Endoscopic endonasal transsphenoidal surgery: implementation of an operative and perioperative checklist

Abstract

<jats:p>Endoscopic endonasal surgery relies heavily on specialized operative instrumentation and optimization of endocrinological and other critical adjunctive intraoperative factors. Several studies and worldwide initiatives have previously established that intraoperative and perioperative surgical checklists can minimize the incidence of and prevent adverse events. The aim of this article was to outline some of the most common considerations in the perioperative and intraoperative preparation for endoscopic endonasal transsphenoidal surgery. The authors implemented and prospectively evaluated a customized checklist at their institution in 25 endoscopic endonasal operations for a variety of sellar and skull base pathological entities. Although no major errors were detected, near misses pertaining primarily to missing components of surgical equipment or instruments were identified in 9 cases (36%). The considerations in the checklist provided in this article can serve as a basic template for further customization by centers performing endoscopic endonasal surgery, where their application may reduce the incidence of adverse or preventable errors associated with surgical treatment of sellar and skull base lesions.</jats:p>

Perioperative management in endoscopic endonasal skull‐base surgery: a survey of the North American Skull Base Society

“…In terms of preoperative practices, while most practitioners used preoperative IV antibiotics and prepared for intraoperative bleeding with at least a type and screen, there was significant variation in most other practice parameters. Only 1 in 3 and 1 in 4 of participants reported never using intranasal or facial preparation prior to surgery, respectively, despite the lack of any evidence in support of their use for prevention of postoperative infections and their lack of inclusion in previously published surgical checklists for endoscopic anterior cranial base surgery . Approximately 1 in 3 of respondents do not employ any head of bed elevation, although there is evidence from a double‐blind randomized controlled trial that a 20‐degree elevation of the head may improve visualization of the surgical field and decrease blood loss in endoscopic endonasal surgery .…”

“ABCDEF Checklist" based on 3D radiological images for preoperative planning of endoscopic sinus surgery

“…The finding of failed surgeries and the persistence and recurrence of sinonasal diseases after ESS due to causes attributable to the surgeon (19,20) , repeatedly raises the need for support toward the radiological location of anatomical landmarks and their inter-relations oriented to the preoperative planning of surgery, despite knowledge of the advantages of navigation during image-guided surgery (21) . Checklists based on the standardization and systematization of the evaluation by radiological images in 2D have translated into a reduction of complications in between 8% and 19% of the neurosurgical approaches (22) , and an improvement of 36% in the rate of foreseeable failures associated with the ESS treatment of the sellar region and the skull base (23,24) . Even so, checklists have not prevented ESS from unsatisfactory outcomes, such surgeries constituting one of the main sources of legal demands in otolaryngology (25,26) .…”

Measurement of Intraoperative Blood Loss in Minimally Invasive Neurosurgery

“…Usually there are various instrumentations used in the endoscopic technique such as the endoscope, the fiber optic cable, the light source, the camera, the monitor and the video recording system [5]. EET surgery procedures are only performed by expert surgeons with the help of an operative and perioperative checklist [6] as it is a relatively new technique and involves two complicated processes. Beginning with the sphenoid sinus approaching process, it is then followed by the tumor elimination process.…”