Learning curve of transsphenoidal surgery for pituitary adenoma under neuroendoscope

Li Yunjun; Wei Qun; Li Wende; Zhao Hao; Zhang Hongtian; Chen Lihua; Xu Ruxiang

doi:10.11850/j.issn.1009-122X.2014.04.004

Abstract：Objective To analyze the learning curve of transsphenoidal surgery under neuroendoscope for pituitary adenoma to provide a reference for better carrying out this kind of operation. Methods Clinical data of 45 patients undergoing neuroendoscopic transsphenoidal surgery for pituitary adenoma were reviewed retrospectively. All the surgeries were completed by the first author at different stages. Every 15 patients were considered as a segment of learning curve and 45 patients were equally divided into beginning segment group, medium segment group and mature segment group. The differences in operative time, surgical outcome and complication rate were compared between the 3 groups. Results There was no significant difference in age, sex and course of disease between the 3 groups (P>0.05). During a follow-up period of 6 months, the operative time, intraoperative bleeding and postoperative complication rate in mature segment group decreased obviously compared with beginning segment group and medium segment group, while the rate of total tumor resection increased significantly (P<0.05), but no significant different between the beginning segment group and medium segment group (P>0.05). The visual disturbance and endocrine disorder were improved after surgery, and no significant difference found between the 3 group (P>0.05). Conclusions The learning curve of neuroendoscopic transsphenoidal surgery for pituitary adenoma is evaluated about 30 procedures. In the rising segment of the learning curve, increasing experience with minimally invasive and gaining endoscopic skill can provide more effective and satisfactory surgery. After entering the plateau, the surgical indications can be gradually expanded.