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Updated: Aug 21, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
The learning curve in minimally invasive pituitary surgery
Robert E Sonnenburg1, David White, Matthew G Ewend
1Department of Otolaryngology--Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina 27599-7070, USA.
Background:
Minimally invasive pituitary surgery (MIPS) is performed via an endoscopic transnasal transsphenoidal approach. This provides excellent illumination, visualization, and magnification of the operative field, in addition to avoiding complications associated with other approaches. In this study we examined the first 45 cases of MIPS to determine if a learning curve exists for this technique.
Methods:
A retrospective chart review was performed of the first 45 cases of MIPS at a major academic medical center. Cases were divided into three groups of 15 patients each. Group characteristics including age, sex, and revision surgery were compared. Complication rates investigated included death, intracerebral hemorrhage, intraoperative cerebrospinal fluid leak, postoperative cerebrospinal fluid leak, use of lumbar drain, meningitis, postoperative epistaxis, ophthalmoplegia, visual impairment, and diabetes insipidus. Other factors examined included intraoperative blood loss, length of stay, and tumor histology. One way analysis of variance statistical analysis was used to determine the significance of differences between groups.
Results:
Groups were comparable in respect to characteristics studied. Statistically significant (p < 0.05) differences in complication rates and other factors between groups were not shown. Complication rates are low.
Conclusion:
This study does not establish a learning curve for our first 45 cases of MIPS. This finding supports the concept that an otolaryngology/neurosurgery team skilled in endoscopic techniques and pituitary surgery can safely transition from open approaches to an endoscopic approach in pituitary surgery.
Insights
This study found no learning curve in the first 45 minimally invasive pituitary surgeries (MIPS). Experienced surgical teams can safely adopt endoscopic pituitary surgery, demonstrating low complication rates.
Area of Science:
- Neurosurgery
- Otolaryngology
- Endoscopic Surgery
Background:
- Minimally invasive pituitary surgery (MIPS) utilizes an endoscopic transnasal transsphenoidal approach.
- This technique offers enhanced visualization and avoids complications of alternative surgical methods.
Purpose of the Study:
- To investigate the existence of a learning curve in MIPS.
- To evaluate the safety and efficacy of MIPS within the initial patient cohort.
Main Methods:
- A retrospective review of the first 45 MIPS cases was conducted.
- Cases were analyzed in three groups of 15, comparing patient demographics and surgical outcomes.
- Complication rates, blood loss, and length of stay were assessed using statistical analysis.
Main Results:
- Patient groups were comparable in terms of age, sex, and revision surgery status.
- No statistically significant differences were observed in complication rates or other surgical factors between the groups.
- Overall complication rates for MIPS were found to be low.
Conclusions:
- The study did not identify a learning curve within the initial 45 MIPS cases.
- Skilled otolaryngology/neurosurgery teams can transition to endoscopic pituitary surgery without compromising patient safety.
- MIPS is a safe and effective approach for pituitary surgery.
