Endoscopic Hypophysectomy

Objective Endoscopic endonasal hypophysectomy constitutes a challenge and an opportunity for the otolaryngologist. In the past 15 years, 246 hypophysectomies have been performed in cooperation with the neurosurgical department of our hospital. Method For the first 182 hypophysectomies a sublabial approach was performed with the use of a microscope. Subsequently, 22 hypophysectomies were performed with a combined approach (sublabial microscope‐endoscope assisted). Lastly, for the most recent 42 hypophysectomies, an endonasal endoscopic 4‐hands technique was applied. Results With all 3 techniques, the success rate did not significantly differ. Complication rate (hemorrhage, cerebrospinal fluid leak) was significantly lower in the endoscopic technique. Hospital stay was also significantly lower in the endoscopic technique. Conclusion The advantages of endoscopic approach are: less traumatic, faster, panoramic view, angle‐view with the use of different endoscopes, and possibility to explore the sella for residual tumor at the end of operation. Its disadvantages are the lack of three‐dimensional view and the need for an assistant to hold the endoscope.