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Quantifying Difficulty in Endoscopic Endonasal Surgery-A Modified Delphi Method Approach.

Valentin Favier1,2, Marc A Tewfik3, Lily H P Nguyen3

  • 1Otolaryngology Head and Neck surgery Department, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier, France.

Journal of Otolaryngology - Head & Neck Surgery = Le Journal D'Oto-Rhino-Laryngologie Et De Chirurgie Cervico-Faciale
|December 8, 2025
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This summary is machine-generated.

This study quantifies surgical difficulty in endoscopic endonasal surgery (EES) by ranking basic skills and procedures. Findings establish a basis for developing progressive EES educational curricula.

Area of Science:

  • Neurosurgery
  • Medical Education
  • Surgical Skill Assessment

Background:

  • Quantifying surgical difficulty is essential for effective training curricula.
  • Endoscopic endonasal surgery (EES) lacks established difficulty metrics for education.
  • A structured approach is needed to develop progressive EES training.

Purpose of the Study:

  • To classify EES basic skills and procedures by expert-perceived difficulty.
  • To establish a framework for a progressive EES educational curriculum.
  • To provide objective measures for surgical training in EES.

Main Methods:

  • A three-round modified Delphi study involving 15 international EES experts.
  • Identification and ranking of 23 basic skills and 26 EES procedures by difficulty.
Keywords:
educationendoscopic endonasal surgeryproceduresskills

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  • Consensus defined as ≥80% agreement among experts.

    • Main Results:

    • Basic skills were categorized into three difficulty levels, from navigation to suturing.
    • Polypectomy was the least difficult procedure; Vidian neurectomy was the most difficult.
    • A strong correlation (R² = .75) was found between expert scores and calculated difficulty.

    Conclusions:

    • Consensus was reached on the difficulty ranking of EES basic skills and procedures.
    • This study provides a foundation for quantifying surgical difficulty in EES.
    • The findings facilitate the development of a structured, progressive EES educational curriculum.