAS in management of common bile duct stones?	3.72	3.89
Pediatric surgery	What are the limitations for MAS in the pediatric population?	3.84	3.47
Patient experience	How can patient experience and quality of recovery be measured after MAS?	3.77	3.78
Basic science	What is the impact of MAS on stress response?	3.79	3.61