A Modified Delphi UK Consensus to Develop a Surgical Safety Checklist for Transoral Robotic Surgery

The utilisation of transoral robotic surgery (TORS) has grown in popularity over recent years with wide applications for both benign and malignant disease. It is important to recognise that the introduction of robotic surgery inserts a new variable into an already error-prone healthcare service that has a high preventable adverse event rate. Surgical safety checklists (SSC) have been well established in recent years and demonstrated to improve outcomes and reduce complications. This study aims to introduce a novel SSC designed for use specifically in operating theatres for cases using TORS.

A modified Delphi process was utilised to define consensus for a proposed TORS specific SSC. An initial iteration was devised using a literature search. Experts with significant TORS experience rated each proposed item for potential inclusion using a Likert scale. The process was repeated until consensus was reached for all items.

Two rounds were completed with seven experts agreeing on various items to be included in the TORS specific SSC.

This novel surgical safety checklist is the first developed specifically for use with TORS. It has been designed using robust Delphi methodology with several TORS experts from high-volume centres across the UK. The aim of the TORS SSC is to be used alongside the WHO SSC and requires ideally long-term and multi-centre adoption in order to validate its implementation.