Introduction: Transsphenoidal surgery with an operative microscope was a standard procedure for pituitary adenomas resection in our institution. Still, since the end of 2020, we have shifted the protocol to endoscopic transsphenoidal approach. This paper presented our learning curve in pituitary surgery using endoscopy instruments.Method: Patients with pituitary tumors who received transsphenoidal surgery during 2019 – 2021 were included. We compared the extent of resection, re-operation rate, blood loss volume, operative time, and complications of 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.Result: Twenty-seven (55.1%) and 22 (44.9%) patients underwent microscopic transsphenoidal and endoscopic transsphenoidal surgery. There was no significant difference in total removal rate, re-operation rate, post-operative CSF leakage rate, blood loss volume, and operative time between the two approaches. Patients who received endoscopic surgery had a higher rate of DI (P = 0.002). Tumors extension to cavernous sinus was a significant predictor of total resection rate (P = 0.002). Multivariate analysis showed that surgical approach, suprasellar and cavernous sinus extension did not significantly affect the extent of surgery.Conclusion: Our endoscopic and microscopic surgery results are comparable despite the limitation of experience with endoscopy instruments. This report supports our transition from microscopic to endoscopic pituitary surgery.
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