Safety of minimally invasive pituitary surgery (MIPS) compared with a traditional approach.
BACKGROUND
Transsphenoidal hypophysectomy is becoming progressively less invasive. Recent endoscopic techniques avoid nasal or intraoral incisions, use of nasal speculums, and nasal packing. Several case series of endoscopic endonasal pituitary surgery have been reported, but relatively little data exists comparing complication rates to more traditional approaches. We compare the complications of our first 50 cases of endoscopic, minimally invasive pituitary surgery (MIPS) to our last 50 sublabial transseptal (SLTS) procedures.


METHODS
Retrospective case control study.


METHODS
Fifty consecutive MIPS procedures and 50 consecutive SLTS procedures were reviewed retrospectively. Complication rates were analyzed and compared.


RESULTS
Total complications per patient (P = .005), postoperative epistaxis (P = .031), lip anesthesia (P = .013), and deviated septum (P = .028) occurred more often in the SLTS group. No significant difference was seen in cerebrospinal fluid leak, meningitis, ophthalmoplegia, visual acuity loss, diabetes insipidus, intracranial hemorrhage, or death. In the MIPS group, length of stay (P < .001), use of lumbar drainage (P = .007), and nasal packing (P < .001) were also significantly reduced.


CONCLUSIONS
Endoscopic endonasal pituitary surgery provides improved complication rates when compared with SLTS approaches. In addition, we note advantages of the MIPS approach, including reduced length of hospital stay and decreased use of lumbar drainage and nasal packing.
White
David R
DR
Department of Otolaryngology--Head and Neck Surgery, University of North Carolina Hospitals, Chapel Hill, NC 27599-7070, USA.
Sonnenburg
Robert E
RE
Ewend
Matthew G
MG
Senior
Brent A
BA
D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007016:Hypophysectomy / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies