Disclosures: The authors report no relevant financial disclosures.
July 06, 2020
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Survey: Preference for endoscopic pituitary surgery doubles from 2010 to 2020

Disclosures: The authors report no relevant financial disclosures.
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Surgeons’ preference for an endoscope over the microscope for transsphenoidal surgery visualization during pituitary surgery more than doubled during the past 10 years, according to survey data.

“Team-based surgery via the endoscopic endonasal approach has quickly becoming the standard operative approach both nationally and internationally for the resection of pituitary tumors,” Debraj Raj Mukherjee, MD, MPH, assistant professor of neurosurgery at Johns Hopkins University School of Medicine and director of neurosurgical oncology at Johns Hopkins Bayview Medical Center, told Healio. “Health care institutions will need to increasingly develop multidisciplinary expertise involving endoscopic endonasal skull-base surgical teams, and patients should increasingly expect their surgeons to provide minimally invasive and maximally effective approaches to treatment of their skull-base tumors, with a premium placed on experience and quality of life outcomes.”

Pituitary brain Adobe
Source: Adobe Stock

Mukherjee and colleagues analyzed data from two web-based surveys sent to members of the International Society of Pituitary Surgeons via a membership Listserv in 2010 (51 respondents) and 2020 (82 respondents). The 33-item surveys collected information on demographics, surgical approach, perceived advantages and disadvantages, and recommendations for improvements; the wording of shared questions was the same for both surveys. Most respondents (95% for both surveys) were full-time academic surgeons from the United States or Europe.

Debraj "Raj" Mukherjee

Researchers found that the preference for a purely endoscopic technique increased from 43% in 2010 to 87% in 2020. Preference for routinely working with an otolaryngologist or second neurosurgeon increased from 35% to 51% between surveys. Most surgeons (74%) reported that they were more likely to achieve a greater extent of resection with the endoscope; however, 51% said this procedure increased operating time.

“The most commonly rated advantage (34%) of endoscopic transsphenoidal surgery was fewer postoperative nasoseptal perforations,” the researchers wrote. In assessing potential advantages of endoscopic surgery, 34% rated postoperative complications, such as cerebrospinal fluid leakage and epistaxis, as the most significant drawback. Other disadvantages cited were technical limits, such as the need to keep the endoscope clean and the path of light clear (17%), a long technical learning curve (11%-12%), and “avoiding sword-fighting” between endoscope and surgical instruments.

Respondents were divided on whether microscopic transsphenoidal surgery should continue to be taught in residency, with 32% advocating for improved endoscopic instrumentation and team training.

“Additional research is needed to develop next-generation endoscopic instrumentation as well as novel approaches to improve team-based, multidisciplinary training for endoscopic endonasal techniques to treat diseases of the skull base,” Mukherjee said.

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For more information:

Debraj Raj Mukherjee, MD, MPH, can be reached at the Department of Neurosurgery, Johns Hopkins University, School of Medicine, 1800 Orleans St., Baltimore, MD 21287; email: dmukher1@jhmi.edu; Twitter: @HopkinsNsurg.