@article{1df610358517408493f93ea507b3c2cf,
title = "Pituitary society expert Delphi consensus: operative workflow in endoscopic transsphenoidal pituitary adenoma resection",
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.",
keywords = "Consensus, Delphi, Endoscopic endonasal, Endoscopic transsphenoidal surgery, Pituitary, Pituitary adenoma, Skull base surgery",
author = "Marcus, {Hani J.} and Khan, {Danyal Z.} and Anouk Borg and Michael Buchfelder and Cetas, {Justin S.} and Collins, {Justin W.} and Dorward, {Neil L.} and Maria Fleseriu and Mark Gurnell and Mohsen Javadpour and Jones, {Pamela S.} and Koh, {Chan Hee} and {Layard Horsfall}, Hugo and Mamelak, {Adam N.} and Pietro Mortini and William Muirhead and Oyesiku, {Nelson M.} and Schwartz, {Theodore H.} and Saurabh Sinha and Danail Stoyanov and Syro, {Luis V.} and Georgios Tsermoulas and Adam Williams and Winder, {Mark J.} and Gabriel Zada and Laws, {Edward R.}",
note = "Funding Information: This manuscript on behalf of the Professional Education Committee of the Pituitary Society, with special thanks to Pouneh K. Fazeli (Neuroendocrinology Unit, Division of Endocrinology and Metabolism, University of Pittsburgh, Pittsburgh, PA USA), Susana M. Mallea-Gil (Division de Endocrinolog{\'i}a, Hospital Militar Central, Buenos Aires, Argentina), Ann McCormack (Department of Endocrinology, St Vincent{\textquoteright}s Hospital, and Garvan Institute of Medical Research, Sydney, Australia), Maria M. Pineyro (Facultad de Medicina, Hospital de Cl{\'i}nicas, Cl{\'i}nica de Endocrinolog{\'i}a Y Metabolismo, Universidad de La Rep{\'u}blica, Montevideo, Uruguay), Nicholas A. Tritos (Neuroendocrine Unit and Neuroendocrine and Pituitary Tumor Clinical Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA). HJM, DZK, CHK, HLH, WM are supported by the Wellcome (203145Z/16/Z) EPSRC (NS/A000050/1) Centre for Interventional and Surgical Sciences, University College London. HJM is also funded by the NIHR Biomedical Research Centre at University College London. MG is supported by the NIHR Cambridge Biomedical Research Centre. JWC receives research grants and consultancy fees from Medtronic (Dublin, Ireland). JWC is the associate medical director of CMR surgical (Cambridge, UK). DS is a shareholder in Odin Vision Ltd (London, UK) and is an employee of Digital Surgery (London, UK). This research was funded in whole, or in part, by the Wellcome Trust [203145Z/16/Z]. For the purpose of Open Access, the authors have applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. Funding Information: This manuscript on behalf of the Professional Education Committee of the Pituitary Society, with special thanks to Pouneh K. Fazeli (Neuroendocrinology Unit, Division of Endocrinology and Metabolism, University of Pittsburgh, Pittsburgh, PA USA), Susana M. Mallea-Gil (Division de Endocrinolog{\'i}a, Hospital Militar Central, Buenos Aires, Argentina), Ann McCormack (Department of Endocrinology, St Vincent{\textquoteright}s Hospital, and Garvan Institute of Medical Research, Sydney, Australia), Maria M. Pineyro (Facultad de Medicina, Hospital de Cl{\'i}nicas, Cl{\'i}nica de Endocrinolog{\'i}a Y Metabolismo, Universidad de La Rep{\'u}blica, Montevideo, Uruguay), Nicholas A. Tritos (Neuroendocrine Unit and Neuroendocrine and Pituitary Tumor Clinical Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA). HJM, DZK, CHK, HLH, WM are supported by the Wellcome (203145Z/16/Z) EPSRC (NS/A000050/1) Centre for Interventional and Surgical Sciences, University College London. HJM is also funded by the NIHR Biomedical Research Centre at University College London. MG is supported by the NIHR Cambridge Biomedical Research Centre. JWC receives research grants and consultancy fees from Medtronic (Dublin, Ireland). JWC is the associate medical director of CMR surgical (Cambridge, UK). DS is a shareholder in Odin Vision Ltd (London, UK) and is an employee of Digital Surgery (London, UK). This research was funded in whole, or in part, by the Wellcome Trust [203145Z/16/Z]. For the purpose of Open Access, the authors have applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. Publisher Copyright: {\textcopyright} 2021, The Author(s).",
year = "2021",
month = dec,
doi = "10.1007/s11102-021-01162-3",
language = "English (US)",
volume = "24",
pages = "839--853",
journal = "Pituitary",
issn = "1386-341X",
publisher = "Kluwer Academic Publishers",
number = "6",
}