{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T06:52:18Z","timestamp":1777877538654,"version":"3.51.4"},"reference-count":55,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Otolaryngology - Head &amp; Neck Surgery"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Surgical difficulty quantification is crucial to develop educational curricula for progressive training. This need remains unmet in endoscopic endonasal surgery (EES).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The objective was to classify the basic skills and procedures of EES according to the perceived difficulty by experts to build a progressive curriculum.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Three-round modified Delphi study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>E-survey with an international panel of EES experts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Fifty-nine international experts were selected on their publications in the field of EES and medical education and invited to participate. Fifteen experts from 5 countries completed the survey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>A 3-round modified Delphi study was conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>In round#1, basic skills and EES procedures were identified and the basic skills required for these procedures were listed. In round#2, the expert panel ranked the difficulty of basic skills, and in round#3, the difficulty of the EES procedures. The basic skills were grouped into 3 categories of increasing difficulty, and the subsequently-calculated difficulty of each EES procedure was compared with the experts\u2019 score. Consensus was defined at \u226580% agreement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty-three basic skills and 26 EES procedures were identified. Basic skills were ranked in 3 groups of increasing difficulty, from easiest (navigation with a 0\u00b0 telescope) to most difficult (suturing in the nasal cavity), with \u226580% agreement. The least difficult procedure ranked was polypectomy, whereas the most difficult was Vidian neurectomy. The correlation between the expert score and the calculated score reached an R\n                      <jats:sup>2<\/jats:sup>\n                      of .75, reflecting the cumulative effect of these required competencies on procedure difficulty.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Consensus was achieved to rank basic skills and EES procedure according to the perceived difficulty by experts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance<\/jats:title>\n                    <jats:p>This study provides a basis for quantifying surgical difficulty in EES and pave the way for developing a progressive educational curriculum.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19160216251390285","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T10:10:45Z","timestamp":1765188645000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Quantifying Difficulty in Endoscopic Endonasal Surgery\u2014A Modified Delphi Method Approach"],"prefix":"10.1177","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7999-951X","authenticated-orcid":false,"given":"Valentin","family":"Favier","sequence":"first","affiliation":[{"name":"Otolaryngology Head and Neck surgery Department, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier, France"},{"name":"Research-Team ICAR, Laboratory of Computer Science, Robotics and Microelectronics of Montpellier (LIRMM), University of Montpellier, French National Centre for Scientific Research (CNRS), Montpellier, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc A.","family":"Tewfik","sequence":"additional","affiliation":[{"name":"Head &amp; Neck Surgery, McGill University Health Centre, Montr\u00e9al, QC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lily H. 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