PDF(Pubmed)
Abstract：
Objective An operative workflow systematically compartmentalizes operations into hierarchal components of phases, steps, instrument, technique errors, and event errors. Operative workflow provides a foundation for education, training, and understanding of surgical variation. In this Part 2, we present a codified operative workflow for the translabyrinthine approach to vestibular schwannoma resection. Methods A mixed-method consensus process of literature review, small-group Delphi\'s consensus, followed by a national Delphi\'s consensus was performed in collaboration with British Skull Base Society (BSBS). Each Delphi\'s round was repeated until data saturation and over 90% consensus was reached. Results Seventeen consultant skull base surgeons (nine neurosurgeons and eight ENT [ear, nose, and throat]) with median of 13.9 years of experience (interquartile range: 18.1 years) of independent practice participated. There was a 100% response rate across both the Delphi rounds. The translabyrinthine approach had the following five phases and 57 unique steps: Phase 1, approach and exposure; Phase 2, mastoidectomy; Phase 3, internal auditory canal and dural opening; Phase 4, tumor debulking and excision; and Phase 5, closure. Conclusion We present Part 2 of a national, multicenter, consensus-derived, codified operative workflow for the translabyrinthine approach to vestibular schwannomas. The five phases contain the operative, steps, instruments, technique errors, and event errors. The codified translabyrinthine approach presented in this manuscript can serve as foundational research for future work, such as the application of artificial intelligence to vestibular schwannoma resection and comparative surgical research.
摘要：
目标手术工作流程系统地将手术划分为阶段的分层组件，steps,仪器,技术错误，和事件错误。操作工作流程为教育提供了基础，培训,以及对手术变异的理解。在第2部分中，我们介绍了经迷路入路切除前庭神经鞘瘤的编码手术工作流程。方法采用文献综述的混合方法共识过程,小组德尔菲的共识，随后与英国头骨基地协会（BSBS）合作进行了全国德尔福的共识。重复每个Delphi轮，直到数据饱和并达成超过90％的共识。结果17名顾问颅底外科医生(9名神经外科医生和8名ENT[耳，鼻子,和咽喉]）的独立实践经验中位数为13.9年（四分位间距：18.1年）。在两个德尔福回合中都有100%的应答率。经迷路入路有以下五个阶段和57个独特步骤：1期，入路和暴露；2期，乳突切除术；3期，内耳道和硬脑膜开放；4期，肿瘤切除和切除；和5期，闭合。结论我们介绍了一个国家的第二部分，多中心，达成共识，经迷路入路治疗前庭神经鞘瘤的编码手术工作流程。五个阶段包含手术，steps,仪器,技术错误，和事件错误。本手稿中提出的编纂的跨迷宫方法可以作为未来工作的基础研究，如人工智能在前庭神经鞘瘤切除术中的应用及比较外科研究。
