A Hierarchal Task Analysis for Endoscopic Resection of Pituitary Adenomas

Background: Pituitary adenomas are one of the most common skull base procedures performed by otolaryngology and neurosurgery teams. Although complications are rare, when they occur, they can be devastating to patients. The use of SHERPA (Systematic Human Error Reduction and Prediction Approach) has been used in healthcare to reduce human errors, and it is based on a hierarchical task analysis (HTA) in which the systemic details of a procedure are outlined. HTA approaches can also serve as a foundation for bimodal education. Trainees can utilize HTAs of surgical procedures to understand a global perspective and the granular steps required to perform the surgery safely. Mentors can use HTAs as an outline to provide detailed feedback to trainees so that they can improve their surgical proficiency. Moreover, HTAs can also serve as a model for deliberate practice in surgical simulation, in which trainees can gain experience in surgical procedures without putting patients at risk. To our knowledge, there have not been any published HTA approaches to pituitary adenomas outlining both the otolaryngologic and neurosurgical roles.

Aim: To develop a multidisciplinary HTA of pituitary adenoma resection that is validated by both experienced trainees and expert otolaryngologists and neurosurgeons for education and feedback.

Methods: To develop the steps of both the otolaryngologic and neurosurgical components of endoscopic resection of a pituitary tumor, a combination of literature review, surgical videos, as well as consensus from otolaryngology and neurosurgery residents, and fellowship-trained otolaryngologists and neurosurgeons were utilized. The following format was used in describing the subtasks required to reach termination of the procedure where digits denoted the hierarchy of tasks: 0. Task, 0.0 Subtask, and 0.0.0 Elementary Task. All tasks were sequential unless specified.

Results: Eleven tasks, 47 subtasks, 27 elementary tasks were necessary for endoscopic pituitary tumor resection. [Fig. 1] demonstrates a flowchart for HTA for the otolaryngologist steps, while [Fig. 2] shows the HTA predominantly for the neurosurgical steps of the operation.

Conclusion: HTA can be a valuable tool in teaching and evaluating surgical trainees with the overall goal of improving patient safety by reducing intraoperative errors.

Figure 1

Figure 2

Publication History

Article published online:
01 February 2023