Endoscopic endonasal transsphenoidal surgery: experience with 50 patients
es have been established as the standard surgical treatment for pituitary adenomas for decades,1,6–8 continuous efforts to improve surgical techniques and their outcomes are still being made.3–5,9–11,16,17,19–21 As an alternative to sublabial or septal incisions for transsphenoidal pituitary surgery, an endonasal microscopic technique has been reported.3,5 Otolaryngologists have used endoscopic techniques for the treatment of most inflammatory sinonasal disorders.18 Eventually, endoscopic sinus surgery replaced the conventional “open” method of sinus surgery. Encouraged by the increased visualization and positive results provided by endoscopy for sinonasal surgery, we have applied endoscopic techniques to transsphenoidal surgery. Initially, we used an endoscope in conjunction with an operating microscope while executing the standard conventional sublabial–transseptal approach. As we gained confidence using the endoscope as a visualizing tool, we developed an endonasal endoscopic transsphenoidal technique that did not require the use of a nasal speculum or transsphenoidal retractor. This endonasal endoscopic technique was used in 46 patients in this series. Our technique has continued to evolve. Although further technical refinement and instrument modifications are required, the short-term surgical results have been satisfactory and have provided for quick patient recovery and minimum morbidity. This report represents our early experience with endoscopic transsphenoidal surgery in 50 patients.