Three-dimensional endoscopic pituitary surgery.
OBJECTIVE
We describe a novel 3-dimensional (3-D) stereoendoscope and discuss our early experience using it to provide improved depth perception during transsphenoidal pituitary surgery.


METHODS
Thirteen patients underwent endonasal endoscopic transsphenoidal surgery. A 6.5-, 4.9-, or 4.0-mm, 0- and 30-degree rigid 3-D stereoendoscope (Visionsense, Ltd., Petach Tikva, Israel) was used in all cases. The endoscope is based on "compound eye" technology, incorporating a microarray of lenses. Patients were followed prospectively and compared with a matched group of patients who underwent endoscopic surgery with a 2-dimensional (2-D) endoscope. Surgeon comfort and/or complaints regarding the endoscope were recorded.


RESULTS
The 3-D endoscope was used as the sole method of visualization to remove 10 pituitary adenomas, 1 cystic xanthogranuloma, 1 metastasis, and 1 cavernous sinus hemangioma. Improved depth perception without eye strain or headache was noted by the surgeons. There were no intraoperative complications. All patients without cavernous sinus extension (7of 9 patients) had gross tumor removal. There were no significant differences in operative time, length of stay, or extent of resection compared with cases in which a 2-D endoscope was used. Subjective depth perception was improved compared with standard 2-D scopes.


CONCLUSIONS
In this first reported series of purely 3-D endoscopic transsphenoidal pituitary surgery, we demonstrate subjectively improved depth perception and excellent outcomes with no increase in operative time. Three-dimensional endoscopes may become the standard tool for minimal access neurosurgery.
Tabaee
Abtin
A
Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York 10065, USA.
Anand
Vijay K
VK
Fraser
Justin F
JF
Brown
Seth M
SM
Singh
Ameet
A
Schwartz
Theodore H
TH
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D035301:Cranial Fossa, Middle / Q000473:pathology / Q000601:surgery; D003399:Craniotomy / Q000295:instrumentation / Q000379:methods*; D003867:Depth Perception / Q000502:physiology; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000295:instrumentation / Q000379:methods*; D007431:Intraoperative Complications / Q000517:prevention & control; D007909:Lenses / Q000639:trends; D008297:Male; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D017063:Outcome Assessment, Health Care; D010902:Pituitary Gland / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D012658:Sella Turcica / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery; D013100:Sphenoid Bone / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome