• Danyal Z Khan, Chan Hee Koh, Adrito Das, Alexandra Valetopolou, John G Hanrahan, Hugo Layard Horsfall, Stephanie E Baldeweg, Sophia Bano, Anouk Borg, Neil L Dorward, Olatomiwa Olukoya, Danail Stoyanov, and Hani J Marcus.
• Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK; Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK. Electronic address: d.khan@ucl.ac.uk.
• World Neurosurg. 2024 Oct 1; 190: e787e796e787-e796.

BackgroundEndoscopic pituitary adenoma surgery has a steep learning curve, with varying surgical techniques and outcomes across centers. In other surgeries, superior performance is linked with superior surgical outcomes. This study aimed to explore the prediction of patient-specific outcomes using surgical video analysis in pituitary surgery.MethodsEndoscopic pituitary adenoma surgery videos from a single center were annotated by experts for operative workflow (3 surgical phases and 15 surgical steps) and operative skill (using modified Objective Structured Assessment of Technical Skills [mOSATS]). Quantitative workflow metrics were calculated, including phase duration and step transitions. Poisson or logistic regression was used to assess the association of workflow metrics and mOSATS with common inpatient surgical outcomes.Results100 videos from 100 patients were included. Nasal phase mean duration was 24 minutes and mean mOSATS was 21.2/30. Mean duration was 34 minutes and mean mOSATS was 20.9/30 for the sellar phase, and 11 minutes and 21.7/30, respectively, for the closure phase. The most common adverse outcomes were new anterior pituitary hormone deficiency (n = 26), dysnatremia (n = 24), and cerebrospinal fluid leak (n = 5). Higher mOSATS for all 3 phases and shorter operation duration were associated with decreased length of stay (P = 0.003 &P < 0.001). Superior closure phase mOSATS were associated with reduced postoperative cerebrospinal fluid leak (P < 0.001), and superior sellar phase mOSATS were associated with reduced postoperative visual deterioration (P = 0.041).ConclusionsSuperior surgical skill and shorter surgical time were associated with superior surgical outcomes, at a generic and phase-specific level. Such video-based analysis has promise for integration into data-driven training and service improvement initiatives.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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