40
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Pituitary society expert Delphi consensus: operative workflow in endoscopic transsphenoidal pituitary adenoma resection

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Purpose

          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.

          Related collections

          Most cited references46

          • Record: found
          • Abstract: not found
          • Article: not found

          The Delphi method as a research tool: an example, design considerations and applications

            Bookmark
            • Record: found
            • Abstract: found
            • Article: found

            Elective surgery cancellations due to the COVID ‐19 pandemic: global predictive modelling to inform surgical recovery plans

            Background The COVID‐19 pandemic has disrupted routine hospital services globally. This study estimated the total number of adult elective operations that would be cancelled worldwide during the 12 weeks of peak disruption due to COVID‐19. Methods A global expert‐response study was conducted to elicit projections for the proportion of elective surgery that would be cancelled or postponed during the 12 weeks of peak disruption. A Bayesian beta‐regression model was used to estimate 12‐week cancellation rates for 190 countries. Elective surgical case‐mix data, stratified by specialty and indication (cancer versus benign surgery), was determined. This case‐mix was applied to country‐level surgical volumes. The 12‐week cancellation rates were then applied to these figures to calculate total cancelled operations. Results The best estimate was that 28,404,603 operations would be cancelled or postponed during the peak 12 weeks of disruption due to COVID‐19 (2,367,050 operations per week). Most would be operations for benign disease (90.2%, 25,638,922/28,404,603). The overall 12‐week cancellation rate would be 72.3%. Globally, 81.7% (25,638,921/31,378,062) of benign surgery, 37.7% (2,324,069/6,162,311) of cancer surgery, and 25.4% (441,611/1,735,483) of elective Caesarean sections would be cancelled or postponed. If countries increase their normal surgical volume by 20% post‐pandemic, it would take a median 45 weeks to clear the backlog of operations resulting from COVID‐19 disruption. Conclusions A very large number of operations will be cancelled or postponed due to disruption caused by COVID‐19. Governments should mitigate against this major burden on patients by developing recovery plans and implementing strategies to safely restore surgical activity. This article is protected by copyright. All rights reserved.
              Bookmark
              • Record: found
              • Abstract: not found
              • Article: not found

              Delphi methodology in health research: how to do it?

                Bookmark

                Author and article information

                Contributors
                hani.marcus@ucl.ac.uk
                Journal
                Pituitary
                Pituitary
                Pituitary
                Springer US (New York )
                1386-341X
                1573-7403
                6 July 2021
                6 July 2021
                : 1-15
                Affiliations
                [1 ]GRID grid.436283.8, ISNI 0000 0004 0612 2631, Division of Neurosurgery, , National Hospital for Neurology and Neurosurgery, ; London, UK
                [2 ]GRID grid.83440.3b, ISNI 0000000121901201, Wellcome/EPSRC Centre for Interventional and Surgical Sciences, , University College London, ; London, UK
                [3 ]GRID grid.8348.7, ISNI 0000 0001 2306 7492, Department of Neurosurgery, , John Radcliffe Hospital, ; Oxford, UK
                [4 ]GRID grid.411668.c, ISNI 0000 0000 9935 6525, Department of Neurosurgery, , University Hospital Erlangen, ; Erlangen, Germany
                [5 ]GRID grid.5288.7, ISNI 0000 0000 9758 5690, Department of Neurosurgery, , Oregon Health & Science University, ; Portland, USA
                [6 ]GRID grid.52996.31, ISNI 0000 0000 8937 2257, Department of Uro-Oncology, , University College London Hospitals NHS Foundation Trust, ; London, UK
                [7 ]GRID grid.5288.7, ISNI 0000 0000 9758 5690, Departments of Medicine (Endocrinology), , Oregon Health & Science University, ; Portland, USA
                [8 ]GRID grid.24029.3d, ISNI 0000 0004 0383 8386, Division of Clinical Endocrinology & NIHR Cambridge Biomedical Research Centre, , Cambridge University Hospitals NHS Foundation Trust, ; Cambridge, UK
                [9 ]GRID grid.5335.0, ISNI 0000000121885934, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, ; Cambridge, UK
                [10 ]GRID grid.414315.6, ISNI 0000 0004 0617 6058, Department of Neurosurgery, , National Neurosurgical Centre, Beaumont Hospital, ; Dublin, Ireland
                [11 ]GRID grid.32224.35, ISNI 0000 0004 0386 9924, Department of Neurosurgery, , Massachusetts General Hospital, Harvard Medical School, ; Boston, USA
                [12 ]GRID grid.50956.3f, ISNI 0000 0001 2152 9905, Department of Neurosurgery and Pituitary Center, Cedars-Sinai Medical Center, ; Los Angeles, USA
                [13 ]GRID grid.15496.3f, Department of Neurosurgery, , San Raffaele University Health Institute Milan, ; Milan, Italy
                [14 ]GRID grid.10698.36, ISNI 0000000122483208, Department of Neurosurgery, , University of North Carolina at Chapel Hill, ; Chapel Hill, North Carolina USA
                [15 ]GRID grid.10698.36, ISNI 0000000122483208, Department of Medicine (Endocrinology), , University of North Carolina at Chapel Hill, ; Chapel Hill, North Carolina USA
                [16 ]GRID grid.5386.8, ISNI 000000041936877X, Department of Neurosurgery, , Weill Medical College of Cornell University, ; New York, USA
                [17 ]GRID grid.416126.6, ISNI 0000 0004 0641 6031, Department of Neurosurgery, , Royal Hallamshire Hospital & Sheffield Children’s Hospital, ; Sheffield, UK
                [18 ]GRID grid.413124.1, ISNI 0000 0004 1784 5448, Department of Neurosurgery, , Hospital Pablo Tobon Uribe and Clinica Medellin—Grupo Quirónsalud, ; Medellin, Colombia
                [19 ]GRID grid.415490.d, ISNI 0000 0001 2177 007X, Department of Neurosurgery, , Queen Elizabeth Hospital Birmingham, ; Birmingham, UK
                [20 ]GRID grid.6572.6, ISNI 0000 0004 1936 7486, Institute of Metabolism and Systems Research, , University of Birmingham, ; Birmingham, UK
                [21 ]GRID grid.416201.0, ISNI 0000 0004 0417 1173, Department of Neurosurgery, , Southmead Hospital Bristol, ; Bristol, UK
                [22 ]Department of Neurosurgery, St Vincent’s Public and Private Hospitals, Sydney, Australia
                [23 ]GRID grid.42505.36, ISNI 0000 0001 2156 6853, Department of Neurosurgery, , University of Southern California, ; Los Angeles, California USA
                [24 ]GRID grid.62560.37, ISNI 0000 0004 0378 8294, Department of Neurosurgery, , Brigham and Women’s Hospital, ; BTM 4, 60 Fenwood Road, Boston, USA
                Author information
                http://orcid.org/0000-0001-8000-392X
                Article
                1162
                10.1007/s11102-021-01162-3
                8259776
                34231079
                df3d0643-eb5c-412f-8a9d-88ad6a5be958
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 9 June 2021
                Categories
                Article

                Medicine
                endoscopic transsphenoidal surgery,endoscopic endonasal,skull base surgery,pituitary adenoma,pituitary,consensus,delphi

                Comments

                Comment on this article

                scite_
                0
                0
                0
                0
                Smart Citations
                0
                0
                0
                0
                Citing PublicationsSupportingMentioningContrasting
                View Citations

                See how this article has been cited at scite.ai

                scite shows how a scientific paper has been cited by providing the context of the citation, a classification describing whether it supports, mentions, or contrasts the cited claim, and a label indicating in which section the citation was made.

                Similar content344

                Cited by21

                Most referenced authors800