Endoscopic Endonasal Transsphenoidal Surgery
Endoscopic Endonasal Transsphenoidal Surgery
We surveyed a total of 25 patients (Table 4) with 16 endoscopic endonasal approaches for pituitary adenomas, 3 for Rathke cleft cysts, 1 arachnoid cyst, and 1 case of lymphocytic hypophysitis. The checklist was also applied to additional anterior skull base endoscopic cases, including 3 anterior fossa CSF leak reconstructions and 1 clival chordoma. Twenty-three cases were direct endoscopic transsphenoidal approaches and two were extended endonasal cases. We used nasoseptal flap reconstruction in 7 cases. The checklist was readily adopted by nursing and anesthesia colleagues without any barriers to implementation.
Our preoperative checklist survey (Table 5) had no missed or incomplete sections. A majority of checkpoints in this section are part of our institutional preoperative checklist and therefore were redundant checkpoints. It is important to note that thyroid replacement and steroid therapy are not part of our institutional list and therefore might be missed or overlooked if not thoroughly reviewed before an operation.
During implementation of the intraoperative checklist (Table 6), no major surgical errors were identified. However, 9 missing surgical components (near misses) that could have delayed or impeded progress during surgery were identified. These items (Table 7) included missing neuronavigation setup/equipment, Clearvision or other lens irrigator, micro-Doppler, recording equipment, and selected endoscopic skull base instruments.
Results
We surveyed a total of 25 patients (Table 4) with 16 endoscopic endonasal approaches for pituitary adenomas, 3 for Rathke cleft cysts, 1 arachnoid cyst, and 1 case of lymphocytic hypophysitis. The checklist was also applied to additional anterior skull base endoscopic cases, including 3 anterior fossa CSF leak reconstructions and 1 clival chordoma. Twenty-three cases were direct endoscopic transsphenoidal approaches and two were extended endonasal cases. We used nasoseptal flap reconstruction in 7 cases. The checklist was readily adopted by nursing and anesthesia colleagues without any barriers to implementation.
Our preoperative checklist survey (Table 5) had no missed or incomplete sections. A majority of checkpoints in this section are part of our institutional preoperative checklist and therefore were redundant checkpoints. It is important to note that thyroid replacement and steroid therapy are not part of our institutional list and therefore might be missed or overlooked if not thoroughly reviewed before an operation.
During implementation of the intraoperative checklist (Table 6), no major surgical errors were identified. However, 9 missing surgical components (near misses) that could have delayed or impeded progress during surgery were identified. These items (Table 7) included missing neuronavigation setup/equipment, Clearvision or other lens irrigator, micro-Doppler, recording equipment, and selected endoscopic skull base instruments.
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