The learning curve in endoscopic pituitary surgery and our experience

Abstract

Experience is the important point in reduction of the complications and in the effectiveness of the surgical procedure in pituitary surgery. Endoscopic pituitary surgery differs from microscopic surgery, since it requires a steep learning curve for endoscopic skills. In this article, we evaluate our learning curve in two groups, as early and late experience. Purely endoscopic transsphenoidal operations were performed on 78 patients, which were retrospectively reviewed and grouped as early and late experience groups. We used the purely endoscopic endonasal approach to the sella that was performed via an anterior sphenoidotomy, without the use of a transsphenoidal retractor. All patients with adenomas were evaluated considering operation time, endocrinology, ophthalmology, total removal and, especially, modifications of standard technique. On the basis of the experience gained with the use of the endoscope in transphenoidal surgery over the years, modifications can be performed on the different phases of the endoscopic approach. Reviewing our cases in two groups of period due to our experience showed that the effectiveness of endoscopic surgery increases and operation time decreases. In our study, we identified a learning curve in endoscopic pituitary surgery.

Endoscopic pituitary surgery

“…Results in terms of mass removal, relief of clinical symptoms, cure of the underlying disease and complication rate are at least similar to those reported in the major microsurgical series [40][41][42][43], but patient compliance is by far better, as reported by subjects having undergone a previous non endoscopic microsurgical transsphenoidal experience [44]. Transsphenoidal endoscopy brings advantages to the patient (less nasal traumatism, no nasal packing, less post-op pain and usually quick recovery), to the surgeon (wider and closer view of the surgical target area, increase of the scientific activity as from the peer-reviewed literature on the topic in the last 10 years, smoothing of interdisciplinary cooperation), to the institution (shorter post-op hospital stay, increase of the case load).…”

Endoscopic versus microscopic transsphenoidal pituitary adenoma surgery: a meta-analysis

“…Demonstrating a statistically significant difference between endoscopic and microscopic techniques will require a larger number of cases. Furthermore, a learning curve [28,29] is anticipated because the endoscopic approach is a newer technique, and gradual improvement in outcomes will occur as the cumulative experience increases over time. Future studies are required to resolve the learning curve issues.…”

Recent Evolution of Endoscopic Endonasal Surgery for Treatment of Pituitary Adenomas

“…58,59) Some reluctance persists with its adoption, especially among microscopically trained neurosurgeon, as they are legitimately unwilling to accept the complications that might results as part of the learning curve. 6) Interestingly, Zaidi et al 60) noted a less experienced surgeon using a fully endoscopic technique was able to achieve outcomes similar to those of a very experienced surgeon using a microscopic technique in a cohort of patients with nonfunctioning tumors smaller than 60 cm 3 .…”