Standardized video-endoscopy and surgical field grading scale for endoscopic sinus surgery: a multi-centre study

Area of Science:

• Otolaryngology
• Surgical Innovation
• Medical Imaging

Background:

• Intraoperative bleeding is a significant challenge in endoscopic sinus surgery (ESS), potentially hindering surgical progress and increasing complication risks.
• Standardized documentation methods are crucial for studying and managing bleeding during ESS.
• Current grading scales may have limitations in accurately assessing surgical field bleeding.

Purpose of the Study:

• To develop a standardized method for documenting and grading intraoperative bleeding in ESS.
• To introduce and validate a novel grading scale for surgical field bleeding during ESS.
• To compare the reliability and sensitivity of the new scale against an existing scale.

Main Methods:

• Video-endoscopy was employed to record bleeding in 20 patients undergoing ESS.
• Standardized and non-standardized video recordings were graded using the Boezaart scale.
• A new 11-point Wormald scale was developed and compared with the Boezaart scale across three international centers using DVD comparisons.

Main Results:

• Standardized video-endoscopy significantly improved both intra- and interrater reliability for both the Boezaart and Wormald scales.
• The Wormald scale demonstrated superior interrater (0.80 vs. 0.74) and intrarater (0.89 vs. 0.83) reliability compared to the Boezaart scale.
• The Wormald scale proved more sensitive to common surgical field variations encountered in ESS.

Conclusions:

• Standardized video-endoscopy is recommended for future research on ESS bleeding due to enhanced reliability and reproducibility.
• The Wormald grading scale is an effective, inexpensive, and sensitive tool for rapid intraoperative bleeding assessment in ESS.
• The Wormald scale addresses limitations of the Boezaart scale, facilitating analysis of hemostatic methods in ESS.