. 2021 Dec;24(6):839-853.

doi: 10.1007/s11102-021-01162-3. Epub 2021 Jul 6.

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

Hani J Marcus^#^{1

2}, Danyal Z Khan^#^{3

4}, Anouk Borg⁵, Michael Buchfelder⁶, Justin S Cetas⁷, Justin W Collins⁸, Neil L Dorward³, Maria Fleseriu^{7

9}, Mark Gurnell^{10

11}, Mohsen Javadpour¹², Pamela S Jones¹³, Chan Hee Koh^{3

4}, Hugo Layard Horsfall^{3

4}, Adam N Mamelak¹⁴, Pietro Mortini¹⁵, William Muirhead^{3

4}, Nelson M Oyesiku^{16

17}, Theodore H Schwartz¹⁸, Saurabh Sinha¹⁹, Danail Stoyanov⁴, Luis V Syro²⁰, Georgios Tsermoulas^{21

22}, Adam Williams²³, Mark J Winder²⁴, Gabriel Zada²⁵, Edward R Laws²⁶

Affiliations

¹ Division of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK. hani.marcus@ucl.ac.uk.
² Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK. hani.marcus@ucl.ac.uk.
³ Division of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK.
⁴ Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK.
⁵ Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK.
⁶ Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany.
⁷ Department of Neurosurgery, Oregon Health & Science University, Portland, USA.
⁸ Department of Uro-Oncology, University College London Hospitals NHS Foundation Trust, London, UK.
⁹ Departments of Medicine (Endocrinology), Oregon Health & Science University, Portland, USA.
¹⁰ Division of Clinical Endocrinology & NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
¹¹ Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
¹² Department of Neurosurgery, National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland.
¹³ Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
¹⁴ Department of Neurosurgery and Pituitary Center, Cedars-Sinai Medical Center, Los Angeles, USA.
¹⁵ Department of Neurosurgery, San Raffaele University Health Institute Milan, Milan, Italy.
¹⁶ Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
¹⁷ Department of Medicine (Endocrinology), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
¹⁸ Department of Neurosurgery, Weill Medical College of Cornell University, New York, USA.
¹⁹ Department of Neurosurgery, Royal Hallamshire Hospital & Sheffield Children's Hospital, Sheffield, UK.
²⁰ Department of Neurosurgery, Hospital Pablo Tobon Uribe and Clinica Medellin-Grupo Quirónsalud, Medellin, Colombia.
²¹ Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
²² Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
²³ Department of Neurosurgery, Southmead Hospital Bristol, Bristol, UK.
²⁴ Department of Neurosurgery, St Vincent's Public and Private Hospitals, Sydney, Australia.
²⁵ Department of Neurosurgery, University of Southern California, Los Angeles, California, USA.
²⁶ Department of Neurosurgery, Brigham and Women's Hospital, BTM 4, 60 Fenwood Road, Boston, USA.

^# Contributed equally.

PMID: 34231079
PMCID: PMC8259776
DOI: 10.1007/s11102-021-01162-3

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

Hani J Marcus et al. Pituitary. 2021 Dec.

. 2021 Dec;24(6):839-853.

doi: 10.1007/s11102-021-01162-3. Epub 2021 Jul 6.

Authors

Affiliations

¹ Division of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK. hani.marcus@ucl.ac.uk.
² Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK. hani.marcus@ucl.ac.uk.
³ Division of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK.
⁴ Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK.
⁵ Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK.
⁶ Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany.
⁷ Department of Neurosurgery, Oregon Health & Science University, Portland, USA.
⁸ Department of Uro-Oncology, University College London Hospitals NHS Foundation Trust, London, UK.
⁹ Departments of Medicine (Endocrinology), Oregon Health & Science University, Portland, USA.
¹⁰ Division of Clinical Endocrinology & NIHR Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
¹¹ Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
¹² Department of Neurosurgery, National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland.
¹³ Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
¹⁴ Department of Neurosurgery and Pituitary Center, Cedars-Sinai Medical Center, Los Angeles, USA.
¹⁵ Department of Neurosurgery, San Raffaele University Health Institute Milan, Milan, Italy.
¹⁶ Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
¹⁷ Department of Medicine (Endocrinology), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
¹⁸ Department of Neurosurgery, Weill Medical College of Cornell University, New York, USA.
¹⁹ Department of Neurosurgery, Royal Hallamshire Hospital & Sheffield Children's Hospital, Sheffield, UK.
²⁰ Department of Neurosurgery, Hospital Pablo Tobon Uribe and Clinica Medellin-Grupo Quirónsalud, Medellin, Colombia.
²¹ Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
²² Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
²³ Department of Neurosurgery, Southmead Hospital Bristol, Bristol, UK.
²⁴ Department of Neurosurgery, St Vincent's Public and Private Hospitals, Sydney, Australia.
²⁵ Department of Neurosurgery, University of Southern California, Los Angeles, California, USA.
²⁶ Department of Neurosurgery, Brigham and Women's Hospital, BTM 4, 60 Fenwood Road, Boston, USA.

^# Contributed equally.

PMID: 34231079
PMCID: PMC8259776
DOI: 10.1007/s11102-021-01162-3

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.

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Conflict of interest statement

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Figures

**Fig. 1**
Schematic diagram of Delphi process – highlighting the generation of a surgical workflow through iterative consensus from Pituitary Society expert members

See this image and copyright information in PMC

References

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical