Although pituitary surgery via the transsphenoidal approach has been performed for over a century, it has only gained widespread acceptance over the past 50 years. As various advances in illumination and magnifcation through microscopic and endoscopic approaches have improved the safety and effcacy of this technique, it has become the workhorse approach for surgery on the pituitary gland. Further advances, including better understanding of pituitary adenoma biology and improved reconstruction techniques, have extended the utility of this approach to treatment of pathology beyond the sella turcica and its contents. We review the history of pituitary surgery with an emphasis on advances with the transsphenoidal approach.

Complex surgical procedures carry signifcant risks and potential for complications, whether performed alone (as single procedure) or in combination (as multiple surgical procedures). Despite the most conscientious preoperative preparations, surprising events may still occur. If the operation takes an unplanned turn, the surgeon has to make diffcult decisions. Some of the most important elements of any surgical procedure are the decisions that the surgeon makes before, during, and after the surgery itself. Notewithstanding its enormous signifcance and regardless of the implications that this decision-making process (DMP) has on surgical outcomes, the subject has received minimal attention in the literature . Subsequently, there are only a few studies that investigate how these decisions are made, although DMP is of great importance both for training and patient safety purposes. How do we surgeons make intraoperative decisions under what can be inauspicious conditions? Some describe these decisions as “intuition” or “gut-level” responses. However often we surgeons have diffculty in describing exactly how we came to specifc decisions during surgery. Clearly, there are many factors that affect decisionmaking of surgeons before and during operations. These factors are the physiologic state of the surgeon, the harmony of teamwork, external factors at work, and the surgeon’s ability to adapt quickly to a changing environment, to name only a few. Yet, the question remains, how to perform an evaluation of the surgical decision and gaining a better understanding of a seemingly gut- level process, which helps surgeons combat the external factors experienced before and during surgery?

Cataract phacoemulsifcation training poses a unique challenge of learning a delicate, complex task in which only one person can operate at any given time. The majority of patient’s remain awake during surgery and training usually has to proceed in a setting of service provision . Not only is an understanding of how the process of phacoemulsifcation surgery will be taught is important for the novice surgeon, it is equally important for the experienced surgeon embarking on a phacoemulsifcation teaching role to determine how to teach the novice surgeon. Given the plethora of techniques possible for every stage of the cataract procedure, the Trainer may no longer perform surgical steps in a basic fashion. Instead advanced skills, developed over years of practice will be applied to complete their own cases. Though important to ensure acquisition of a broad repertoire of skills by the end of training, the novice surgeon needs to be taught basic, fundamental phacoemulsifcation skills initially. The novice surgeon may fail to perform advanced intraocular movements if their confdence or skill level has not developed suffciently, consequently it may not be appropriate to mimic such techniques. Surgical steps should not be ‘challenging’ but rather remain well within the Trainee’s competency and comfort level. The book aims to provide a framework for phacoemulsifcation training: concepts are introduced over the course of the book and a training program for the Trainer to follow. Important concepts will be repeated in successive chapters to reiterate the concept for the Trainee.