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Category: Volume 10 Issue 06 June 2022
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Title: A Journey from Endoscopic to Microscopic transsphenoidal surgery

Authors: Dr DK Vatsal, Dr SR Gupta, Dr Mudit Mehrotra, Dr Pavani Vatsal, Dr Priti Vatsal

 DOI: https://dx.doi.org/10.18535/jmscr/v10i6.13

Abstract

Background: Endoscopic transsphenoidal surgery was a standard procedure for pituitary adenomas resection in our institution. Since the end of 2016, we have shifted the protocol to microscopic transsphenoidal approach. This paper presented our experience in pituitary surgery using sublabial transsphenoidal approach.

Methods: Patients with pituitary tumors who received transsphenoidal surgery during 2003-2022 were included. We compared the extent of resection, re-operation rate, blood loss volume, operative time, and complications mainly postoperative cerebrospinal fluid (CSF) leakage and diabetes insipidus (DI) between microscopic and endoscopic transsphenoidal approaches. Tumors extension to the suprasellar area and cavernous sinus were also analyzed to see their relationship with surgical outcomes.

Results: Out of total 210 patients, 122 (58.1%) and 88 (41.9%) patients underwent microscopic transsphenoidal and endoscopic transsphenoidal surgery. There was a significant difference in total removal rate (p=0.01). There was no significant difference in re-operation rate, post-operative CSF leakage rate and blood loss volume. Operative time was significantly (p=0.0001) lower in microscopic surgery. Patients who received endoscopic surgery had a higher rate of DI (p=0.0001). Tumors extension to cavernous sinus was not a significant predictor of near total resection rate (p=0 .08).

Conclusion: Our endoscopic and microscopic surgery results are comparable except for the operating time, total removal of tumour and incidence of DI, which are better with microscopic surgery. This report supports our transition from endoscopic to microscopic pituitary surgery.

Keywords: Transsphenoidal surgery, Endoscopic, Microscopic, operating time.

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Corresponding Author

Dr Priti Vatsal

Consultant Gynaecologist, ICON Hospital, Sec.-F, Jankipuram, Lucknow, India