Neurosurgical Review

, Volume 29, Issue 4, pp 298–305 | Cite as

The learning curve in endoscopic pituitary surgery and our experience

  • Koc Kenan
  • Anik İhsan
  • Ozdamar Dilek
  • Cabuk Burak
  • Keskin Gurkan
  • Ceylan Savas
Original Article


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.


Learning curve Pituitary surgery Endoscope 



We wish to express our deep and sincere gratitude to Luigi Maria Cavallo and Felice Esposito.


  1. 1.
    Alfieri A, Jho HD (2001) Endoscopic endonasal approaches to the cavernous sinus: surgical approaches. Neurosurgery 49:354–360; discussion 360-362PubMedCrossRefGoogle Scholar
  2. 2.
    Cappabianca P, Cavallo LM, Colao A, de Divitiis E (2002) Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas. J Neurosurg 97:293–298PubMedGoogle Scholar
  3. 3.
    Cappabianca P, Cavallo LM, de Divitiis E (2004) Endoscopic endonasal transsphenoidal surgery. Neurosurgery 55:933–941PubMedCrossRefGoogle Scholar
  4. 4.
    Cappabianca P, Cavallo LM, Esposito F, Valente V, de Divitis E (2002) Sellar repair in endoscopic transsphenoidal surgery: results of: 70 cases. Neurosurgery 51:1365–1372PubMedCrossRefGoogle Scholar
  5. 5.
    Cappabianca P, de Divitis E (2004) Endoscopy and transsphenoidal surgery. Neurosurgery 54:1043–1050PubMedCrossRefGoogle Scholar
  6. 6.
    Cavallo LM, Cappabianca P, Galzio R, Iaconnetta G, de Divitiis E, Tschabitscher M (2005) Endoscopic transnasal approach to the cavernous sinus versus transcranial route: anatomic study. Neurosurgery 56(2 Suppl):379–389; discussion 379-389PubMedCrossRefGoogle Scholar
  7. 7.
    Cho DR, Liau WR (2002) Comparison of endonasal endoscopic surgery and sublabial microsurgery for prolactinomas. Surg Neurol 58:371–376PubMedCrossRefGoogle Scholar
  8. 8.
    Ciric I, Ragin A, Baumgartner C et al (1997) Complications of transsphenoidal surgery: results of a national survey, review, of the literature, and personal experience. Neurosurgery 40:225–237PubMedCrossRefGoogle Scholar
  9. 9.
    de Divitiis E, Cappabianca P, Cavallo LM (2002) Endoscopic transsphenoidal approach: adaptability of the procedure to different sellar lesions. Neurosurgery 51:699–707PubMedCrossRefGoogle Scholar
  10. 10.
    Frank G, Pasquini E (2002) Endoscopic endonasal approaches to the cavernous sinus: surgical approaches. Neurosurgery 50:675PubMedCrossRefGoogle Scholar
  11. 11.
    Guiot G, Rougerie J, Fourestler A, Fournier A, Comoy C, Vulmiere J, Groux R (1963) Une nouvelle technique endoscopique. Exploration endoscopiques intracraniennes. La Presse Medicale 71:1225–1228PubMedGoogle Scholar
  12. 12.
    Jankowski R, Auque J, Simon C, Marchal JC, Hepner H, Wayoff M (1992) Endoscopic pituitary tumor surgery. Laryngoscope 102:198–202PubMedCrossRefGoogle Scholar
  13. 13.
    Jho HD (2000) Endoscopic transsphenoidal surgery. In: Schmidek HH (ed) Schmidek & Sweet, Operative neurosurgical techniques: indications, methods, and results, 4th edn, vol 1. WB Saunders, Philadelphia, pp 385–397Google Scholar
  14. 14.
    Jho HD (2001) Endoscopic transsphenoidal surgery. J Neuro-Oncol 54:187–195CrossRefGoogle Scholar
  15. 15.
    Jho HD, Alfieri A (2001) Endoscopic endonasal pituitary surgery: evolution of surgical technique and equipment in 150 operations. Minim Invasive Neurosurg 44(1):1–12Google Scholar
  16. 16.
    Jho HD, Carrau RL (1997) Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurgery 87:44–51CrossRefGoogle Scholar
  17. 17.
    Jho HD, Carrau RL, Ko Y, Daly MA (1996) Endoscopic pituitary surgery: an early experience. Surg Neurol 47:213–223CrossRefGoogle Scholar
  18. 18.
    Kristof RA, Schramm J, Redel L, Neuloh G, Wichers M, Klingmuller D (2002) Endocrinological outcome following first time transsphenoidal surgery for GH-, ACTH-, and PRL-secreting pituitary adenomas. Acta Neurochir 144:555–561CrossRefGoogle Scholar
  19. 19.
    Melmed S, Casanueva FF, Cavagnini F, Chanson P, Frohman L, Grossman A, Ho K, Kleinberg D, Lamberts S, Laws E, Lombardi G, Vance ML, Werder KV, Wass J, Giustina A (2002) Acromegaly treatment consensus workshop participants. Guidelines for acromegaly management. J Clin Endocrinol Metab 87:4054–4058PubMedCrossRefGoogle Scholar
  20. 20.
    Ogawa T, Matsumoto K, Nakashima T, Okano M, Ono Y, Fukushima K et al (2001) Hypophysis surgery with or without endoscopy. Auris Nasus Larynx 28:143–149PubMedCrossRefGoogle Scholar
  21. 21.
    Sonnenburg RE, White D, Ewend MG, Senior B (2004) The learning curve in minimally invasive pituitary surgery. Am J Rhinol 18(4):259–263Google Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Koc Kenan
    • 1
  • Anik İhsan
    • 1
  • Ozdamar Dilek
    • 2
  • Cabuk Burak
    • 1
  • Keskin Gurkan
    • 3
  • Ceylan Savas
    • 1
  1. 1.Department of NeurosurgeryKocaeli University, School of MedicineKocaeliTurkey
  2. 2.Department of Anesthesiology and ReanimationKocaeli University, School of MedicineKocaeliTurkey
  3. 3.Department of OtolaryngologyKocaeli University, School of MedicineKocaeliTurkey

Personalised recommendations