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Inspired by the Critical View of Safety in laparoscopic cholecystectomy and engineering \u201cphase-gate\u201d process, we propose the Critical Views for Phase Progression (CVPPs) \u2013 a set of visual cues confirming phase objectives and safe phase progression. Designed to be clinically relevant and machine-readable, CVPPs aim to support training and future AI-driven guidance systems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A three-round modified Delphi process was conducted involving 15 pituitary surgery experts from 13 centres across Europe and North America. CVPPs for the naso-sphenoid, sellar, and closure phases were classified as \u201cEssential\u201d, \u201cDesirable\u201d or \u201cNot Necessary\u201d. Consensus required\u2009\u2265\u200970% agreement. A local validation study was subsequently performed involving six experts who reviewed 15 intraoperative video clips and rated their confidence to proceed, which was compared against the predefined reference derived from the finalised CVPPs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Consensus identified essential and desirable CVPPs across all three phases for both micro- and macroadenoma variants, reflecting differences in exposure goals and surgical risk. Validation demonstrated high concordance between participant ratings and predefined references. Discrepancies arose only in a minority of intentionally incomplete (\u201cunsafe\u201d) views and were attributable to contextual misinterpretation of short video segments, rather than disagreement with the CVPP framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This international, multicentre consensus is the first to define CVPPs. By standardising intraoperative visual benchmarks, CVPPs can enhance training, mitigate risks, and provide a foundation for future AI-driven guidance systems capable of real-time anatomical annotation and decision support.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11102-026-01636-2","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T08:54:45Z","timestamp":1769590485000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Critical views for safe surgical phase progression in endoscopic endonasal transsphenoidal pituitary adenoma resection: modified Delphi consensus"],"prefix":"10.1007","volume":"29","author":[{"given":"Tjasa","family":"Zaletel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danyal Z.","family":"Khan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anjana","family":"Wijekoon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhehua","family":"Mao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joao Paulo","family":"Almeida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anouk","family":"Borg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Chainey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D.","family":"Cusimano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel A.","family":"Donoho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Dorward","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Carlos","family":"Fernandez-Miranda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Fiore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theofanis","family":"Giannis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfonso Lagares","family":"Gomez-Abascal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Harris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhiney","family":"Jain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Lau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sacit B.","family":"Omay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor","family":"Paredes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Prevedello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Zada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danail","family":"Stoyanov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Bano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hani J.","family":"Marcus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,28]]},"reference":[{"issue":"6","key":"1636_CR1","doi-asserted-by":"publisher","first-page":"839","DOI":"10.1007\/s11102-021-01162-3","volume":"24","author":"HJ Marcus","year":"2021","unstructured":"Marcus HJ, Khan DZ, Borg A, Buchfelder M, Cetas JS, Collins JW, Dorward NL, Fleseriu M, Gurnell M, Javadpour M, Jones PS, Koh CH, Layard Horsfall H, Mamelak AN, Mortini P, Muirhead W, Oyesiku NM, Schwartz TH, Sinha S, Stoyanov D, Syro LV, Tsermoulas G, Williams A, Winder MJ, Zada G, Laws ER (2021) Pituitary society expert Delphi consensus: operative workflow in endoscopic transsphenoidal pituitary adenoma resection. 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