title: Endoscopic Versus Microscopic Transsphenoidal Approach for Pituitary Adenomas: Comparison of Outcomes During the Transition of Methods of a Single Surgeon.
abstract: OBJECTIVE
  The transition from microscopic to fully endoscopic transsphenoidal surgery requires a surgeon to assess how the change in technique will affect the extent of tumor resection (EOR), outcomes, and complications. We compared a single surgeon's experience transitioning from one technique to the other and examined the operative outcomes and EOR between microscopic versus endoscopic transsphenoidal surgery.
  
  
  METHODS
  Retrospective data analysis of adult patients who were treated surgically for a pituitary adenoma between August 2005 and May 2015 by a single neurosurgeon, who was originally trained and practiced in the microscopic transsphenoidal approach. Patient demographics, perioperative conditions, tumor characteristics, operative times, volumetric EOR, postoperative outcome, and the endoscopic learning curve were evaluated.
  
  
  RESULTS
  One hundred and nine patients underwent microscopic transsphenoidal surgery and 275 patients underwent a fully endoscopic approach. The patient characteristics were similar in the 2 groups. Operative room time was significantly shorter in the endoscopic group than in the microscopic group (180.2 vs. 215.6 minutes; P < 0.001). The endoscopic and microscopic groups had similar volumetric EOR (85.1% vs. 82.8%; P = 0.371) as well as residual tumor volume (1.06 cm3vs. 1.15 cm3; P = 0.765). The mean length of hospital stay was 2.4 days in the endoscopic group and 3.2 days in the microscopic group (P = 0.03).
  
  
  CONCLUSIONS
  During the transition from the microscopic to the endoscopic approach, similar surgical outcomes and EOR were achieved in the 2 cohorts. In our experience, the endoscopic approach offers the advantage of shorter operative times and lengths of hospital stays after the surgeon has developed more experience with the technique.
authors.affiliation: Department of Neurological Surgery and Oncology Outcomes Laboratory, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Chikezie I
authors.initials: CI
authors.lastname: Eseonu
authors.affiliation: Department of Neurological Surgery and Oncology Outcomes Laboratory, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Karim
authors.initials: K
authors.lastname: ReFaey
authors.affiliation: Department of Neurological Surgery and Oncology Outcomes Laboratory, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Jordina
authors.initials: J
authors.lastname: Rincon-Torroella
authors.affiliation: Department of Neurological Surgery and Oncology Outcomes Laboratory, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Oscar
authors.initials: O
authors.lastname: Garcia
authors.affiliation: Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Gary S
authors.initials: GS
authors.lastname: Wand
authors.affiliation: Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Roberto
authors.initials: R
authors.lastname: Salvatori
authors.affiliation: Department of Neurological Surgery and Oncology Outcomes Laboratory, Johns Hopkins University, Baltimore, Maryland, USA. Electronic address: quinones@post.harvard.edu.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Quinones-Hinojosa
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D002983:Clinical Competence / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D059032:Learning Curve; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008866:Microsurgery / Q000706:statistics & numerical data*; D008875:Middle Aged; D044583:Neuroendoscopy / Q000706:statistics & numerical data*; D000069471:Neurosurgeons; D061646:Operative Time; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Endoscopic surgery; Microsurgery; Outcome; Pituitary adenoma; Transsphenoidal surgery