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 compartmentalises 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 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 consensus, followed by a national Delphi consensus was performed in collaboration with British Skull Base Society (BSBS). Each Delphi round was repeated until data saturation and over 90% consensus was reached. Results Eighteen consultant skull base surgeons (10 neurosurgeons; 8 ENT) with median 17.9 years of experience (IQR 17.5 years) of independent practice participated. There was a 100% response rate across both Delphi rounds. The operative workflow for the retrosigmoid approach contained 3 phases and 40 unique steps: Phase 1: approach and exposure; Phase 2: tumour debulking and excision; Phase 3: closure. For the retrosigmoid approach, technique and event error for each operative step was also described. Conclusions We present Part 1 of a national, multi-centre, consensus-derived codified operative workflow for the retrosigmoid and 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.

Generating Operative Workflows for Vestibular Schwannoma Resection: A Two-Stage Delphi's Consensus in Collaboration with the British Skull Base Society. Part 2: The Translabyrinthine Approach

“…The translabyrinthine approach contains two more phases and 19 more steps than the retrosigmoid approach. 1 …”

“…The methodology was drawn from previous work from our group and was completed in parallel to the retrosigmoid operative workflow generation 1 6 . This process aimed to generate a comprehensive workflow framework which captured how each approach could reasonably be performed.…”

“…1 Schematic diagram of Delphi's process, highlighting the generation of a surgical workflow through iterative consensus from British Skull Base Society expert members. 1 Adapted from Marcus et al 7 …”

“…In Part 1 of this series we generated, through expert Delphi's consensus, a codified operative workflow for the retrosigmoid approach to vestibular schwannoma 1 . An operative workflow systematically deconstruct complex procedures into defined tasks and errors.…”