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Generating Operative Workflows for Vestibular Schwannoma Resection: A Two-Stage Delphi's Consensus in Collaboration with the British Skull Base Society. Part 1: The Retrosigmoid Approach.

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 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.

SUBMITTER: Layard Horsfall H

PROVIDER: S-EPMC10477012 | biostudies-literature | 2023 Oct

REPOSITORIES: biostudies-literature

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Generating Operative Workflows for Vestibular Schwannoma Resection: A Two-Stage Delphi's Consensus in Collaboration with the British Skull Base Society. Part 1: The Retrosigmoid Approach.

Layard Horsfall Hugo H Khan Danyal Z DZ Collins Justin J Cooke Stephen S Freeman Simon R SR Gurusinghe Nihal N Hampton Susie S Hardwidge Carl C Irving Richard R Kitchen Neil N King Andrew A Khalil Sherif S Koh Chan H CH Leonard Colin C Marcus Hani J HJ Muirhead William W Obholzer Rupert R Pathmanaban Omar O Robertson Iain J A IJA Shapey Jonathan J Stoyanov Danail D Teo Mario M Tysome James R JR Saeed Shakeel R SR Grover Patrick P

Journal of neurological surgery. Part B, Skull base 20221010 5

<b>Objective</b> 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. <b>Methods</b> A mixed-method consensus process of literature review, small-group Delphi's c ...[more]

PMID: 37671298

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Project description:Objective Patient positioning is a matter of ongoing debate in the surgical treatment of vestibular schwannoma (VS). Main endpoints of this discussion are preservation of facial nerve functioning, extent of resection, and complications. In this meta-analysis, we aim to investigate the impact of patient positioning on VS surgery via the retrosigmoid approach. Methods We searched for eligible comparative trials on PubMed, Cochrane library, and Web of Science. Positioning groups were compared regarding facial nerve outcome, extent of resection, postoperative hydrocephalus, postoperative CSF leaks, perioperative venous air embolism, and perioperative mortality. Two groups of positions were defined, and the following positions were allocated to those groups: (1) Semi-sitting and Sitting-position; (2) Lateral position, supine position with extensive head rotation, lateral oblique (=Fukushima/Three-quarter prone), and park-bench position. Results From 374 full-text screenings, 7 studies met the criteria and were included in our meta-analysis comprising 1640 patients. Our results demonstrate a significantly better long-term (≥6 months) outcome of the facial nerve after VS surgery in the semi-sitting positioning (OR: 1.49, 95%CI: 1.03-2.15, p = 0.03). Positioning did not influence the extent of resection, rate of postoperative CSF leaks, and the presence of a postoperative hydrocephalus. Overall incidence of venous air embolisms was significantly associated with VS surgery in sitting positioning (OR: 6.77, 95% CI: 3.66-12.54, p < 0.00001). Perioperative mortality was equal among both positioning groups. Conclusion Semi-sitting positioning seems to be associated with an improved facial nerve outcome after VS surgery via the retrosigmoid approach. Venous air embolisms are significantly more often observed among VS patients who underwent surgery in the sitting position, but the perioperative mortality is equal in both positioning groups. Both positioning groups are a safe procedure. Multicentric prospective randomized trials are needed to evaluate the risk-benefit ratio of each positioning in VS surgery via the retrosigmoid approach. Graphical Abstract

Project description:To ascertain attitudes to resourcing, collaboration and publication in toxicology, a survey was developed and distributed to British Toxicology Society (BTS) members. The survey comprised 14 questions with 5 response options (strongly agree; agree; conflicted; disagree; strongly disagree) and a free text box. One hundred completed surveys were received by the cut-off date for data analysis. Unsurprisingly, 60% of participants disagreed or strongly disagreed that toxicology research is adequately funded in the UK; only 12% agreed with this statement. A similar proportion of participants (53%) disagreed with the statement that funding councils give equal opportunity to toxicology whereas 31% were conflicted on this point. An overwhelming 97% of respondents agreed that collaboration is important in driving toxicology research whereas only 38% agreed that competition is important. When this question was broadened out beyond the discipline of toxicology, a similar profile was seen suggesting that participants held similar views on toxicology versus other types of research. Many respondents were conflicted regarding the role of competition both in toxicology and in other research disciplines. Free text comments suggested that some competition is good to drive quality but can be counterproductive when competing for limited resources. Most participants were in favour of making toxicology research data openly available (86%) and in favour of open access publication (89%) although there were reservations about the cost of open access. Many (60%) thought the current system of peer review is fair but 65% also supported the idea of double-blind peer review (where both reviewer and author are anonymized). Others suggested a step in the opposite direction towards increased transparency (revealing and holding reviewers to account) would be preferable. Overall, there was a broad theme in free text responses that the need for experienced toxicologists has increased at a time when training and investment in the discipline has declined. However, not all respondents held that view with some noting that toxicology both as a research and as an applied discipline is strong within the UK scientific community.

Dataset Information

Generating Operative Workflows for Vestibular Schwannoma Resection: A Two-Stage Delphi's Consensus in Collaboration with the British Skull Base Society. Part 1: The Retrosigmoid Approach.

Publications

Generating Operative Workflows for Vestibular Schwannoma Resection: A Two-Stage Delphi's Consensus in Collaboration with the British Skull Base Society. Part 1: The Retrosigmoid Approach.

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