title: Meta-analysis of endoscopic versus sublabial pituitary surgery.
abstract: OBJECTIVE
  To determine whether the endoscopic or sublabial transseptal transsphenoidal approach for pituitary surgery has superior outcomes or decreased complication rates.
  
  
  METHODS
  Retrospective meta-analysis of literature.
  
  
  METHODS
  A MEDLINE search was conducted identifying all relevant literature in the English language from 1998 through 2010. Studies explicitly identifying pure sublabial or completely endoscopic approaches were included. Meta-analysis comparing the two techniques was performed for multiple outcome measures utilizing a random effects approach.
  
  
  RESULTS
  A total of 21 endoscopic studies (n = 2,335) and 17 sublabial studies (n = 2,565) met inclusion criteria. Analysis revealed significantly superior rates of gross tumor resection (79% vs. 65%, P < .0001), as well as lower rates of cerebral spinal fluid leak (5% vs. 7%, P < .01), septal perforation (0% vs. 5%), and postoperative epistaxis (1% vs. 4%, P < .0001) for the endoscopic approach compared to the sublabial approach. There was no difference between the two techniques in the incidence of meningitis, diabetes insipidus, or resolution of hormonal abnormality. Hospital stay (P = .01) was shorter for endoscopic surgery compared to sublabial surgery, and there was no significant difference in terms of length of operation.
  
  
  CONCLUSIONS
  The sublabial transsphenoidal approach has been the gold standard for pituitary surgery for many years. However, meta-analysis of the recent literature demonstrates superior outcomes and decreased postoperative complications with the endoscopic approach, potentially justifying a shift toward endoscopic pituitary surgery.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Georgetown University Hospital, Washington, DC 20010, USA.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: DeKlotz
authors.forename: Stanley H
authors.initials: SH
authors.lastname: Chia
authors.forename: Wenxin
authors.initials: W
authors.lastname: Lu
authors.forename: Kepher H
authors.initials: KH
authors.lastname: Makambi
authors.forename: Edward
authors.initials: E
authors.lastname: Aulisi
authors.forename: Ziad
authors.initials: Z
authors.lastname: Deeb
mesh_terms: D004724:Endoscopy / Q000379:methods*; D006801:Humans; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D010902:Pituitary Gland / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000601:surgery*; D013100:Sphenoid Bone / Q000601:surgery*