Mitani Sohei, Nishio Naoki, Kitani Takashi, Ugumori Toru, Wakisaka Hiroyuki, Tanaka Keiko, Miao Beiping, Chan Jason Y K, Holsinger F Christopher, Hato Naohito
From the Department of Otolaryngology-Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.
Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
Ann Surg Open. 2021 Apr 7;2(2):e059. doi: 10.1097/AS9.0000000000000059. eCollection 2021 Jun.
This study aimed to verbalize fundamental surgical skills required for open head and neck surgery (OHNS), to organize them by categorization, and to establish a consensus among surgeons regarding the importance and difficulty of each skill.
Improvement of fundamental surgical skills is the core of surgical education; however, surgical skills are not yet organized, and consensus in any surgical field remains uncertain.
Fundamental surgical skills during OHNS were collected from surgical textbooks, real surgeries, and expert interviews. The items were analyzed to calculate the frequency of words and were categorized by 2 expert surgeons. After consensus on the importance and difficulty of each item was established by 15 expert surgeons using a Delphi survey, principal component (PC) analysis was performed to integrate importance and difficulty into a single parameter.
Sixty skills were verbalized and categorized into 7 categories: "skin flap elevation (n = 6)," "vessel management (n = 9)," "nerve preservation (n = 8)," "instrument handling (n = 11)," "counter traction (n = 7)," "tissue exposure (n = 9)," and "flow and planning (n = 10)." In the Delphi survey, expert consensus was established after 2 voting rounds (Cronbach's α ≥ 0.80). The "counter traction" and "flow and planning" categories had high PC scores, which indicate priority in surgical education.
Fundamental OHNS skills were verbalized, categorized, and evaluated via expert consensus. Assessment of surgeons' skills by the structured items hereby developed will help standardize the quality of OHNS and improve patient outcomes.
本研究旨在阐述开放性头颈外科手术（OHNS）所需的基本手术技能，对其进行分类整理，并就每项技能的重要性和难度在外科医生中达成共识。
基本手术技能的提升是外科教育的核心；然而，手术技能尚未得到系统整理，任何外科领域的共识仍不明确。
从外科教科书、实际手术及专家访谈中收集OHNS过程中的基本手术技能。对这些项目进行分析以计算词汇出现频率，并由两位专家外科医生进行分类。在15位专家外科医生通过德尔菲调查就每个项目的重要性和难度达成共识后，进行主成分（PC）分析，将重要性和难度整合为一个单一参数。
共阐述了60项技能，并分为7类：“皮瓣掀起（n = 6）”、“血管处理（n = 9）”、“神经保护（n = 8）”、“器械操作（n = 11）”、“对抗牵引（n = 7）”、“组织暴露（n = 9）”和“流程与规划（n = 10）”。在德尔菲调查中，经过两轮投票达成了专家共识（克朗巴哈系数α≥0.80）。“对抗牵引”和“流程与规划”类别具有较高的PC得分，表明在外科教育中具有优先地位。
通过专家共识阐述、分类并评估了OHNS的基本技能。通过此处开发的结构化项目对外科医生的技能进行评估，将有助于规范OHNS的质量并改善患者预后。
