目的:手术工作流程分析旨在系统地将手术分解为分层组成部分。它促进了教育,培训,以及对手术变异的理解。在内镜经蝶入路垂体腺瘤的手术实践中,有已知的教育需求和变化。通过一个迭代的共识过程,我们生成了反映当代外科实践的外科工作流程。
方法:在垂体学会内进行了由文献综述和迭代德尔菲调查组成的混合方法共识过程。重复每一轮的调查,直到数据饱和和>90%的共识达成。
结果:在两个Delphi回合中均有100%的响应率和无减员。18名国际专家小组成员参加了会议。4个阶段的广泛工作流程(鼻,蝶骨,sellar和closure)和40个步骤,与相关的技术错误和不良事件,由100%的小组成员在一轮回合中达成一致。捕获了手术步骤中的核心和病例特异性或外科医生特异性变化。
结论:通过国际专家小组共识,已经制定了内镜经蝶入路垂体腺瘤切除术的工作流程.此工作流程捕获了广泛的当代操作实践。商定的“核心”步骤将作为教育的基础,培训,评估和技术开发(如模型和模拟器)。“可选”步骤强调了将从进一步研究中受益的实践异质性领域(例如颅底修复方法)。可以进行进一步的调整,以增加世界各地的适用性。
OBJECTIVE: Surgical workflow analysis seeks to systematically break down operations into hierarchal components. It facilitates education, training, and understanding of surgical variations. There are known educational demands and variations in surgical practice in endoscopic transsphenoidal approaches to pituitary adenomas. Through an iterative
consensus process, we generated a surgical workflow reflective of contemporary surgical practice.
METHODS: A mixed-methods
consensus process composed of a literature review and iterative Delphi surveys was carried out within the Pituitary Society. Each round of the survey was repeated until data saturation and > 90%
consensus was reached.
RESULTS: There was a 100% response rate and no attrition across both Delphi rounds. Eighteen international expert panel members participated. An extensive workflow of 4 phases (nasal, sphenoid, sellar and closure) and 40 steps, with associated technical errors and adverse events, were agreed upon by 100% of panel members across rounds. Both core and case-specific or surgeon-specific variations in operative steps were captured.
CONCLUSIONS: Through an international expert panel
consensus, a workflow for the performance of endoscopic transsphenoidal pituitary adenoma resection has been generated. This workflow captures a wide range of contemporary operative practice. The agreed \"core\" steps will serve as a foundation for education, training, assessment and technological development (e.g. models and simulators). The \"optional\" steps highlight areas of heterogeneity of practice that will benefit from further research (e.g. methods of skull base repair). Further adjustments could be made to increase applicability around the world.