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
