title: Nationwide shift from microscopic to endoscopic transsphenoidal pituitary surgery.
abstract: OBJECTIVE
  Transsphenoidal pituitary surgery can be carried out with either an operating microscope or with an endoscope, but the relative frequency of both techniques is unknown.
  
  
  METHODS
  All microscopic and endoscopic transsphenoidal pituitary surgeries were extracted from the Centers for Medicare and Medicaid Services Part B data files between the years 2003 and 2013. National and state-level trends were compared over time.
  
  
  RESULTS
  Endoscopic surgery significantly increased and microscopic surgery significantly decreased over the years 2003-2013. Thirty-eight of 48 states increased their use of endoscopic surgery, while 38 of 48 states decreased their use of microscopic surgery.
  
  
  CONCLUSIONS
  Nationwide data show a clear trend for an increasing use of endoscopic transsphenoidal surgery at the expense of microscopic surgery. The underlying causes of these trends are unknown, but clearly deserve further investigation.
authors.affiliation: California Center for Pituitary Disorders and Center for Minimally Invasive Skull Base Surgery, Department of Neurological Surgery, University of California, 505 Parnassus Ave., M779, San Francisco, CA, 94143, USA. john.rolston@ucsf.edu.
authors.forename: John D
authors.identifier: http://orcid.org/0000-0002-8843-5468
authors.initials: JD
authors.lastname: Rolston
authors.affiliation: California Center for Pituitary Disorders and Center for Minimally Invasive Skull Base Surgery, Department of Neurological Surgery, University of California, 505 Parnassus Ave., M779, San Francisco, CA, 94143, USA.
authors.forename: Seunggu J
authors.initials: SJ
authors.lastname: Han
authors.affiliation: California Center for Pituitary Disorders and Center for Minimally Invasive Skull Base Surgery, Department of Neurological Surgery, University of California, 505 Parnassus Ave., M779, San Francisco, CA, 94143, USA.
authors.forename: Manish K
authors.initials: MK
authors.lastname: Aghi
mesh_terms: D016208:Databases, Factual; D006801:Humans; D007016:Hypophysectomy / Q000379:methods / Q000639:trends*; D016014:Linear Models; D008866:Microsurgery / Q000639:trends*; D057605:Natural Orifice Endoscopic Surgery / Q000639:trends; D044583:Neuroendoscopy / Q000639:trends*; D010900:Pituitary Diseases / Q000601:surgery; D010902:Pituitary Gland / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000601:surgery*; D013100:Sphenoid Bone; D014481:United States