Endoscopic endonasal pituitary surgery: evolution of surgical technique and equipment in 150 operations.
OBJECTIVE
The evolution of the senior author's (HD Jho) surgical experience on endoscopic endonasal transsphenoidal pituitary surgery is reviewed in order to introduce a standardized surgical technique for pituitary endoscopy.


METHODS
The progressive evolution of the surgical technique and the development of surgical instrumentation in transsphenoidal endoscopy is reviewed based upon the experience of more than 150 operations performed by the senior author between the years 1993 and 1998.


RESULTS
An endoscope was used to assist visualization during conventional microscopic surgery in the first four cases (endoscope-assisted microsurgery). Subsequently, endonasal pituitary endoscopy was performed via a nostril. When the endonasal route was adopted, it eliminated the use of a transsphenoidal retractor. The use of vasoconstrictors and any form of nasal packing was discovered to be unnecessary. The inferior margin of the middle turbinate was such a consistent surgical landmark leading to the sella that the use of an intraoperative fluoroscopic C-arm was also eliminated. The adoption of a septal breaker, variously angled suction cannulas and suction-coagulators has made the operation cleaner, easier and faster. As experience increased, the operation time progressively shortened and mucosal trauma became minimal. The median patient hospital stay was one night and postoperative discomfort was noted to be minimal.


CONCLUSIONS
The evolution of the senior author's endoscopic pituitary surgery is reported with a description of our current standardized surgical technique.
Jho
H D
HD
Center for Minimally Invasive Innovative Microneurosurgery, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. hdjho@neuronet.pitt.edu
Alfieri
A
A
D000172:Acromegaly / Q000601:surgery*; D003480:Cushing Syndrome / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D008866:Microsurgery / Q000295:instrumentation* / Q000379:methods; D009296:Nasal Cavity / Q000601:surgery; D010902:Pituitary Gland / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000601:surgery*; D015175:Prolactinoma / Q000601:surgery*; D013100:Sphenoid Bone / Q000601:surgery; D013523:Surgical Equipment; D020535:Video-Assisted Surgery / Q000379:methods