Experience Summary

In this 360-degree video, observe the theatre team conducting the WHO checklist (or 'in brief') for a child who is undergoing a complex mastoid exploration for cholesteatoma removal.

Clinical Context

The use of the World Health Organization (WHO) Surgical Safety Checklist is a critical component of perioperative care, particularly in paediatric patients undergoing complex otologic procedures such as mastoid exploration for cholesteatoma removal. Cholesteatoma represents an abnormal growth of keratinising squamous epithelium within the middle ear and mastoid, which can lead to significant complications if left untreated, including hearing loss, vertigo, facial nerve injury, intracranial infections, and even life-threatening meningitis or abscess formation. Given the complexity and potential risks associated with mastoid surgery in children, the meticulous application of the WHO checklist serves to enhance patient safety and optimise surgical outcomes.

The WHO Surgical Safety Checklist, developed to reduce perioperative morbidity and mortality, promotes effective communication, teamwork, and systematic verification of critical safety steps before, during, and after surgery. In the context of a child undergoing complex mastoid exploration, the checklist helps ensure that all members of the multidisciplinary team — including surgeons, anaesthetists, theatre nurses, and support staff — are aligned regarding the patient's identity, the surgical site, and the planned procedure. This is particularly important in paediatric cases where miscommunication or errors in site identification can have serious consequences.

Prior to induction of anaesthesia, the checklist ensures confirmation of patient identity, procedure details, allergy status, and availability of necessary equipment, such as facial nerve monitors or microsurgical instruments. In surgeries for cholesteatoma, the checklist reinforces the importance of preoperative imaging review (typically high-resolution CT of the temporal bones) to anticipate anatomical variations and potential complications, such as proximity to the facial nerve or lateral sinus.

The checklist also prompts discussion of anticipated challenges, including the risk of facial nerve injury, CSF leak, or postoperative infection, allowing the team to plan accordingly. For children, additional paediatric-specific considerations — such as airway management, fluid balance, and appropriate dosing of antibiotics — are addressed during the checklist process.

Learning Outcomes

1. Gain experience observing an MDT approach to discussing the management of complex ear surgery.
2. Understand the team members involved in the care of this patient.
3. Observe the WHO checklist in practice.

External Resources

• Effects of perioperative briefing and debriefing on patient safety: a prospective intervention study
• WHO Guidelines for Safe Surgery 2009: Safe Surgery Saves Lives