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1部分中,我们介绍了乙状结肠后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,随后是全国德尔福的共识,与英国头骨基地协会(BSBS)合作进行。重复每个Delphi轮,直到数据饱和并达成超过90%的共识。结果18名顾问颅底外科医生(10名神经外科医生和8名ENT[耳,鼻子,和喉咙])的独立实践经验中位数为17.9年(四分位数范围:17.5年)。德尔福的两轮都有100%的回复率。乙状结肠后入路的手术工作流程包括三个阶段和40个独特步骤,如下所示:第一阶段,入路和暴露;第二阶段,肿瘤减积和切除;第三阶段,闭合。对于乙状窦后入路,技术,还描述了每个操作步骤的事件错误。结论我们介绍了一个国家的第一部分,多中心,达成共识,乙状结肠后入路前庭神经鞘瘤的编码手术工作流程,包括阶段,steps,仪器,技术错误,和事件错误。本手稿中提出的编码的乙状结肠方法可以作为未来工作的基础研究,如手术工作流程分析或神经外科模拟和教育。
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 1, we present a codified operative workflow for the
retrosigmoid 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 Eighteen consultant skull base surgeons (10 neurosurgeons and 8 ENT [ear, nose, and throat]) with median 17.9 years of experience (interquartile range: 17.5 years) of independent practice participated. There was a 100% response rate across both Delphi\'s rounds. The operative workflow for the
retrosigmoid approach contained three phases and 40 unique steps as follows: phase 1, approach and exposure; phase 2, tumor debulking and excision; phase 3, closure. For the
retrosigmoid approach, technique, and event error for each operative step was also described. Conclusion We present Part 1 of a national, multicenter, consensus-derived, codified operative workflow for the
retrosigmoid approach to vestibular schwannomas that encompasses phases, steps, instruments, technique errors, and event errors. The codified
retrosigmoid approach presented in this manuscript can serve as foundational research for future work, such as operative workflow analysis or neurosurgical simulation and education.