Sublabial transsphenoidal pituitary surgery: a new modified technique for a less-invasive sublabial approach

The history of the transsphenoidal approach for pituitary surgery is reviewed in this mini review. There are several approaches to the sphenoid sinus, and the sublabial transseptal and transnasal transseptal approaches are presently the most widely accepted standard techniques. Although the transnasal approach has several advantages in comparison with the sublabial approach, it is difficult to accomplish in the small nostril without an alotomy incision or external rhinoplasty incision, which may lead to noticeable scarring or nasal deformity. Therefore, the sublabial approach still remains the workhorse method, especially for patients with small nostrils like Asian people including the Japanese. We have developed a less-invasive sublabial approach to overcome the disadvantages associated with the conventional sublabial approach. The basic differences between this modified sublabial approach and the conventional approach are: a smaller incision (1-1.5 cm long) and almost midline vertical skin incision underneath the upper lip, minimal development of an inferior tunnel, no widening of the maxillary rim of the piriform aperture, and a strictly unilateral approach. This less-invasive approach uses a slim and small nasal speculum originally designed for the transnasal approach. This modified sublabial approach was applied to 41 patients and was confirmed to be a simple, rapid, and less-invasive technique with significantly fewer mucosal complications compared with the conventional approach. We conclude that this modified sublabial approach offers a good alternative to the conventional standard sublabial approach.