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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 2: The Translabyrinthine Approach
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 2, we present a codified operative workflow for the translabyrinthine 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 Seventeen consultant skull base surgeons (nine neurosurgeons and eight ENT [ear, nose, and throat]) with median of 13.9 years of experience (interquartile range: 18.1 years) of independent practice participated. There was a 100% response rate across both the Delphi rounds. The translabyrinthine approach had the following five phases and 57 unique steps: Phase 1, approach and exposure; Phase 2, mastoidectomy; Phase 3, internal auditory canal and dural opening; Phase 4, tumor debulking and excision; and Phase 5, closure.
Conclusion We present Part 2 of a national, multicenter, consensus-derived, codified operative workflow for the translabyrinthine approach to vestibular schwannomas. The five phases contain the operative, steps, instruments, technique errors, and event errors. The codified translabyrinthine approach presented in this manuscript can serve as foundational research for future work, such as the application of artificial intelligence to vestibular schwannoma resection and comparative surgical research.
Keywordsretrosigmoid - translabyrinthine - vestibular schwannoma - skull base surgery - consensus - Delphi
This work has not been presented, either partly or wholly.
Study conception and methodology was led by H.J.M., J.C., M.F., M.G., D.Z.K., C.H.K., H.L.H. and W.M. Material preparation, data collection and analysis were performed by H.L.H., D.Z.K., J.C., S.C., S.R.F., N.G., S.H., C.H., R.I., N.K., A.K., S.K., C.H.K., C.L., H.J.M., W.M., R.O., O.P., I.J.A.R., J.S., D.S., M.T., J.R.T., S.R.S., and P.G. contributed to data collection. The first draft of the manuscript was written by H.L.H., H.J.M., and P.G. All authors reviewed and edited subsequent versions of the manuscript. All authors read and approved the final manuscript.
Ethical and Informed Consent
Ethical approval and informed consent were unnecessary due to the nature of the study (consensus process amongst health care professionals).
Available upon reasonable request.
* Denotes joint senior authorship.
Received: 03 March 2022
Accepted: 20 June 2022
Article published online:
10 October 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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